Psychotherapy with traumatised refugees – the design of a randomised clinical trial

There is little evidence as to which kind of psychotherapy is the most effective in the treatment of traumatised refugees. At the Competence Center for Transcultural Psychiatry, a series of clinical trials have been conducted since 2008. The first results are pending publication. The aim of this paper is to discuss some of the challenges in adapting Cognitive Behavioural Therapy (CBT) to the treatment of traumatised refugees, as well as describe a randomised clinical trial designed to test two such adaptations. In the described trial one group receives CBT with a focus on cognitive restructuring while the other group receives CBT focusing on Stress Management. A main goal of this setup is to test whether some, perhaps even most, of the traumatised refugees referred to treatment, may benefit from a more direct focus on current stress, and its alleviation through simple, repetitive exercises, compared to a focus on analysing and changing thought patterns

Fel i småhusentreprenad, köp ett nytt hus och få ett fel på köpet

Husköpet är ett av de viktigaste köpen en privatperson gör i sitt liv. När ett nytt hus köps av en entreprenör ska konsumenten kunna vara säker på att konstruktionen är hållbar. Under mitten 1990-talet dök det upp ett nytt sätt i byggbranschen att bygga småhus på. Dessa byggdes med enstegstätade fasader, som på den tiden ansågs vara ett rätt och bra sätt att bygga på. Efter några år upptäckte däremot flertalet konsumenter som hade förvärvat ett nytt hus, byggt på detta sätt att det uppkom fukt och mögelskador i fasaden. Det var inte endast fel i fastigheten utan visade sig även vara skadligt för privatpersonernas hälsa. I och med att konstruktionen är behäftad med allvarliga fel och så pass många konsumenter har blivit drabbade blir detta ett stort problem för de berörda konsumenterna samt övriga konsumenter som ska förvärva ett nytt hus. Problemen har framför allt uppkommit på hus i södra delarna av Sverige då husen inte tål att utsättas för det klimat som råder, det vill säga mycket blåst och regn. Vilket skydd konsumenterna har när fel uppkommer i fastigheten är en mycket snårig väg och det finns mycket mer som man som privatperson måste tänka på och undersöka innan husköpet görs

Satisfaction of trauma-affected refugees treated with antidepressants and Cognitive Behavioural Therapy

Purpose: This study seeks to evaluate the satisfaction of trauma-affected refugees after treatment with antidepressants, psycho-education and flexible Cognitive Behavioral Therapy (CBT) including trauma exposure. Material and methods: A treatment satisfaction questionnaire was completed by patients at the end of a randomised controlled trial (RCT) comparing treatment with CBT and antidepressants. A patient satisfaction score was developed based on the questionnaire, and predictors of satisfaction were analysed in regression models. Telephone interviews were conducted with patients dropping out of treatment before the end of the trial. Results: In total, 193 trauma-affected refugees with PTSD were included in the study. Patients were overall satisfied with flexible CBT including exposure treatment in cases where this was part of the treatment. There was no statistically significant association between treatment outcome and satisfaction and satisfaction and treatment efficacy were independent of each other. The results showed that bi-cultural patients who had lived in Denmark for more than a decade were satisfied with the treatment based on a western psychotherapy model. Discussion: Treatment with selective serotonin reuptake inhibitor and flexible CBT, including trauma exposure, is acceptable for trauma-affected refugees. More studies are needed to evaluate patient satisfaction with western psychotherapy models in refugee patients who have recently arrived and to compare satisfaction with alternative treatment models

“After all the traumas my body has been through, I feel good that it is still working.” – Basic Body Awareness Therapy for traumatised refugees

