Prevalence, trends, and factors associated with hypertensive crisis among Peruvian adults / Prevalencia, tendencias y factores asociados a la crisis hipertensiva en adultos peruanos / Prevalência, tendências e fatores associados à crise hipertensiva em adultos peruanos

There are few studies focused on the epidemiology of hypertensive crisis at the population level in resource-constrained settings. This study aimed to determine the prevalence and trends over time of hypertensive crisis, as well as the factors associated with this condition among adults. A secondary data analysis was carried out using the Peruvian Demographic and Family Health Survey (ENDES). Hypertensive crisis was defined based on the presence of systolic (≥ 180mmHg) or diastolic (≥ 110mmHg) blood pressure, regardless of previous diagnosis or medication use. The factors associated with our outcome were evaluated using multinomial logistic regression, and the trend of hypertensive crisis was evaluated using the Cochrane-Armitage test. Data from 260,167 participants were analyzed, with a mean age of 44.2 (SD: 16.9) years and 55.5% were women. Hypertension prevalence was 23% (95%CI: 22.7-23.4) and, among them, 5.7% (95%CI: 5.4-5.9) had hypertensive crisis, with an overall prevalence of 1.5% (95%CI: 1.4-1.6). From 2014 to 2022, a significant decrease in the prevalence of hypertensive crisis was observed, from 1.7% in 2014 to 1.4% in 2022 (p = 0.001). In the multivariable model, males, increasing age, living in urban areas, high body mass index, and self-reported type 2 diabetes were positively associated with hypertensive crisis, whereas higher educational level, socioeconomic status, and high altitude were inversely associated. There is a need to improve strategies for the diagnosis, treatment, and control of hypertension, especially hypertensive crisis.

Pocos estudios se han centrado en la epidemiología de la crisis hipertensiva a nivel poblacional en entornos de recursos limitados. El objetivo de este estudio fue determinar la prevalencia y tendencia, a lo largo del tiempo, de la crisis hipertensiva y los factores asociados a esta condición en adultos. Se realizó un análisis de datos secundarios utilizando la Encuesta Demográfica de Salud Familiar (ENDES) de Perú. La crisis hipertensiva se definió en función de la presencia de presión arterial sistólica (≥ 180mmHg) o diastólica (≥ 110mmHg), independientemente del diagnóstico previo o del uso de medicamentos. Los factores asociados a los resultados se evaluaron mediante regresión logística multinomial, y la tendencia a la crisis hipertensiva se estimó mediante la prueba Cochran-Armitage. Los datos de 260.167 participantes, con una media de 44,2 años (DE: 16,9) y 55,5% mujeres, fueron analizados. La prevalencia de hipertensión fue del 23% (IC95%: 22,7-23,4), de la cual el 5,7% (IC95%: 5,4-5,9) tuvo crisis hipertensiva, con una prevalencia general del 1,5% (IC95%: 1,4-1,6). En el período 2014-2022 se constató una disminución significativa en la prevalencia de crisis hipertensiva, del 1,7% en 2014 al 1,4% en 2022 (p = 0,001). En el modelo multivariable, el sexo masculino, el aumento de la edad, vivir en áreas urbanas, el alto índice de masa corporal y la diabetes autoinformada se asociaron positivamente con la crisis hipertensiva, mientras que mayor nivel educativo, nivel socioeconómico y elevada altitud estuvieron asociadas de manera inversa. Es necesario mejorar las estrategias para el diagnóstico, el tratamiento y el control de la hipertensión, especialmente de la crisis hipertensiva.

Há poucos estudos focados na epidemiologia da crise hipertensiva em nível populacional em ambientes com recursos limitados. O objetivo deste estudo foi determinar a prevalência e a tendência, ao longo do tempo, da crise hipertensiva e fatores associados a essa condição em adultos. Uma análise de dados secundários foi realizada usando a Pesquisa Demográfica de Saúde Familiar (ENDES) do Peru. Crise hipertensiva foi definida com base na presença de pressão arterial sistólica (≥ 180mmHg) ou diastólica (≥ 110mmHg), independentemente de diagnóstico prévio ou uso de medicação. Os fatores associados aos resultados foram avaliados por meio de regressão logística multinomial, e a tendência de crise hipertensiva foi avaliada pelo teste de Cochrane-Armitage. Os dados de 260.167 participantes, com média de 44,2 anos (DP: 16,9) e 55,5% mulheres, foram analisados. A prevalência de hipertensão foi de 23% (IC95%: 22,7-23,4), dentre eles, 5,7% (IC95%: 5,4-5,9) apresentaram crise hipertensiva, com prevalência geral de 1,5% (IC95%: 1,4-1,6). De 2014 a 2022, observou-se queda significativa na prevalência de crise hipertensiva, de 1,7% em 2014 para 1,4% em 2022 (p = 0,001). No modelo multivariável, sexo masculino, idade crescente, residir em área urbana, índice de massa corporal elevado e diabetes autorreferido associaram-se positivamente à crise hipertensiva, enquanto maior escolaridade, nível socioeconômico e altitude elevada associaram-se inversamente. Há necessidade de aprimorar as estratégias de diagnóstico, tratamento e controle da hipertensão arterial, especialmente da crise hipertensiva.

