Prevalence of complex post-traumatic stress disorder in refugees and asylum seekers: systematic review

BACKGROUND: Refugees and asylum seekers often report having experienced numerous complex traumas. It is important to understand the prevalence of complex post-traumatic stress disorder (CPTSD), which can follow complex traumas. AIMS: This systematic review aims to summarise the available literature reporting the prevalence in refugees and asylum seekers of three operationalised definitions of CPTSD: the ICD-11 diagnostic criteria, the ICD-10 criteria (for enduring personality change after catastrophic experience) and the DSM-IV criteria (for disorders of extreme stress not otherwise specified). METHOD: Six electronic databases were searched for studies reporting the prevalence of CPTSD in adult refugee and/or asylum-seeking samples. Owing to heterogeneity between the studies, a narrative synthesis approach was used to summarise studies. Methodological quality was assessed using the Joanna Briggs Critical Appraisal Checklist for Prevalence Studies. This systematic review has been registered with PROSPERO (registration number CRD42020188422, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=188422). RESULTS: Systematic searches identified 15 eligible studies, with 10 examining treatment-seeking samples and five using population samples. CPTSD prevalence in treatment-seeking samples was between 16 and 38%. Prevalence in population samples ranged from 2.2 to 9.3% in four studies, with the fifth reporting a much higher estimate (50.9%). CONCLUSIONS: This review highlights both the high prevalence of CPTSD in treatment samples and the lack of research aiming to establish prevalence of CPTSD in refugee and asylum-seeking populations. Understanding the prevalence of these disabling disorders has implications for policy and healthcare services for the appropriate promotion, planning and provision of suitable treatment and interventions for this highly traumatised population

“Pay attention when turning a corner”: an overview of mental health policies in Brazil

Introduction: Brazilian’s history of psychiatric care is complex and has some dark periods, but the country managed to get international recognition for its mental health policies in the last years. Those have been currently suffering setbacks. Purpose: Review the historical context of mental health in Brazil, assessing the changes made after 2016, and carry out a critical analysis of the current inclination. Methodology: literature and narrative review using official governmental documents. Results and Discussion: Through its history, Brazil’s had ups and downs in the care of mental health patients. After almost 30 years of policies that are centered around the individual, and not only the individual’s disease, the hospitalocentric model of care has been subtly making its comeback, together with normatives that revogue rights before acquired and corroborates with segregation of the mentally ill. Conclusions: The current changes in the Mental Health politics are not walking alongside the line with movements responsible for the implementation of a biopsychosocial care. It provokes and invites us to continue fighting for fair health programs and for the continuation of the Universal Health Syste

Megacities and High Speed Rail systems: which comes first?

A megacity is usually defined as a metropolitan area with a total population in excess of 10 million people. The number of megacities is increasing worldwide. In most agglomerations and megacities, urban planning and public infrastructure can guide the urban development in order to achieve a proper sustainable structure only partially. The extension of cities is in most cases in advance of urban development work and the provision of public facilities (Kotter, 2004). In Europe, apart from London and Paris, megacities are rarer. However, due to the general high density of population in Europe and the short distance between medium and large cities there is the possibility of High Speed Rail (HSR) enables the emergence of groups of cities that will be linked together and thus reap the economic benefits associated with megacities, namely economies of scale, economies of agglomeration and bigger labour markets. In this contribution the authors argue that in some cases, specific facilities can foster the formation of megacities; in fact, this is the case of HSR systems. Specifically, High-Speed trains can be used to solve two different accessibility problems. In the first case, where a point-to-point link is dominant, each train is a potential substitute for an air connection between two cities, i.e. it connects cities (or rather CBDs) at long distance with a direct train connection (Blum et al., 1997).The HSR links between Paris and Lyon, Paris and London and, Tokyo and Osaka, could be seen as examples of this first type of train connection. In the second case, where a HSR network is dominant, the rail system links together many cities and CBDs and, hence, creates a new type of region with a high intra-regional accessibility sharing a common labour market and a common market for household and business services. In this case the HSR binds together cities in a band, where each pair of cities is at a time distance of between 20 minutes and 1 hour, allowing daily commuting. In the U.S., HSR projects are very recent and they will have the role of connecting already formed megacities. An example is the state of California, which is planning an 800-mile HSR service connecting Los Angeles and San Francisco into a two and a half hour trip. On the other hand, Europe, together with Asia, is the leader in HSR systems; in fact the development of HSR has been one of the central features of recent European Union transport infrastructure policy. The proposals for a European HSR network emerged in a report of the 1990 Community of European Railways and this was essentially adopted as the base for what became the European Community’s proposed Trans-European Network for HSR (Vickerman, 1997). In this paper the case studies of Portugal, where the HSR is a work in progress and of Italy, in which some lines have already been built, will be described in detail from the viewpoint of the various kinds of development described above

Which is your diagnosis?

