Era Freud un Bionià? Perspectives dels tractaments pares-infants

Els clínics dels tractaments pares-infants conceptualitzen elseu treball i la seva comprensió de la ment del nen de diversesmaneres, encara que sovint sense utilitzar termes clàssicspsicoanalítics. Això és paradoxal ja que la teoriapsicoanalítica des dels seus inicis va basar-se enespeculacions sobre la ment de l’infant. Les àrees en les qualsFreud substancialment va basar la seva teoria en les sevesespeculacions inclouen les seves visions del somni, laformació de l’inconscient, el principi del plaer, la repressióprimària i la repressió pròpiament dita, el procés primari isecundari i la sexualitat.En els primers escrits de Freud un pot discernir traces dela teoria de Bion del continent/contingut i del món de les emocions del nen. El projecte d’anar seguint el rastre de lessemblances no té únicament un interès històric. També portal’esperança d’inspirar els clínics per aplicar conceptespsicoanalítics en la seva comprensió del procés terapèutic enel treball pares-infants. Això pot ajudar-los a comprendre elmón intern, en el sentit psicoanalític, del bebè en teràpia ambels seus pares. S’il·lustra amb una vinyeta clínica

Tractament psicoanalític amb infants i pares: què, per què i quan?

Björn Salomonsson presenta el tractament psicoanalític pares`infants,una anàlisi, però amb tres persones a l'habitació. Al llarg de l'article dóna resposta a les tres preguntes: Què, perquè i quan? No és un tractament que funciona a través de la mare: aquí l'analista parla directament al bebè, és un parlar deveritat, i el bebè -encara que no entengui el significat de les paraules- percep la sinceritat de l'analista i el seu compromís.L'autor il·lustra el seu pensament amb el cas de la Kirsten i laMyra, una mare i una nena que tenen un contacte difícil imolta tristesa

Revision after shoulder replacement for acute fracture of the proximal humerus

Background and purpose — For more than half a century, stemmed hemiarthroplasty (SHA) has been used in the treatment of comminuted and displaced fractures of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been increasingly popular in cases where it is difficult to obtain satisfactory fixation of the tuberosities. We report revision rates and reasons for revision after shoulder arthroplasty for acute fractures of the proximal humerus. Patients and methods — This study was based on a common dataset from the Nordic Arthroplasty Register Association (NARA), which includes data reported to the national shoulder arthroplasty registries in Denmark, Sweden, and Norway. We included 6,756 shoulder arthroplasties performed for acute fractures between 2004 and 2013. Results — There were 6,112 SHAs (90%) and 565 RSAs (8.4%). The cumulative arthroplasty survival rate after 5 years was 0.96 for both SHA and RSA. The relative risk of revision of RSA was 1.4 (95% CI: 0.9–2.2) with SHA as reference. For both types of arthroplasty, the most common reason for revision was infection (SHA 0.8%, RSA 2.1%). The relative risk of revision due to infection was 3.1 (95% CI: 1.6–5.9) for RSA with SHA as reference. The relative risk of revision for patients who were less than 75 years of age was 2.8 (95% CI: 2.0–3.8) compared to older patients. Interpretation — Revision after shoulder arthroplasty for acute fractures was rare. Survival rates were similar between SHA and RSA, but RSA had a statistically significant and clinically relevant higher risk of revision because of infection

The Western Ontario Shoulder Instability Index (WOSI): validity, reliability, and responsiveness retested with a Swedish translation

Background and purpose The WOSI score questionnaire is a tool designed for self-assessment of shoulder function for patients with instability problems. We made a translation into Swedish and retested the score by analyzing the psychometric properties validity, reliability, and responsiveness