O percurso pela atenção à crise em saúde mental na cidade do Rio de Janeiro / The journey through mental health crisis care in the city of Rio de Janeiro

Resumo O conceito de crise em saúde metal envolve uma complexa formulação multidimensional, forjada no contexto da Reforma Psiquiátrica Brasileira, que nem sempre é tomado de maneira unívoca pelos envolvidos. Contudo, há de se considerar uma rede capaz de dar respostas adequadas sobre como acolher essa situação, de maneira que o trabalho em rede é uma condição essencial dessa abordagem. Este artigo traz a discussão do manejo da crise em saúde mental nos Centros de Atenção Psicossocial III (CAPS III) do município do Rio de Janeiro, Brasil, a partir da perspectiva dos gestores de saúde de nível central e local, realizada por meio de entrevistas semiestruturadas e analisadas com base na Teoria da Estruturação de Giddens. Este trabalho identificou que o Rio de Janeiro apresenta um modelo de atenção à crise estruturado em rede de atenção centralizada e rede integrada, uma vez que apresenta grande integração da rede de urgência com a Rede de Atenção Psicossocial (RAPS), sobretudo com os CAPS III, e as situações de crises são atendidas preferencialmente em serviços específicos para seu atendimento. Ainda assim, pela perspectiva de Giddens, os CAPS III têm legitimidade para cumprir o papel de atenção à crise em saúde mental.

Abstract The concept of crisis in mental health involves a complex multidimensional formulation, forged in the context of the Brazilian Psychiatric Reform, which is not always taken unequivocally by those involved. However, it is necessary to consider a network capable of providing adequate answers on how to provide care in this situation; thus, networking is an essential condition of this approach. This article discusses the management of the mental health crisis in Psychosocial Care Centers III (CAPS III) in the municipality of Rio de Janeiro, Brazil, from the perspective of central and local health care managers, via semi-structured interviews and analysis based on Giddens' Theory of Structuring. This study found that the municipality of Rio de Janeiro adopts a crisis care model structured into a centralized care network and integrated network, with an emergency network highly integrated with the Psychosocial Attention Network (RAPS), especially with the CAPS III, and the crisis situations are cared for preferably in specific services. Still, from Giddens' perspective, CAPS III have the legitimacy to provide care toward mental health crisis.

Comparing Methods of Seizure Response Monitoring During Electroconvulsive Therapy: Comparer les méthodes de surveillance des interventions en cas de crise durant la thérapie par électrochocs.

OBJECTIVE: Electroconvulsive therapy (ECT) is used to treat several mental illnesses. Seizure duration is used to determine if the administered stimulus was adequate. Duration is estimated by electroencephalogram (EEG) interpretation and/or observed motor response (OMR). Neither method is considered the gold standard. This study investigated the relationship between the 2 methods. The hypothesis was that both EEG and OMR would be significantly positively correlated. Previous researchers have suggested that the 2 methods resulted in different estimates. METHODS: A case series was conducted using recorded estimates obtained prospectively from 102 ECTs on adult psychiatric inpatients. RESULTS: A strong positive association was not observed in this study, correlation coefficient 0.510 (p < 0.001). CONCLUSIONS: This study suggests that the 2 methods differ, and further research is needed to determine the best indicator of adequate treatment.

Capacidad de los Centros de Atención Psicosocial de Alcohol y Drogas para manejar situaciones de crisis / The ability of Psychosocial Care Centers specialized in Alcohol and Drugs to handle crises / Capacidade de manejo de situações de crise por Centros de Atenção Psicossocial Álcool e Drogas

Objetivo: evaluar la capacidad de los Centros de Atención Psicosocial de Alcohol y Otras Drogas 24 horas para manejar situaciones de crisis de las personas que consumen AOD en la atención integral. Método: estudio cuantitativo, evaluativo y longitudinal, realizado de febrero a noviembre de 2019. La muestra inicial estuvo compuesta por 121 personas que consumen AOD, que recibieron atención integral en situaciones de crisis en dos Centros de Atención Psicosocial para Alcohol y Otras Drogas 24 horas en el centro de São Paulo. Los mismos fueron reevaluados después de 14 días de atención. La capacidad para manejar la crisis se evaluó mediante un indicador validado. Los datos se analizaron utilizando estadísticas descriptivas y modelos de regresión de efectos mixtos. Resultados: sesenta y siete personas que consumen AOD completaron el follow-up (54,9%). Durante la atención de las situaciones de crisis, nueve personas que consumen AOD (13,4%; p=0,470) fueron derivadas a otros servicios de la red de salud: siete por complicaciones clínicas, una por intento de suicidio y una por hospitalización psiquiátrica. La capacidad de los servicios para manejar situaciones de crisis fue del 86,6%, fue considerada positiva. Conclusión: los dos servicios evaluados fueron capaces de manejar situaciones de crisis en su área de influencia, evitando internaciones y contando con el apoyo de la red cuando fue necesario, logrando así los objetivos de desinstitucionalización.

