Development of a patient rated scale for mental health global state for use during humanitarian interventions

Funding: Médecins Sans FrontièresWe present the results of a cross-cultural validation of the Mental Health Global State (MHGS) scale for adults and adolescents (<14 years old). We performed two independent studies using mixed methods among 103 patients in Hebron, Occupied Palestinian Territories and 106 in Cauca, Colombia. The MHGS was analyzed psychometrically, sensitivity and specificity, ability to detect clinically meaningful change, compared to the Clinical Global Impression-Severity scale (CGI-S). Principal component analysis was used to reduce the number of questions after data collection. The scale demonstrated good internal consistency, with a Cronbach alpha score of 0.80 in both settings. Test retest reliability was high, ICC 0.70 (95% CI [0.41-0.85]) in Hebron and 0.87 (95% CI [0.76-0.93]) in Cauca; inter-rater reliability was 0.70 (95% CI [0.42-0.85]) in Hebron and 0.76 (95% CI [0.57-0.88]) in Cauca. Psychometric properties were also good, and the tool demonstrated a sensitivity of 85% in Hebron and 100% in Cauca, with corresponding specificity of 80% and 79%, when compared to CGI-S. The MHGS showed promising results to assess global mental health thereby providing an additional easy to use tool in humanitarian interventions. Additional work should focus on validation in at least one more context, to adhere to best practices in transcultural validation

Emoções e relações em tempos de COVID-19: uma etnografia digital em tempos de crise

A pandemia global da COVID-19 e seus derivados na vida social, política e econômica intensificou algumas das desigualdades e vulnerabilidades existentes, ao mesmo tempo em que levou a novas formas de viver o cotidiano, marcadas principalmente pelo confinamento. Nossa pesquisa tem como objetivo analisar, a partir do prisma da antropologia médica, os efeitos emocionais e relacionais da nova situação e sua evolução durante os próximos meses. Para isso, tomamos como ponto de partida a crescente centralidade das redes sociais e as novas tecnologias de comunicação num contexto de distância social e/ou física. Nos baseamos nessas tecnologias e em suas potencialidades metodológicas para coletar dados sobre as condições e efeitos do confinamento e da crise sanitária. Com esse objetivo estamos coletando dados qualitativos e quantitativos através de um questionário online que combina perguntas abertas com perguntas de escolha múltipla. Alguns resultados preliminares são apresentados neste texto.The global pandemic of the COVID-19 and its consequences in social, political and economic life have intensified some of the existing inequalities and vulnerabilities, while at the same time have brought about new ways of daily life, marked by confinement. Our research aims to analyze, from the perspective of medical anthropology, the emotional and relational effects of the new situation, and its evolution over the coming months. To this end, we have taken as our starting point the growing centrality of social networks and new communication technologies in a context of social and/or physical distance. We have based on these technologies and their methodological potentialities to collect data on the effects of confinement and the health crisis. To this end, we are collecting qualitative and quantitative data through an online questionnaire that combines open questions with multiple-choice questions. Some preliminary results are presented in this text.La pandemia global de la COVID-19 y sus derivadas en la vida social, política y económica han intensificado algunas de las desigualdades y vulnerabilidades existentes, a la vez que han propiciado nuevas formas de vivir lo cotidiano, marcadas principalmente por el confinamiento. Nuestra investigación pretende analizar, desde el prisma de la antropología médica, los efectos emocionales y relacionales de la nueva situación y su evolución durante los próximos meses. Para ello hemos partido de la centralidad creciente que tienen las redes sociales y las nuevas tecnologías de comunicación en un contexto de distanciamiento social y/o físico. Nos hemos basado en estas tecnologías y en sus potencialidades metodológicas para recoger datos sobre las condiciones y los efectos del confinamiento y la crisis sanitaria. Con este objetivo, estamos recabando datos cualitativos y cuantitativos mediante un cuestionario online que combina preguntas abiertas con otras de elección múltiple. En este texto se presentan algunos resultados preliminares

A Cross-Sectional Survey on Professionals to Assess Health Needs of Newly Arrived Migrants in Spain

