[Supporting perinatal professionals]. / L'accompagnement des professionnels en périnatalité.

No professional, no team can be a caregiver if they themselves are not well supported, well "cared for", i.e. if they are not well looked after. Professional support is therefore not a luxury, but a sine qua non of quality care and psychological care. After a few reminders about practice analysis and supervision, the impact of the baby's functioning on that of professionals (an impact to be taken into account in terms of their support) is considered, before tackling the concept of intransitive demand, which is also to be considered in the work of supervision.

Supereu e neurose: dos pecados do pai à demanda do Outro, "Goza! / Surmoi et névrose: des péchés du père aux demandes de l'Autre, "Jouis !" / Superego and neurosis: from the sins of the father to the demands of the Other, "Enjoy!"

Neste artigo, por meio do arcabouço freudo-lacaniano, analisou-se teoricamente o supereu na neurose, com o objetivo de investigar suas especificidades e seus truques, que invariavelmente levam o sujeito ao pior. O neurótico demanda amor, demanda ser demandado e recebe suas próprias demandas de forma invertida como demanda do Outro. Então, pelas fraturas da metáfora paterna, o supereu na neurose articula seus imperativos à demanda do Outro obstruindo o desejo, o que pode ser demonstrado com a figura do toro e com o grafo do desejo. Conclui-se, com a importância de pesquisar o supereu que carrega mistérios, paradoxos e sutilezas, que ainda deixam perguntas, também diferenciando as estratégias e os modos de gozo que essa instância impõe à neurose e com o destino do supereu no final de análise.

Dans cet article, à travers le cadre freudo-lacanien, le surmoi dans la névrose est analysé théoriquement, dans le but d'enquêter sur ses spécificités et ses astuces, qui conduisent invariablement le sujet au pire. Le névrosé demande de l'amour, demande à être demandé et reçoit ses propres demandes de façon inversée comme la demande de l'Autre. Puis, à travers les fractures de la métaphore paternelle, le surmoi dans la névrose articule ses impératifs à la demande de l'Autre, obstruant le désir, ce qui peut être démontré avec la figure du tore et avec le graphe du désir. Il se conclut sur l'importance de rechercher le surmoi porteur de mystères, de paradoxes et de subtilités, qui laisse encore desinterrogations, en différenciant également les stratégies et les modes de jouissance que cette instance impose à la névrose et avec le destin du surmoi au fin de l'analyse.

In this article, through the Freudian-Lacanian framework, the superego in neurosis was theoretically analyzed, with the aim of investigating its specificities and its tricks, which invariably lead the subject to the worst. The neurotic demands love: they demand to be demanded and also receive their own demands in an inverted way as the Other's demand. Then, through the fractures of the paternal metaphor, the superego in neurosis articulates its imperatives to the demand of the Other, obstructing desire. We try to demonstrate this unconscious operation with the figure of the torus and with the graph of desire. It concludes with the importance of researching the superego that carries mysteries, paradoxes and subtleties, which still leave questions, also differentiating the strategies and modes of jouissance that this instance imposes on neurosis and with the destiny of the superego at the end of the analysis.

[An ethic of substitution towards an adolescent in psychological suffering]. / Une éthique de la substitution à l'égard d'un adolescent en souffrance psychique.

In the light of our practice with adolescents admitted to child psychiatry, it appears that the most vulnerable among them are distinguished by their failure to request care. In resonance with a psychopathology of the link, the propensity of the professionals to substitute for it is palpable. From a phenomenological reading of the care practice and its ethical dimension, the aim is to try to confront the different components of substitution. The substitutive attitude opens the possibility of a co-creative encounter.

[Workplace-based Assessments: A Needs Analysis of Residents and Supervisors]. / Arbeitsplatz-basierte Assessments: eine Bedarfsanalyse bei Assistenzärztinnen und ­ärzten sowie ihren Supervisierenden.

Workplace-based Assessments: A Needs Analysis of Residents and Supervisors Abstract. During residency training, four workplace-based assessments (WBA) are planned per year in the form of Mini-CEX and/or DOPS. They were introduced as a tool for giving feedback and defining learning objectives in the clinical setting. The aim of the present study is to identify facilitating and inhibiting factors. The results will provide information to improve the use of this learning tool to effectively promote learning in the workplace. First, all users must be trained in its use. In particular, it is important to provide immediate and specific feedback that identifies opportunities for improvement and sets achievable learning goals. Documentation should be user-friendly and provide an overview of the learning process. WBAs should not be perceived as a duty, but as a tool for valuable learning moments.