Objective: to assess the ability of 24-hour Psychosocial Care Centers specialized in Alcohol and Other Drugs to handle the users' crises in comprehensive care. Method: a quantitative, evaluative, and longitudinal study was conducted from February to November 2019. The initial sample consisted of 121 users, who were part of the comprehensibly care in crises by two 24-hour Psychosocial Care Centers specialized in Alcohol and other Drugs in downtown São Paulo. These users were re-evaluated 14 days after admission. The ability to handle the crisis was assessed using a validated indicator. The data were analyzed using descriptive statistics and regression of mixed-effects models. Results: 67 users (54.9%) finished the follow-up period. During crises, nine users (13.4%; p=0.470) were referred to other services from the health network: seven due to clinical complications, one due to a suicide attempt, and another for psychiatric hospitalization. The ability to handle the crisis in the services was 86.6%, which was evaluated as positive. Conclusion: both of the services analyzed were able to handle crises in their territory, avoiding hospitalizations and enjoying network support when necessary, thus achieving the de-institutionalization objectives.

Objetivo: avaliar a capacidade dos Centros de Atenção Psicossocial Álcool e outras Drogas 24 horas em manejar situações de crise dos usuários no acolhimento integral. Método: estudo quantitativo, avaliativo e longitudinal, realizado de fevereiro a novembro de 2019. A amostra inicial foi composta por 121 usuários, acolhidos integralmente em situações de crise por dois Centros de Atenção Psicossocial Álcool e outras Drogas 24 horas do centro de São Paulo. Estes foram reavaliados após 14 dias de acolhimento. A capacidade de manejar a crise foi avaliada por um indicador validado. Os dados foram analisados por estatística descritiva e por regressão de modelos de efeitos mistos. Resultados: sessenta e sete usuários concluíram o follow-up (54,9%). Durante o acolhimento às situações de crise, nove usuários (13,4%; p=0,470) foram encaminhados para outros serviços da rede de saúde: sete por complicações clínicas, um por tentativa de suicídio e um para internação psiquiátrica. A capacidade de manejo das situações de crise pelos serviços foi de 86,6%, avaliada como positiva. Conclusão: os dois serviços avaliados foram capazes de manejar situações de crise no próprio território, evitando internações e tendo apoio da rede quando necessário, atingindo assim, os objetivos da desinstitucionalização.

O papel do CAPS I na vida de seus usuários: um estudo a partir dos itinerários terapêuticos / The role of CAPS I in the lives of its users: a study based on therapeutic itineraries / El papel del CAPS I en la vida de sus usuarios: un estudio basado en itinerarios terapéuticos

Este artigo buscou compreender, a partir do itinerário terapêutico de pessoas em sofrimento psíquico e egressas de internação psiquiátrica, a inserção do centro de atenção psicossocial como equipamento de cuidado em suas trajetórias. Trata-se de estudo inspirado na Epistemologia Qualitativa de Gonzalez Rey no qual foram realizadas entrevistas com seis pessoas, de 27 a 52 anos, em tratamento em um Centro de Atenção Psicossocial tipo 1, e para análise do material transcrito foram adotados procedimentos inspirados no conceito de indicadores de González Rey e na análise temática de conteúdo. Neste artigo, foram discutidas duas categorias: (1) "O manicômio está presente" e (2) "CAPS: espaço de convivência e substituto da vida social?". Os indicadores apontaram que a internação psiquiátrica foi um recurso utilizado após inserção em CAPS, o qual é destacado mais como local de convívio do que de produção de autonomia e de desinstitucionalização. No percurso dos usuários, as internações ocorreram em hospitais gerais, hospitais especializados e comunidades terapêuticas. Os serviços de atenção primária não aparecem como ponto de cuidado à saúde mental, os serviços de urgência estão presentes na atenção às crises, dando ao CAPS contornos de um serviço para a convivência e não para o cuidado na crise. (AU)

Based on the therapeutic itinerary of individuals experiencing psychic distress and who have undergone psychiatric hospitalization, this study aimed to comprehend the integration of the Center of Psychosocial Attention as a care facility along their path. The study is inspired by Gonzalez Rey's Qualitative Epistemology, in which interviews were conducted with six individuals aged between 27 and 52, receiving treatment at a type 1 Center of Psychosocial Attention. Procedures inspired by González Rey's concept of indicators and thematic content analysis were employed to analyze the transcribed material. This paper will discuss two categories: (1) "The presence of the psychiatric hospital," and (2) "CAPS: A space for interaction and a substitute for social life?" The indicators reveal that psychiatric hospitalization was resorted to after involvement with CAPS, which is perceived more as a space for coexis-tence than for fostering autonomy and deinstitutionalization. As per the users' itineraries, hospitalizations occurred in general hospitals, specialized hospitals, and therapeutic communities. Primary care services do not emerge as a focal point for mental health care, whereas emergency services are present for crisis intervention, portraying CAPS as a service more geared towards coexistence rather than crisis management.

Este artículo buscó comprender, a partir del itinerario terapéutico de las personas en distrés psicológico y las dadas de alta de hospitalización psiqui-átrica, la inserción del centro de atención psicosocial como equipamiento de atención en sus trayectorias. Se trata de un estudio inspirado en la Epistemo-logía Cualitativa de González Rey, en el que se realizaron entrevistas a seis personas, de 27 a 52 años, en tratamiento en un Centro de Atención Psicosocial tipo 1 y para el análisis del material transcrito, procedimientos inspirados por el concepto de indicadores de González Rey y el análisis de contenido temático. En este artículo se discutirán dos categorías: (1) "Está presente el asilo" y (2) ¿"CAPS: espacio de convivencia y sustituto de la vida social?". Los indicadores señalaron que la hospitalización psiquiátrica fue un recurso utilizado después de la inserción en CAPS, que se destaca más como un lugar de socialización que para producir autonomía y desinstitucionalización. En el curso de los usuarios, los ingresos se realizaron en hospitales generales, hospitales especializados y comunidades terapéuticas. Los servicios de atención primaria no aparecen como un punto de atención en salud mental, los servicios de emergencia están presentes en la atención de crisis, dando al CAPS los contornos de un servicio de convivencia y no de atención en crisis. (AU)

[The narcissistic envelope of the care team in times of crisis in psychiatry]. / L'enveloppe narcissique de l'équipe soignante par temps de crise en psychiatrie.