Atención sanitaria; Migrante; EncuestaAtenció sanitària; Migrant; EnquestaHealthcare; Migrant; SurveyHeightened conflicts and lack of safety due to reasons related to economic, social, ethnic, religious, sexual orientation, political, or nationality matters have increased migratory movements during the last, few decades. Unfortunately, when migrants arrive in new territories, they can face many barriers. For example, in Spain, some migrants have difficulties in accessing health services. The main objective of this study was to describe, from the perspective of social and healthcare professionals, health needs and barriers faced among migrants who recently arrived in Spain when accessing the health system. To accomplish this aim, we carried out a cross-sectional descriptive study using a newly created self-administered questionnaire. Statistical analysis was done using the SPSS 23.00® program. Survey collection was from April 2018 to October 2018, and the cohort comprised a total of 228 professionals. Most participants were females (76%), with an average age of 35 years [interquartile range (IQR) 29.8–43.0]. The most represented profession in the cohort was physician (48%), followed by social care professionals (32%), nursing (11%), and other (8%). Of these individuals, 61% stated having either little or limited knowledge of international migrant health rights, and 94% believed migrants must overcome barriers to receive health services. The four most reported barriers were as follows: language, cultural differences, administrative issues, and fear of being undocumented. Additionally, by order of importance, professionals viewed mental health disorders and infectious diseases as the most common contributors to disease burden in this group. The four most popular strategies implemented by professionals to improve healthcare access further for migrants included intercultural competency training for professionals; access to community health agents; access to translators; and development of health system navigation skills among those newly arrived. Study results suggest that governments should make greater efforts to provide social and healthcare professionals with more effective tools that overcome communication barriers and cultural competence training modules.Research reported in this publication was supported by co-funding from the Third EU Health Program (2014-2020) Project Grants (HP-PJ-2016) under Grant Agreement 738091 (MyHealth Consortium)

Refugiados en movimiento : retos políticos, legales y sociales en tiempos de inestabilidad

La conferencia internacional «Refugees on the move: thinking beyong the Euro-Mediterranean crisis» (21 y 22 de abril 2016) que inspira esta publicación, fue organizada gracias a la subvención de la Generalitat de Catalunya, AGAUR, a través el proyecto GRC-SGR 2014 (1524).En el marco del CER-M (UAB-UB), hemos organizado la conferencia internacional «Refugees on the move: thinking beyong the Euro-Mediterranean crisis» celebrada el 21 y 22 de abril 2016 en el CCCB y Espai Contrabandos. Esta conferencia tuvo como objetivo crear un espacio de debate y reflexión en torno a las implicaciones teóricas, político-legales y sociales que estos desplazamientos están conllevando. En el evento participaron académicos de ámbito nacional e internacional, así como personas expertas y profesionales que trabajan sobre el terreno. Fruto de estas jornadas, y a partir de las aportaciones de sus participantes, el equipo del CER-M (UAB-UB) presentamos este monográfico bilingüe.The CER-M (UAB-UB) organised the international conference "Refugees on the move: thinking beyond the Euro-Mediterranean crisis" on the 21st and 22nd of April 2016 at the CCCB and Espai Contrabandos. The conference aimed at creating a space of debate and reflection around the theoretical, political, legal and social implications of these displacements are causing. International and national academics, as well as experts and professionals working in the field participated in the event. As a result of the conference, and based on the contributions of the participants, the CER-M team presents this bilingual monographic

RESET: Reflexiones antropológicas ante la pandemia de COVID-19

El término reset apela a la sensación de reinicio, paréntesis o stand-by que ha sacudido nuestras vidas desde el inicio del año 2020 a consecuencia de la pandemia de COVID-19. Como suele ocurrir, los reinicios alimentan la incertidumbre; en ellos se depositan esperanzas y también precauciones. Son ambiguos en términos de su temporalidad, pues en ellos se confunde fácilmente el acto de reiniciar con lo que ya se está reiniciando. Son límite y limen, y, como tal, engullen pasado, presente y futuro. Este libro se ha escrito desde el reset de forma coral, pues incorpora 48 reflexiones elaboradas durante el punto álgido de la pandemia, entre el 14 de abril y el 11 de mayo de 2020, en diferentes países

Guía Breve sobre el Apoyo en Salud mental/Psicosocial a los refugiados sirios en España

La presente guía breve recoge una serie de orientaciones teóricas y prácticas que permiten hacer algunas recomendaciones contextualizadas en tres ejes sobre el apoyo de salud mental/psicosocial de refugiados sirios en España. Primero, se destaca la importancia de realizar una evaluación comprensiva de las necesidades de salud mental/psicosociales de los grupos de población afectados directa e indirectamente, antes de elaborar una estrategia de salud mental/psicosocial que no discrimine a unos refugiados frente a otros por razón de su país de origen. Segundo, las intervenciones de salud mental/psicosociales propuestas, basadas en la información obtenida de la evaluación de las necesidades, se desarrollan sobre un sistema piramidal (IASC, 2007). La competencia cultural representa un componente transversal necesario tanto en el proceso de la evaluación de las necesidades como en la elaboración de la estrategia o en la implementación de las intervenciones, fundamental para asegurar la eficacia de los programas implementados

The effects of exercise interventions on quality of life in clinical and healthy populations; a meta-analysis