[Involuntary admission to psychiatry at the request of caregivers: The point of view of caregivers]. / Les soins psychiatriques à la demande d'un tiers : le point de vue du tiers.

OBJECTIVES: In France, the family and friends of a patient with a psychiatric disorder can legally be involved in the decision to involuntary admission to psychiatry through care at the request of a third party. This involvement has been questioned in recent years, notably to protect this third party. The main objective of this work was to assess whether providing the third party with information on care without consent when providing care at the request of a third party (SDT) had an impact on the third party's experience. The secondary objectives were to identify other factors that might impact the third party's experience of the SDT, and to assess the impact of the SDT on the relationship between the third party and his or her hospitalized relative, as well as the factors that might influence it. METHODS: The study was based on a questionnaire, constructed after meeting several members of an association of relatives of patients with psychiatric disorders : UNAFAM. This questionnaire questioned the context of hospitalization, the information provided concerning care without consent, the experience of the third party at the time of hospitalization and at a distance, and the impact of hospitalization on the relationship between the third party and his or her hospitalized relative, both at the time of hospitalization and at a distance. This questionnaire was then sent to UNAFAM members in three randomly selected regions. It was specified that it was only intended for people who had already been a third party during SDT. The results were received anonymously. RESULTS: Among the 166 respondents, 85 (51.2 %) had received information about involuntary admission, and there was more frequent relief at the time of hospitalization (P<0.01) and at a distance (P<0.01), and less frequent feelings of violence towards their loved one at a distance from hospitalization (P=0.02) compared to those who had not received information. The negative impact of hospitalization on the relationship between the third party and their hospitalized relative was lower (P=0.04) among third parties who received information. The fact that the doctor was perceived as being mainly responsible for the decision to hospitalize also preserved the third party's experience and relationship with his or her relative. However, third parties who understood their involvement as an administrative necessity reported less frequent relief (P=0.01), and the negative impact of hospitalization on their relationship with their relative was higher (P=0.01). Conversely, the fact that they felt integrated into the care and listened to by the health care team was correlated with a better experience of the situation by the third party, and a lesser negative impact of hospitalization on the relationship between the third party and their relative. CONCLUSIONS: Providing information to the third party about involuntary admission at the time of an SDT could improve his or her experience of the situation and limit the negative impact of hospitalization on his or her relationship with his or her loved one. Although it seems important for the third party to feel that the majority of the decision to hospitalize is made by the physician, including him/her in this decision could improve his/her experience of the situation and limit the negative impact of hospitalization on the relationship between the third party and his/her family member.

[The right to die and assisted suicide: Review and critical analysis]. / Droit à mourir et suicide assisté : état des lieux et analyse critique.