The narcissistic envelope plays a fundamental role for psychiatric care teams to whom it guarantees sufficient internal security, supporting their investment in the therapeutic relationship. The hospital crisis is undermining these teams. By promoting the denarcissization of the nursing staff, it increases their resistance and questions the future of the care team registered in a collective in psychiatry.

Substance use disorder in the context of the economic crisis, covid-19 pandemic and social unrest: a cross-sectional study across Beirut (2020-2021).

BACKGROUND: Substance use disorder (SUD) is related to the interplay of various factors. The primary objective of this study was to assess the variation in substance use (SU) among a set of Lebanese people undergoing treatment for SUD during the Lebanese economic crisis, COVID-19 pandemic, and Beirut Blast. METHODS: A cross-sectional study including Lebanese adults previously diagnosed with and being treated for SUD at the Skoun center was conducted. Data collection was done using a paper-based Arabic questionnaire tackling the economic crisis, the Covid-19 pandemic, and the Beirut Blast, as well as the following scores: APGAR, PHQ-9, GAD-7 and PCL-6. Data were analyzed using SPSS version 25.0 with P value<0.05 considered significant. A bivariate analysis was conducted to study the association between the use of substances and study variables and scores. RESULTS: The sample included 126 men and 10 women. Most participants had a stable consumption of illicit drugs (58.8%), alcohol (76.5%), prescription drugs (70.6%) and non-prescription drugs (89%). Additionally, most participants had concomitant mild or moderate depression (55.1%), mild or moderate anxiety (50.7%), and PTSD (61.8%). Factors found to significantly increase SU were economic distress, change in employment status, and decrease in working hours. PTSD was also identified as a risk factor for increased illicit drug and alcohol use. Furthermore, severe anxiety was found to be a risk factor for increased alcohol consumption. CONCLUSION: Most participants were able to maintain a stable pattern of SU despite the quadruple crisis in Lebanon highlighting the important role played by Lebanese Non-Governmental Organizations (NGOs) and efforts employed to control SUD.

Assessing healthcare capacity crisis preparedness: development of an evaluation tool by a Canadian health authority.

Introduction: The COVID-19 pandemic presented health systems across the globe with unparalleled socio-political, ethical, scientific, and economic challenges. Despite the necessity for a unified, innovative, and effective response, many jurisdictions were unprepared to such a profound health crisis. This study aims to outline the creation of an evaluative tool designed to measure and evaluate the Vitalité Health Network's (New Brunswick, Canada) ability to manage health crises. Methods: The methodology of this work was carried out in four stages: (1) construction of an evaluative framework; (2) validation of the framework; (3) construction of the evaluative tool for the Health Authority; and (4) evaluation of the capacity to manage a health crisis. Results: The resulting evaluative tool incorporated 8 dimensions, 74 strategies, and 109 observable elements. The dimensions included: (1) clinical care management; (2) infection prevention and control; (3) governance and leadership; (4) human and logistic resources; (5) communication and technologies; (6) health research; (7) ethics and values; and (8) training. A Canadian Health Authority implemented the tool to support its future preparedness. Conclusion: This study introduces a methodological strategy adopted by a Canadian health authority to evaluate its capacity in managing health crises. Notably, this study marks the first instance where a Canadian health authority has created a tool for emergency healthcare management, informed by literature in the field and their direct experience from handling the SARS-CoV-2 pandemic.

Análise das consequências sociais e de saúde da crise humanitária nas Terras Yanomami

Objetivo: identificar as repercussões sociais e de saúde da crise humanitária nas terras Yanomami, conforme divulgado em matérias jornalísticas. Método: trata-se de um estudo qualitativo, do tipo documental, descritivo, cujas fontes primárias são reportagens e notícias veiculadas em jornais de abrangência nacional entre janeiro e fevereiro de 2023 e cuja pesquisa foi conduzida pela busca em arquivos on-line de jornais nacionais, utilizando palavras-chave, como "saúde de populações indígenas", "Yanomami" e "crise humanitária". Resultados: a análise das reportagens selecionadas permitiu evidenciar pontos básicos, relacionados a questões políticas, sociais e de saúde enfrentadas pelos povos Yanomami. Os achados deste estudo foram organizados em duas grandes categorias: a crise política e humanitária no território Yanomami; e os aspectos de saúde e de saneamento do povo Yanomami. Conclusões: o estudo possibilitou identificar as repercussões midiáticas sobre questões sociais e de saúde, decorrentes da crise humanitária nas terras Yanomami, destacando a vulnerabilidade desse povo diante da negligência do Estado, ao longo dos últimos anos, e evidenciando déficits das redes de atenção à saúde e fragilidades das legislações ambientais, como fatores-chave.

