Women's experiences of trauma-informed care for forced migrants: A qualitative interview study.

Introduction: Forced migration affect the health and wellbeing of millions of women. The aim was to explore experiences of trauma-informed care among women who are forced migrants. Methods: This was an exploratory qualitative study. Eleven women who had concluded treatment at multidisciplinary trauma centers in Sweden were interviewed, recruited through consecutive sampling. Audio-recorded interviews were transcribed and analyzed with systematic text condensation. Results: Women dealt with mental and physical manifestations in a challenging psychosocial situation. Various structural and individual barriers were addressed that hindered access to adequate health services. Women appreciated various benefits of the treatment and recalled the care as supportive and compassionate. However, undergoing treatment was considered demanding, requiring significant determination and energy. Participants suggested that peer support could enhance the support. Conclusions: Migrant women experience a range of health-related burdens and encounter barriers to trauma-informed care. While demanding, treatment has the potential to alleviate symptoms. Health professionals and stakeholders providing trauma-informed care need to ensure that their services are accessible and culturally sensitive towards the unique needs of women. Peer support has the potential to enhance support further, which need further evaluation.

Trauma-informed care for women who are forced migrants: a qualitative study among service providers.

AIMS: The aim was to explore service providers' perspectives on trauma-informed care for women who are forced migrants. METHODS: Service providers (n=32) employed at one of six centres providing trauma-informed care for forced migrants were recruited by way of managers. Audio-recorded and transcribed semi-structured focus group discussions were analysed with systematic text condensation. RESULTS: The analysis revealed exposure to gender-based violence and abuse within patriarchal structures as the main challenges for women. Participants recognised remarkable strength and resilience among women. A range of structural, psychosocial and individual barriers to trauma-informed care were addressed. While trauma-informed care was considered to have the potential to improve the health for many women, participants articulated room for improvement in the competence of service providers and the conditions impacting women's opportunities to access support. CONCLUSIONS: Violence, abuse and oppression against forced migrant women severely impact their health and possibilities of accessing support. Services providing trauma-informed care for forced migrants need to empower women, and carefully consider gender-related aspects impacting women's opportunities to access and utilise trauma-informed care. To ensure that women who need support access it, trauma-informed services should work with outreach efforts, ensure competence development among providers, counteract practical barriers and coordinate with health and social services.

Support interventions to promote health and wellbeing among women with health-related consequences following traumatic experiences linked to armed conflicts and forced migration: a scoping review.

BACKGROUND: Women exposed to armed conflicts and forced migration face significant health-related risks and consequences. Consequently, there is a need to identify and develop effective interventions that provide tailored support for them. The aim of this scoping review was to examine research evaluating support interventions promoting the health and well-being among women with traumatic experiences linked to armed conflict and/or forced migration. METHODS: A scoping review of empirical studies evaluating non-pharmacologic/non-surgical interventions promoting health and well-being among adult women with traumatic experiences linked to armed, torture, and/or forced migration, identified through systematic searches in February 2022 within five databases (AMED, CINAHL, Cochrane Library, PsycINFO, and PubMed). Methodological characteristics and results were extracted and analyzed with narrative analysis using tabulations, descriptive statistics, text-based summaries, and thematization. RESULTS: Assessment of 16 748 records resulted in 13 included reports. The methodological approaches were quantitative (n = 9), qualitative (n = 2), and mixed methods (n = 2), with most reports being feasibility/pilot studies (n = 5) and/or randomized controlled trials (n = 4). The most common recruitment strategy was non-probability sampling (n = 8). Most interventions were conducted in North America (n = 4), Asia (n = 3) or Middle East (n = 3). Thirteen intra-intervention techniques and five categories of components utilized within the interventions were identified, the most common being skill building (n = 12). Ten developed the interventions through theoretical frameworks or manuals/therapy, while five developed interventions through public or stakeholder involvement. Eleven studies evaluated outcomes related to psychological health, disorders, or distress. A large proportion of the investigated outcomes showed post-exposure improvements and improvements when compared with controls. Qualitative findings highlighted improved mental and physical health, empowerment and stigma reduction, and enhanced knowledge. CONCLUSION: Few studies have developed and evaluated tailored support interventions for this population, containing a range of components and intra-intervention techniques. No clear focus was identified regarding outcome measures, and most studies used non-probability sampling. Few developed interventions through public contribution in collaboration with women. While limited studies show promising effects on women's mental health, more empirical intervention research that closely corresponds to women's needs are needed.

Experiences of armed conflicts and forced migration among women from countries in the Middle East, Balkans, and Africa: a systematic review of qualitative studies.