OBJECTIVES: In the context of the present re-examination of the French bioethical laws by the National Advisory Ethics Committee ("Comité consultatif national d'éthique": CCNE), a recent survey indicated a request of the public opinion to obtain a medical aid in end of life and a so-called "assisted suicide". This led psychiatrists to re-consider their role and deontological position which usually led them to consider a request for an assistance in suicide as - a priori - a pathological demand, occurring within a suicidal crisis. The present article intends to: 1) describe the laws and practices of countries which allow medically assisted end of life help procedures; 2) clarify the definitions of "assisted suicide", "assistance to suicide" and "euthanasia"; 3) consider available epidemiological data and the roles given to doctors and, more specifically psychiatrists, in these procedures; 4) analyse the rationale behind these demands. These considerations should enable French psychiatrists to clarify their position when facing requests for a medical aid in dying. METHODS: Four European countries (Switzerland, the Netherlands, Belgium, Luxemburg) and Oregon (the first US state to introduce legislation) were considered, since they accumulated and published a large amount of experiences and data about "assisted suicide" and medical help in dying. In total, 127 articles were selected, mainly from PubMed and Cairn databases, published between 1997 and 2020. These articles deal with legal considerations, epidemiological data, ethical and sociological considerations. RESULTS: Laws and practices differ notably according to the state/country. In Belgium, the Netherlands and Luxemburg, as in Oregon, the medical help in dying has been de-criminalized, as long as certain legal criteria are met. In Switzerland, where no specific law exists in the penal code, non-governmental associations have benefited from the legal vacuum and organized the practice of "assisted suicide" for "altruistic motives". In the scientific and legal literature, the terms used to describe and define the medical help in dying upon request differ greatly. In France, the National Advisory Ethics Committee defines euthanasia ("euthanasie"), assisted suicide ("suicide assisté") and suicide assistance ("assistance au suicide"). Available epidemiological data, whatever the country considered, indicate that requests for a medical aid in dying are expressed mainly by patients aged over 60 years and suffering from cancer. Psychiatric diseases account for only 1% to 3%. Most often, systematic assessment by a psychiatrist is neither requested nor made, when the demand does not occur during a primary psychiatric illness. In the case of an existing primary psychiatric pathology, a psychiatrist assesses the case against formal legal predefined criteria. This latter practice was only recently introduced, after some feedback and after legal actions had been brought to Court. When the underlying motivations of the request are considered, it appears that, even in the absence of an evolving psychiatric condition, several psychological or psychopathological reasons prevail such as spirituality, attachment style, social isolation, despair, depression… which should greatly benefit psychiatric exploration, investigation and expertise. CONCLUSION: In some countries, the request for medically assisted help in dying has become a legal and social reality. In France, where the public debate is still open, it should be emphasized that a psychiatric assessment and interview should be systematically provided to any person requesting medical assistance to die or commit suicide. It is the commitment of psychiatrists to understand the implicit demands and unexpressed motives underlying this request which have strong links with the unique life-events and emotional experiences of the person. The psychiatrist has a unique role in the contextualization of such a request.

[Involuntary Psychiatric Hospitalizations: From request to a call center to hospitalization]. / Admission en soins psychiatriques a la demande d'un tiers : de l'appel au SAMU a l'hospitalisation.

BACKGROUND: Involuntary psychiatric hospitalization (IPH) is a heavy and complex psychiatric exception measure. In the Seine-Saint-Denis department (low medical density), the evaluation of the patient in psychiatric decompensation is the responsibility of the out-of-hours general practitioners (GP) mandated by the call center. Their feeling is the non-achievement of the procedure once the patient arrives at the emergency room. We aimed to evaluate the outcome of patients following a request for IPH from these GP. METHODS: We conducted a retrospective study based on all requests for IPH received during 2016 at the Seine-Saint-Denis emergency medical call center. The characteristics of the call and the patient, as well as the decisions of the regulator and the GP were collected. The decision of hospitalization in the emergency room was sought for patients referred for IPH. RESULTS: Of the 7541 calls for decompensation, 539 were for an IPH. These calls occurred during non-working hours in 55 % of cases. A GP was involved in more than two-thirds of the cases and requested an IPH for 240/304 (79 %) patients. Patients were male in 56 % of cases with an average age of 40 (±16) years. IPH was confirmed for 132 (61 %) patients. This rate did not differ from the 65 % reported in the literature (Z-test, P=0.26). Voluntary hospitalization was performed for 37 (17 %) other patients. DISCUSSION: The IPH rate for patients referred by GP mandated by the call center was comparable to that following the requests of the attending physicians, validating their intervention in this critical context.

[Medico-legal framework for emergency care of a patient with psychiatric conditions]. / Cadre médico-légal des soins en urgence d'un patient à présentation psychiatrique.

The care and referral of patients with psychiatric conditions is a perilous process. It combines the need for care with respect for individual freedom. Knowledge of the different legal frameworks is thus necessary for psychiatric care at the request of a third party, care without request of a third party within the framework of a procedure for imminent danger, and finally for the injunction of psychiatric care on the decision of a State representative. These are necessary prerequisites for practising in an emergency structure.

Maternal lack of sleep in the first two years after childbirth: Perceived impacts and help-seeking behaviors.