[Creating a community of heads of department to meet hospital system challenges: First experience in haematology]. / Créer une communauté de chefs de service pour répondre aux défis du système hospitalier : première expérience en hématologie.

The French hospital system crises are constantly forcing the heads of departments to adapt and find solutions for maintaining optimal patient care in a context of staff shortage. Facing these challenges, we had the desire to create a community of department heads capable of helping each other, sharing their experiences, relying on collective intelligence and, ultimately, contributing to rebuilding their hospitals from the bottom up. In this respect, we arranged a two-day seminar, which brought together fourteen heads of hematology departments who share the same desire to challenge their organizations with a collaborative approach and make them evolve. The seminar was animated by an external speaker and included many fruitful sessions, both formal and informal. Following this seminar, participants are now interested in sharing this experience with other department heads throughout the organization of "collaborative seminars of heads of department." Such seminars would serve to create a real community of department heads capable of supporting each other to improve our organizations and to generate new ideas to participate in the reconstruction of our health system from the bottom. This approach is in line with the current strategy of public services to restore a prominent role to hospital departments. We hope that our initiative will also inspire heads of departments in other specialties.

Effectiveness of crisis resolution and home treatment teams in mental health crisis: a systematic review protocol / A efetividade das equipas de hospitalização domiciliária psiquiátrica: um protocolo de revisão sistemática / La efectividad de los equipos de hospitalización domiciliaria de atención psiquiátrica: un protocolo de revisión sistemática

Abstract Background: People with mental health crises may need intensive care support that, in many countries, implies a psychiatric hospitalization that may negatively affect the individual. Furthermore, it involves the individuals' removal from their daily spaces, which implies an adaptive effort when returning to the community. In order to reduce the treatment's impact of a mental health crisis, Crisis Resolution or Home Treatment (CRHT) Teams have been providing an alternative to inpatient treatment. Aim: To analyze and highlight CRHT teams' effectiveness in reducing days of treatment, relapse, and rehospitalization of adults (18-65 years) compared to treatment as usual defined as inpatient treatment. Methods: We will develop a systematic review of the current literature by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2019 Statement. Two authors will independently conduct study inclusion, data extraction, quality, and bias risk assessments. We will include experimental study designs like randomized clinical trials, non-randomized, quasi-experimental, before and after studies, prospective and retrospective cohort studies, and case-control studies involving working-age adults (18-65 years) irrespective of culture, ethnicity, or mental health diagnosis. Results: We will include primary outcomes like days of treatment, relapse (as defined by each study), and rehospitalization. Secondary outcomes will be service user satisfaction, dropout rate, and the proportion of patients with adverse events (suicide, self-harm, or aggression/violence). Conclusions: This study will allow evidence to determine the need to create and encourage the implementation of CRHT teams to provide an effective alternative response to psychiatric hospitalization.

Resumo Contexto: A pessoa em crise de saúde mental pode precisar de tratamento intensivo que, em muitos países, implica um internamento psiquiátrico que pode afetar negativamente o indivíduo. Além disso, envolve o seu afastamento dos espaços quotidianos, o que implica um esforço adaptativo ao retornar à comunidade. A fim de reduzir o impacto do tratamento de uma crise de saúde mental, as Equipes de Hospitalização Domiciliária Psiquiátrica (EHDP) constituem-se como alternativa ao internamento hospitalar. Objetivo: Analisar e evidenciar a eficácia das EHDP na redução de dias de tratamento, recaídas e reinternamento de adultos (18-65 anos) em comparação com o tratamento usual definido como internamento hospitalar. Métodos: Desenvolveremos uma revisão sistemática da literatura de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2019 Statement. Dois autores conduzirão independentemente a inclusão de estudos, a extração de dados, a avaliação da qualidade e do risco de viés. Incluiremos estudos experimentais como ensaios clínicos randomizados, não randomizados, quase-experimentais, estudos pré e pós-teste, estudos de coorte prospetivos e retrospetivos e estudos de caso-controle envolvendo adultos em idade ativa (18-65 anos), independentemente da cultura, etnia ou diagnóstico de saúde mental. Resultados: Incluiremos outcomes primários como dias de tratamento, recaída (conforme definido por cada estudo) e reinternamento. Os outcomes secundários incluem a satisfação do cliente com o serviço, taxa de abandono e proporção de pacientes com eventos adversos (suicídio, automutilação ou agressão/violência). Conclusões: Este estudo trará evidências para determinar a necessidade de criar e incentivar a implementação de EHDP como uma resposta alternativa eficaz ao internamento psiquiátrico.

