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1.
Sociol Health Illn ; 44(6): 936-952, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35510616

RESUMO

The Enhanced Interrogation programme was a medicalised interrogation programme that was designed by the United States in the wake of 9/11. It is now widely recognized that the Enhanced Interrogation programme engaged in some activities that were, at the least, tantamount to torture. The programme was designed by Psychologists and overseen by other professionals, including medical professionals. This article argues that the Enhanced Interrogation programme displayed many of the features of what Sociologists refer to as Edgework. It demonstrated voluntary risk-taking by health and other professionals; this risk-taking pressed up against catastrophic outcomes across multiple dimensions; risks were taken for the purposes of escaping a death-saturated macrosocial context; and the health professionals in the programme were highly skilled. The article argues that a new form of Edgework can be detected by studying the programme, which the article refers to as 'Institutional Edgework'.


Assuntos
Tortura , Pessoal de Saúde , Humanos , Estados Unidos
2.
BMC Health Serv Res ; 22(1): 533, 2022 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-35459239

RESUMO

BACKGROUND: Torture, abuse and dental anxiety (TADA) are often precursors to developing a pathological relationship with dental care due to elevated anxiety. Consequently, patients who suffer from one or more of these tend to avoid dental services. This could leave them with severe tooth decay, which could affect their general and psychosocial health. Norwegian dental services have implemented the TADA service to specifically alleviate dental anxiety and restore oral health for the TADA patient group. However, the service has not been evaluated, and there is a need to understand how and why this service works, for whom, under what circumstances. Therefore, this study aimed to develop theories on how the service's structure alleviates dental anxiety and restores these patients' oral health. Although developed in a Norwegian context, these theories may be applicable to other national and international contexts. METHODS: This realist evaluation comprised multiple sequential methods of service and policy documents (n = 13), followed by interviews with service developers (n = 12). RESULTS: The analysis suggests that, by subsidising the TADA service, the Norwegian state has removed financial barriers for patients. This has improved their access to the service and, hence, their service uptake. National guidelines on service delivery are perceived as open to interpretation, and can hereby meet the needs of a heterogeneous patient group. The services have become tailored according to the available regional resources and heterogeneous needs of the patient population. A perceived lack of explicit national leadership and cooperative practices has resulted in regional service teams becoming self-reliant and insular. While this has led to cohesion within each regional service, it is not conducive to interservice collaborations. Lastly, the complexity of migration processes and poor dissemination practices is presumed to be the cause of the lack of recruitment of torture survivors to the service. CONCLUSIONS: Policy documents and service developers described the TADA service as a hybrid bottom-up/top-down service that allows teams to practise discretion and tailor their approach to meet individual needs. Being free of charge has improved access to the service by vulnerable groups, but the service still struggles to reach torture survivors.


Assuntos
Tortura , Transtornos de Ansiedade , Ansiedade ao Tratamento Odontológico/prevenção & controle , Humanos , Saúde Bucal , Sobreviventes
3.
Transcult Psychiatry ; 59(3): 380-392, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35382629

RESUMO

Despite the high prevalence of sexual torture and its close link with gender, little work has been published on refugee torture survivors from Muslim-majority countries. The aim of this project was to introduce a gender-critical framework, that draws on post-modern and post-colonial feminism, to the study of sexual torture in terms of its operationalization and psychological impact in Iranian, Afghan, and Kurdish refugees in the United Kingdom (UK). This exploratory qualitative research was conducted in collaboration with two voluntary organizations in the UK. Mental healthcare providers (HCPs) were invited to participate through convenience sampling from amongst their staff as well as from community mental health services. Torture survivors were recruited through snowball sampling. The study consists of two parts: 1) semi-structured face-to-face interviews with a total of eight experts (doctors and therapists) and three torture survivors; followed by 2) a focus group with four experts to discuss the emerging results from the interviews and together reflect on the politics of gender and sexuality in the context of torture ('assisted sense-making'). A thematic gender-critical analysis was performed for the qualitative data. Our findings from interviews with (only Kurdish) torture survivors and HCPs suggest that gender mediates the impact of sexual torture at the intersection of gender, cultural norms, forms of social inequality, and body politics. The conclusions of the study will have implications for health services by deepening our understanding of variables that intersect in an entangled and unpredictable network.


