Customer-oriented counseling for physical activity in older people: study protocol and selected baseline results of a randomized-controlled trial (ISRCTN 07330512).

The objective of this study is to describe the rationale, design and selected baseline results of a 2-year randomized-controlled trial (RCT) on the effects of physical activity counseling in community-living older people. After a four-phase screening and data-collection process targeting all independently living people in the city center of Jyväskylä, Finland, six hundred and thirty-two 75-81-year-old cognitively intact, sedentary persons who were able to move independently outdoors at least minimally and willing to take part in the RCT were randomized into intervention and control groups. At baseline, over half of the subjects exercised less than two to three times a month and two-thirds were willing to increase their physical activity level. The desire to increase physical activity was more common (86%) among subjects with mobility limitation compared with those without (60%, P=0.004). The intervention group received an individualized face-to-face counseling session, followed by phone contacts every 3 months throughout the intervention. The study outcomes include physical activity level, mobility limitation, functional impairments, disability, mood, quality of life, use of services, institutionalization and mortality. The screening and recruitment process was feasible and succeeded well, and showed that unmet physical activity needs are common in older people.

[Managing adolescent and adult victims of extra-familial rape soon after aggression]. / Prise en charge des adolescents et des adultes victimes de viols extra-familiaux dans les suites récentes de leur agression.

Rape victims often experience severe and prolonged symptoms in the aftermath of the assault. Psychological assistance offered rapidly after the assault should mitigate the intensity and moderate the duration of rape-related problems. This paper tried to identify the widely-accepted therapeutic approaches from a review of the current literature; it has its roots in the clinical experience acquired by our mobile crisis service in this type of situation, too. The goal of the following practices concerning the victim and the victim's immediate family is to assist the victim to reclaim control as quickly as possible over what has happened and to return to a normal functioning. The therapist should adopt an empathetic attitude, actively and instructively, even more so, and in an even more flexible way than for other patients. Knowledge of one's potential reactions to that kind of situation is useful since the counter-transference is here particularly intense. Doubting the patient's word is part of these negative reactions and must be avoided. It is better to respect the victim's feelings of guilt in the first instance. The relating of the facts, despite its cathartic value, should not be imposed on the patient. It should be noted that these last two points are controversial. It is also important to give information, during interviews, about the symptoms which can occur, the defence mechanisms that the individual sets up for just such occasions and on the most common difficulties encountered in personal relationships. In particular, the therapist must verify that concrete measures are taken to protect the victim against another attack. As far as the immediate family is concerned, it seems particularly important to involve them and, better still, meet them. Their reaction to the rape has a determining influence on the victim's capacity to cope with the trauma and its consequences. On the one hand, the immediate family should be helped in giving support to the victim by telling them all the details of what the patient could suffer, their potential reaction towards the victim and the victim's potential reactions towards them. The question of security must also be brought up with the family, in particular the risk of suicide which can be great. On the other hand, it is important to meet the family to give them support because they too may have difficulty in coming to terms with the violence of the aggression and its consequences. These approaches are up to now the only guidelines available since no psychotherapeutic technique (based on controlled studies) has proved to be more efficient than another and since the clinical experience of the authors are leading them to opposite therapeutic options. Different psychotherapeutic techniques are recommended: short therapies such as cognitive-behavioural therapies or hypnosis, or longer ones such as psychoanalytic psychotherapy. Several of these different options, to which must be added physical techniques like relaxation and medication, are often used simultaneously and/or in succession. As for drug treatments no controlled study conducted with this population has proved their efficiency on post-traumatic stress disorder. According to us they are essentially useful in order to diminish the intensity of the symptoms of anxiety.

[Suicidal action and sacrificial violence: systemic and anthropological hypothesis]. / Passage à l'acte suicidaire et violence sacrificielle: hypothèse systémique et anthropologique.

Studies concerning suicidal behavior show practical limitations of epidemiology and risk factor analysis. Suicidal behaviour is usually considered as a consequence of mental disease, but suicide cannot be studied without addressing the context of the acting-out. Suicide attempt can be interpreted as a thematic relational act, in which the central phenomenon is anger. Using the anthropological hypothesis of scapegoating described by René Girard and a theoretical systemic approach, we propose a vision of suicide attempts in a micro-social context, offering a new interpretation of the acting-out. Application of the hypothesis to the suicidal context shows that suicidal behavior may be considered as a relationship modality. The understanding of rivalry mechanisms and integration of care in a context which takes account of the complexity of suicidal behaviour offers the possibility of developing potentially valuable approaches to prevention.

[Questionnaire on professional satisfaction with psychiatric emergency services: the professionals' opinion]. / Enquête de satisfaction auprès des utilisateurs d'un service d'urgence psychiatrique: l'avis des professionnels.

Professional's satisfaction concerning medical wards to which they address their patients are scarce, but is part of quality evaluation. The primary care network criticizes often the access to specialized psychiatric cares in emergency. The rapid emergency crisis team (ERIC) is a mobile emergency and post-emergency crisis team depending from public services. It has for purpose to offer early access to specialized care before admission to psychiatric hospital, which general practitioners or other members of social network alert it for a crisis psychiatric situation. The aim of this study was to evaluate the adequacy of ERIC to the needs of professionals, and to improve the collaboration within the network. We performed a mailed study using a questionnaire to 150 general practitioners, 25 private psychiatrists, 7 social circonscriptions, and 5 police departments depending on our intervention's catchment area. Forty-two percent of the professionals answered. Emergency psychiatric crisis situations are scarce, and professional's satisfaction is excellent. ERIC is considered as useful, and the accessibility is underlined. However, information transmitted at the end of the intervention is criticized by the professionals. This study allows to improve some of the procedures and will help to an evolution of our functioning. Moreover, it allows to propose a strategy of prevention oriented to early access to specialized cares.

[Security and home emergency psychiatric interventions]. / Sécurité et interventions psychiatriques à domicile en urgence.

Sectorisation of cares leads professionals to a confrontation with violent home patients. These interventions need a maximal security for professionals. Emergency Mobile Crisis Team (ERIC) has more than 6,000 crisis home interventions' experience. The aim of this study was to assess violent situations during a 42 months experience. We present 70 situations of danger for professionals, and their consequences. Difficulties lead to procedural safety measures, which are presented. Prevention of violence during intervention needs an acute preparation, a clear evaluation of context, and passive or active securisation measures. Occurrence of acting-out is low, but situations considered as dangerous are frequent. We propose some pragmatic issues to increase security in crisis home interventions.