Narrativas femininas e saúde mental: a saída da República Democrática do Congo e o refúgio no Rio de Janeiro / Female narratives and mental health: the departure from Democratic Republic of Congo and the refuge in Rio de Janeiro

O objetivo central desta dissertação é refletir sobre o processo de refúgio e a relação deste com a saúde mental de mulheres naturais da República Democrática do Congo (RDC), residentes no Rio de Janeiro. Essa dissertação foi realizada a partir de um estudo qualitativo, de abordagem etnográfica, composto por observação participante e entrevistas, realizado em uma instituição de acolhimento a esta população - a Caritas RJ. A partir das falas dessas mulheres, este trabalho traz ponderações sobre como o Brasil que, até o momento, detém uma legislação favorável à questão do refúgio (lei 9.474 de 1997), na realidade, não apresenta providências de acordo com o que se comprometeu e contribui para a manutenção de vulnerabilidades. Ao analisar as trajetórias das mulheres negras, congolesas, refugiadas em território nacional, me apoio nos conceitos de precarização da vida e sofrimento social, para associar os contextos de violência persistentes e suas interferências em quadros mentais. Neste sentido, foi possível notar a ampla capacidade de resiliência apresentada por elas e sua relação com a religião e a cultura. Entre os adoecimentos, foi observado maior presença de quadros de natureza somatoforme, ansiosa e depressiva (Transtornos Mentais Comuns - TMC). Diante deste contexto, as propostas da Saúde Mental Global (SMG), com tratamentos baseados em evidências e particularizados entre diferentes culturas, podem beneficiar esse grupo

The main goal of this dissertation is to reflect on the refugee process and the relationship between it and the mental health of women from the Democratic Republic of Congo (DRC) residing at Rio de Janeiro. This is a qualitative study with an ethnographic approach composed of participant observation and interviews, performed at a host institution for this population - Caritas RJ. Based on the statements of these women, this work brings forward considerations about how Brazil, which until now has legislation favorable to the issue of refuge (Law 9.474 of 1997), in fact, does not present provisions according to what it has committed and contributes to the maintenance of vulnerabilities. In analyzing the trajectories of black Congolese women refugees in the national territory, I use as a theoretical base the concepts of precariousness of life and social suffering in order to associate persistent contexts of violence and their interference in mental conditions. In this sense, it was possible to note the wide capacity of resilience presented by them and their relation to religion and culture. Among the diseases, there was a greater presence of somatoform, anxious and depressive conditions (Common Mental Disorders - CMD). Given this context, Global Mental Health (MCH) proposals with evidence-based and individualized treatments among different cultures may benefit this group

Unresolved Splenomegaly in Recently Resettled Congolese Refugees - Multiple States, 2015-2018.

In 2014, panel physicians from the International Organization for Migration (IOM), who conduct Department of State-required predeparture examinations for U.S.-bound refugees at resettlement sites in Uganda, noticed an unusually high number of Congolese refugees with enlarged spleens, or splenomegaly. Many conditions can cause splenomegaly, such as various infections, liver disease, and cancer. Splenomegaly can result in hematologic disturbances and abdominal pain and can increase the risk for splenic rupture from blunt trauma, resulting in life-threatening internal bleeding. On CDC's advice, panel physicians implemented an enhanced surveillance and treatment protocol that included screening for malaria (through thick and thin smears and rapid diagnostic testing), schistosomiasis, and several other conditions; treatment of any condition identified as potentially associated with splenomegaly; and empiric treatment for the most likely etiologies, including malaria and schistosomiasis. CDC recommended further treatment for malaria with primaquine after arrival, after glucose-6-phosphate dehydrogenase testing, to target liver-stage parasites. Despite this recommended treatment protocol, 35 of 64 patients with available follow-up records had splenomegaly that persisted beyond 6 months after resettlement. Among 85 patients who were diagnosed with splenomegaly through abdominal palpation or ultrasound at any point after resettlement, 53 had some hematologic abnormality (leukopenia, anemia, or thrombocytopenia), 16 had evidence of current or recent malaria infection, and eight had evidence of schistosomiasis. Even though primaquine was provided to a minority of patients in this cohort, it should be provided to all eligible patients with persistent splenomegaly, and repeated antischistosomal therapy should be provided to patients with evidence of current or recent schistosomiasis. Given substantial evidence of familial clustering of cases, family members of patients with known splenomegaly should be proactively screened for this condition.

Notes from the Field: Splenomegaly of Unknown Etiology in Congolese Refugees Applying for Resettlement to the United States - Uganda, 2015.

Approximately 70,000-90,000 refugees are resettled to the United States each year, and during the next 5 years, 50,000 Congolese refugees are expected to arrive in the United States. The International Organization for Migration (IOM) performs refugee medical examinations overseas for the U.S. Refugee Resettlement Program. In 2014, IOM reported that a large number of U.S.-bound Congolese refugees from Uganda had spleens that were enlarged on examination. During two evaluations of refugee populations in western Uganda in March and July 2015, refugees with splenomegaly on physical examination were offered additional assessment and treatment, including abdominal ultrasonography and laboratory testing. Among 987 persons screened, 145 (14.7%) had splenomegaly and received further testing. Among the 145 patients with splenomegaly, 63.4% were aged 5-17 years (median = 14.8 years). There was some evidence of family clustering, with 33 (22.7%) of the 145 cases occurring in families.

A Biocultural Investigation of Gender Differences in Tobacco Use in an Egalitarian Hunter-Gatherer Population.

