Women's health access in the context of forced migration in portugal: vulnerabilities and adaptation / Acesso à saúde de mulheres em contexto de migração forçada em Portugal: vulnerabilidades e adaptação / Acceso a la salud de las mujeres en el contexto de la migración forzada en Portugal: vulnerabilidades y adaptación

This article presents, the vulnerabilities related with regarding access to health services facedby refugee women, of a research project conducted in Portugal between 2020 and 2022 as part of the Masters in Intercultural Relations program at Universidade Aberta. Objective: The overall goal was to gain a better understanding of the psychosocial reality of women who arrived in Portugal as a result of forced migration, focusing on the main difficulties of the migratory and adaptation journey -highlighting vulnerabilities related to health and access to health services at the present article -and the protective factors that facilitated their processes of resilience, adaptation, and social integration. Methodology:The meaningsof the protagonists' experiences were disclosed through nine semi-structured and in-depth interviews with a woman from Iraq, seven from Syria, and one from Libya, which were conducted separately, recorded and transcribed. Following the transcription and translation of the interviews, the content analysis began with the coding and categorization of the obtained data. Results:The investigationuncovered a number of vulnerabilities triggered by the migratory experience and gender belonging, such as prejudice, social isolation, and cultural shock (mostly linked to religion and clothing), which validated the intersectional analysis. The findings highlight a number of obstacles in the host nation, including access to health care, the quality of institutional interactions, and knowledge of the Portuguese language.Conclusions:The current investigation led to theconclusion that there are flawsin Portugal in terms of ensuring full access to health care for forced migrant women, highlighting as major obstacles: a lack of information in languagesother than Portuguese, a lack of offers tolearn and masterthe Portugueselanguage, a lack of knowledge about how health institutions work, and a lack of sensitivity and intercultural skills inhealthcareservices (AU).

Este artigo apresenta as vulnerabilidades relacionadas no acesso aos serviços de saúde sentidas por mulheres refugiadas, de um projeto de investigação realizado em Portugal entre 2020 e 2022 no âmbito do Mestrado em Relações Interculturais da Universidade Aberta. Objetivo:O objetivo geral foi conhecer melhor a realidade psicossocial das mulheres que chegaram a Portugal como resultado da migração forçada, focando as principais dificuldades do percurso migratório e de adaptação,destacando as vulnerabilidades relacionadas com a saúde e acesso aos serviços de saúde, além dos fatores de proteção que facilitaram seus processos de resiliência, adaptação e integração social. Metodologia:Os significados das vivências das protagonistasforam relevados por meio de nove entrevistas semiestruturadas e em profundidade, realizadas individualmente, gravadas e transcritas, com umamulher do Iraque, seteda Síria e umada Líbia. Após transcrição e tradução das entrevistas, a análise de conteúdopartiu da codificação e categorização da informação recolhida.Resultados:A investigação desvelou uma série de vulnerabilidadescausadas pela experiência migratória epertença de gênero,como a discriminação sentida sob a forma de preconceitos, o isolamento social e o choque cultural (sobretudo relacionado com a religião e o vestuário utilizado), o que justificou a análise intersecional. Os resultados revelam umconjuntode desafiosno país de acolhimento, como o acesso à saúde, a qualidade das relações institucionais e o domínio da língua portuguesa.Conclusões: A presente investigação permitiu concluir que existem algumas carências em Portugal no que diz respeito à garantia do pleno acesso aos cuidados de saúde sentidas pelasmulheres migrantes forçadas, destacando-se como principais obstáculos: a falta de informação numa língua que não o português, a falta de domínio da língua portuguesa, o desconhecimento sobre o funcionamento das instituições de saúde e falta de sensibilidade e de competências interculturais nos cuidados de saúde (AU).

Este artículo presenta, las vulnerabilidades relacionadasconen el acceso a los servicios de salud que sienten las mujeres refugiadas, de un proyectorealizado en Portugal entre 2020 y 2022 en el ámbito del Máster en Relaciones Interculturales de la Universidade Aberta.Objetivo: El objetivo fue comprender la realidad psicosocial de las mujeres que llegaron a Portugal como resultado de la migración forzada, centrándose en las principales dificultades del viaje de migración y adaptación, destacandovulnerabilidades relacionadas con la salud y el acceso a los servicios de salud, además de los factores de protección que facilitaron sus procesos de resiliencia, adaptación e integración social. Metodología: Los significados de las experiencias fueron revelados através de nueve entrevistas semiestructuradas y en profundidad, realizadas individualmente, grabadas y transcritas, con una mujer de Irak, siete de Siria y una de Libia. Luego de la transcripción y traducción, se inició el análisis de contenido con la codificación y categorización de la información.Resultados: La investigación reveló vulnerabilidades provocadas por la experiencia migratoria y la pertenencia de género,como la discriminación sentida en forma de prejuicio, el aislamiento social y el choque cultural (principalmente relacionado con la religión y la vestimenta), que justificaron el análisis interseccional.Los resultados revelan desafíos en Portugal,como el acceso a la salud, la calidad de las relaciones institucionales y el dominio de la lengua portuguesa.Conclusiones: La presente investigación llevó a la conclusión de que existen fallas en Portugal en cuanto a garantizar el pleno acceso a la atención de la salud de las refugiadas,destacándose: falta de información en un idioma diferenteal portugués, falta de dominio de la lengua portuguesa, falta de conocimiento sobre el funcionamiento de las instituciones de salud y falta de sensibilidad y habilidades interculturales en la atención de la salud (AU).