Resumen Contexto: Las personas con crisis de salud mental pueden necesitar apoyo en cuidados intensivos que, en muchos países, implica una hospitalización psiquiátrica que puede afectar negativamente al individuo. Además, implica la salida de los individuos de sus espacios cotidianos, lo que implica un esfuerzo adaptativo al regresar a la comunidad. Para reducir el impacto del tratamiento de una crisis de salud mental, los equipos de resolución de crisis o de tratamiento en el hogar (ERCTH) han estado brindando una alternativa al tratamiento hospitalario. Objetivo: Analizar y destacar la efectividad de los ERCTH en la reducción de días de tratamiento, recaída y rehospitalización de adultos (18-65 años) en comparación con el tratamiento habitual definido como tratamiento hospitalario. Metodología: Desarrollaremos una revisión sistemática de la literatura actual mediante la Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2019 Statement. Dos autores realizarán de forma independiente la inclusión de los estudios, la extracción de datos, las evaluaciones de la calidad y riesgo de sesgo. Incluiremos diseños de estudios experimentales como ensayos clínicos aleatorizados, no aleatorizados, cuasiexperimentales, estudios de antes y después, estudios de cohortes prospectivos y retrospectivos, y estudios de casos y controles con adultos en edad laboral (18-65 años) independientemente de la cultura, origen étnico o diagnóstico de salud mental. Resultados: Incluiremos resultados primarios como días de tratamiento, recaída (según la definición de cada estudio) y rehospitalización. Los resultados secundarios será la satisfacción del cliente del servicio, la tasa de abandono y la proporción de pacientes con eventos adversos (suicidio, autolesiones o agresión/violencia). Conclusiones: Este estudio aportará evidencias para determinar la necesidad de crear y fomentar la implementación de ERCTH para ofrecer una respuesta alternativa efectiva a la hospitalización psiquiátrica.

[Patient partnership: sharing experience in sickle cell vaso-occlusive crisis]. / Partenariat patient : partage d'expérience dans le cas d'une crise vaso-occlusive drépanocytaire.

The patient partnership is a new approach in which the patient, through his knowledge acquired from his experience with the disease, is a stakeholder in decisions about care, the organization of the health system and choices in terms of health policy. A team from the Blois hospital (41) was able to share the experience of a patient partnership during the analysis of a complex medical situation with a young man with sickle cell disease in a vaso-occlusive crisis. She reports here this new and enriching experience.

Devouring and Asphyxia: Paradigm Crisis, the Depletion of the Hero and Complex Thought1.

This article deals with the profound paradigm crisis that affects modernity and threatens the destiny of humanity. This crisis results from the lack of perspective offered by the paradigm of modernity with its emphasis on unilateral rationality, scientific objectivity, and exploitation of natural resources by a hyper development of an inflated Hero archetype. The emergence of a new paradigm of complexity, C. G. Jung's complex psychology, and Ameridian perspectivism, may offer new paths to approach these serious problems lived by modern man. A clinical vignette illustrates how complex psychology may also help with individual patients suffering from psychosomatic complaints.

Cet article traite de la profonde crise de paradigme qui affecte la modernité et qui menace le destin de l'humanité. Cette crise est le résultat du manque de perspective offert par le paradigme de la modernité, qui met l'accent sur la rationalité unilatérale, l'objectivité scientifique, et l'exploitation des ressources naturelles dans un hyper-développement de l'archétype du Héros, affecté par l'inflation. L'émergence d'un nouveau paradigme de la complexité, la psychologie complexe de C.G. Jung, et le perspectivisme Amérindien peuvent offrir de nouvelles ouvertures pour aborder ces problèmes sérieux que vit l'homme moderne. Une vignette clinique illustre comment la psychologie complexe peut aussi aider en ce qui concerne les patients individuels souffrants de problèmes psychosomatiques.

Este artículo aborda la profunda crisis de paradigma que afecta a la modernidad y amenaza el destino de la humanidad. Esta crisis es el resultado de la falta de perspectiva que ofrece el paradigma de la modernidad con su énfasis en la racionalidad unilateral, la objetividad científica y la explotación de los recursos naturales mediante el hiperdesarrollo de un arquetipo de Héroe inflado. La emergencia de un nuevo paradigma de la complejidad, la psicología compleja de C.G. Jung y el perspectivismo Amerindio pueden ofrecer nuevas vías para abordar estos graves problemas que vive el hombre moderno. Una viñeta clínica ilustra cómo la psicología compleja también puede ayudar con pacientes individuales que sufren dolencias psicosomáticas.

[Optimization of critical care according to the principles applied in aeronautics]. / Optimisation des soins critiques selon les principes appliqués en aéronautique.

Care requires the full attention of caregivers, particularly in emergencies, where it consumes energy and generates emotions. To be efficient and to remain so, we must know how to manage our stress with full awareness. The culture of quality in the aeronautics industry teaches us to adjust the right tension over time, individually or as a team, on a daily basis as well as in times of crisis. The management of a patient in a critical somatic or psychological situation has strong similarities with the aeronautical crisis management model, which allows us to draw inspiration from it.

O papel da informação e da comunicação em situações de emergência: a crise sanitária e humanitária no território Yanomami / The role of information and communication in emergency situations: the health and humanitarin crisis in the Yanomani territory / El papel de la información and de la comunicación en situaciones de emergencia: la crisis sanitaria y humanitaria en el territorio Yanomani

A crise humanitária no território Yanomami, agravada nos últimos anos com a invasão de atividades de garimpo, revela uma trama de fatores sociais, ambientais e políticos, que resultaram numa 'emergência' sanitária e humanitária, em seus diversos sentidos. O fluxo contínuo de levantamento de dados, a análise da situação e a comunicação de riscos é que podem revelar o contexto em que essa emergência ocorre e permitir a intervenção oportuna na crise. Nesta nota, procuramos identificar potencialidades e limitações dos dados existentes, informações e estratégias de comunicação voltadas para emergências de saúde.

The humanitarian crisis in the Yanomami territory, exacerbated in recent years by the invasion of mining activities, reveals a set of social, environmental and political factors that resulted in a health and humanita-rian 'emergency' in its various meanings. Only the continuous flow of data collection, situation analysis and risk communication can unveil the context in which this emergency occurs and allow appropriate interven-tion in the crisis. In this note, we seek to identify the potential and limitations of available data, information and communication strategies related to health emergencies.