Most evidence-based sleep interventions (e.g., graduated extinction of nighttime crying) are in opposition to many parents' values. This warrants taking a step back and asking the parents about their main concerns regarding their baby's sleep and the type of help they would be likely to use. This study aimed to describe and identify, among mothers of a 0- to 24-month-old child, the perceived impact of lack of sleep, sleep-related help-seeking behaviors as well as the most concerning aspects of the child's sleep, and preferred sleep intervention modalities. Another objective was to identify the factors associated with a negative impact of postpartum sleep, concerns for the child's sleep, and interest in sleep interventions. Canadian mothers (N = 932) were recruited by email snowball sampling and through Facebook to complete an online questionnaire designed for the purposes of the study. Most mothers reported a negative impact of postpartum sleep on their romantic relationship (79.4%) and quality of life (76.7%). Low parental self-efficacy (PSE) about managing the child's sleep was the best predictor of a negative impact of lack of sleep and sleep-related concerns, above and beyond any other child's or mother's characteristics. The preferred intervention modalities were reliable websites and online courses on child sleep, with a greater interest in home visits among mothers who need help the most (low self-efficacy, high concerns). Interventions should aim at increasing PSE about the child's sleep in both parents and include home visits for those who need it the most.

Muchas intervenciones sobre el dormir con base en la evidencia (v.g. la extinción gradual del llanto en la noche) solicitan un débil cumplimiento por parte de los padres. Esto amerita un paso atrás para investigar las principales preocupaciones de los padres acerca del sueño de sus bebés y el tipo de ayuda que ellos prefieren. Este estudio se propuso describir, entre madres de niños de 0 a 24 meses de nacidos, la percepción del impacto de la falta de sueño, los aspectos más preocupantes del sueño del infante, así como las preferidas modalidades de intervención. Otro objetico fue identificar los factores asociados con estos principales resultados del estudio. Se reclutaron madres canadienses (N = 932) a través de Facebook para completar un cuestionario en forma electrónica diseñado para este estudio. La mayoría de las madres reportaron un impacto negativo del sueño posterior al parto sobre sus relaciones románticas (79.4%) y sobre la calidad de vida (76.7%). La baja autoeficacia de la madre acerca de cómo manejar el sueño del niño resultó ser el mejor factor de predicción de un impacto negativo de la falta de sueño y de las preocupaciones relacionadas con el sueño, más allá de cualquier otra característica del niño o de la madre. Las modalidades de intervención preferidas fueron los confiables sitios en la internet y cursos por computadora acerca del sueño del infante, con un mayor interés en visitas a casa entre las madres que necesitan más ayuda (baja autoeficacia, alto número de preocupaciones). Las intervenciones deben proponerse aumentar la autoeficacia de las madres con respecto al sueño e incluir visitas a casa para aquellas que las necesitan más.

Bien des interventions de sommeil factuelles (par exemple la disparition graduée des pleurs la nuit) produit peu de suivi de la part des parents. Cela mérite de se poser afin d'investiguer les inquiétudes principales des parents concernant le sommeil de leur bébé et le type d'aide qu'ils préféreraient. Cette étude s'est donné pour but de décrire, parmi les mères d'un enfant de 0 à 24 mois, l'impact perçu du manque de sommeil, les aspects les plus inquiétants du sommeil de l'enfant, et les modalités d'intervention préférées. Un autre objectif était d'identifier les facteurs liés à ces principaux résultats de l'étude. Des mères canadiennes (N = 932) ont été recrutées au travers de Facebook afin de remplir un questionnaire en ligne développé pour cette étude. La plupart des mères ont fait état d'un impact négatif du sommeil postpartum sur leur relation romantique (79,4%) et leur qualité de vie (76,7%). Une auto-efficacité parentale peu élevée pour ce qui concerne la gestion du sommeil de l'enfant était le meilleur prédicteur d'un impact négatif du manque de sommeil et de soucis liés au sommeil, au-delà de toutes caractéristiques de la mère et de l'enfant. Les modalités d'intervention préférées étaient des sites internet fiables et des cours en ligne sur le sommeil de l'enfant, avec un plus grand intérêt pour des visites à domicile chez les mères qui en avaient le plus besoin (auto-efficacité peu élevée, grandes inquiétudes). Les interventions devraient se donner pour but d'augmenter l'auto-efficacité parentale liée au sommeil et inclure des visites à domicile pour ceux qui en ont le plus besoin.