The benefits of collaboration:The Nordic Arthroplasty Register Association

□ The Nordic Arthroplasty Register Association (NARA) was established in 2007 by arthroplasty register representatives from Sweden, Norway and Denmark with the overall aim to improve the quality of research and thereby enhance the possibility for quality improvement with arthroplasty surgery. Finland joined the NARA collaboration in 2010. □ NARA minimal hip, knee and shoulder datasets were created with variables that all countries can deliver. They are dynamic datasets, currently with 25 variables for hip arthroplasty, 20 for knee arthroplasty and 20 for shoulder arthroplasty. □ NARA has published statistical guidelines for the analysis of arthroplasty register data. The association is continuously working on the improvement of statistical methods and the application of new ones. □ There are 31 published peer-reviewed papers based on the NARA databases and 20 ongoing projects in different phases. Several NARA publications have significantly affected clinical practice. For example, metal-on-metal total hip arthroplasty and resurfacing arthroplasty have been abandoned due to increased revision risk based on i.a. NARA reports. Further, the use of uncemented total hip arthroplasty in elderly patients has decreased significantly, especially in Finland, based on the NARA data. □ The NARA collaboration has been successful because the countries were able to agree on a common dataset and variable definitions. The collaboration was also successful because the group was able to initiate a number of research projects and provide answers to clinically relevant questions. A number of specific goals, set up in 2007, have been achieved and new one has emerged in the process

The Bankart repair versus the Putti-Platt procedure: A randomized study with WOSI score at 10-year follow-up in 62 patients

Background and purpose This randomized study compared clinical results after surgery for posttraumatic shoulder instability with either an anatomical repair or an older, less anatomical but commonly used method. The less anatomical procedure has been considered quicker and less demanding, but it has been questioned regarding the clinical result. We therefore wanted to compare the clinical outcome of the two different procedures. Our hypothesis was that the anatomical repair would give less residual impairment postoperatively

Baby worries : A randomized controlled trial of mother-infant psychoanalytic treatment

Aims: This thesis had three aims. (1) To explore a new treatment method of baby worries or mother-infant relational disturbances; mother-infant psychoanalytic treatment (MIP). The exploration focused on clinical applicability and underlying theory. (2) To investigate a method of assessing infant functioning by a mother-report questionnaire on infant social and emotional functioning. (3) To compare outcomes of MIP treatments with the usual Child Health Centre care (CHCC) in a randomized controlled trial (RCT) that included investigating moderating effects of patient and treatment factors. Material/Methods: Aim (1) was approached by investigating tape-recorded single-case vignettes of MIP treatments from the perspectives of psychoanalytic and semiotic theory and infant behavioural research. Aims (2) and (3) were approached by an RCT with a quantitative between-group comparison of MIP and CHCC. The sample consisted of 80 mothers and infants below 1.5 years, where the mother reported baby worries. They were recruited from Child Health Centres in Stockholm, or advertisements at parenting internet sites and the delivery ward and the nursing centre of the Karolinska University Hospital. The dyads were randomized to CHCC or MIP. MIP treatments were conducted by psychoanalysts within the Mother-Infant Psychoanalytic Project of Stockholm (MIPPS). Follow-up assessments were made after six months. Instruments: The Ages and Stages Questionnaire: Social Emotional (ASQ:SE), the Emotional Availability Scales (EAS), the Edinburgh Postnatal Depression Scale (EPDS), the General Severity Index (GSI) of the Symptom Check List-90, the Parent-Infant Relationship Global Assessment Scale (PIR-GAS), the Swedish Parental Stress Questionnaire (SPSQ), CHC and paediatrician records, and patient and treatment factors collected during interviews. Results: (1) The theoretical discussion of MIP treatment focused on how analyst and baby communicate. Infant research findings seemed to support clinical experiences that an infant may understand the emotional aspects of the communication with the analyst. Semiotic theory was used to describe the different communicative levels. Psychoanalytic theory was used to explicate the therapeutic action of MIP. It was found to consist in the analyst s holding or metabolizing the anxieties of mother and baby, and in translating their communication into more comprehensible messages. Finally, it was found that therapeutic experiences with mothers and infants may widen the therapist s sensitivity to the non-verbal layers of adult patients in treatment. (2) The methodological study of the questionnaire on baby functioning, the ASQ:SE, was performed on the sample s pre-treatment scores. It demonstrated the close links of the ASQ:SE with mother-reported psychological distress (EPDS, GSI, SPSQ) but not with external ratings of baby functioning (EAS, PIR-GAS). This was especially the case for depressed mothers. The study pointed at problems with measuring infant functioning in clinical samples and to the need of developing valid instruments. (3) The RCT showed that MIP, as compared with CHCC, yielded significantly better Treatment by Time effects on the EPDS, maternal sensitivity (EAS), and the PIR-GAS, nearly significant effects on the SPSQ, and non-significantly better effects on the ASQ:SE, the GSI, and the remaining EAS dimensions. Qualitative assessments, so-called ideal types, of mothers and babies made pre-treatment were shown to moderate outcomes. Participator mothers improved their sensitivity (EAS) to a significantly greater extent from MIP than from CHCC. A contrasting but non-significant pattern was found among the Abandoned mothers. Affected babies improved their PIR-GAS scores, and their mothers improved their sensitivity (EAS), significantly more from MIP than from CHCC. Conclusions: MIP seems well suited for mothers intent on participating in psychoanalytic work and who feel they somehow play a part in the baby worries. For those who are anxious or in partner conflict, therapy needs to be more supportive. Affected babies seem more helped by MIP than by CHCC, probably due to MIP s direct baby address. Further studies need to compare the clinical efficacy and theory of MIP with other treatment modes. Its long-term effects also need to be investigated