Basic Body Awareness Therapy (BBAT) is a form of physiotherapy that is often used for psychiatric patients in Scandinavian countries. To our knowledge, there have not been any studies investigating BBAT as a treatment for traumatised refugees until now. Objective: To explore the compliance, acceptability and treatment satisfaction using group BBAT in traumatised refugees. To study changes in psychiatric and somatic symptoms as well as the quality of life, level of functioning and quality of movement during treatment with BBAT. Method: All Arabic speaking patients that previously had received treatment at the Competence Centre for Transcultural Psychiatry in Copenhagen from April 2008 to June 2009 were invited to participate (N=29). Nine persons were included in a male (N=4) and female (N=5) group. All participants were traumatised refugees. The BBAT treatment consisted of 14 sessions over a period of 14 weeks. Before and after treatment the participants were interviewed using a semi-structured interview guide. The interviews were transcribed and analyzed with a thematic approach. The participants also filled out self-administrated questionnaires and two physiotherapists tested the participants’ movement harmony using the Body Awareness Rating Scale-Movement Harmony (BARS-MH) test. At the end of the study, the participants filled out anonymous questionnaires about treatment satisfaction. Results: The results showed that the participants had a high compliance, acceptability and treatment satisfaction with BBAT. The majority of participants showed improvements in symptoms from baseline to post-intervention on the self-administrated questionnaires and in the BARS-MH test. Conclusions: Further research is needed to expand the scientific knowledge regarding the use of BBAT in traumatised refugees. If future research can confirm our positive findings it will have a considerable impact on future treatment designs and for the individual patient

Sustainable food systems education in nutrition and dietetics: an appraisal of the tertiary landscape in multiple countries

A content analysis of course descriptions from program websites was conducted between 2021and 2022. Courses were reviewed, analyzed, and evaluated using a novel sustainability metric.Despite a growing awareness of the gap between professional expectations and competence,there has been no comprehensive appraisal of sustainable food systems (SFS) education withindietetics and nutrition programs to date. Dietitians and nutritionists play important roles inpromoting sustainability yet many perceive themselves to be inadequately trained. This projectexplored how, and to what degree, SFS education is incorporated into accredited nutrition anddietetics programs in the United Kingdom, Australia, and Canada. SFS is integrated into theeducation environment of some, but not all, dietetics and nutrition programs to varying degrees(no, partial, and full). Partial and full integration was present in a small percentage of courses,with a larger percentage in nutrition programs. SFS education was offered more often through asingle unit than a dedicated course. Twelve best practice examples of courses dedicated to SFSwere identified. In the UK, their focus was nutrition and diet, contrasting food and food systemsin Australia and Canada. These findings provide insight into SFS education for professionalsocieties, instructors, and program directors. Through intentional curricular designconsiderations supported by this study, program leads can take small, consciousreorganizational steps to integrate SFS. This study offers a sound methodology to initiate andbenchmark further assessment and a novel approach for other professions looking to equip theirfuture workforce through SFS educatio

Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy:a randomised study

BACKGROUND: The prevalence of trauma-related psychiatric disorders is high among refugees. Despite this, little is known about the effect of pharmacological treatment for this patient group. The objective of the present study was therefore to examine differences in the effects of venlafaxine and sertraline on Post-Traumatic Stress Disorder (PTSD), depression and functional impairment in trauma-affected refugees. METHODS: The study was a randomised pragmatic trial comparing venlafaxine and sertraline in combination with psychotherapy and social counselling. PTSD symptoms were measured on the Harvard Trauma Questionnaire – part IV, which was the primary outcome measure. Other outcome measures included: Hopkins Symptom Check List-25 (depression and anxiety), Social Adjustment Scale – short version (social functioning), WHO-5 Well-being Index (quality of life), Crisis Support Scale (support from social network), Sheehan Disability Scale (disability in three areas of functioning), Hamilton Depression and Anxiety scale, the somatisation items of the Symptoms Checklist-90, Global Assessment of Functioning scales and the summarised score of pain in four body areas rated on visual analogue scales. RESULTS: Two hundred seven adult refugee patients were included in the trial (98 in the venlafaxine and 109 in the sertraline group). Of these, 195 patients were eligible for intention-to-treat analyses. Small but significant pre-treatment to post-treatment differences were found on the Harvard Trauma Questionnaire and a number of other ratings in both groups. On the primary outcome measure, no difference was found in treatment effect between the sertraline and venlafaxine group. A significant group difference was found in favour of sertraline on the Sheehan Disability Scale. CONCLUSION: Sertraline had a slightly better outcome than venlafaxine on some of the secondary outcome measures, but not on the primary outcome measure. Furthermore, a higher percentage of dropouts was found in the venlafaxine group compared to the sertraline group. Although this could indicate that sertraline was better tolerated, which is supported by other studies, a final conclusion on tolerability cannot be drawn from the current study due to lack of systematic reporting of side effects. TRIAL REGISTRATION: ClinicalTrials.gov NCT01569685. Registration date: 28/2/12 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12888-016-1081-5) contains supplementary material, which is available to authorized users