Migração forçada, refúgio, alimentação e nutrição: uma revisão integrativa da literatura na perspectiva da segurança alimentar e nutricional / Forced Migration, Refuge, Food and Nutrition: An Integrative Literature Review from the Perspective of Food and Nutritional Security

Resumo Introdução: Até o final de 2020, 82,4 milhões de pessoas foram forçadas ao deslocamento no mundo. Este quantitativo qualifica a população deslocada à força como a maior já registrada, sendo 1% da população mundial. Cerca de 80% dessas pessoas estão em países afetados por grave insegurança alimentar. Objetivo: Analisar a produção científica sobre migrações forçadas, refúgio e nutrição, com foco na segurança alimentar e nutricional. Método: Trata-se de uma revisão integrativa da literatura, por meio das bases: Biblioteca Virtual de Saúde, USA National Library of Medicine, Portal Periódicos da CAPES e Science Direct. Resultado: Foram encontrados 717 artigos, 334 (46,6%) no MEDLINE, 241 (33,6%) no Portal Periódicos CAPES, 110 (15,3%) no Science Direct e 32 (4,5%) na BVS. Cinco temas foram identificados: (1) Segurança Alimentar e Nutricional; (2) Práticas alimentares e aculturação; (3) Nutrição Materno-Infantil; (4) Dupla carga de má-nutrição; (5) Estratégias de Educação Alimentar e Nutricional. Conclusão: As dificuldades em função das diversidades culturais evidenciadas pelo idioma e práticas alimentares; a falta de acesso a trabalho e renda; acesso a serviços e cuidados adequados em saúde estão dentre os principais desafios para o acesso à segurança alimentar e nutricional.

Abstract Objective: To analyze the existing scientific production on forced migrations, refuge and nutrition, with a focus on food and nutrition security. Method: This is an integrative literature review, using the bases: Virtual Health Library, USA National Library of Medicine, Periodical Portal of the Coordination for the Improvement of Higher Education Personnel and Science Direct. Results: 717 articles were found, 334 (46.6%) in MEDLINE, 241 (33.6%) in Portal Periódicos CAPES, 110 (15.3%) in Science Direct and 32 (4.5%) in the VHL. Five themes were identified: (1) Food and Nutritional Security; (2) Food Practices and Acculturation; (3) Maternal and Child Nutrition; (4) Double burden of malnutrition; (5) Food and Nutrition Education Strategies. Conclusion: Difficulties due to cultural diversities evidenced by language and food practices; lack of access to work and income; access to services and adequate health care are among the main challenges for access to food and nutrition security.

Cognitive evaluation in unaccompanied refugee children: a systematic review / Avaliação cognitiva em crianças refugiadas desacompanhadas: uma revisão sistemática

Abstract Objective: This study aims to identify what existing literature has shown about possible cognitive alterations in unaccompanied refugee children. Data sources: The search was performed in the Web of Science, PsycInfo, Scopus, and PubMed databases, including articles published in any year and in any language. The research was submitted to the Prospero protocol (ID: CRD42021257858), and the quality of the included articles was evaluated using the Mixed Methods Appraisal Tool. Data synthesis: Memory and attention are the main topics identified, largely because they are related to symptoms of post-traumatic stress disorder. However, low specificity was observed in the conduction of cognitive assessments, leading to relevant inconsistencies in the collected data. Conclusions: The use of psychological assessment instruments that are either poorly adapted or not adapted at all to the populations studied casts doubt on the validity of the data produced so far.

RESUMO Objetivo: Identificar o que a literatura tem apresentado a respeito de possíveis alterações cognitivas em crianças refugiadas desacompanhadas. Fontes de dados: Foi realizada uma busca nas bases de dados Web of Science, PsycInfo, Scopus e PubMed, que incluiu artigos indexados produzidos em qualquer período e em qualquer idioma. A pesquisa foi submetida ao protocolo do International Prospective Register of Systematic Reviews — Prospero (ID: CRD42021257858), e a qualidade dos artigos selecionados foi avaliada por meio do Mixed Methods Appraisal Tool. Síntese dos dados: Memória e atenção foram os principais tópicos identificados, em grande parte por sua relação com sintomas de transtorno do estresse pós-traumático. Contudo, foi observada baixa especificidade na condução dos testes cognitivos, levando a importantes inconsistências entre os dados coletados. Conclusões O uso de instrumentos de avaliação psicológica mal adaptados ou inadaptados para as populações estudadas coloca em dúvida a validade dos dados produzidos.

Xenophobia and medicine (profession of a doctor): can the two coexist in the 21st century? / Xenofobia y medicina (profesión del médico): ¿pueden ambas coexistir en el siglo XXI? / Xenofobia e medicina (profissão de um doutor): podem os dois coexistirem no Século 21?

Abstract: This study was conducted to reveal how physicians view the access of refugees, who have difficulties in accessing health services and who may experience various health rights violations, to health services and to discuss the case in terms of medical ethics and deontology. Xenophobia, which is one of the main causes of discrimination in health, needs to be evaluated. In this context, quantitative research methods were used to measure the xenophobia levels of physicians working in Eskişehir province. Stratified sampling method was used to evaluate the views of the physicians. The study data were collected through the Xenophobia Scale developed by Kees Van Der Veer et al. and a questionnaire created by the researchers. The age distribution of the physicians in the study was 38,069±10,337. The distribution of the scores obtained from the xenophobia scale was found to be high (56.20±11.54). Of the physicians in the study, 34.3% stated that they would not want to provide health services for refugees if they were given the right to choose. They mainly thought that health services should not be provided free of charge for refugees and should be provided in separate places, refugees affected the access of the citizens of the Turkish Republic to health services negatively, the number of children should be limited, refugees would increase violence in health and public health problems, and that there should be an interpreter in health institutions. "Refugees do not deserve discrimination in health services" in terms of medical ethics. "Physicians should reach a common consensus against all kinds of discrimination while carrying out their profession." When xenophobia shows its effect in the field of health, it turns into a phenomenon that damages human dignity, causes all kinds of inequality, and moves medicine away from its deontology.