Shoulder instability : A clinical and MRI-based analysis

Shoulder instability is a common but complex and challenging area of shoulder pathology, and new diagnostic methods and treatments are continuously developed. We conducted this study to evaluate the clinical outcome of shoulder instability with respect to different diagnostic possibilities and surgical treatments. We have studied the patient material from our department, consisting of atraumatic instability, posttraumatic recurrent anterior instability, and primary shoulder dislocations. This was done by following up surgical treatments. We also evaluated diagnostic enhancement by arthroscopy and MR-arthrography, as well as the use of MRI as a prognostic tool in primary dislocations. To measure the clinical outcome, we have validated a Swedish translation of a self-evaluating shoulder instability score. Study I 27 shoulders with atraumatic shoulder instability were treated with a capsular imbrication procedure and followed up after 2 years or more. Capsular imbrication was found to be a good treatment for involuntary atraumatic shoulder instability in cases where physical rehabilitation and lifestyle adjustment have failed. Study II A prospective study comparing detection of lesions in recurrent instability of the shoulder on MR arthrography imaging (MRA) and arthroscopy was made in 50 patients. An assessment of agreement between MRA observers and observer repeatability show that MRA is a potentially useful tool for the detection of lesions associated with shoulder instability, and promises acceptable reliability and repeatability. Study III The WOSI score questionnaire is a tool designed for self-assessment of shoulder function for patients with instability problems. We retested a translation of the score into Swedish. At this retest the WOSI score had good validity, high reliability, and high responsiveness, at the same level as in the original publication. Study IV 60 patients with primary posttraumatic shoulder dislocation were treated with closed reduction and examined by MRI within 2 weeks. Ages above 30, isolated fractures of the major tubercle, and Bony Bankart lesions were all prognostic factors for a good functional result and a stable shoulder at 8-year follow-up after a primary dislocation. Study V This randomised study compares an anatomical repair (Bankart suture) with a less anatomical method (Putti-Platt procedure). The Putti-Platt procedure was found to be quicker and less demanding. After assessment of pain and general shoulder function, only a small difference was found between the two surgical methods, with a slightly better outcome (in terms of pain and ROM) with a Bankart suture compared to the Putti-Platt procedure

Klimatfrågans psykologi

Växthusgasernas klimateffekter har varit kända i över ett sekel. Deras halter i atmosfären stiger allt snabbare i takt med ökande antal negativa klimateffekter. Trots dessa kunskaper råder en förbluffande passivitet när det gäller att sätta in kraftfulla åtgärder. Tekniska och politiska analyser och initiativförslag dissekeras sönder, internationella avtal sägs upp, och problemet förnekas totalt i vissa tongivande kretsar. Artikeln anlägger ett psykologiskt perspektiv på denna diskrepans mellan vetande och handling. Den analyserar ett flertal psykologiska faktorer som försvårar för oss att vidta nödvändiga åtgärder för att komma tillrätta med klimathotet. Den hävdar att människans psyke är konstruerat för att fokusera på det omedelbara, vare sig det gäller att avvärja faror eller att utföra etiska handlingar. Effektiva klimatåtgärder måste ta hänsyn till denna ”kognitiva och etiska närsynthet” och omvandla den till konstruktiv handling. Använda begrepp är förnekande, beljugande, projektion, dissonans, distans, skuld och apati. De hämtas huvudsakligen från psykoanalytisk teori samt social- och kognitions-psykologi