In the developing world, the dramatic male bias in tobacco use is usually ascribed to pronounced gender disparities in social, political, or economic power. This bias might also reflect under-reporting by woman and/or over-reporting by men. To test the role of gender inequality on gender differences in tobacco use we investigated tobacco use among the Aka, a Congo Basin foraging population noted for its exceptionally high degree of gender equality. We also tested a sexual selection hypothesis-that Aka men's tobacco use is related to risk taking. Tobacco use, income, tobacco purchases, tobacco sharing, reasons for using tobacco, risk taking, and other variables were measured using structured surveys and peer reports. Tobacco use was verified by testing for salivary cotinine, a nicotine metabolite. Contrary to expectations, we found a very large male bias in tobacco use. Low levels of use among females appeared to be explained by aversions to tobacco, concerns over its negative effects on fetal health, and a desire to attract husbands, who prefer nonsmoking wives. High male use appeared to be related to a desire to enhance hunting abilities and attract and/or retain wives, who prefer husbands that smoke. We conclude that low levels of smoking by Aka women are better explained by the hypothesis that women evolved to avoid plant toxins to protect their fetuses and nursing infants. High male use might be better explained by sexual selection. We also highlight the important role that recreational drugs appear to play in hunter-gatherer sharing relationships.

Pilot evaluation of a health promotion program for African immigrant and refugee women: the UJAMBO Program.

The UJAMBO Program was a series of one session group workshops with Congolese and Somali women in the United States built around a DVD using African immigrant women's stories which provided basic information about mammography, pap smears and mental health services for trauma. The current study is an evaluation of the UJAMBO program addressing the impact on participants'knowledge of these health services and their intentions to use these services.

[Acute poststreptoccocal chorea: an atypical postoperative reaction following cardiac surgery for mitral valvulopathy]. / Chorée aiguë post-streptococcique : une étrange réaction après chirurgie d'une insuffisance mitrale rhumatismale.

We report on a 12-year-old patient from Congo who presented acute chorea following cardiac surgery for poststreptococcal mitral valvulopathy. She showed severe and asymmetrical chorea, associated with motor impersistence and agitation. Biological investigations disclosed inflammatory signs and brain MRI was normal. Due to the negative results of the biological and morphological investigations, the diagnosis of Sydenham chorea was suspected. High doses of oral steroids resulted in a dramatic improvement of the chorea as well as the behavior disturbance within 1 month. Sydenham chorea is not an unusual complication of rheumatic fever. Usually, patients develop chorea a few weeks after beta-hemolytic streptococcal pharyngitis. Details on its pathophysiology remain to be determined. Our case highlights its possible onset in the postoperative period if alternative etiologies of infantile chorea have been excluded.

Vitamin D deficiency and hyperparathyroidism in relation to ethnicity: a cross-sectional survey in healthy adults.

BACKGROUND: The study of vitamin D status at population level gained relevance since vitamin D deficiency was recently suggested to trigger chronic disease. AIM OF THE STUDY: We aimed to describe vitamin D status, its association with bone and mineral metabolism and risk factors for deficiency in adults over 40 years in Belgium. METHODS: We conducted a cross-sectional survey in a stratified random sample of 401 subjects aged between 40 and 60 years living in Brussels, and drawn from 4 different ethnic backgrounds: autochthonous Belgian, Moroccan, Turkish and Congolese. 25-Hydroxyvitamin D (25OHD), parathyroid hormone (PTH), osteocalcin, C-telopeptide and bone mineral density was measured. RESULTS: Three-hundred and six subjects (77%) showed 25OHD concentrations below 50 nmol/l,135 (34%) below 25 nmol/l and 18 (5%) below 12.5 nmol/l. The proportion of subjects with vitamin D deficiency was four times greater amongst those of Moroccan or Turkish descent compared with those of Congolese or Belgian descent. Moroccan subjects showed a significant higher PTH and bone marker concentrations compared to Belgian. Ethnicity, season and sex were independently associated with vitamin D deficiency in multivariate analysis. CONCLUSION: The prevalence of vitamin D deficiency is very high amongst the adult population of Brussels but immigrants are at greater risk. Given the established link between population health and adequate vitamin D status, a policy of vitamin D supplementation should be considered in these risk groups.

[Medical transportation of Congolese children by the Foundation "Terre des hommes" Netherlands (1989--1998)]. / Transfert sanitaire d'enfants congolais par la Fondation <> Pays-Bas (1989--1998).

We report the 10 year assessment of collaboration with the Foundation "Terre des hommes" concerning the medical transfer in the Netherlands of 41 children carrying pathologies which couldn't be treated or operated on in Brazzaville. The average age was 3 years and 6 months old (extremes: 2 months - 15 years). 33 non-cyanotic cardiopathies dominated by ventricular septal defect (VSD) (n = 10) and 11 cyanotic cardiopathies among them the tetralogy of Fallot (n = 5) were admitted. The other pathologies were respectively: osseous (n = 3), vesical (n = 2), pulmonary tumoral, ophthalmic in 1 case. The surgery consisted in a complete repair in 19 cases, palliative in 9 cases. Two children proved to be inoperable. Eight other extra-cardiac pathologies had a specific surgery for each case. The average stay in the Netherlands was 1 month 13 days (extremes: 1 - 12 months). The evolution was favourable for 35 children all pathologies included. Four deaths occurred in the Netherlands and 2 in Congo. The organization of the technology transfer would be probably a better choice in the future.

[Chicken bones in the uterus--an exceptional reason for sterility]. / Hühnerknochen im Uterus - eine ungewöhnliche Ursache von Sterilität.

Chicken bones in the uterus - an exceptional reason for sterility.Because of a substantial increase in the migration from developing countries to Europe, gynaecologists have to face more the fact, that they are confronted more frequently both with medical and social problems from these regions. WE present the following case: In 1999 a Congolese women was referred to our clinic because of sterility of unknown reason. The hysteroscopy followed by D & C showed chicken bones in the uterus. It can be assumed, that a clandestine abortion performed in her native land is the reason for this finding.