Towards better child protection programmes:a qualitative evaluation of Youth Disseminating Life Skills Programme

The present study aimed to assess the acceptability of a 12-week training programme, Youth Disseminating Life Skills Programme whose aims were to help university students acquire knowledge on and to increase sensitivity towards child abuse and neglect by adopting a qualitative methodology. The sample consisted of 13 university students who took part in the Youth Disseminating Life Skills Programme (10 female, 3 male: mean age 22 years; age range: 20–31). With the help of a general interview guide, the focus group meetings were held. Established conventions guided the analysis. Participants recounted feelings about and benefits of the Programme, and ways to improve the Programme. Feelings about the Programme included both positive (e.g. feeling hopeful) and negative feelings (e.g. feeling traumatised). Participants recounted a variety of benefits of the Programme (e.g. correcting some myths about child abuse). Participants proposed some ways whereby the Programmecouldbeimproved.Some findingscouldbeinterpretedin terms of existing literature/theory. Other findings extended the literature and could be viewed as targets for future child protection programmes

Long-term effectiveness of Self-Help Plus in refugees and asylum seekers resettled in Western Europe: 12-month outcomes of a randomised controlled trial

AimsAs refugees and asylum seekers are at high risk of developing mental disorders, we assessed the effectiveness of Self-Help Plus (SH + ), a psychological intervention developed by the World Health Organization, in reducing the risk of developing any mental disorders at 12-month follow-up in refugees and asylum seekers resettled in Western Europe.MethodsRefugees and asylum seekers with psychological distress (General Health Questionnaire-12 ⩾ 3) but without a mental disorder according to the Mini International Neuropsychiatric Interview (M.I.N.I.) were randomised to either SH + or enhanced treatment as usual (ETAU). The frequency of mental disorders at 12 months was measured with the M.I.N.I., while secondary outcomes included self-identified problems, psychological symptoms and other outcomes.ResultsOf 459 participants randomly assigned to SH + or ETAU, 246 accepted to be interviewed at 12 months. No difference in the frequency of any mental disorders was found (relative risk [RR] = 0.841; 95% confidence interval [CI] 0.389–1.819; p-value = 0.659). In the per protocol (PP) population, that is in participants attending at least three group-based sessions, SH + almost halved the frequency of mental disorders at 12 months compared to ETAU, however so few participants and events contributed to this analysis that it yielded a non-significant result (RR = 0.528; 95% CI 0.180–1.544; p-value = 0.230). SH + was associated with improvements at 12 months in psychological distress (p-value = 0.004), depressive symptoms (p-value = 0.011) and wellbeing (p-value = 0.001).ConclusionsThe present study failed to show any long-term preventative effect of SH + in refugees and asylum seekers resettled in Western European countries. Analysis of the PP population and of secondary outcomes provided signals of a potential effect of SH + in the long-term, which would suggest the value of exploring the effects of booster sessions and strategies to increase SH + adherence.</p

Trajectories of psychosocial symptoms and wellbeing in asylum seekers and refugees exposed to traumatic events and resettled in Western Europe, Turkey, and Uganda

Background: Longitudinal studies examining mental health trajectories in refugees and asylum seekers are scarce.Objectives: To investigate trajectories of psychological symptoms and wellbeing in refugees and asylum seekers, and identify factors associated with these trajectories. Method: 912 asylum seekers and refugees from the control arm of three trials in Europe (n = 229), Turkey (n = 320), and Uganda (n = 363) were included. We described trajectories of psychological symptoms and wellbeing, and used trauma exposure, age, marital status, education, and individual trial as predictors. Then, we assessed the bidirectional interactions between wellbeing and psychological symptoms, and the effect of each predictor on each outcome controlling for baseline values.Results: Symptom improvement was identified in all trials, and for wellbeing in 64.7% of participants in Europe and Turkey, versus 31.5% in Uganda. In Europe and Turkey domestic violence predicted increased symptoms at post-intervention (ß = 1.36, 95% CI 0.17-2.56), whilst murder of family members at 6-month follow-up (ß = 1.23, 95% CI 0.27-2.19). Lower wellbeing was predicted by murder of family member (ß = -1.69, 95% CI -3.06 to -0.32), having been kidnapped (ß = -1.67, 95% CI -3.19 to -0.15), close to death (ß = -1.38, 95% CI -2.70 to -0.06), and being in the host country >= 2 years (ß = -1.60, 95% CI -3.05 to -0.14). In Uganda at post-intervention, having been kidnapped predicted increased symptoms (ß = 2.11, 95% CI 0.58-3.65), and lack of shelter (ß = -2.51, 95% CI -4.44 to -0.58) and domestic violence predicted lower wellbeing (ß = -1.36, 95% CI -2.67 to -0.05). Conclusion: Many participants adapt to adversity, but contextual factors play a critical role in determining mental health trajectories.</p

Continued reinnervation of full thickness skin after transposition

The aim of this experiment was to investigate the transposition of reinnervated skin grafts. In the first stage, a full thickness graft was placed on the sensory nerve supplying the anterolateral thigh skin of a rat (n = 72). The animals were then divided into three groups according to the period between the first and second stages: Group I, 2 weeks (n=24); Group II, 4 weeks (n=24); and Group III, 8 weeks (n=24). In six rats from each of the three groups, the grafts were excised for histochemical examination at the end of the interval between the first and second stages. In the remaining rats, the grafts based on the sensory nerves were transposed to other recipient sites (stage 2). By subdividing each of the three groups into three subgroups skin grafts were then excised for histochemical examination at 2-week, 4-week and 8-week intervals. The contralateral side acted as the control. Specific thiocholine methods were employed to demonstrate the cholinesterase activities of the regenerating nerves into the grafts. In all groups, apart from the first group, nerve regeneration into the graft showed no interruption. This study demonstrated that a skin graft based on a sensory nerve may substitute for a secondary end organ, and its transposition does not result in loss of reinnervation. © 1993 Springer-Verlag

Large atrial septal aneurysm and delayed improvement of renal failure due to nephrotoxic drugs (and hemodialysis) in a diabetic patient

PubMedID: 12071598Atrial septal aneurysm (ASA) is a well known morphologic abnormality and has been largely investigated with both transthoracic (TTE) and/or transesophageal echocardiography (TEE) (1-3). Its association with other congenital and acquired heart diseases and midsystolic clicks has been reported (3-5). ASA also may be associated with an increased risk of embolic events (1,2). In many cases, it is an incidental finding. We describe a patient with acute renal failure associated with nephrotoxic drugs and ASA suggesting endocarditis

The free radial forearm flap for closure of large defects of upper lip and adjacent cheek tissue

Four cases with large defects of the upper lip and adjacent cheek, reconstructed with radial forearm free flaps, are presented. The defects were secondary to tumor excision, three recurrent and one primary. Because of the extensive infiltration of the tumor into the adjacent tissues, the excisions were extensive. There were also large mucosal defects. Free radial forearm flaps were chosen to repair these defects instead of local cheek or lip flaps. The free flap was easily folded to repair skin and mucosa simultaneously. Although the patients had partial loss of orbicularis oris muscle, they did not completely lose upper lip function. Drooling was controlled, and there was no microstomia. This is the free flap of choice to repair a large defect of the upper lip and adjacent cheek tissue in selected cases. © 1989 Springer-Verlag