Psychosocial predictors of treatment outcome for trauma-affected refugees

Background: The effects of treatment in trials with trauma-affected refugees vary considerably not only between studies but also between patients within a single study. However, we know little about why some patients benefit more from treatment, as few studies have analysed predictors of treatment outcome. Objective: The objective of the study was to examine possible psychosocial predictors of treatment outcome for trauma-affected refugees. Method: The participants were 195 adult refugees with posttraumatic stress disorder (PTSD) who were enrolled in a 6- to 7-month treatment programme at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The CTP Predictor Index used in the study included 15 different possible outcome predictors concerning the patients’ past, chronicity of mental health problems, pain, treatment motivation, prerequisites for engaging in psychotherapy, and social situation. The primary outcome measure was PTSD symptoms measured on the Harvard Trauma Questionnaire (HTQ). Other outcome measures included the Hopkins Symptom Check List-25, the WHO-5 Well-being Index, Sheehan Disability Scale, Hamilton Depression and Anxiety Scales, the somatisation scale of the Symptoms Checklist-90, Global Assessment of Functioning scales, and pain rated on visual analogue scales. The relations between treatment outcomes and the total score as well as subscores of the CTP Predictor Index were analysed. Results: Overall, the total score of the CTP Predictor Index was significantly correlated to pre- to post treatment score changes on the majority of the ratings mentioned above. While employment status was the only single item significantly correlated to HTQ-score changes, a number of single items from the CTP Predictor Index correlated significantly with changes in depression and anxiety symptoms, but the size of the correlation coefficients were modest. Conclusions: The total score of the CTP Predictor Index correlated significantly with outcomes on most of the rating scales, but correlations were modest in size, possibly due to the number of different factors influencing treatment outcome