Resumen: Se realizó este estudio para revelar cómo ven los médicos el acceso de refugiados con dificultades para acceder a servicios de salud y que sufren violaciones a sus derechos de salud, y para discutir el caso desde la ética médica y la deontología. La xenofobia es una de las principales causas de discriminación en cuidados de salud, por lo que necesita ser evaluada. En este contexto, se usaron métodos de investigación cuantitativa para medir los niveles de xenofobia de médicos que trabajan en la provincia de Eskişehir. Se usó un método de muestra estratificada para evaluar los puntos de vista de los médicos. Los datos del estudio fueron recolectados mediante la escala de Xenofobia desarrollada por Kees Van Der Veer y colaboradores, y mediante un cuestionario creado por los investigadores. La distribución de la edad de los médicos que participaron en el estudio fue de 38,069±10,337. Se encontró que la distribución de los puntajes obtenidos de la escala de xenofobia fue alta (56.20±11.54). De los médicos del estudio, 34.3% manifestó que no proporcionarían servicios de salud a los refugiados si se les diera el derecho a elegir. Principalmente pensaban que los servicios de salud no debieran proporcionarse gratis a los refugiados, debiera hacerse en lugares separados, los refugiados restringen el acceso a los servicios de salud de los ciudadanos de la República de Turquía, debiera limitarse el número de niños, los refugiados incrementan los problemas de violencia y salud pública y debiera haber intérpretes en las instituciones de salud. De acuerdo con la ética médica, "los refugiados no merecen ser discriminados en los servicios de salud". "Los médicos debieran llegar a un consenso común en contra de toda clase de discriminación mientras que cumplen con su profesión". Cuando la xenofobia muestra sus efectos en el campo de la salud, se transforma en un fenómeno que daña la dignidad humana, causa toda clase de desigualdades y lleva a la medicina a apartarse de su deber.

Resumo: Esse estudo foi realizado para mostrar como médicos veem o acesso de refugiados -que tem dificuldades em acessar serviços de saúde e que podem experimentar diversas violações em direitos à saúde- a serviços de saúde e para discutir o situação em termos de ética médica e deontologia. Xenofobia, que é uma das principais causas de discriminação na saúde, necessita ser avaliada. Nesse contexto, métodos de pesquisa quantitativa foram utilizados para medir os níveis de xenofobia de médicos trabalhando na província de Eskisehir. Métodos de amostragem estratificada foram utilizados para avaliar o ponto de vista dos médicos. Os dados do estudo foram coletados através da Escala de Xenofobia desenvolvida por Kees Van Der Veer et al. e um questionário criado pelos pesquisadores. A distribuição etária dos médicos no estudo foi 38,069±10,337. A distribuição dos escores obtidos na escala de xenofobia foi alta (56.20±11.54). Dos médicos no estudo, 34,3% afirmaram que eles poderiam não querer prestar serviços de saúde para refugiados se fosse dado a eles o direito de escolher. Eles principalmente pensam que serviços de saúde não deveriam ser fornecidos gratuitamente para refugiados e que deveriam ser fornecidos em lugares separados, que refugiados afetam negativamente o acesso de cidadãos da República Turca a serviços de saúde, que o número de crianças deveria ser limitado, que os refugiados poderiam aumentar a violência na saúde e os problemas de saúde pública, e que deveria haver um intérprete nas instituições de saúde. "Refugiados não merecem ser discriminados em serviços de saúde" em termos de ética médica. "Médicos deveriam alcançar um consenso contra todas as formas de discriminação quando no exercício de sua profissão". Quando a xenofobia mostra seus efeitos no campo da saúde, ela se transforma em um fenômeno que danifica a dignidade humana, causa todas as formas de desigualdades e afasta a medicina para longe de sua deontologia.

Migration and refuge: necessary topics for Nursing teaching in COVID-19 times / Migración y refugio: cuestiones necesarias para la enseñanza de la enfermería en tiempos del COVID-19 / Migração e refúgio: temas necessários para o ensino na Enfermagem em tempos de COVID-19

ABSTRACT Objectives: to present an overview of migratory processes and access to health care for immigrants in Brazil and reflect on the importance of training in Nursing from an interdisciplinary perspective, focused on the care of this population in the context of a pandemic. Methods: this is a theoretical-reflective study based on the authors' experiences and anchored in the literature. Results: some particularities in the access to health services by migrants and refugees show how the pandemic's advancement and continuity impacted them in different ways. Interdisciplinary research and teaching are essential to study and better understand the health needs of the migrant population in Brazil, especially in the context of a pandemic. Final Considerations: the training of health professionals, especially in Nursing, must include these people's specificities so that future interventions are more sensitive and closer to their reality.

RESUMEN Objetivos: presentar el panorama de los procesos migratorios junto al acceso a los cuidados de salud de los inmigrantes en Brasil y reflexionar sobre la importancia de la formación en Enfermería dirigida a la atención de esta población desde una perspectiva interdisciplinaria en el contexto de la pandemia. Métodos: se trata de un estudio teórico-reflexivo, pautado en las experiencias de los autores y también basado en la literatura. Resultados: algunas particularidades en el acceso a los servicios de salud de los migrantes y las personas refugiadas evidencian que éstas han sido impactadas de diferentes maneras con el avance y la continuidad de la pandemia. La investigación y la enseñanza con un enfoque interdisciplinario son importantes para estudiar y comprender mejor las necesidades sanitarias de la población migrante en el país, especialmente en el contexto de la pandemia. Consideraciones Finales: la formación de los profesionales sanitarios, especialmente en Enfermería, debe comprender las especificidades de estas personas para que las futuras intervenciones sean más sensibles y cercanas a la realidad que viven.

RESUMO Objetivos: apresentar o panorama dos processos migratórios e de acesso à saúde de imigrante no Brasil e refletir sobre a importância da formação em Enfermagem, numa perspectiva interdisciplinar, voltada ao cuidado dessa população, no contexto de pandemia. Métodos: trata-se de um estudo teórico-reflexivo, pautado nas experiências dos autores e ancorado na literatura. Resultados: algumas particularidades no acesso a serviços de saúde de migrantes e pessoas refugiadas evidenciam como elas têm sido impactadas de diferentes maneiras com o avanço e continuidade da pandemia. A pesquisa e ensino de abordagem interdisciplinar são importantes para estudar e melhor compreender as necessidades de saúde da população migrante no país, especialmente no contexto de pandemia. Considerações Finais: a formação de profissionais de saúde, especialmente em Enfermagem, deve compreender as especificidades destas pessoas para que futuras intervenções sejam mais sensíveis e próximas da realidade que vivem.