A clínica psicanalítica frente à demanda trans / The psychoanalytical clinic facing the trans demand / La clinique psychanalytique face à la demande trans

O objetivo deste trabalho é investigar a escuta psicanalítica numa instituição de saúde voltada para a população trans, tomando como central o conceito lacaniano de demanda. Busca-se uma definição do fenômeno trans que evite tanto a abordagem dos manuais classificatórios quanto as perspectivas em psicanálise que o atrelam a uma estrutura determinada. Propõe-se um trabalho com a demanda que vise localizar a função do processo transexualizador para cada sujeito. Conclui-se que o trabalho com a demanda visa a elaboração das condições subjetivas para que alguém possa sustentar as consequências do seu pedido de transição.

The psychoanalytical clinic facing the trans demand: The aim of this paper is to investigate the psychoanalytic listening in a health institution focused on the trans population taking as central the lacanian concept of demand . We seek a definition of the trans phenomenon that avoid both the approach of the classification manuals and the perspectives on psychoanalysis that link it to a specific structure. We propose a work with the demand aimed at locating the function of the transsexualizing process for each subject. We conclude that work with the demand aims to develop subjective conditions so that someone can sustain the consequences of their transition`s request.

La clinique psychanalytique face à la demande trans: L'objectif de ce travail est d'étudier l'écoute psychanalytique dans un établissement de santé centré sur la population trans, en prenant comme point central le concept lacanien de demande. Nous cherchons une définition du phénomène trans quiévite à la fois l'approche des manuels classificatoires et les perspectives en psychanalyse qui le lient à une structure déterminée. Il est proposé un travail auprès de la demande qui vise à situer la fonction du processus de transexualisation pour chaquesujet. On en conclut que le travail avec la demande vise à l'élaboration des conditions subjectives pour que quelqu'un puisse supporter les conséquences de sa demande de transition

[Compliance's assessment of ultrasound and x-ray requests at Mopti's Sominé Dolo hospital]. / Evaluation de la conformite des demandes d'echographie et de radiographie a l'hopital Somine Dolo de Mopti.

OBJECTIVE: To assess the compliance of requests for ultrasound and radiography examinations at Mopti's hospital. MATERIALS AND METHODS: This was a cross-sectional study from January 2018 to June 2018. The variables analyzed were the different compliance criteria grouped into administrative, clinical and minor.The data analysis was done with SPSS version 20 and Excel 2013 software. RESULTS: Out of 2000 requests, radiography represented 61.05% compared to 38.95% of ultrasound cases. The administrative criteria were completed in more than 95% of the cases. The purpose of the review was absent in 95% of the requests. The non-compliance rate for the requests was 95.65%. The requests of general practitioners, specialists and medical assistants were respectively non-compliant with 93.62%; 95.68% and 100%. CONCLUSION: At the end of this study, we observed an insufficiency in the quality of prescriptions for requests for medical imaging examinations with a high rate of non-compliance. This could lead to examination practice not suited to the clinical situation, interpretation errors, complications for the patient and high and unnecessary economic cost.

OBJECTIF: Evaluer la conformité des demandes d'examens d'échographie et de radiographie à l'hôpital de Mopti. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude transversale de Janvier 2018 à juin 2018. Les variables analysées étaient les différents critères de conformité regroupés en critères administratifs, cliniques et mineurs.L'analyse des données a été faite avec les logiciels SPSS version 20 et Excel 2013. RÉSULTATS: Sur 2000 demandes, la radiographie représentait 61,05 % contre 38,95 % de cas d'échographie.Les critères administratifs étaient renseignés dans plus de 95% des cas. La finalité de l'examen était absente dans 95% des demandes. Le taux de non-conformité des demandes était 95,65 %. Les demandes des médecins généralistes, des spécialistes et des assistants médicaux étaient respectivement non conformes avec 93,62%; 95,68% et 100%. CONCLUSION: Au terme de cette étude nous avons observé une insuffisance dans la qualité des prescriptions des demandes des examens d'imagerie médicale avec un taux de non-conformité élevé. Ceci pourrait être à l'origine d'une pratique d'examen non adaptée à la situation clinique, des erreurs d'interprétation, des complications pour le patient et d'un coût économique élevé et inutile.

The effect of general duty police ensemble on graded exercise and simulated work performance.