Assuntos
Refugiados , Transtornos de Estresse Pós-Traumáticos , Tortura , Humanos , Irã (Geográfico) , Prevalência , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Sobreviventes/psicologia , Tortura/psicologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-35329237

RESUMO

Refugees and asylum seekers often face delayed mental health diagnoses, treatment, and care. COVID-19 has exacerbated these issues. Delays in diagnosis and care can reduce the impact of resettlement services and may lead to poor long-term outcomes. This scoping review aims to characterize studies that report on mental health screening for resettling refugees and asylum seekers pre-departure and post-arrival to a resettlement state. We systematically searched six bibliographic databases for articles published between 1995 and 2020 and conducted a grey literature search. We included publications that evaluated early mental health screening approaches for refugees of all ages. Our search identified 25,862 citations and 70 met the full eligibility criteria. We included 45 publications that described mental health screening programs, 25 screening tool validation studies, and we characterized 85 mental health screening tools. Two grey literature reports described pre-departure mental health screening. Among the included publications, three reported on two programs for women, 11 reported on programs for children and adolescents, and four reported on approaches for survivors of torture. Programs most frequently screened for overall mental health, PTSD, and depression. Important considerations that emerged from the literature include cultural and psychological safety to prevent re-traumatization and digital tools to offer more private and accessible self-assessments.


Assuntos
COVID-19 , Refugiados , Transtornos de Estresse Pós-Traumáticos , Tortura , Adolescente , COVID-19/diagnóstico , COVID-19/epidemiologia , Criança , Feminino , Humanos , Saúde Mental , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Tortura/psicologia
5.
Eur J Oral Sci ; 130(3): e12860, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35218586

RESUMO

Patients with a trauma history, whether sexual abuse or torture, or dental phobia, tend to avoid dental services due to severe dental anxiety. Subsequently, they experience poor oral health, lower quality of life, and poorer general health. In Norway, a specific service (torture, abuse, and dental anxiety [TADA]) targets these patients' dental anxiety through cognitive behavioural therapy (CBT) prior to dental restoration. By exploring patients' experiences with TADA services using a realist evaluation approach, this paper aims to increase our understanding of how this type of service addresses patients' dental anxiety in terms of its mechanisms and contextual factors. Interviews with TADA patients (n = 15) were analysed through a template analysis driven by context-mechanism-outcome heuristics. The analysis revealed that patients value a dental practitioner who provides a calm and holistic approach, positive judgements and predictability elements that lean towards a person-centred care approach. Provided this, patients felt understood and cared for, their shame was reduced, self-esteem emerged, and control was gained, which led to alleviation of dental anxiety. Therefore, our findings suggest that combining CBT with a person-centred care approach helps alleviate patients' dental anxiety. This provides insights into how dental services could be executed for these patients.


Assuntos
Ansiedade ao Tratamento Odontológico , Tortura , Ansiedade ao Tratamento Odontológico/terapia , Odontólogos , Humanos , Papel Profissional , Qualidade de Vida
6.
Transl Psychiatry ; 12(1): 37, 2022 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-35082270

RESUMO

Torture has profound psychological and physiological consequences for survivors. While some brain structures and functions appear altered in torture survivors, it is unclear how torture exposure influences functional connectivity within and between core intrinsic brain networks. In this study, 37 torture survivors (TS) and 62 non-torture survivors (NTS) participated in a resting-state fMRI scan. Data-driven independent components analysis identified active intrinsic networks. Group differences in functional connectivity in the default mode network (DMN), salience network (SN) and central executive network (CEN) of the triple network model, as well any prefrontal network, were examined while controlling for PTSD symptoms and exposure to other potentially traumatic events. The analysis identified 25 networks; eight comprised our networks of interest. Within-network group differences were observed in the left CEN (lCEN), where the TS group showed less spectral power in the low-frequency band. Differential internetwork dynamic connectivity patterns were observed, where the TS group showed stronger positive coupling between the lCEN and anterior dorsomedial and ventromedial DMN, and stronger negative coupling between a lateral frontal network and the lCEN and anterior dorsomedial DMN (when contrasted with the NTS group). Group differences were not attributed to torture severity or dissociative symptoms. Torture survivors showed disrupted dynamic functional connectivity between a laterally-aligned lCEN that serves top-down control functions over external processes and the midline DMN that underpins internal self-referential processes, which may be an adaptive response to mitigate the worst effects of the torture experience. This study provides a critical step in mapping the neural signature of torture exposure to guide treatment development and selection.