Reconstruction of parking places : the creation of multifunctional green spaces

Densification that takes place in both Sweden and the rest of the world can lead to the nature around the cities being protected but can also mean that greenery and good habitats within the cities are lost. In the discussion about densification, the handling of unused surfaces is a factor. Many of these unused surfaces are parking spaces in residential areas that are in poor condition and in need of refurbishment. This study has dealt with whether the right design and choice of materials when reprocessing unused parking surfaces can lead to multifunctional surfaces. Surfaces that, through increased ecosystem services, are in line with sustainable urban construction. Lomma is one of Sweden's fastest growing municipalities, which means that there are major changes in the municipality's urban areas. At the same time as new areas for densification are investigated, there are clear goals within the municipality's urban planning to create close-up green areas that can benefit residents in the immediate area. Since the problems surrounding unused, worn-out parking areas are also present in the Lomma municipality, it is possible to create residential-close multifunctional surfaces. At present, the municipality has designed two surfaces with the aim of reducing the number of parking spaces, increasing green qualities and managing stormwater locally with permeable materials. Lomma municipality's local environmental goals focus on sustainable construction regarding ecology and health, reduction of traffic noise levels in residential environment and proximity to natural and green areas for residents in the municipality. The local targets also highlight the development of the municipality's green structure with the aim of increasing biodiversity, improving stormwater management, improving the outdoor climate and creating a long-term sustainable urban environment. In this study, the municipality of Lomma has acted as a reference point regarding the problem of unused parking areas and the work towards sustainable urban construction. The result of this study has shown that by creating areas where the hardened materials are reduced and vegetation are increased, small unused parking spaces can fill new functions. By promoting green environments, most ecosystem services that the surfaces contribute can increase. Ecosystem services such as stormwater management, increased air quality, reduced noise levels and increased biodiversity. In parallel with the development of the study, a guiding document has been created. Omprojektering av parkeringsyta – vägledning och utformningsförslag 2019 is a script that deals with design proposals, plant materials, stormwater solutions and biodiversity. These are aspects that are relevant when reconstructing parking areas.Förtätning som sker i både Sverige och övriga världen kan leda till att naturen kring städerna skyddas men kan även innebära att grönska och goda livsmiljöer inom städerna går förlorade. I diskussionen kring förtätning är hanteringen av obrukade ytor en faktor. Många av dessa obrukade ytor är parkeringsplatser i bostadsområden som är i dåligt skick och i behov av upprustning. Denna studie har behandlat huruvida rätt utformning och materialval vid omprojektering av obrukade parkeringsytor kan leda till multifunktionella ytor. Ytor som, genom ökade ekosystemtjänster, går i linje med hållbart stadsbyggande. Lomma är en av Sveriges snabbast växande kommuner, vilket innebär att det sker stora förändringar i kommunens tätorter. Samtidigt som nya områden för förtätning undersöks finns det inom kommunens stadsplanering även tydliga mål att skapa bostadsnära grönytor som kan gynna de boende i närområdet. Eftersom problematiken kring obrukade, slitna parkeringsytor finns även i Lomma kommun finns möjlighet att skapa bostadsnära multifunktionella ytor. Kommunen har i dagsläget projekterat om två ytor med målsättning att minska antalet parkeringsplatser, öka gröna kvaliteter och hantera dagvatten lokalt med genomsläppliga material. Lomma kommuns lokala miljömål fokuserar på hållbart byggande gällande ekologi och hälsa, minskning av trafikbullernivåer vid bostadsmiljö och närhet till natur- och grönområden för boende i kommunen. De lokala målen lyfter även fram utvecklingen av kommunens grönstruktur med målsättning att öka den biologiska mångfalden, förbättra dagvattenhanteringen, förbättra utomhusklimatet samt att skapa en långsiktigt hållbar stadsmiljö. I denna studie har Lomma kommun fungerat som referenspunkt gällande problematiken kring obrukade parkeringsytor och arbetet mot hållbart stadsbyggande. Resultatet av denna studie har visat att genom att skapa ytor där de hårdgjorda materialen minskas och de gröna ytorna ökas kan små obrukade parkeringsplatser fylla nya funktioner. Genom att gynna gröna miljöer kan flertalet ekosystemtjänster så som dagvattenhantering, förhöjd luftkvalitet, sänkt bullernivå och ökad biologisk mångfald som ytorna bidrar med öka. Parallellt med framtagandet av studien har ett vägledande dokument skapats. Omprojektering av parkeringsytor – vägledning och utformningsförslag 2019 är en skrift som behandlar utformningsförslag, ståndortsanpassat växtmaterial, dagvattenlösningar samt biologisk mångfald. Dessa är aspekter som är relevanta för kommuner och andra aktörer vid omprojektering av bostadsnära parkeringsytor

Loss of glutathione peroxidase 3 expression is correlated with epigenetic mechanisms in endometrial adenocarcinoma

Glutathione peroxidase 3 (GPX3) is one of the key enzymes in the cellular defense against oxidative stress and the hepatocyte growth factor receptor, (MET) has been suggested to be influenced by the GPX3 gene expression. In a previous microarray study performed by our group, Gpx3 was identified as a potential biomarker for rat endometrial adenocarcinoma (EAC), since the expression was highly downregulated in rat EAC tumors. Herein, we have investigated the mRNA expression and Gpx3 and Met in rat EAC by real time quantitative PCR (qPCR), and the methylation status of Gpx3. In addition we have examined the expression of GPX3 and MET in 30 human EACs of different FIGO grades and 20 benign endometrial tissues. We found that the expression of GPX3 was uniformly down regulated in both rat and human EAC, regardless of tumor grade or histopathological subtype, implying that the down-regulation is an early event in EAC. The rate of Gpx3 promoter methylation reaches 91%, where biallelic methylation was present in 90% of the methylated tumors. The expression of the Met oncogene was slightly upregulated in EACs that showed loss of expression of Gpx3, but no tumor suppressor activity of Gpx3/GPX3 was detected. Preliminary results also suggest that the production of H2O2 is higher in rat endometrial tumors with down-regulated Gpx3 expression. A likely consequence of loss of GPX3 protein function would be a higher amount of ROS in the cancer cell environment. Thus, the results suggest important clinical implications of the GPX3 expression in EAC, both as a molecular biomarker for EAC and as a potential target for therapeutic interventions