This 2-part study examined the impact of general duty police ensemble on selected cardiopulmonary responses during incremental treadmill exercise and on simulated work performance in 25 healthy young male and female participants. Part I comprised randomly ordered treadmill tests in 2 experimental conditions: physical training (PT; undergarments, shorts, t-shirt, and running shoes) and police duty ensemble (PDE; undergarments, body armour, patrol uniform, boots, duty belt with required equipment, radio, and weapons). The PDE added 10.3 kg (SD 0.4) or 14% (SD 2) body mass. Participants walked at 5.6 km·h-1, starting at 0% grade with 2% increases in grade every 2 min. The 4% stage was 6 min in duration to achieve physiological steady state. Subsequently, the 2-min increments continued to exhaustion. Part II evaluated performance time on a recognized job-related work simulation circuit, in 3 experimental conditions: (i) PT, (ii) weighted belt (WB; PT plus a 7.5 kg weighted belt), and (iii) PDE. In Part I, physiological responses (e.g., oxygen uptake, ventilation, heart rate) were elevated (p < 0.05) with PDE during submaximal exercise but peak values were unchanged. Test duration and peak power output were significantly reduced with PDE. In Part II, circuit completion time was increased in PDE but not WB when compared with PT (p < 0.05). Heart rate and perceived exertion were similar in all conditions and perceived dyspnea was higher in PDE. Novelty Police duty ensemble negatively affected exercise performance more than would be expected due to load mass alone. Specificity must be considered when simulating occupational load carriage.

Effect of chemical oxygen demand load on the nitrification and microbial communities in activated sludge from an aerobic nitrifying reactor.

In this study, we explored the effect of chemical oxygen demand (COD) load on the nitrification and microbial communities in activated sludge isolated from an aerobic nitrifying tank. The activated sludge was cultured in three different COD groups: L-COD, 200 mg/L; M-COD, 1200 mg/L; H-COD, 4200 mg/L. The results indicated that the COD exerts a negligible effect on the nitrogen removal ability within the first 24 h. However, the nitrification rate decreased with culture time; the ammonium degradation rates were found to be 80.26%, 57.56%, and 43.43% at 72 h in the three COD groups, respectively. These values correspond to decreases of 19.40%, 41.83%, and 51.48%, respectively, in relation to those observed at 24 h. The activated sludge in the different COD groups exhibited similar community compositions after 24 h, as assessed by Illumina high-throughput sequencing, while a significant difference in the relative abundances of some organisms occurred after 48 and 72 h. Proteobacteria was the main phylum, with a relative abundance of >51.45%. The genera Aridibacter, Paracoccus, Nitrospira, and Nitrosomonas were suppressed by COD load over time. This study may contribute to our knowledge about the nitrification ability and microbial communities in activated sludge at different COD load levels.

[Nursing clinical approach to boredom]. / Petite clinique infirmière de l'ennui.

The acute crisis is often followed by boredom. Patients become impatient, restless, looking for ways to take their mind off things and entertain themselves. The occupational activity can then come to the rescue of these downtimes, offering solutions to encourage an encounter. Caregivers work together to 'bore' the patient. In this search for the encounter, they must take the risk of forgoing the occupational activity for the sake of the therapeutic.

[Characteristics of patients who received an indication of involuntary admission, with or without the involvement of a third party, in a Parisian psychiatric emergency unit]. / Caractérisation d'une population de patients hospitalisés sous contrainte en ASPDT/u et ASPPI à partir d'un service d'urgence psychiatrique parisien.

BACKGROUND: The French mental health law, first enacted on July 5, 2011, introduced the possibility of psychiatric commitment in case of extreme urgency (imminent peril - ASPPI). The decision of involuntary admission can then be made by the hospital director based on a medical certificate, without the need of a third party request. This procedure was intended to be applied on an exceptional basis, but its use is steadily increasing against the other types of involuntary care. Our study aimed at comparing the characteristics of patients who had received an indication for involuntary admission due to imminent peril (ASPPI) or at the request of a third party (ASPDT/u) in a psychiatric emergency ward, according to sociodemographic and clinical characteristics and regarding the potential implication of a third party. METHODS: An observational study was conducted among patients from the Centre Psychiatrique d'Orientation et d'Accueil (CPOA), located at Sainte-Anne hospital in Paris, from August 1st to 31st, 2016. RESULTS: One hundred and fifty patients with an indication for involuntary commitment were included, 101 of whom for ASPDT/u (67 %) and 49 for ASPPI (33 %). For more than half of the patients from the ASPPI group, a third party had been identified with (39 %) or without (17 %) contact information. Compared to ASPDT/u patients, ASPPI individuals were more socially vulnerable, showed more negligence, and had a lower mean functioning score. The indication for ASPPI status was also associated with behavioural quirks, prior psychiatric hospitalization (especially as an ASPPI patient) and with the diagnosis of chronic psychosis instead of mood disorder. CONCLUSION: Our exploratory results help to better understand how the ASPPI procedure is used in psychiatric emergency wards six years after enactment of the law. They highlight the differences between ASPPI patients and ASPDT/u and raise ethical issues regarding involuntary psychiatric care.

