Internamiento involuntario vs. Retención ilegal en pacientes contrastorno mental grave / Involuntary internment vs. Illegal retention in patients with serious mental disorder

Aunque una buena actitud hacia la terapia y el cumplimiento de la misma son claves para el éxito del tratamiento, en ciertas situaciones el uso de medidas coercitivas en personas con trastornos mentales es la única forma de prevenir daños graves al paciente y a otras personas. La decisión de utilizar estas medidas, como el internamiento involuntario, es un desafío para los médicos, ya que tienen que lidiar no solo con la voluntad del paciente y de sus familiares, que se encuentran en una situación emocional desbordada, sino también con el conocimiento de la normativa vigente, especialmente complejas. Para proteger los derechos del paciente en estas situaciones difíciles y del personal clínico, es esencial que el mismo conozca los límites de su actuación en el marco del procedimiento legal. Por ello, se necesitan más estudios en la materia, que ofrezcan conclusiones contrastadas con respecto a las diferencias entre el internamiento involuntario y la retención ilegal.(AU)

Even though a good attitude towards therapy and adherence are key to an effective treatment, in certain circumstances the use of coercive actions in people with mental disorders is the only way to prevent serious harm to the patient and to others. The choice to use coercive measures, such as involuntary internment, is a challenge for doctors, since not only do they have to deal with the patient and their relatives who are in a highly emotional situation, but there are also complex legal regulations. To defend the rights of patients in these difficult situations, and to avoid legal consequences for clinical staff due to illegal acts, it is essential that staff are familiar with all of the relevant legal rules and procedures. Further studies are warranted to obtain clear conclusions regarding differences between involuntary internment and illegal retention.(AU)

Mental health professionals' attitudes towards mental competency and involuntary commitment in anorexia nervosa: Construction, validation and results of the ACINOVAN questionnaire.

INTRODUCTION: Anorexia nervosa is a serious disorder that causes high rates of morbidity and mortality. Involuntary treatments are only legally admissible if the patient is not competent. However, assessing their capacity can be really complex. This implies that the final decision can be influenced by the individual attitudes of the physician. OBJECTIVE: To create and empirically validate a questionnaire in Spanish that makes it possible to measure the attitude towards capacity and involuntary commitment and compare between categorical groups. METHODS: The sample consisted of 338 mental health professionals. The items were validated by groups of experts. An exploratory factor analysis and group comparisons were carried out. RESULTS: Favourable evidence was obtained of a 13-item model consisting of three factors: pro-intervention, lack of competence and chronicity. Professionals tend to believe in the lack of capacity and the need for involuntary interventions, as well as differential suitability due to chronicity. Support prior to involuntary interventions was significantly related to the pro-intervention and absence of capacity factors, and training in bioethics to chronicity. CONCLUSIONS: The resulting instrument is valid and reliable. Its use can be useful to professionals, patients and society.

Actitudes de los profesionales de la salud mental ante la capacidad y el internamiento no voluntario en anorexia nerviosa: construcción, validación y resultados del cuestionario ACINOVAN / Mental Health Professionals' Attitudes Towards Mental Competency and Involuntary Commitment in Anorexia Nervosa: Construction, Validation and Results of the Acinovan Questionnaire

RESUMEN Introducción: La anorexia nerviosa es un trastorno grave que causa tasas elevadas de morbilidad y mortalidad. La aplicación de una intervención no voluntaria solo es legalmente admisible si el paciente no es competente. Sin embargo, la evaluación de su capacidad puede ser extremadamente compleja. Ello conlleva que la decisión final pueda verse influida por las actitudes individuales del facultativo. Objetivo: Crear y validar empíricamente un cuestionario en español que permita medir la actitud hacia la capacidad y el internamiento no voluntario y comparar entre grupos categóricos. Métodos: Formaron la muestra 338 profesionales de salud mental. Los ítems fueron validados por grupos de expertos. Se realizaron un análisis factorial exploratorio y comparaciones grupales. Resultados: Se obtuvo un modelo de 13 ítems formado por 3 factores: prointervención, ausencia de capacidad y cronicidad. Los profesionales tienden a creer en la ausencia de capacidad y la necesidad de la intervención no voluntaria, así como en la idoneidad diferencial en virtud de la cronicidad. El respaldo previo a intervenciones involuntarias se relacionó significativamente con los factores prointervención y ausencia de capacidad y la formación en bioética, con la cronicidad. Conclusiones: El instrumento resultante es válido y fiable. Puede ser útil a profesionales, pacientes y sociedad.