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Avaliação da mobilidade em espaços urbanos com deficiências para pessoas com dificuldade de locomoção

Esta pesquisa pretende avaliar as condições de mobilidade oferecidas ao pedestre (incluindo Pessoas com Dificuldade de Locomoção) considerando o nível de acessibilidade dos espaços urbanos, através de avaliação multicritério em ambiente SIG. É apresentado um estudo piloto em um campus universitário para os seguintes grupos de usuários: 1) sem deficiência aparente, 2) com deficiência física, 3) com deficiência sensorial/visual e 4) com restrição de locomoção. Os resultados identificaram locais com piores níveis de acessibilidade para cada tipo de usuário, evidenciando que a disposição das edificações do setor pedagógico em blocos independentes e dispersos gera bolsões de acessibilidade mais elevada. Contudo, esses bolsões nem sempre comunicam entre si por zonas de fácil acessibilidade o que compromete a mobilidade global no campus, sobretudo para os cadeirantes. As conclusões sugerem que o método é adequado e promissor para identificar espaços urbanos com deficientes soluções para a mobilidade de grupos específicos da população usuária

Chronic hepatitis C: hepatic iron content does not correlate with response to antiviral therapy

The complex interaction between hepatitis C virus infection, iron homeostasis and the response to antiviral treatment remains controversial. The aim of this study was to evaluate the influence of hepatic iron concentration (HIC) on the sustained virological response (SVR) to antiviral therapy in patients with chronic hepatitis C. A total of 50 patients who underwent pretreatment liver biopsy with assessment of HIC by graphite furnace atomic absorption spectroscopy and were subsequently submitted to antiviral treatment with interferon/peginterferon and ribavirin were included in the study. Patients with alcoholism, history of multiple blood transfusion, chronic kidney disease, hemolytic anemia and parenteral iron therapy were excluded. The iron related markers and HIC were compared between those who achieved an SVR and non-responders (NR) patients. The mean age was 45.7 years and the proportion of patients' gender was not different between SVR and NR patients. The median serum iron was 138 and 134 µg/dL (p = 0.9), the median serum ferritin was 152.5 and 179.5 ng/mL (p = 0.87) and the median HIC was 9.9 and 8.2 µmol/g dry tissue (p = 0.51), for SVR and NR patients, respectively. Thus, hepatic iron concentration, determined by a reliable quantitative method, was not a negative predictive factor of SVR in patients with chronic hepatitis C presenting mild to moderate hepatic iron accumulation.A complexa interação entre infecção pelo vírus da hepatite C, homeostase do ferro e resposta ao tratamento antiviral permanece controversa. O objetivo deste estudo foi avaliar a influência da concentração hepática de ferro (CHF) na resposta virológica sustentada (RVS) à terapia antiviral na hepatite C crônica. Foram incluídos 50 pacientes que foram submetidos à biopsia hepática pré-tratamento com determinação da CHF por espectrofotometria de absorção atômica com forno de grafite e tratados posteriormente com interferon/peginterferon e ribavirina. Pacientes com alcoolismo, história de múltiplas transfusões sanguíneas, doença renal crônica, anemia hemolítica e terapia com ferro parenteral foram excluídos. O perfil de ferro sérico e a CHF foram comparados entre aqueles que atingiram RVS e os não-respondedores (NR). A média de idade dos pacientes foi 45,7 anos e não houve diferença na proporção de homens e mulheres entre os grupos RVS e NR. A mediana do ferro sérico foi 138 and 134 µg/dL (p = 0.9), a mediana da ferritina sérica foi 152,5 e 179,5 ng/mL (p = 0,87) e a CHF mediana foi 9,9 e 8,2 µmol/g de tecido seco (p = 0,51), para pacientes com RVS e NR, respectivamente. Concluindo, a concentração hepática de ferro, determinada por um método quantitativo confiável, não foi um fator preditivo negativo de RVS em pacientes com hepatite C crônica e acúmulo de ferro hepático leve a moderado

Digital games, cognitive skills, and motivation: : children’s perception in the school context

In addition to entertainment, games have been recognized as enhancers of cognition and associated with increased motivation in the school learning context. The possibility of immersion and active player participation is considered a distinguished aspects of game design. Therefore, this study proposed the application of Brain School’s digital games using tablets during a school year, with weekly interventions of 50 minutes in a class of the second year of elementary school. Twenty-five students were analyzed with an average of eight years old. At the end of the interventions, the evaluation was carried out through individual interviews. The results revealed that most of children felt motivated to participate in the games activities. However, there was no association between level of motivation and cognitive skills investigated (attention and problem solving), nor between preferred games and cognitive skills trained. However, qualitative data showed that children liked using games and acknowledged that the activity contributed with the exercise of their abilities. In general, this research contributed to reinforcing the importance of the diversification of methodological strategies which include the use of digital games in education

The relationship between the different low birth weight strata of newborns with infant mortality and the influence of the main death determinants in the extreme south of Brazil

Background: Low birth weight (LBW) newborns present different health outcomes when classified in different birth weight strata. This study evaluated the relationship of birth weight with Infant mortality (IM) through the influence of biological, social, and health care factors in a time series. Methods: Retrospective cohort study with data collected from Information Systems (Live Births and Mortality). The mortality trends were performed for each birth weight stratum: extremely low, 4000 g. Chi-square tests analyzed IM rates. Sequential Poisson regression analyzed the impact of the determinant factors. Results: A total of 277,982 newborns were included in the study and 2088 died before their first year. There was a tendency for a decrease in mortality in all strata of weight. With the exception of macrosomics, all other strata had a higher risk for IM when compared with adequate birth weight. Extremely LBW newborns presented higher risk for mortality when born in a public hospital. A higher percentage of infant deaths were associated with lower maternal age and lower schooling for all strata. Prenatal care with less than three visits demonstrated a risk for IM in low, insufficient, and adequate birth weight strata. The cesarean section was a protective factor for IM in Extremely and Very LBW strata and it was a risk factor in adequate birth weight stratum. Conclusions: LBW had a greater association with IM, especially those children of younger mothers and those born in public hospitals