La crisis humanitaria en el territorio Yanomami, agudizada en los últimos años por la invasión de las ac-tividades de minerías, revela un conjunto de factores sociales, ambientales y políticos, que resultan en la 'emergencia' sanitaria y humanitaria, en sus diversas acepciones. El flujo continuo de recopilación de datos, el análisis de la situación y la comunicación de riesgos es que pueden desvelar el contexto en el que se produce esta emergencia y permitir la intervención oportuna en la crisis. En esta nota, buscamos iden-tificar el potencial y las limitaciones de los datos existentes, informaciones y estrategias de comunicación relacionadas con las emergencias sanitarias.

[Digital adaptation of a therapeutic education program in the context of Covid-19]. / Adaptation numérique d'un programme d'éducation thérapeutique dans le contexte de la Covid-19.

The context of containment due to the Covid-19 epidemic forced professionals to suspend their face-to-face therapeutic education programs. For young patients with asthma, the situation was made even more complex by anxiety-provoking communications (which turned out to be inaccurate) about the possible aggravating role of corticosteroids in the event of Covid-19, which led to untimely discontinuations and sometimes to a decrease in their therapeutic adherence, exposing them to an increased risk of poor control of their disease. Faced with the feeling of abandonment felt by some families in this singular context, a team at Trousseau Hospital in Paris decided to rethink and adapt its distance therapeutic education workshops.

[Crisis consultations in child and adolescent psychiatry in Reims: Cross-sectional study of the population of accompanied minors]. / Dispositif de crise en psychiatrie de l'enfant et de l'adolescent à Reims : étude transversale de la population des mineurs accompagnés.

INTRODUCTION: The crisis consultation unit (CCU) of the child psychiatry department of the Reims University Hospital was created to respond to an increasing demand for rapid interventions with minors. OBJECTIVE: The objective of this study is to observe the characteristics of the population received in this facility and to explore the links between the data, to hypothesize about its specificities. METHOD: We conducted a cross-sectional study of data collected during telephone assessments between June 2016 and January 2018. A univariate analysis was performed using EpiInfo© software and the pvalue.io© statistical interface using R statistical software. A total of 263 telephone contacts were counted. RESULTS: A greater activity of the service is found during the school period. The majority of minors did not have any psychiatric or psychological follow-up at the time of the call. Boys consulted earlier, preferably for externalized disorders. The youngest children are often referred to prevent symptoms following an acute stress. CONCLUSION: Our study allowed us to draw up a sociodemographic profile and to show certain trends observed within the CCU of the child psychiatry department of the Reims University Hospital, in particular the multiplicity of reasons for consultation. At a time when the health crisis is impacting the mental health of the entire population and increasing the time required for treatment, this type of system is particularly relevant to the possible reorganization of the care offered by the CMP. The CCU would make it possible to report the most urgent situations, which would then benefit from specific care (hospitalization, medication, specific consultations).

[Impact of the suicidal crisis intervention training program on the confidence and skills of hospital professionals in the Hauts-de-France region]. / Impact de la formation à l'intervention de crise suicidaire sur la confiance et les aptitudes des professionnels hospitaliers des Hauts-de-France.

INTRODUCTION: Suicide is a major public health issue given its huge human and economic consequences. Symptoms prior to suicide are often not specific. Nevertheless, the majority of suicidal people express suicidal thoughts, and nearly one in two meet a health professional in the period preceding the act. Being able to recognize the warnings and intervene during the suicidal crisis, defined as a mental crisis where the major risk is suicide, is to seize the opportunity to postpone the suicidal plan and to gain time to implement in place lasting strategies to combat suffering. Thus, the training for suicidal crisis intervention is a major axis of the suicide prevention strategy. Recently, crisis intervention training programs have been updated with knowledge accumulated since the early 2000's. In France, one of the countries most concerned by suicide, the Hauts-de-France region is one of the most impacted. In this context, the Regional Health Agency of Hauts-de-France included in its Regional Health Program of 2018-2023 the training of healthcare workers who work with high suicidal risk patients. The suicidal crisis intervention training program (SCIT) has been introduced to hospital staffs in Hauts-de-France. The purpose of this study was to evaluate this program. METHODS: Eight training sessions with 15 to 21 participants were carried out from 2019 November to 2021 January in the Hauts-de-France region. Participants were volunteer healthcare professionals in direct contact with suicidal crisis patients. The training included three modules. The first one concerned the suicidal crisis intervention training: definition of the suicidal crisis, typology of the crisis, vulnerability development, crisis evaluation and crisis intervention practice. The second concerned the evaluation with the RED scale (Risk-Emergency-Danger) and the adequate patient orientation to a psychiatric unit. The third was dedicated to the Gatekeeper training with the constitution of a Gatekeeper network to enhance the capacity to detect suicidal risk and to orient the concerned person towards an adequate evaluation or care organization. We evaluated the first two levels of the Kirkpatrick's model: level 1) the participant's satisfaction (rated out of 10), and level 2) the degree of confidence in their professional abilities (rated out of 10) and their skills in responding to a person in a suicidal crisis (using the SIRI-2-VF - French version of the Suicide Intervention Response Inventory-2). The participants were interviewed before (T0), just after (T1) and at one month of training (T2). RESULTS: Among the 141 health professionals who followed the training, 139 answered the questionnaire at least one time (13 psychologists, 22 doctors, 97 nurses and 7 head nurses). The participation rates were 99.3 % at T0, 96.4 % at T1 and 46.0 % at T2. Most of the participants were nurses (69.8 %), and 33.1 % of the respondents declared they had already followed a suicidal crisis training. The satisfaction with the training was evaluated at 8.6 (± 1.3) out of 10. There was no significant difference among the professions, neither between those having already received or not a previous training. The self-perceived capacity to manage a suicidal crisis was rate 6.8 (± 1.8) out of 10 at T0. There was a significant increase just after the training (8.1±1.2 vs 6,8±1,8, p<0,001) which persisted at 1 month (8.1±1.1 vs 6.8±1.8, P<0.001). The score at the SIRI-2-VF was 15.0 (± 4.2) out of 30 at T0. There was a significant increase just after the training (17.5±3.5 vs 15.0±4.2, P<0.001), which persisted at 1 month (17.0±4.0 vs 15.0±4.2, P<0.001). DISCUSSION: This is the first evaluation of the suicidal crisis intervention training program. This program increased and homogenized the competency of the participants to manage suicidal ideation and behaviors. Those who followed a previous training maintained higher scores than the others, which shows the importance of repeated training to maintain a satisfying level of knowledge over the long term. One of the strengths of this training is the use of roleplay which enhances the learning and abilities to interact with people at suicidal risk. It seems important to integrate a suicidal crisis intervention training in the cursus of health students to avoid suicide and the dramatic consequences for the entourage and the health professionals who are confronted with it. CONCLUSION: The SCIT program showed encouraging results in terms of confidence and capacity of the healthcare professionals to intervene in suicidal crisis.