Vida e trabalho de refugiado: a imagem como experiência do olhar a partir de uma obra de Escher / Refugee's life and work: image as experience of the look from a painting by Escher

Vida e trabalho no percurso de refugiado estão entre os mais recentes desafios contemporâneos que instigam o olhar e o pesquisar. A fim de potencializar a discussão, julgou-se pertinente atentar para a experiência do olhar frente à imagem. Tomou-se a xilogravura Dia e Noite, arte de Maurits Cornelius Escher, que alude ao movimento migratório de pássaros, por também ela provocar o olhar dadas as características que o artista lhe imprime. Como base teórica condutora da discussão, tomaram-se os conceitos de espaço liso e estriado, de Deleuze e Guattari, imbricados em referencial relativo à situação de refugiado. A conversa entre imagem e teoria ampliou o olhar para além das questões burocráticas, jurídicas e estatísticas, frequentemente associadas aos estudos acerca de refugiado, e permitiu apontar relações de continuidade e coexistência em seus modos de viver e trabalhar. Entende-se que, ao provocar a experiência do olhar, a imagem pode ser capturada, recortada, reduzida, ampliada, torcida, num esforço de sentido não necessariamente óbvio.(AU)

Life and work on the refugee journey are among the latest contemporary challenges that instigate to look and to research. In order to enhance the discussion, it was considered pertinent to pay attention to the experience of looking at the image. We took the woodcut Day and Night, art by Maurits Cornelius Escher, which alludes to the migratory movement of birds, because it also provokes the look, given the characteristics that the artist imprints on it. The concepts of smooth and striated space, by Deleuze and Guattari, imbricated in a reference regarding the refugee situation, were taken as the theoretical basis for the discussion. The conversation between image and theory broadened the look beyond bureaucratic, legal and statistical issues, often associated with studies about refugees and allowed pointing out relationships of continuity and coexistence in their ways of living and working. It is understood that, by provoking the experience of the look, the image can be captured, cut, reduced, enlarged, twisted, in an effort of meaning not necessarily obvious.(AU)

La vida y el trabajo en el curso de la vida de los refugiados son algunos de los retos contemporáneos más recientes que instigan la mirada y la investigación. Para mejorar el debate, se consideró pertinente centrarse en la experiencia de mirar la imagen. Se tomó la xilografía Día y Noche, obra de Maurits Cornelius Escher, que alude al movimiento migratorio de las aves, ya que también provoca la mirada dadas las características que el artista le imprime. Los conceptos de espacio liso y estriado, de Deleuze y Guattari, se utilizaron como base teórica para la discusión. La conversación entre la imagen y la teoría amplió la mirada más allá de las cuestiones burocráticas, legales y estadísticas que suelen asociarse a los estudios sobre los refugiados, y nos permitió señalar relaciones de continuidad y convivencia en sus formas de vivir y trabajar. Se entiende que al provocar la experiencia de la mirada, la imagen puede ser capturada, recortada, reducida, ampliada, retorcida, en un esfuerzo por dar un sentido que no es necesariamente obvio.(AU)

Impactos da (des)territorialização nos processos de subjetivação: experiências migratórias de refugiadas venezuelanas em Bogotá / Impacts of (de)territorialization on processes of subjectivation: migratory experiences of Venezuelan refugee women in Bogotá / Impactos de la (des)territorialización en los procesos de subjetivación: experiencias migratorias de refugiadas venezolanas en Bogotá

O presente artigo visa analisar os impactos nos processos de subjetivação de mulheres venezuelanas que, em meio ao forte fluxo migratório recente, se veem diante de um processo de (des)territorialização. Propõem-se discussões sobre elementos do sofrimento ético-político, a construção identitária e a feminização da migração, a partir da produção de narrativas, tendo a categoria de gênero como analisador fundamental de tais fluxos. As entrevistas com mulheres que se encontravam em Bogotá, Colômbia, versaram sobre as memórias da Venezuela, a motivação para a saída, o trânsito na fronteira, a chegada à cidade, as dificuldades cotidianas de adaptação, e os ecos desse processo. Ao final, a escuta dessas experiências emerge como forma de enfrentamento ao silenciamento de vozes marginalizadas e de reflexão sobre as estratégias de acolhimento que têm sido adotadas na região.

This article aims to analyze the impacts on the processes of subjectivation of Venezuelan women who, amidst the strong recent migratory flow, find themselves facing a process of (de)territorialization. Discussions are proposed about elements of ethical-political suffering, identity construction and the feminization of migration, based on the production of narratives, with the gender category as a fundamental analyzer of such flows. The interviews with women who were in Bogotá, Colombia, were about the memories of Venezuela, the motivation to leave, the border traffic, the arrival in the city, the daily difficulties of adaptation, and the echoes of this process. In the end, listening to these experiences emerges as a way of confronting the silencing of marginalized voices and reflecting on the reception strategies that have been adopted in the region.

Este artículo tiene como objetivo analizar los impactos en los procesos de subjetivación de mujeres venezolanas que, en medio del fuerte flujo migratorio reciente, se enfrentan a un proceso de (des)territorialización. Se proponen discusiones sobre elementos del sufrimiento ético-político, la construcción de la identidad y la feminización de la migración, a partir de la producción de narrativas, con la categoría de género como analizador fundamental de dichos flujos. Las entrevistas con mujeres que se encontraban en Bogotá, Colombia, versaron sobre los recuerdos de Venezuela, la motivación para la salida, el tráfico fronterizo, la llegada a la ciudad, las dificultades diarias de adaptación y los ecos de este proceso. Al final, la escucha de estas experiencias surge como forma de enfrentar el silenciamiento de las voces marginadas y reflexionar sobre las estrategias de acogida que se han adoptado en la región.