[Pulmonary function testing of dyspnea complaint by the pulmonologist]. / Investigation fonctionnelle respiratoire de la dyspnée chronique par le pneumologue.

Dyspnea results from an imbalance between ventilatory demand (linked to CO2 production, PaCO2 set-point and wasted ventilation-physiological dead space) and ventilatory capacity (linked to passive-compliance, resistance-and active-respiratory muscles-components of the respiratory system). Spirometry and static lung volumes investigate ventilatory capacity only. Ventilatory demand (increased for instance in all pulmonary vascular diseases due to increased physiological dead space) is not evaluated by these routine measurements. DLCO measurement, which evaluates both demand and capacity, depicts the best statistical correlation to dyspnea, for instance in obstructive and interstitial pulmonary diseases. Dyspnea has multiple domains and is inherently complex and weakly explained by resting investigations: explained variance is below 50%. The diagnostic strategy investigating dyspnea has to distinguish complaints related or not to exercise because dyspnea can occur independently from any effort. Cardiopulmonary exercise testing (V'O2, V'CO2, V'E and operating lung volumes measurements) allows the assessment of underlying pathophysiological mechanisms leading to functional impairment and can contribute to unmask potential underlying mechanisms of unexplained dyspnea although its "etiological diagnostic value" for dyspnea remains a challenging issue.

Comparison of energy-matched high-intensity interval and moderate-intensity continuous exercise sessions on latency to eat, energy intake, and appetite.

High-intensity interval exercises (HIIex) have gained popularity but their effects on eating behavior are poorly known. The aim of this study was to evaluate whether the effects of HIIex on the 3 main components of eating behavior (appetite, intake, and latency to eat) differ from those of moderate-intensity continuous exercises (MICex) for the same energy expenditure. Fifteen young normal-weight males completed 3 sessions in a counterbalanced order: HIIex (30-s bouts at 90% of maximal oxygen uptake interceded with 60-s bouts at 35% of maximal oxygen uptake for 20 min), MICex (42% of maximal oxygen uptake for 40 min), and a resting session (REST). Trials were scheduled 80 and 100 min after a standard breakfast for MICex and HIIex, respectively. At 120 min, participants were isolated until they asked for lunch. Appetite was rated on 4 visual analog scales (hunger, desire to eat, fullness, and prospective consumption) every 15 min until meal request. Results showed that the mean latency of requesting lunch was significantly longer after HIIex than after REST (+17.3 ± 4.3 min, P = 0.004), but not after MICex (P = 0.686). Energy intake was not different between conditions, leading to a negative energy balance in the 2 exercise sessions. Thus, the effects of HIIex on eating behavior are likely primarily mediated through the latency of meal initiation. However, inter-individual variability was large and further studies are needed to identify the predictive factors of this response.

Total energy expenditure in elite open-water swimmers.

This study aimed to examine the total energy expenditure (TEE) and physical activity level (PAL) of elite open-water swimmers. Our study group included 5 world-class competitive open-water swimmers. TEE was measured using the doubly labeled water method for 1 week. The TEE was 4549 ± 1185 kcal/day. The PAL was 3.22 ± 0.46. Our results may provide a reference to optimize energy requirement support.