Assuntos
Imageamento por Ressonância Magnética , Tortura , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Humanos , Rede Nervosa/diagnóstico por imagem , Sobreviventes
10.
Psychol Trauma ; 14(1): 80-90, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34138611

RESUMO

Objective: This mixed-methods study assessed the prevalence of pre-and postmigration trauma and stressors as determinants of refugee mental health in resettlement. Method: Forty-four war-affected Syrian civilians arriving in Portugal through four streams-UNHCR resettlement, EU relocation, spontaneous asylum, and higher education programs for refugees-participated in focus groups and individual interviews. Participants completed self-report measures of trauma and torture and PTSD symptoms, and narrated pre- and postmigration experiences and distress through semistructured interviews. We used descriptive statistics to characterize incidence of trauma and distress, and thematic analysis to identify themes of pre- and postflight stressors. Results: Participants reported a mean 12.9 (SD = 7.2) war trauma events, with six men also disclosing having been tortured. Twenty-five percent met diagnostic criteria for PTSD. Key results identified preflight contextual, personal, family, and community daily stressors capable of shattering prewar meaning systems, and postflight common stressors aggravated by state-sponsored host conditions, the ongoing conflict, and, for the student group, subsequent to temporary returns to Syria. Conclusion: Regardless of legal status on arrival, civilians from war-torn countries may be exposed to pre- and postmigration trauma and stressors that severely impact their mental health, reinforce feelings of uprootedness, and dim integration prospects. Findings highlight the need for host countries to create opportunities for agency and autonomy to improve refugees' own integration prospects and ability to initiate their path to recovery. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Refugiados , Transtornos de Estresse Pós-Traumáticos , Tortura , Humanos , Masculino , Saúde Mental , Autorrelato , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Síria
13.
J Trauma Stress ; 35(1): 138-147, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34275166

RESUMO

Refugee children in the Nordic countries have been reported to perform poorly in school and carry a high burden of familial posttraumatic stress. The present study aimed to investigate the impact of maternal and paternal posttraumatic stress on the school performance of refugee children. We used national register data on school grades at age 15-16 along with demographic and migration indicators during 2011-2017 in a population of 18,831 children in refugee families in Stockholm County, Sweden. Parental posttraumatic stress was identified in regional data from three levels of care, including a tertiary treatment center for victims of torture and war. Multivariable linear and logistic regression models were fitted to analyze (a) mean grade point averages as Z scores and (b) eligibility for upper secondary school. In fully adjusted models, children exposed to paternal posttraumatic stress had a lower mean grade point average, SD = -0.14, 95% CI [-0.22, -0.07], and higher odds of not being eligible for upper secondary education, OR = 1.37, 95% CI [1.14, 1.65]. Maternal posttraumatic stress had a similar crude effect on school performance, SD = -0.15, 95% CI [-0.22, -0.07], OR = 1.25, 95% CI [1.00, 1.55], which was attenuated after adjusting for single-parent households and the use of child psychiatric services. The effects were similar for boys and girls as well as for different levels of care. Parental posttraumatic stress had a small negative effect on school performance in refugee children, adding to the intergenerational consequences of psychological trauma.


Assuntos
Refugiados , Transtornos de Estresse Pós-Traumáticos , Tortura , Adolescente , Criança , Pai , Feminino , Humanos , Masculino , Pais , Refugiados/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia
14.
J Law Med ; 29(1): 254-259, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35362293

RESUMO

The present study evaluates the reported medical examination procedures in Turkish detention facilities of Turkish detainees who sought asylum in Germany after their detention in Turkey and the present process of medico-legal reporting, to evaluate compliance with the principles of the Istanbul Protocol and to discuss the issue in the context of the literature. Fifty-one participants were asked questions related to the examination steps specified in the Istanbul Protocol. 61% of participants were examined in an inappropriate place according to Istanbul Protocol. 42 participants (82.3%) claimed they had been mistreated through beatings, improper application of handcuffs, being forced to stand up for a long time, lying on bare concrete floors, staying in confined spaces without fresh air, and psychological torture. The answers given by the participants revealed that not all medical examinations conducted by the Turkish authorities during the detention were carried out in accordance with the Istanbul Protocol.


