The Silences Framework: A Method for researching sensitive themes and marginalized health perspectives (English version)

Objective: To describe the experience of applying of The Silences Framework to underpin health research investigating Tuberculosis/HIV/AIDS coinfection . Method: The Silences Framework originally developed following a study exploring the decisions and silences surrounding black Caribbean men living in England, discussing the themes 'sexual health' and 'ethnicity'. Following this study a conceptual a theory for research on sensitive issues and health care of marginalized populations was developed called 'Screaming Silences' which forms the foundation of The Silences Framework. Screaming Silences define research areas and experiences that are poorly studied, little understood or silenced. Results: The Silences Framework supports researchers in revealing "silences" in the subjects they study - as such results may reflect how beliefs, values, and experiences of some groups influence their health. This framework provides the application of four complementary stages: working the silences, hearing silences, voicing silences and working with the silences. The analysis occurs cyclically and can be repeated as long as the silences inherent in a study are not revealed. Conclusion: this article presents The Silences Framework and the application of the notion of "sounds of silence", mapping an antiessentialist theoretical framework for its use in sensitive research in health and nursing areas, being a reference for other researchers in studies involving marginalized populations. KEYWORDS: Inequalities in health. Methods. Nursing. Coinfection. Research. Tuberculosis. Acquired immunodeficiency syndrome

Family ties of crack cocaine users cared for in a psychiatric emergency department

This study characterizes the family ties of crack cocaine users cared for in a psychiatric emergency department in southern Brazil. It is a qualitative study with a series of cases carried out in the city of Maringá, PR, Brazil from April to June 2010. Data were collected through semi-structured interviews, analyzed using content analysis, and organized into two categories: family ties as facilitators in the use of crack cocaine and other drugs; and fragmented family ties of crack users. Loss of relational bonds with family and social milieu was observed among the ten studied users in addition to the presence of drugs and violence in the family sphere. Further studies addressing the use of crack and its interface with the family are encouraged, taking into consideration that families have an essential role in the initiation and continuity of drug use.El objetivo del estudio fue conocer el vínculo familiar de usuarios de crack atendidos en una Unidad de Emergencia Psiquiátrica del Sur de Brasil. Se trata de una investigación cualitativa, con delineamiento de serie de casos, realizada en el municipio de Maringá, en Paraná, en el período de abril a junio de 2010. Para la recolección de datos se utilizó un guión semiestructurado de entrevista. Los datos fueron analizados siguiendo la técnica de análisis de contenido y organizados en dos categorías: el vínculo familiar como facilitador del uso de crack y otras drogas, y el vínculo familiar fragmentado de los usuarios de crack. Entre los diez usuarios investigados, se evidenció: pérdida de los vínculos relacionales con la familia y con el medio social y, presencia de drogas y violencia en el ambiente familiar. La realización de investigaciones sobre el uso de crack y su interfaz con la familia deben ser estimuladas, ya que las familias poseen un papel fundamental en la iniciación y continuidad del uso de drogas.O objetivo deste estudo foi conhecer o vínculo familiar de usuários de crack, atendidos em uma unidade de emergência psiquiátrica do Sul do Brasil. Trata-se de pesquisa qualitativa, com delineamento de série de casos, realizada no município de Maringá, PR, no período de abril a junho de 2010. Para a coleta dos dados utilizou-se roteiro semiestruturado de entrevista. Os dados foram analisados seguindo a técnica de análise de conteúdo e organizados em duas categorias: o vínculo familiar como facilitador do uso de crack e outras drogas, e o vínculo familiar fragmentado de usuários de crack. Entre os dez usuários investigados, evidenciou-se a perda dos vínculos relacionais com a família e o meio social, presença de drogas e violência no ambiente familiar. A realização de pesquisas sobre o uso de crack e sua interface com a família deve ser estimulada, visto que as famílias possuem papel fundamental na iniciação e continuidade ao uso de drogas

Chromosome evolution in Cophomantini (Amphibia, Anura, Hylinae)

The hylid tribe Cophomantini is a diverse clade of Neotropical treefrogs composed of the genera Aplastodiscus, Boana, Bokermannohyla, Hyloscirtus, and Myersiohyla. The phylogenetic relationships of Cophomantini have been comprehensively reviewed in the literature, providing a suitable framework for the study of chromosome evolution. Employing different banding techniques, we studied the chromosomes of 25 species of Boana and 3 of Hyloscirtus; thus providing, for the first time, data for Hyloscirtus and for 15 species of Boana. Most species showed karyotypes with 2n = 2x = 24 chromosomes; some species of the B. albopunctata group have 2n = 2x = 22, and H. alytolylax has 2n = 2x = 20. Karyotypes are all bi-armed in most species presented, with the exception of H. larinopygion (FN = 46) and H. alytolylax (FN = 38), with karyotypes that have a single pair of small telocentric chromosomes. In most species of Boana, NORs are observed in a single pair of chromosomes, mostly in the small chromosomes, although in some species of the B. albopunctata, B. pulchella, and B. semilineata groups, this marker occurs on the larger pairs 8, 1, and 7, respectively. In Hyloscirtus, NOR position differs in the three studied species: H. alytolylax (4p), H. palmeri (4q), and H. larinopygion (1p). Heterochromatin is a variable marker that could provide valuable evidence, but it would be necesserary to understand the molecular composition of the C-bands that are observed in different species in order to test its putative homology. In H. alytolylax, a centromeric DAPI+ band was observed on one homologue of chromosome pair 2. The band was present in males but absent in females, providing evidence for an XX/XY sex determining system in this species. We review and discuss the importance of the different chromosome markers (NOR position, C-bands, and DAPI/CMA3 patterns) for their impact on the taxonomy and karyotype evolution in Cophomantini

A systematic review evaluating the psychometric properties of measures of social inclusion

Introduction: Improving social inclusion opportunities for population health has been identified as a priority area for international policy. There is a need to comprehensively examine and evaluate the quality of psychometric properties of measures of social inclusion that are used to guide social policy and outcomes. Objective: To conduct a systematic review of the literature on all current measures of social inclusion for any population group, to evaluate the quality of the psychometric properties of identified measures, and to evaluate if they capture the construct of social inclusion. Methods: A systematic search was performed using five electronic databases: CINAHL, PsycINFO, Embase, ERIC and Pubmed and grey literature were sourced to identify measures of social inclusion. The psychometric properties of the social inclusion measures were evaluated against the COSMIN taxonomy of measurement properties using pre-set psychometric criteria. Results: Of the 109 measures identified, twenty-five measures, involving twenty-five studies and one manual met the inclusion criteria. The overall quality of the reviewed measures was variable, with the Social and Community Opportunities Profile-Short, Social Connectedness Scale and the Social Inclusion Scale demonstrating the strongest evidence for sound psychometric quality. The most common domain included in the measures was connectedness (21), followed by participation (19); the domain of citizenship was covered by the least number of measures (10). No single instrument measured all aspects within the three domains of social inclusion. Of the measures with sound psychometric evidence, the Social and Community Opportunities Profile-Short captured the construct of social inclusion best. Conclusions: The overall quality of the psychometric properties demonstrate that the current suite of available instruments for the measurement of social inclusion are promising but need further refinement. There is a need for a universal working definition of social inclusion as an overarching construct for ongoing research in the area of the psychometric properties of social inclusion instruments

Italian guidelines for primary headaches: 2012 revised version

The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105–190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version