ABSTRACT Introduction: Anorexia nervosa is a serious disorder that causes high rates of morbidity and mortality. Involuntary treatments are only legally admissible if the patient is not competent. However, assessing their capacity can be really complex. This implies that the final decision might be influenced by the individual attitudes of the physician. Objective: To create and empirically validate a questionnaire in Spanish that makes it possible to measure the attitude towards capacity and involuntary commitment and compare between categorical groups. Methods: The sample consisted of 338 mental health professionals. The items were validated by groups of experts. An exploratory factor analysis and group comparisons were carried out. Results: Favourable evidence was obtained of a 13-item model consisting of three factors: pro-intervention, lack of capacity and chronicity. Professionals tend to believe in the lack of capacity and the need for involuntary interventions, as well as differential suitability due to chronicity. Having ever supported involuntary interventions was significantly related to the pro-intervention and lack of capacity factors, and training in bioethics to chronicity. Conclusions: The resulting instrument is valid and reliable. Its use can be useful to professionals, patients and society.

Visibilizar indivíduos, ocultar instituições: uma análise documental de categorias governamentais para abordar o fenômeno do confinamento no Brasil / Making individuals visible, hiding institutions: a document analysis of government categories to address the phenomenon of confinement in Brazil / Visibilizar a los individuos, esconder las instituciones: un análisis documental de las categorías gubernamentales para abordar el fenómeno del encierro carcelario en el Brasil

Objetivo: descrever e analisar categorias para se referir a pessoas e estabelecimentos adotadas nos setores saúde e justiça do Poder Executivo Federal, acentuando assim a dimensão política do fenômeno do confinamento no Brasil. Metodologia: desenvolvemos uma perspectiva panorâmica dos resultados obtidos, destacando o número e a frequência dessas categorias. Nossa análise documental focalizou cartilhas e outros materiais educativos, identificados e caracterizados após consulta a quatro websites. Resultados: reunimos 147 documentos, a maioria deles com a finalidade de suscitar engajamento social e a minoria para definir normas. No setor justiça, localizamos 412 registros de expressões para se referir a populações e 274 para se referir a estabelecimentos, bem como 619 e 390 no setor saúde, de modo que se apresenta o público da política quase o dobro de vezes do que o serviço ofertado nesses materiais educativos. Conclusão: há mais categorias para se referir às populações-alvo das políticas sanitárias e penitenciárias do que aos espaços nos quais se recomenda que elas sejam alocadas. Em algumas áreas técnicas, quase cinco vezes mais, como se o processo de formulação dessas formas de ação estatal colaborasse para visibilizar indivíduos e ocultar instituições.

Objective: to describe and analyze categories to refer to people and establishments adopted in the health and justice sectors of the Federal Executive Branch thus accentuating the political dimension of the phenomenon of confinement in Brazil. Methods: we developed an overview of the results, highlighting the number and frequency of these categories. Our document analysis focused on primers and other educational materials identified and characterized after consulting four websites. Results: we gathered 147 documents, most of them with the purpose of raising social engagement, and a few defining norms. In the justice sectorwe found 412 records of expressions to refer to populations, and 274 to refer to establishments, as well as 619 and 390 in the health sector so that the policy target audience is presented almost twice as often as the service offered in these educational materials. Conclusion: there are more categories to refer to the target populations of health and penitentiary policies than to the spaces in which it is recommended that they be allocated. In some technical areas, almost five times more, as if the process of formulating these forms of state action collaborated to make individuals visible while hiding institutions.

Objetivo: describir y analizar categorías para referirnos a personas y establecimientos adoptados en los sectores de salud y justicia del Poder Ejecutivo Federal, acentuando así dimensión política del fenómeno del encierro carcelario en el Brasil. Metodología: Desarrollamos una perspectiva panorámica de los resultados obtenidos, destacando el número y frecuencia de estas categorías. Nuestro análisis documental se centró en folletos y otros materiales educativos, identificados y caracterizados después de consultar cuatro sitios web. Resultados: reunimos 147 documentos, la mayoría de estos con el propósito de crear compromiso social y en menor proporción para definir normas. En el sector justicia encontramos 412 registros de expresiones para referirse a poblaciones y 274 para referirse a los establecimientos, así como 619 y 390 en el sector salud, de este modo, es presentado el público de la política en casi el doble de veces que el servicio ofrecido en estos materiales educativos. Conclusión: hay más categorías para referirse a las poblaciones-alvo de políticas de salúd y penitenciarias, que a espacios en los cuales se recomienda que estas sean asignadas. En algunas áreas técnicas casi cinco veces más, como si el proceso de formulación de estas formas de acción estatal colaborara a hacer visibles a los individuos y ocultar las instituciones

[Coronavirus disease 2019 (COVID-19): Involuntary admission yes, involuntary treatment no]. / Coronavirus disease 2019 (COVID-19): internamiento involuntario sí, tratamiento obligatorio no.