Prevalence of psychiatric symptoms among refugee adolescents in Turkey: a controlled study

Objective: To investigate prevalence of internalized and externalized psychological symptoms and war-related adverse events among a representative secondary-school sample of Syrian refugee adolescents, and to compare levels of depression, anxiety, and stress between Syrian refugee adolescents and Turkish adolescents. Methods: Syrian refugee adolescents (n=70) and Turkish adolescents (n=70) were asked to complete the Depression, Anxiety, and Stress Scales (DASS-42) and Strengths and Difficulties Questionnaire (SDQ). Results: DASS and SDQ scores were significantly different between the two groups; scores in all problem areas were higher in refugees. Loss of a family member increased depression, stress, and total difficulty scored, whereas witnessing death increased anxiety and stress and experiencing multiple events increased depression, anxiety, and total difficulty scores. Maternal years of schooling correlated inversely with SDQ emotional symptoms, conduct problems, and hyperactivity/inattention problem scores. Both parents' years of schooling correlated inversely with SDQ total difficulties scores. Conclusion: Syrian refugee adolescents had higher depression, anxiety, behavioral problems, peer relationship problems, and general difficulties than their Turkish peers. Facilitating refugees' access to mental health services, educating their parents, consulting, and monitoring at-risk children may contribute to reducing psychosocial problems in refugee children.

Pediatric perspectives on treating uncommon genotypes of hepatitis C in the United States

Rationale: Hepatitis C in the pediatric population is a large health burden globally. With its diverse genotypes as well as genotypic subtypes, there is a discrepancy in the genotypes used in research compared to their prevalence. HCV genotype 6 which is endemic to South China and Southeast Asia comprises approximately one-third of all HCV infections worldwide, but make up a minority of cases studied in HCV research. Patient concerns: We report a case of HCV-6 seen in an 11-year-old Burmese immigrant to the U.S. and describe the new direct acting antiviral treatment guidelines for pediatrics with HCV genotype 6. Interventions: The patient completed a 12-week course of ledipasvir/sofosbuvir (90 mg/400 mg), per FDA weight-based recommendations for treatment-naive HCV genotypes 4-6, without any complications. Outcomes: The patient was treated successfully with an undetectable HCV viral load one month after treatment completion. Lessons: HCV-6, although previously uncommon in the U.S., is becoming more prevalent. Updated guidelines include the use of direct acting antivirals, which have been proven effective for HCV-6. Lessons on barriers to care in the immigrant population as well as the value of HCV genotyping are also discussed.

Famílias refugiadas africanas: qualidade de vida, expectativas e necessidades em relação à saúde / African refugee families: quality of life, needs and expectations regarding health

Resumo O Brasil abriga indivíduos de diversos países em situação de refúgio, tal como é definida pela Lei nº 9.474/1997 ou por autodeclaração. O uso do Sistema Único de Saúde faz parte dos direitos dos refugiados. Apesar desse direito, observa-se a ocorrência de preconceitos, desinformação e dificuldades de acesso a serviços. O objetivo desta pesquisa foi mensurar a qualidade de vida e compreender as necessidades e expectativas de famílias de refugiados africanos em relação à saúde. O estudo foi realizado em dois momentos: quantitativo e qualitativo. Os participantes responderam a escala de qualidade de vida WHOQOL-bref. Foi extraída uma família da amostra para a realização do genograma estrutural e de entrevista semiestruturada com questão norteadora. A análise quantitativa foi feita por estatística descritiva e os discursos obtidos, pela análise de conteúdo proposta por Laurence Bardin. Como resultados, no parâmetro de 0 a 100, a média apresentada foi de 49,57, classificando a qualidade de vida como "nem boa, nem ruim". Esse resultado é condizente com os discursos dos entrevistados e está relacionado à falta de emprego e dinheiro. Em relação à saúde, as avaliações não diferem das dos brasileiros: o serviço apresenta demora no atendimento, faltam médicos e os postos são distantes. Destaca-se também o preconceito vivido por alguns participantes ao serem atendidos pelos serviços de saúde, pelo fato de serem africanos.

Abstract Brazil is home to individuals from different countries in refuge situation, as defined by Law no. 9,474/1997 or by self-declaration. The Brazilian National Health System is available to refugees, but, despite this right, prejudice, misinformation, and difficulties in accessing these services are observed. The objective of this research is to measure their quality of life and to understand the needs and expectations of African refugee families in relation to health. The study was performed in two moments: a quantitative and a qualitative one. Participants responded to the WHOQOL-Bref quality of life scale. A sample family was extracted to compose the structural genogram and to participate in a semi-structured interview with a guiding question. The quantitative analysis was done by descriptive statistics and the discourses obtained were evaluated by the content analysis proposed by Laurence Bardin. Results showed, in the 0 to 100 parameter, a mean of 49.57, classifying the quality of life as "neither good, nor bad". This result is consistent with the discourses of the interviewees, related to lack of employment and money. Regarding health, their evaluations do not differ from those of Brazilians: the service presents delays in care, lack of doctors and the health posts are far away. The prejudice suffered by some participants when being attended by the health services, related to being African, was also highlighted.

De uma clínica do refúgio: violência, trauma e escrita / On a clinic of refuge: violence, trauma and writing / De la clinique de refuge: violence, traumatisme et écriture / De una clínica del refugio: violencia, trauma y escrita

O artigo apresenta uma reflexão sobre as atuais políticas de migração e o status quo do refugiado, circunscrevendo algumas especificidades de sua configuração subjetiva. Elementos traumáticos e hiatos expressivos no âmbito da capacidade representacional revelam-se como contingências, corolário da exposição reiterada à precariedade e à violência. A partir de algumas ferramentas metapsicológicas e da interlocução entre psicanálise, cultura e literatura, desenvolvem-se os aspectos mais relevantes e idiossincráticos de uma clínica do refúgio. Para tanto, utiliza-se como recurso ilustrativo a narrativa de caráter fortemente autobiográfico Por que a criança cozinha na polenta (2004), da escritora romena Aglaja Veteranyi.

