Direito à saúde nas populações de refugiados: uma revisão sistemática com meta-análise / Right to health in refugee populations: a systematic review with meta-analysis

Objetivo: avaliar evidências acerca da garantia dos direitos à saúde das populações de refugiados no mundo. Fontes de dados: foram utilizados os seguintes bancos de dados: MEDLINE, acessado via Biblioteca Virtual em Saúde (BVS), e SCOPUS. Com a finalidade de realizar uma pesquisa mais segura e direcionada, os autores optaram pelo uso reunir todos os descritores (MeSH) usando o operador AND da seguinte forma: (Refugees AND Right to health AND human rights). Seleção de estudo: A seleção primária ocorreu pela análise dos títulos e abstracts/resumos seguida da elegibilidade baseada nos critérios de inclusão previamente estabelecidos. Extração de dados: algumas informações foram extraídas dos estudos como autor / ano, tipo de participantes e seus respectivos números, tipos de intervenções, número de sessões ou tempo de acompanhamento e resultados. Resultados: As estratégias de pesquisa resultaram em 241 artigos. Com o uso subsequente dos critérios de inclusão e exclusão, 10 estudos foram inseridos na amostra (n) e incluídos por razões qualitativas e quantitativas. Para análise estatística foi utilizado o programa Stata 14.0 em que foi calculado a meta-análise pelo método de efeitos aleatórios, metarregressão para analisar associação entre as variáveis analisadas e metabias para análise de viés dos resultados apresentados.Os gráficos gerados foram respectivamente Forest Plot, Bublle Plot. Conclusão: A falta de acesso à informação, a língua, a cultura e o estranhamento do país são fatores que contribuem para a precarização da saúde do refugiado e dificulta o seu acesso a ela.

Vulnerability and the bioethics through the experiences of illness

Background: Vulnerable people are relatively or absolutely incapable of protecting their own interests. Vulnerability is an anthropological attribute of human beings due to the simple fact of being alive. Brazilian society has long been established as a matter through the eyes of social scientists. In the name of it, the vulnerability in the doctor-patient context is now being a much-discussed issue. Purpose: This study aims to analyze the current studies regarding the insertion of vulnerability in the health issue, reflexively dealing with the ethical matters involved, as well as with the narratives’ insertion in this process. Methods: This article is based on data extracted from Scientific Electronic Library Online (Scielo) and on secondary data from textbooks about vulnerability, ethics, physician-patient relationship and narratives. Results and discussion: Doctors are faced with dilemmas in clinical practice: moral, ethical, legal, social, religious and economic. On these occasions, question their own values. By listening carefully to the stories of patients, health professionals broaden their perspectives, organize and integrate complex situations, which assists in conducting these difficult situations. Conclusion: Reflect the concept of vulnerability raises (re) think health practices, particularly in bringing to light the social experience of illness and hospitalization of the patient

Childhood Depression in Family Narratives

BACKGROUND: The family narratives are true contextual cues in the representation of the experiences of illness of depressive child. The family members use healthcare services in an attempt to understand the disease so that describe the everyday practices in the living with the child. OBJECTIVE: This original article aims to present childhood depression with its various nuances and its many consequences in the family context. METHODS: The universe of this study involved 24 families in the age group ranging from 45 to 70 years who searched the care services at Children's Psychosocial Care Center (CAPSi). Through the records, a survey of the family members was performed, from case reports, in the course of medical and psychological consultations. This is a purposive sample, which was selected by approximation the inclusion criteria, a sample of 12 family members of both sexes. The attention focused on the use of narrative interview - which is recognized as a genre of sociolinguistic research - fully recorded. RESULTS: The family member has its convivial trajectory with the disease through a specific identity and enunciation with the child. The family narratives show up symbolic portraits to the rescue of the guiding elements of the depressive situation. The family narratives are shown as spaces of reinterpretation of pain and psychological distress. The disorder explained in the narratives of childhood depression inserted in understanding plays a crucial role in exposing the intensity of pain and psychological distress. CONCLUSION: It is fundamental important in clinical care the psychiatric practice inserted into the historical and social context of the family members who have their own living narrative with the disease

Ebola: an international public health emergency

The outbreak of Ebola in West Africa could become one of the worst infectious-disease-driven humanitarian crises of recent times. With more than 3000 deaths since the first case was confirmed in March 2014, the international community has recognized Ebola as a public health emergency of international concern and a clear threat to global health security. The complexity of dealing with this Ebola outbreak has highlighted the need for traditional actors, such as WHO and the CDC, to embrace the wider health and humanitarian community. The epidemic reinforces the need for nations to investment in health infrastructure and disease surveillance to keep pace with other developments in Africa. If Ebola arrives in high-income and middleincome nations, it should be contained quickly. The crisis shows the importance of sufficient levels of multilateral funding for WHO. The world needs a strong WHO, with the financing and political influence to fulfil its historic mission

How to face the association between tobacco and psychosis?

Evidences suggest an association between tobacco and psychosis. However, the reasons why people with psychosis have a higher tendency to smoke than the general population are not yet clear. Recently, Gurillo et al. reported that daily use of tobacco is associated with an increased risk of psychotic disorder and an earlier age of onset of psychotic illness. His study also calculated a significant mean difference in age at onset, expressed in years, and estimated the prevalence of smoking in people with their first episode of psychosis. According to this and other findings, it could be said that the causes of the smoking-schizophrenia association are complex and cannot be explained solely as a result of some aspect of schizophrenia. Thus, new studies in this area are needed, as well as strategies that look for the monitoring of smoking effects in order to reduce it among individuals with schizophrenia. Key-words: Tobacco, Psychosis, Illness

Low Irisin Levels in Patients with Type 2 Diabetes Mellitus without Current Treatment: A Systematic Review

Background: The Irisin is a myokine associated with the improvement on insulin resistance caused by diet and increased physical energy expenditure. Recent studies have shown that patients with Type 2 Diabetes Mellitus (T2DM) have reduced levels of irisin, showing it as a potential marker for various endocrine and cardiovascular diseases. This study aimed to verify if T2DM patients never treated or without ongoing treatment have reduced levels of irisin when compared to individuals with other metabolic profiles. Methods and Findings: Systematic review of the literature, considering the primary studies published in 2012 to 2016, with the outcome Irisin levels in patients never treated or without current treatment in the ambience of Type 2 Diabetes Mellitus. The search was conducted through the electronic database Scopus (Elsevier), using the key words: "Irisin", "Human" and "Diabetes Mellitus". From the 91 studies found, 8 met the eligibility criteria. Significant differences were found on levels of irisin in patients with T2DM compared to normoglycemic individuals, obese and/or pre-diabetic. On average, there was a reduction of 15 pg/ml in plasma levels of irisin in diabetics. However, a minority of studies says that this relationship does not exist. Conclusion: Irisin reduced levels were found in patients with T2DM and is also related to lipid profile, with the risk of developing endocrine diseases, such as diabetes and obesity, and high risk for cardiovascular diseases because of its relationship with endothelial dysfunction. This generates the need for research in order to explore the isolation and clinical use of irisin for treatment of disorders related to imbalance in energy demand, obesity and diabetes. Descriptors: Irisin, Human, Diabetes Mellitus