BACKGROUND: A significant proportion of the global population is displaced, many being women. Qualitative studies can generate in-depth findings that will contribute to an understanding of their experiences, but there is a need for further synthetization efforts. The aim was to provide a comprehensive perspective about adult women's experiences of armed conflicts and forced migration, focusing on women in or from countries in the Middle East, Balkans, or Africa. METHODS: Systematic review of English reports presenting empirical qualitative studies published in scientific journals 1980 or later, utilizing searches performed in September 2021 within three databases combined with manual screening. Of the 3 800 records screened in total, 26 were included. Methodological details and quality were appraised using pre-specified extraction and appraisal tools. The findings within the included reports were analyzed with thematic analysis. RESULTS: Most reports utilized interviews, including in total 494 participants, and were appraised as having insignificant methodological limitations. The first theme concerns changed living conditions, involving reduced safety, insufficient access to resources meeting basic needs, forced migration as a last resort, and some positive effects. The second theme concerns the experienced health-related consequences, involving psychological distress, risks during pregnancy and childbirth, exposure to violence and discrimination as a woman, as well as a lack of adequate healthcare services and social support. The third theme concerns the resources and strategies that enhance resilience, involving social support and family life, as well as utilization of internal resources and strategies. CONCLUSION: When experiencing armed conflicts and forced migration, women face significant challenges related to changed living conditions and are exposed to health-related consequences. Consistently, women are targets of severe structural and personal violence, while lacking access to even the most basic healthcare services. Despite facing considerable hardships, these women display extraordinary resilience and endurance by finding strength through social support and internal resources. Synthesized qualitative research illustrates that women value social support, including peer support, which is a promising intervention that needs to be evaluated in future experimental studies.

Is the association between physical activity and healthcare utilization affected by self-rated health and socio-economic factors?

BACKGROUND: Physical activity and healthcare utilization has negative association. However, there appears to be limited knowledge of how this association is affected by self-rated health (SRH) and socio-economic status (SES). Therefore, the aim of this study was to examine the association between leisure-time physical activity (LTPA) and healthcare utilization, and investigate how SRH, gender, age and SES affected this association. METHODS: A cross-sectional public health survey was conducted in Skåne, Sweden 2012, based on a random sample with 55,000 participants (response rate 51 %; 28,028 individuals included in the study) aged 18-80 years. The data was linked to individual healthcare utilization data and socio-economic data. Logistic regression analyses were conducted to study the association between LTPA and healthcare utilization. Path analysis was used to investigate the possible mediation effect of SRH to the association between LTPA and healthcare utilization. RESULTS: Compared to sedentary leisure time the odds ratio for health care utilization decreased with increasing level of LPTA; physically active 0.89 (95 % CI: 0.81-0.96), for average exercise 0.74 (0.67-0.81) and for vigorous exercise 0.65 (0.60-0.72). The socio-economic variables attenuated this association to a small degree, but SRH had a strong impact. While the mediation analysis illustrated that the indirect effects were strong (and in the expected order so that higher levels of LTPA were more negatively associated with poor health) and highly significant, the direct effects suggested that higher levels of physical activity were more positively associated with healthcare utilization than lower levels. The indirect effects were substantially stronger than the direct effects. CONCLUSIONS: There was a significant negative association between decreased healthcare utilization and increased LPTA, and the association remained after adjustment for socio-economic variables. The mediation analysis (with SRH as the mediator between LTPA and healthcare utilization) showed that the indirect effects were strong and in the expected order, but the direct effects of LTPA on healthcare utilization was positive so that higher levels of LTPA had higher healthcare utilization. These results suggest that even though higher physical activity in total decreases the healthcare utilization, parts of the association that is not mediated through SRH actually increase healthcare utilization.

Biodigestores anaeróbicos de flujo ascendente para la depuración de líquido cloacal

El trabajo permitió verificar la aplicabilidad del tratamiento anaerobio a la depuración de líquido cloacal sin utilizar calefacción en clima templado. Compara el comportamiento de reactores de lecho fijo (filtro anaerobio) con manto de barro de flujo ascendente (UASB) operados en condiciones similares durante el período de 450 días y a escala semipiloto. Los tiempos de residencia hidráulica utilizados entre 24 y 6 horas, alcanzándose remociones medias del orden de 65 por ciento para DQO y 70 por ciento para DBO

Biodigestores anaeróbicos de flujo ascendente para la depuración de líquido cloacal

El trabajo permitió verificar la aplicabilidad del tratamiento anaerobio a la depuración de líquido cloacal sin utilizar calefacción en clima templado. Compara el comportamiento de reactores de lecho fijo (filtro anaerobio) con manto de barro de flujo ascendente (UASB) operados en condiciones similares durante el período de 450 días y a escala semipiloto. Los tiempos de residencia hidráulica utilizados entre 24 y 6 horas, alcanzándose remociones medias del orden de 65 por ciento para DQO y 70 por ciento para DBO

Plano de ação para minimizar riscos sanitários através da educação permanente em saúde

A diálise é um procedimento de alto custo/complexidade e requer uma articulação entre os níveis secundários e terciários de assistência. Nos últimos anos, houve um acréscimo de sua demanda, o que acarreta um custo financeiro significativo, uma vez que no Brasil, 95% dos tratamentos dialíticos são pagos pelo SUS. Tendo em vista o imprescindível papel de promover a orientação e informação quanto às boas práticas nos serviços de terapia renal substitutiva, este trabalho visa realizar um Programa de Educação Permanente desenvolvido pelos técnicos das vigilâncias sanitárias estadual e municipal do Rio de Janeiro. O público-alvo das ações educativas são os profissionais de saúde que atuam nos serviços de diálise localizados no município do Rio de Janeiro, abordando as novas legislações em vigor e o gerenciamento de risco e qualidade, a fim de promover a qualificação dos serviços e segurança do paciente.