This paper discusses current migration policies and the status quo of refugees by circumscribing some specificities of its subjective configuration. Traumatic elements and expressive hiatuses belonging to the representational capacity show to be contingencies, a corollary of repeated exposure to precariousness and violence. Based on some metapsychological tools and the interlocution between psychoanalysis, culture and literature, the most relevant and idiosyncratic aspects of the clinic of refuge are developed. To achieve that, the strongly autobiographical narrative "Why the Child is Cooking in the Polenta" by Romanian writer Aglaja Veteranyi is used as an illustrative resource.

Cet article présente une réflexion sur les politiques migratoires actuelles et le statu quo du réfugié, circonscrivant certaines spécificités de sa configuration subjective. Les éléments traumatiques et les lacunes d'expression dans le domaine de la capacité de représentation se révèlent comme des contingences, corollaire d'une exposition répétée à la précarité et à la violence. À partir d'outils métapsychologiques et l'articulation entre la psychanalyse, la culture et la littérature, on développe les aspects les plus pertinents et idiosyncratiques d'une clinique du refuge. À cette fin, le roman fortement autobiographique « Pourquoi l'enfant cuisait dans la polenta ¼ de l'écrivain roumaine Aglaja Veteranyi est utilisé à titre d'illustration.

El artículo presenta una reflexión sobre las actuales políticas de migración y el status quo del refugiado, circunscribiendo algunas especificidades de su configuración subjetiva. Elementos traumáticos y brechas expresivas en el ámbito de la capacidad representacional se revelan como contingencias, corolario de la exposición reiterada a la precariedad y a la violencia. A partir de algunas herramientas metapsicológicas y de la interlocución entre el psicoanálisis, la cultura y la literatura, se desarrollan los aspectos más relevantes e idiosincrásicos de una clínica del refugio. Para ello, se utiliza como recurso ilustrativo una narrativa de carácter fuertemente autobiográfico: ¿Por qué se cuece el niño en la polenta?, de la escritora rumana Aglaja Veteranyi.

Dieser Artikel analysiert die aktuelle Migrationspolitik und den Status Quo der Flüchtlinge, wobei einige Besonderheiten ihrer subjektiven Konfiguration näher betrachtet werden. Traumatische Elemente und expressive Lücken im Rahmen der Repräsentationsfähigkeit offenbaren sich als Kontingenz, als Konsequenzen der wiederholten Einwirkung von Prekarität und Gewalt. Basierend auf einigen metapsychologischen Begriffen und der Verknüpfung von Psychoanalyse, Kultur und Literatur werden die bedeutenden und idiosynkratischen Aspekte einer Klinik der Zuflucht entwickelt. Außerdem wird ebenfalls das Buch „Warum das Kind in der Polenta kocht" der rumänischen Schriftstellerin Aglaja Veteranyi als darstellendes Mittel verwendet.

Assessing the Effectiveness of a Mental Health Literacy Programme for Refugee Teachers in Malaysia

@#Background: Children and young refugees often experience negative events that affect their mental health. Their caregivers may also be in the same predicament, implying that the teachers in schools are a potential source of help and support. However, most teachers have little understanding of mental health and are, thus, clueless in helping their students. To address this need, a newly developed one-day mental health literacy programme was conducted among 68 refugee teachers in Malaysia. Methods: Participants learned the symptoms of mental health issues among children and adolescents in the context of post-trauma, provision of early intervention, and channel for professional supports. They also answered a packet of measurements of mental health literacy before and after the programme. Results: The paired sample t-test showed that participants reported higher willingness to contact with people having mental health problems (t = 2.787, P = 0.008, Cohen’s d = 0.394), less stereotypes toward mental illness (t = 4.603, P < 0.001, d = 0.651) and a better understanding of self-help strategies (t = 2.16, P = .036, d = 0.322) than baseline. Conclusion: The results of this study offered preliminary empirical evidence on the effectiveness of the programme as a promising channel for alleviating mental health issues among refugees.

Prevalence of Possible Depression and Post-traumatic Stress Disorder among Community Dwelling Adult Refugees and Refugee Applicants in South Korea

BACKGROUND: Because there has been a recent increase in refugee applications in Korea, the mental health of these refugees merits greater study. METHODS: We surveyed 129 refugees (including those in process of refugee application) and 121 migrant workers living in urban communities, using: the Patient Health Questionnaire-9 for depressive symptoms, the Impact Event Scale-Revised for post-traumatic stress disorder (PTSD) symptoms, and the health questionnaires used in 2016 Korean National Health and Nutrition Examination Survey (KNHANES). The majority of refugee subjects were from sub-Saharan Africa and Middle East. We compared the prevalence of possible depression and possible PTSD between refugees and migrant workers and refugees and age-gender matched samples from the KNHANES 2016. RESULTS: Frequency of suicidal planning during the last year was higher in the refugee group than Korean nationals, but frequency of suicidal attempt was not. High risk drinking was found in 0.8% of refugees, 6.6% of migrant workers and 27.2% of Korean nationals. Possible depression was present in 42.9% of refugee subjects, 33.3% of migrant workers, and 4.2% of Korean controls. Possible PTSD was present in 38.9% of refugees compared to 12.5% of migrant workers. Only major risk factor for depression among refugees was a traumatic event before entering Korea. CONCLUSION: Possible depression and PTSD are significantly more prevalent in refugees, compared to both migrant workers and Korean nationals. Prevalence rates are commensurate with refugee studies worldwide. Appropriate early screening and intervention schemes need to be developed for refugees entering Korea.

Os errantes, um desafio para a psicanálise: uma clínica da errância? / Wanderers, a challenge for Psychoanalysis: a clinical practice of “wandering” / Los errantes, un desafío para el psicoanálisis: ¿una clínica de la errancia? / Les errants, un defi pour la psycanalise: une clinique de l'errance?

Neste artigo, a autora aborda um dos aspectos mais sombrios da globalização neoliberal, a presença cada vez maior de refugiados e errantes, assim como a particularidade de uma escuta analítica do traumatismo vivido por essas pessoas, que aceitaram morrer para poder viver. Seria possível falar de uma clínica da errância?