The aim of the study was to provide an overview of the effect of exercise interventions on subjective quality of life (QoL) across adult clinical populations and well people, and to systematically investigate the impact of the exercise setting, intensity and type on these outcomes. From a systematic search of six electronic databases, 56 original studies were extracted, reporting on 7937 sick and well people. A meta-analysis was conducted on change in QoL from pre- to post-intervention compared with outcomes from a no-exercise control group, using weighted (by the study's sample size) pooled mean effect sizes and a fixed-effects model. Significant differences in outcome were found when treatment purpose was compared; prevention/promotion (well populations), rehabilitation, or disease management. Three to 6 months post-baseline, a moderate positive effect of exercise interventions was found for overall QoL in rehabilitation patients, but no significant effect for well or disease management groups. However, physical and psychological QoL domains improved significantly relative to controls in well participants. Psychological QoL was significantly poorer relative to controls in the disease management group. This pattern of results persisted over 1 year. With some exceptions, better overall QoL was reported for light intensity exercise undertaken in group settings, with greater improvement in physical QoL following moderate intensity exercise. The implications for future health care practice and research are discussed.Quality of life (QoL) Physical activity Exercise Meta-analysis Illness Health Interventions

Necesidades de salud mental y psicosociales de los refugiados en Europa

Entre las múltiples necesidades de los refugiados que llegan en Europa, se debe prestar una especial atención a la protección de su salud mental y su bienestar psicosocial. La revisión de la literatura presenta una heterogeneidad en las tasas de trastornos mentales debida, al menos en parte, a las características de los grupos estudiados, el contexto y la situación en el país de acogida, y la calidad metodológica de los estudios, particularmente con los métodos de muestreo. Más allá del debate acerca de la relevancia intercultural de los diagnósticos de enfermedades mentales, los problemas de salud mental relacionados con la inmigración forzada varían: reacciones normales a eventos "a-normales"; exacerbaciones de trastornos de salud mental pre-existentes; problemas impulsados por la violencia y el desplazamiento relacionados con conflictos, problemas relacionados con la adaptación al país de acogida, etc. Los factores que influyen en el estado de salud mental y el bienestar psicosocial de los refugiados en Europa incluyen las características de personalidad de cada persona y la percepción de sus vivencias en el país de origen, durante el tránsito y en el país de acogida. El presente capítulo tiene implicaciones clínicas en cuanto al diseño e implementación de actuaciones en salud mental y psicosociales adaptadas a las necesidades de la población diana

Screening and routine diagnosis of mental disorders among migrants in primary care: A cross-sectional study

Background: Migrants in host countries are at risk for the development of mental health conditions. The two aims of the study were to describe routine diagnoses of mental disorders among migrant patients at primary healthcare level and the associated risk factors, and to test the utility of an innovative migrant mental health assessment by evaluating whether the health professionals followed the recommendations proposed by the clinical decision support system (CDSS) tool. Methods: A cross-sectional study was carried out in eight primary care centres (PCCs) in four non-randomly selected health regions of Catalonia, Spain from March to December 2018. Routine health data and mental health diagnoses based on the International Classification of Diseases (10th edition), including mental, behavioural and neuro developmental disorders (F01-F99), symptoms and signs involving emotional state (R45), and sleep disorders (G47), were extracted from the electronic health records. The proportion of mental health conditions was estimated and logistic regression models were used to assess any possible association with mental health disorders. The utility of the mental health assessment was assessed with the proportion of questionnaires performed by health professionals for migrants fulfilling the mental health screening criterion (country of origin with an active conflict in 2017) and the diagnoses given to the screened patients. Results: Of 14,130 migrants that visited any of the PCCs during the study period, 7,358 (52.1 %) were women with a median age of 38.0 years-old. There were 520/14,130 (3.7 %) migrant patients diagnosed with a mental disorder, being more frequent among women (342/7,358; 4.7 %, p-value < 0.001), migrants from Latin-America (177/3,483; 5.1 %, p < 0.001) and those who recently arrived in Spain (170/3,672; 4.6 %, p < 0.001). A lower proportion of mental disorders were reported in migrants coming from conflicted countries in 2017 (116/3,669, 3.2 %, p = 0.053).Out of the 547 mental health diagnoses reported in 520 patients, 69/14,130 (0.5 %) were mood disorders, 346/14,130 (2.5 %) anxiety disorders and 127/14,130 (0.9 %) sleeping disorders. Mood disorders were more common in migrants from Eastern Europe (25/2,971; 0.8 %, p < 0.001) and anxiety disorders in migrants from Latin-America (126/3,483; 3.6 %, p < 0.001), while both type of disorders were more often reported in women (p < 0.001).In the adjusted model, women (aOR: 1.5, [95 % CI 1.2–1.8, p < 0.001]), migrants with more than one visit to the health center during the study period (aOR: 4.4, [95 %CI 2.8–6.8, p < 0.001]) and who presented an infectious disease (aOR: 2.1, [95 %CI 1.5–3.1, p < 0.001]) had higher odds of having a mental disorder.Lastly, out of the 1,840 migrants coming from a conflicted country in 2017 who were attended in centres where the CDSS tool was implemented, 29 (1.6 %) had a mental health assessment performed and the tool correctly identified one individual. Conclusions: Mental health is a condition that may be overlooked in migrants at primary healthcare. Interventions at this level of care must be reinforced and adapted to the needs and circumstances of migrants to ensure equity in health services