Critérios para acolhimento noturno, segundo a equipe de um centro de atenção psicossocial / Criterios de recepción nocturna según el equipo del centro de atención psicosocial / Criteria for night reception according to the psychosocial care center team

RESUMO. O acolhimento noturno configura-se como um dos recursos oferecidos pelos Centros de Atenção Psicossociais de tipo III no cuidado aos sujeitos em sofrimento psíquico grave. Este estudo teve como objetivo identificar as percepções de profissionais de um Centro de Atenção Psicossocial tipo III sobre os critérios para inserção e alta de usuários em acolhimento noturno. Trata-se de uma pesquisa qualitativa da qual participaram nove profissionais respondendo a um roteiro semiestruturado de entrevista sobre dados sociodemográficos e questões sobre o funcionamento e os critérios para o acolhimento noturno no referido serviço e realizada análise de conteúdo temática com os dados obtidos. A análise de conteúdo temática apontou que a estabilização da crise e a proteção à vida configuram-se como critérios centrais para a inserção no acolhimento noturno, o qual pode assumir tanto o sentido de vigilância sobre o comportamento do usuário quanto de oportunidade para desenvolver vínculo com a equipe. Diante disso, conclui-se que o acolhimento noturno tem função estratégica no manejo às situações de crise em saúde mental e que muitos são os desafios enfrentados pela equipe na interlocução dos diversos pontos da rede de atenção psicossocial no cuidado aos seus usuários.

RESUMEN. La recepción nocturna está configurada como uno de los recursos ofrecidos por los Centros de Atención Psicosocial Tipo III en la atención de sujetos con angustia psicológica severa. Este estudio tuvo como objetivo identificar las percepciones de los profesionales en un Centro de Atención Psicosocial tipo III sobre los criterios de inserción y alta de los usuarios en la atención nocturna. Es una investigación cualitativa en la que participaron nueve profesionales, que respondieron a un guión de entrevista semiestructurada sobre datos socidemográficos y preguntas sobre el funcionamiento y los criterios para la recepción nocturna en el servicio referido. El análisis del contenido temático se realizó con los datos obtenidos. El análisis de contenido temático de que la estabilización de la crisis y la protección de la vida son criterios centrales para la inserción en la recepción nocturna, que puede asumir tanto un sentido de vigilancia sobre el comportamiento del usuario como una oportunidad para desarrollar un vínculo con el paciente. equipo En vista de esto, se concluye que la atención nocturna tiene un papel estratégico en el manejo de situaciones de crisis en salud mental y que el equipo enfrenta muchos desafíos al hablar sobre los diferentes puntos de la red de atención psicosocial en el cuidado de sus usuarios.

ABSTRACT. Night care is one of the resources offered by Type III Psychosocial Care Centers in the care of subjects in severe psychological distress. This study aimed to identify the perceptions of professionals in a Psychosocial Care Center type III on the criteria for insertion and discharge of users in night care. It is a qualitative research in which nine professionals participated, responding to a semi-structured interview script about socidemographic data and questions about the functioning and criteria for night reception at the referred service. Thematic content analysis was performed with the data obtained. Thematic content analysis that the stabilization of the crisis and the protection of life are central criteria for insertion in the night reception, which can assume both a sense of vigilance about the user's behavior and an opportunity to develop a bond with the patient. team. In view of this, it is concluded that night care has a strategic role in managing crisis situations in mental health and that there are many challenges faced by the team when talking about the different points of the psychosocial care network in caring for its users.