This article addresses one of the darkest aspects of neoliberal globalization, i.e. the increasingly massive presence of refugees and migrants. The author writes about the particularity of an analytic listening to the trauma that has been experienced by those who have agreed to die in order to live. Perhaps we could speak of a clinical practice of “wandering”?

Este artículo aborda uno de los aspectos más sombríos de la globalización neoliberal, la presencia cada vez mayor de refugiados y errantes, así como la particularidad de una escucha analítica del trauma sufrido por estas personas que aceptaron morir para poder vivir. ¿Podríamos tal vez hablar de una clínica de la errancia?

Le présent article se penche sur l'un des aspects les plus sombre de la mondialisation néolibérale, celui de la présence chaque fois plus massive de réfugiés et d'errants, ainsi que sur la particularité d´une écoute analytique du traumatisme enduré par ces personnes qui ont accepté de mourir pour pouvoir vivre. Pourrionsnous parler d´une clinique de l'errance ?

Os fluxos migratórios mistos e os entraves à proteção aos refugiados / Mixed migration flows and the obstacles to the refugees protection / Los flujos migratorios mixtos y las barreras a la protección de los refugiados

Resumo O artigo discute o fenômeno dos fluxos migratórios mistos, considerando seus impactos sobre o reconhecimento das solicitações de refúgio, seu enquadramento jurídico nos países de passagem e destino e, especialmente, a proteção aos refugiados. Os Estados Nacionais, invariavelmente, tratam as migrações internacionais de forma generalista, desconsiderando os elementos específicos e individuais que as motivaram. Isso faz com que muitos solicitantes de refúgio, que utilizam os mesmos mecanismos e rotas dos denominados migrantes voluntários, sejam prejudicados no acesso ao direito de reconhecimento de seus pedidos. Tal realidade tem influenciado os debates sobre os fluxos migratórios na academia e nos órgãos protetivos e de promoção de ações voltadas aos refugiados, como é o caso do Alto Comissariado das Nações Unidas para Refugiados (Acnur) e do sistema americano desenvolvido após a Declaração de Cartagena. O presente texto pretende analisar, com base nos documentos de organismos internacionais e nos debates realizados na academia, o que são fluxos mistos e a forma como as questões relativas ao tema têm sido debatidas no âmbito internacional, apresentando boas práticas e soluções que permitam assegurar aos refugiados a proteção a que fazem jus.(AU)

Abstract The paper discusses mixed migration flows considering its impacts on the requests of refugee status recognition, its legal framework in the transit and destination countries and, specially, the protection to refugees. The National States have, invariably, been treating international migration in a general way, disregarding specific and individuals elements that have motivated them. The consequence of this modus operandi is that many refugee applicants, who use the same mechanisms and routes as the so-called voluntary migrants, have disadvantages in the access to the right of recognition of their requests. Such reality have affected the debates on migratory flows in both the academy and in the refugee protection and advocacy bodies, such is the case of UNHCR and the American System developed after the Cartagena Declaration. Accordingly, based on documents from the international organizations and in the debates carried out in the Academia, the paper will analyze the mixed flows and the way these questions concerning the topic have been debated in the international arena, presenting good practices and solutions that can assure to the refugees the protection to which they are entitled.

Resumen El artículo discute el fenómeno de los flujos migratorios mixtos, considerandos sus impactos sobre el reconocimiento de las solicitudes de refugio, los marcos legales de los países de tránsito y destino y, especialmente, la protección a los refugiados. Los Estados Nacionales, invariablemente, tratan a la migración internacional de manera general, sin tener en cuenta los elementos específicos e individuales que las motivaron. Esto lleva a que muchos solicitantes de refugio, que utilizan los mismos mecanismos y rutas de los llamados migrantes voluntarios, tengan obstáculos en el acceso al derecho de reconocimiento de sus solicitudes de refugio. Esta realidad ha afectado los debates sobre flujos migratorios tanto en la academia como en los órganos de protección y de promoción de las acciones dirigidas a los refugiados, como es el caso de ACNUR y del sistema americano desarrollado después de la Declaración de Cartagena. En este sentido, el artículo busca analizar, con base en los documentos de las organizaciones internacionales y en las discusiones de la academia, qué son los flujos mixtos y cuál es la forma como las cuestiones relativas a este tema han sido debatidas en ámbito internacional, presentando las mejores prácticas y las soluciones que pueden garantizar la protección a que los refugiados tienen derecho.

Cardiovascular Disease–related Health Beliefs and Lifestyle Issues Among Karen Refugees Resettled in the United States From the Thai-Myanmar (Burma) Border / 예방의학회지

OBJECTIVES: Refugees resettled in the US may be at risk for cardiovascular disease (CVD). However, little is known about CVD-related issues among Karen refugees who have migrated to the US from the Thai-Myanmar border. The purpose of this study was to examine CVD-related health beliefs and lifestyle issues among Karen refugees resettled in the US. METHODS: Karen refugees resettled in the US from the Thai-Myanmar border (n=195) participated in a survey study on health beliefs related to CVD, salt intake, physical activity (PA), and smoking in the fall of 2016. RESULTS: A high-salt diet, physical inactivity, and smoking were major lifestyle problems. Participants who adhered to a low-salt diet considered themselves to be susceptible to CVD. Most participants did not engage in regular PA. Regular PA was associated with less perceived susceptibility to CVD and greater perceived benefits of a healthy lifestyle for decreasing the likelihood of CVD. CONCLUSIONS: Each refugee population may require individualized strategies to promote PA and a healthy diet. Future studies should develop health education programs that are specifically designed for Karen refugees and evaluate such programs. In addition to health education programs on healthy lifestyle choices, tobacco cessation programs seem to be necessary for Karen refugees. At the same time, it is important to foster strategies to increase the utilization of preventive care among this population by promoting free or reduced-fee resources in the community to further promote their health.