We had the opportunity to know a judicial decision in relation to a nonagenarian COVID-19 patient, which is clarifying regarding the complex issue of involuntary admission and involuntary treatment of the elderly. The judge authorized the involuntary admission but denied the possibility of imposing medical treatment against the will of the patient. This situation invites us to review the different types of involuntary admission that our legal system provides and how involuntary medical treatment is regulated according to its purpose and the patient's ability to decide. In the field of public health, the determining element to be able to impose any sanitary measure against the will of the patient is the risk to the health of the population. In the case presented, the judge rejects the possibility of authorizing medical treatment for not contributing anything from the point of view of public health. However, it does authorize involuntary admission as it is essential to guarantee isolation.

Mental Health Professionals' Attitudes Towards Mental Competency and Involuntary Commitment in Anorexia Nervosa: Construction, Validation and Results of the Acinovan Questionnaire. / Actitudes de los profesionales de la salud mental ante la capacidad y el internamiento no voluntario en anorexia nerviosa: construcción, validación y resultados del cuestionario ACINOVAN.

INTRODUCTION: Anorexia nervosa is a serious disorder that causes high rates of morbidity and mortality. Involuntary treatments are only legally admissible if the patient is not competent. However, assessing their capacity can be really complex. This implies that the final decision might be influenced by the individual attitudes of the physician. OBJECTIVE: To create and empirically validate a questionnaire in Spanish that makes it possible to measure the attitude towards capacity and involuntary commitment and compare between categorical groups. METHODS: The sample consisted of 338 mental health professionals. The items were validated by groups of experts. An exploratory factor analysis and group comparisons were carried out. RESULTS: Favourable evidence was obtained of a 13-item model consisting of three factors: pro-intervention, lack of capacity and chronicity. Professionals tend to believe in the lack of capacity and the need for involuntary interventions, as well as differential suitability due to chronicity. Having ever supported involuntary interventions was significantly related to the pro-intervention and lack of capacity factors, and training in bioethics to chronicity. CONCLUSIONS: The resulting instrument is valid and reliable. Its use can be useful to professionals, patients and society.

Effects of COVID-19 confinement measures on training loads and the level of well-being in players from Chile women's national soccer team / Efectos de las medidas de confinamiento por COVID-19 en el grado de bienestar y la carga de entrenamiento de las jugadoras de la selección nacional de fútbol de Chile

Abstract Introduction: Due to the current COVID-19 pandemic, many countries have implemented control and prevention measures, such as compulsory lockdowns, affecting all spheres of life. Since the field of professional soccer is no exception, such measures may have a negative impact on the player's well-being and their perceived training loads. Objective: To determine the impact of COVID-19 lockdown measures on the training load and the well-being of female professional soccer players in Chile. Materials and methods: Exploratory, cross-sectional, descriptive study conducted on 32 players of the Chile women's national soccer team. The perception of training load and the level of well-being were assessed by means of the rating of perceived exertion (RPE) scale and a questionnaire developed in 2010, respectively. Both the administration of the questionnaire and the permanent monitoring of the RPE records were carried out in two periods of 12 weeks: regular preparatory phase (12/12/2019-10/03/2020) and lockdown (16/03/2020-07/06/2020). Data were analyzed using descriptive statistics and the Wilcoxon test was used to determine if there were significant differences between periods. Results: Significant differences (p<0.05) and threshold effect sizes (ES)=1.2, 2.0 and 4.0 (large, very large, and extremely large, respectively) were found between both periods in all variables evaluated by the well-being questionnaire (except for sleep quality): muscle soreness and stress level (ES=1.9), perceived fatigue (ES=2.5), general well-being (ES=2.4), and mood (ES=4.2). No differences were found regarding the perception of the training load (ES=0.1) between both periods. Conclusions: The level of well-being among the participants was negatively affected by the compulsory lock-down. Therefore, coaching staffs should continue to monitor the level of the well-being of professional soccer players during the lockdown, both individually and collectively. Even though the perception of training load was not affected, it is not possible to state that a more extended period of confinement will not reduce it, resulting in a drop in performance.