Impasses no acesso ao saber na clínica psicanalítica com crianças / Impasses dans l'accès à la connaissance dans une clinique psychanalytique avec des enfants / Dificultad en el acceso al saber en la clínica psicoanalítica con niños / Difficulties of access to knowledge in child psychoanalytic clinic

Resumo Este artigo investiga as relações da criança com o saber. O ponto de partida é a prática clínica com crianças que apresentaram impasses no acesso ao saber escolar e, na investigação analítica, revelaram a trama inconsciente na qual o saber ocupa um lugar no sintoma familiar. Apresentaremos a discussão teórica considerando que o acesso ao saber porta uma dimensão estrutural de impedimento, que é a impossibilidade do saber diante da castração. Sendo assim, percorreremos dois caminhos para discutir o que impede o acesso ao saber. No primeiro caminho abordaremos a relação entre demanda e desejo e suas incidências sobre a criança. No segundo percurso discutiremos a relação entre saber e verdade, explorando as relações e os limites entre os dois termos, acrescentando a essa discussão um terceiro termo essencial: o gozo.

Résumé Cet article examine les relations de l'enfant avec la connaissance. La pratique clinique et la recherche analytique avec des enfants qui ont présenté des impasses dans l'accès à les connaissances scolaires révèlent souvent la relation inconsciente dans laquelle la connaissance occupe une place dans le symptôme familier. Une discussion théorique sera présentée, considérant que l'accès au savoir porte une dimension structurelle d'empêchement, qui est l'impossibilité du savoir face à la castration. De cette façon, deux chemins seront abordés pour discuter de ce qui empêche l'accès à la connaissance. D'abord, la relation entre la demande et le désir et leurs incidences sur l'enfant sera abordée. Dans le deuxième chemin, la relation entre connaissance et vérité sera discutée, en explorant les relations et les frontières entre les deux termes, en ajoutant à cette discussion un troisième terme essentiel : la jouissance.

Resumen Este artículo examina las relaciones entre el niño y el saber. El punto de partida es la práctica clínica con niños que presentaron dificultades en el acceso al saber escolar, y en la investigación analítica se reveló la trama inconsciente en la que el saber ocupa un lugar en el síntoma familiar. Presentamos la discusión teórica considerando que el acceso al saber contiene una dimensión estructural de impedimento, que es la imposibilidad del saber ante la castración. Por eso recorreremos dos caminos para discutir lo que impide el acceso al saber. En el primer, abordaremos la relación entre demanda y deseo y sus incidencias sobre el niño. En el segundo, discutiremos la relación entre saber y verdad, explorando las relaciones y los límites entre los dos términos, añadiendo a esa discusión un tercer término esencial: el goce.

Abstract This paper investigates the child's relationship with knowledge. Clinical practice and analytical research with children with difficulties to access school knowledge revealed the unconscious dynamics in which knowledge occupies a place in the family symptom. A theoretical discussion will be presented considering that access to knowledge bears a structural dimension of impediment, which is the impossibility of knowing in the face of castration. Therefore, we will investigate two paths to discuss what prevents access to knowledge. The first addresses the relationship between demand and desire and how it affects children. The second discusses the relationship between knowledge and truth, exploring the relationships and boundaries between both, adding to this discussion a third essential term: jouissance.

[Medical human resources planning in Europe: A literature review of the forecasting models]. / La planification des médecins en Europe : une revue de la littérature des modèles de projection.

BACKGROUND: Healthcare is a labor-intensive sector in which half of the expenses are dedicated to human resources. Therefore, policy makers, at national and internal levels, attend to the number of practicing professionals and the skill mix. This paper aims to analyze the European forecasting model for supply and demand of physicians. METHODS: To describe the forecasting tools used for physician planning in Europe, a grey literature search was done in the OECD, WHO, and European Union libraries. Electronic databases such as Pubmed, Medine, Embase and Econlit were also searched. RESULTS: Quantitative methods for forecasting medical supply rely mainly on stock-and-flow simulations and less often on systemic dynamics. Parameters included in forecasting models exhibit wide variability for data availability and quality. The forecasting of physician needs is limited to healthcare consumption and rarely considers overall needs and service targets. Besides quantitative methods, horizon scanning enables an evaluation of the changes in supply and demand in an uncertain future based on qualitative techniques such as semi-structured interviews, Delphi Panels, or focus groups. Finally, supply and demand forecasting models should be regularly updated. Moreover, post-hoc analyze is also needed but too rarely implemented. CONCLUSION: Medical human resource planning in Europe is inconsistent. Political implementation of the results of forecasting projections is essential to insure efficient planning. However, crucial elements such as mobility data between Member States are poorly understood, impairing medical supply regulation policies. These policies are commonly limited to training regulations, while horizontal and vertical substitution is less frequently taken into consideration.