Insomnia in North Korean Refugees: Association with Depression and Post-Traumatic Stress Symptoms

OBJECTIVE: We investigated the prevalence of insomnia and its clinical characteristics in North Korean refugees. METHODS: North Korean refugees living in South Korea (48 males, 129 females; mean age 38.22+/-12.24 years) and South Koreans (112 males, 203 females; mean age 39.48+/-10.32 years) completed the following questionnaires: the Self-reported Questionnaire on Insomnia, Center for Epidemiological Studies-Depression Scale (CES-D), Trauma Exposure Check List for North Korean Refugees, and the Impact of Event Scale-Revised (IES-R). RESULTS: North Korean refugees had insomnia more often than South Koreans did (38.42% vs. 8.89%). Depression combined with insomnia was also more prevalent in North Korean refugees (28.25% vs. 3.17%). Compared with South Koreans with insomnia, North Korean refugees with insomnia showed higher CES-D scores. The North Korean refugees with insomnia had experienced a larger number of traumatic events, and had higher CES-D and IES-R scores compared to North Korean refugees without insomnia. Insomnia in North Korean refugees was also associated with the presence of significant depressive and post-traumatic stress disorder (PTSD) symptoms. CONCLUSION: Insomnia was common in North Korean refugees and was closely associated with depressive and PTSD symptoms. Our study suggests that complaints of insomnia may indicate more severe psychopathology, especially in refugees.

Effects of Parenting Stress in North Korean Refugee Fathers on Their Parenting Behavior

PURPOSE: The purpose of this study was to identify effects of parenting stress in North Korean refugee fathers on their parenting behavior. METHODS: A descriptive study design was used. Data were collected during 2014 and 2015 in a settlement support center for North Korean refugees and 99 North Korean refugee fathers participated. Data were analyzed using SPSS 21.0. RESULTS: Warmth·encouragement parenting behavior received the highest score. The score for parenting stress was 81.98 out of 180, and 32.3% of participants were found to need professional help (≥PSI 90). There were significant negative correlations between warmth·encouragement parenting behavior and parenting stress. There were also significant positive correlations between rejection·neglect parenting behavior and parenting stress. Predictors of warmth·encouragement behavior were parent-child dysfunctional interaction which explained 10.1% of the variance. Predictors of rejection·neglect behavior were parent-child dysfunctional interaction, number of children and wife's education level which explained 33.4% of the variance. CONCLUSION: Findings show that North Korean refugee fathers' parenting stress significantly influenced warmth·encouragement and rejection·neglect parenting behavior indicating a need to identify ways to decrease parenting stress. Parenting education can guide North Korean refugee fathers to strengthen parent-child positive interactions and therefore promote their children's growth and development.

Molecular epidemiology of HIV-1 strains in the south-east and east of Turkey

OBJECTIVE: To detect the subtype characterization and drug-resistant mutations in HIV-1 strains after the refugee movement from Syria to Turkey between 2011 and 2014 in south east border lines. METHODS: A total of 65 patients were included in this study, of which 57 (88%) patients were antiretroviral therapy-naive patients. HIV-1 RNA was detected and quantified by real-time PCR assay. HIV-1 subtypes and circulating recombinant forms (CRFs) were identified by phylogenetic analysis (neighbor-joining method), and drug-resistant mutations were analyzed. RESULTS: Three major HIV groups were indicated. Two of these groups were located in subtype B. The other group showed heterogeneity. Subtype B (48/65, 73.8%), followed by CRFs (12/65, 18.5%) was the most common strain. Subtype of CRFs consisted of CRF01_AE (9/65, 13.8%) and CRF02_AG (3/65, 4.6%). Subtype C (1/65, 1.5%), sub-subtypes A1 (2/65, 3.1%) and F1 (2/65, 3.1%) were also detected with low prevalence. The rate of overall primary antiretroviral resistance was 4.9% (3/61). Drug-resistant rate for non-nucleoside reverse transcriptase inhibitors was 4.9%. The thymidine analogue mutation rate was 13.1% (8/61). CONCLUSIONS: HIV molecular epidemiology studies are necessary to determine transmission patterns and spread. Subtype B and CRF01_AE, CRF02_AG are the most prevalent strains in the south-east of Turkey. However, subtype C, sub-subtypes A1 and F1 are of low prevalence but persist in the south-east of Turkey. In the near future, changing of HIV epidemiology will be possible in Turkey due to migration movement in border lines and resistance testing will play an important role in HIV management.

Molecular epidemiology of HIV-1 strains in the south-east and east of Turkey

To detect the subtype characterization and drug-resistant mutations in HIV-1 strains after the refugee movement from Syria to Turkey between 2011 and 2014 in south east border lines. Methods: A total of 65 patients were included in this study, of which 57 (88%) patients were antiretroviral therapy-naive patients. HIV-1 RNA was detected and quantified by real-time PCR assay. HIV-1 subtypes and circulating recombinant forms (CRFs) were identified by phylogenetic analysis (neighbor-joining method), and drug-resistant mutations were analyzed. Results: Three major HIV groups were indicated. Two of these groups were located in subtype B. The other group showed heterogeneity. Subtype B (48/65, 73.8%), followed by CRFs (12/65, 18.5%) was the most common strain. Subtype of CRFs consisted of CRF01_AE (9/65, 13.8%) and CRF02_AG (3/65, 4.6%). Subtype C (1/65, 1.5%), sub-subtypes A1 (2/65, 3.1%) and F1 (2/65, 3.1%) were also detected with low prevalence. The rate of overall primary antiretroviral resistance was 4.9% (3/61). Drug-resistant rate for non-nucleoside reverse transcriptase inhibitors was 4.9%. The thymidine analogue mutation rate was 13.1% (8/61). Conclusions: HIV molecular epidemiology studies are necessary to determine transmission patterns and spread. Subtype B and CRF01_AE, CRF02_AG are the most prevalent strains in the south-east of Turkey. However, subtype C, sub-subtypes A1 and F1 are of low prevalence but persist in the south-east of Turkey. In the near future, changing of HIV epidemiology will be possible in Turkey due to migration movement in border lines and resistance testing will play an important role in HIV management.