Resumen Introducción. Debido a la actual pandemia por COVID-19, muchos países tomaron medidas de control y prevención como el confinamiento obligatorio, afectando todas las esferas de la vida. Ya que los futbolistas profesionales no son una excepción, este tipo de medidas puede tener un impacto negativo en su bienestar y en su percepción sobre las cargas de entrenamiento. Objetivo. Determinar los efectos de las medidas de confinamiento por COVID-19 en la carga de entrenamiento y el grado de bienestar de jugadoras de fútbol profesional de Chile. Materiales y métodos. Estudio transversal, exploratorio-descriptivo realizado en 32 jugadoras de la Selección Nacional de Fútbol de Chile. El grado de bienestar y la carga de entrenamiento se evaluaron mediante un cuestionario desarrollado en 2010 y mediante la escala de percepción subjetiva del esfuerzo (PSE) y el volumen de entrenamiento expresado en minutos, respectivamente. Ambas evaluaciones se realizaron en 2 periodos de 12 semanas : periodo preparatorio regular (12/12/2019-10/03/2020) y periodo de confinamiento (16/03/2020-07/06/2020). Los datos se analizaron mediante estadística descriptiva y la prueba de Wilcoxon se utilizó para determinar si hubo diferencias significativas entre ambos periodos. Resultados. Se encontraron diferencias significativas (p<0.05) y umbrales de tamaño del efecto (TE) iguales a 1.2, 2.0 y 4.0 (grande, muy grande y extremadamente grande, respectivamente) entre ambos periodos en todas las variables evaluadas por el cuestionario de bienestar (a excepción de calidad de sueño): dolor muscular y nivel de estrés (TE=1.9), fatiga percibida (TE=2.5), bienestar general (TE=2.4) y estado de ánimo (TE=4.2). No se observaron diferencias en la PSE (TE=0.1) entre ambos periodos. Conclusiones. El confinamiento obligatorio afectó negativamente el grado de bienestar de las participantes, por lo que es necesario que los cuerpos técnicos monitoreen constantemente, de manera individual y colectiva, el grado de bienestar de los futbolistas profesionales durante estos periodos; si bien la percepción en la carga de entrenamiento no se vio afectada, no es posible asegurar que un periodo mayor de confinamiento no la disminuya y esto resulte en una baja del rendimiento.

Alternativas a los internamientos en salud mental: hospitalización domiciliaria desde la perspectiva española y anglosajona / Alternatives to admissions in mental health: home treatment from the Spanish and Anglo-Saxon perspective

En España, los internamientos por motivo de trastorno mental suelen implicar una pérdida de libertades, ya que en general se realizan en unidades de puertas cerradas o bajo condiciones de carácter restrictivo. En este artículo se revisan las características de estos internamientos y la legislación española al respecto. Se realiza una comparativa con Reino Unido, donde se dispone de una ley exclusivamente dedicada a la salud mental, y se analiza el modelo anglosajón de hospitalización domiciliaria como alternativa al ingreso hospitalario. En conclusión, existe una mayor protección legislativa de los derechos fundamentales de los usuarios de salud mental en Reino Unido respecto a España. Es necesaria una reforma legislativa y el desarrollo de políticas sanitarias dirigidas a reducir los internamientos y fomentar otras alternativas de tratamiento. La hospitalización domiciliaria ha demostrado ser una alternativa eficaz al ingreso hospitalario, permitiendo tratar a la persona en el ambiente menos restrictivo posible y un mayor respeto de su autonomía (AU)

In Spain, most of the admissions in mental health units imply a lack of freedom since they are carried out in facilities with closed doors or under restrictive conditions. This article analyzes the characteristics of those admissions and its legislation in Spain; then, it is compared with the United Kingdom model, where there is a specific law for mental health. We describe their model of home treatment, which is implemented as an alternative to hospital admissions. In conclusion, there is a better legislative protection of mental health users' fundamental rights in the United Kingdom than Spain. Legislative reform and the development of health policies to reduce hospitalizations and promote other treatment alternatives are necessary. Home treatment has proven to be an effective alternative to hospital admission, allowing the person to be treated in the least restrictive environment possible and greater respect for their autonomy (AU)

A Espanya, els internaments per motiu de trastorn mental solen implicar una pèrdua de llibertats, ja que en general es realitzen en unitats de portes tancades o sota condicions de caràcter restrictiu. En aquest article es revisen les característiques d'aquests internaments i la legislació espanyola sobre aquest tema. Es realitza una comparativa amb Regne Unit, on es disposa d'una llei exclusivament dedicada a la salut mental, i s'analitza el model anglosaxó d'hospitalització domiciliària com a alternativa a l'ingrés hospitalari. En conclusió, existeix una major protecció legislativa dels drets fonamentals dels usuaris de salut mental a Regne Unit respecte a Espanya. És necessària una reforma legislativa i el desenvolupament de polítiques sanitàries dirigides a reduir els internaments i fomentar altres alternatives de tractament. L'hospitalització domiciliària ha demostrat ser una alternativa eficaç a l'ingrés hospitalari, permetent tractar a la persona en l'ambient menys restrictiu possible i un major respecte de la seva autonomia (AU)