Assuntos
Tortura , Humanos , Exame Físico , Tortura/psicologia , Turquia
15.
BMJ Open ; 11(11): e053670, 2021 11 05.
Artigo em Inglês | MEDLINE | ID: mdl-34740935

RESUMO

INTRODUCTION: Healthcare professionals working in somatic departments are not trained to recognise signs of torture or provide appropriate healthcare to torture survivors, which may result in retraumatisation during surgical treatment. METHODS AND ANALYSIS: This protocol outlines a four-stage qualitative-method strategy for the development and evaluation of guidelines for prevention of retraumatisation of torture survivors during surgical care. The systematic search for literature review in stages 1 and 2 was conducted in August 2019 and March 2021, respectively, using nine databases. The search strategies employed in stage 1, without imposing any date limits, resulted in the inclusion of eight studies that addressed inadequate healthcare strategies associated with retraumatisation. The clinical guidelines review in stage 2 will include publications from 2000 onwards, which will be appraised using the Appraisal of Guidelines Research and Evaluation Version II instrument. Following multi-institutional recruitment in Norway, stage 3 will explore survivors' experiences of receiving surgical treatment using indepth interviews (n=8-12), which will be audio-recorded, transcribed verbatim and analysed using the interpretative phenomenological analysis approach. In stage 4a, based on the findings from stages 1, 2 and 3, a set of clinical guidelines for preventing retraumatisation during surgical treatment will be developed. Next, the feasibility and acceptability of the guidelines will be assessed in stage 4b in three interdisciplinary focus group interviews (n=5 per group) and text condensation analyses. ETHICS AND DISSEMINATION: The Regional (South-East C) Committee for Medical and Health Research Ethics approved the study in May 2021 (#227624). In stages 3 and 4, an informational letter and an informed consent form will be distributed to the participants to sign before the interview. The study results will be disseminated through publications, conference presentations, and national and local public forums to healthcare professionals, service managers, policymakers and refugee-supporting agencies.


Assuntos
Refugiados , Tortura , Pessoal de Saúde , Humanos , Pesquisa Qualitativa , Sobreviventes
17.
Torture ; 31(1): 19-36, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34606475

RESUMO

BACKGROUND: International law prohibits threats made by state officials when amounting to torture or other forms of ill-treatment (hereafter "ill-treatment"). Yet, there remains a pressing need to better distinguish in practice the threatening acts which amount to torture or illtreatment (and as prohibited) from acts which fall short. Responding to this need, this article reviews the literature and offers a discussion towards functionally conceptualising and, in turn, qualifying threats as torture or ill-treatment. METHOD: Following a systematic full-text search of databases with the relevant Englishlanguage keywords, journal articles, NGO reports, case-law and UN documents were selected based on their relevance for conceptual, evidentiary and legal critique of threatsas- torture. DISCUSSION: Prevailing legal reasoning around threats-as-torture centres on the words "real, credible and immediate", with inadequate explication as to their application. To this end, this article proposes that an assessment of the perception of practice and proximity of state authorities to harm could be used to help qualify threats as "real, credible and immediate" and therefore torturous.


Assuntos
Tortura , Humanos , Direito Internacional , Percepção
18.
Torture ; 31(1): 37-52, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34606476

RESUMO

INTRODUCTION: Due to the COVID-19 pandemic, Freedom from Torture developed remote telephone assessments to provide interim medico-legal reports, ensuring people could obtain medical evidence to support their asylum claim. METHOD: To audit this new way of working, feedback was collected from the doctors, interpreters, individuals being assessed, and senior medical and legal staff who reviewed the reports. This paper presents findings from the first 20 assessments. RESULTS: Individuals assessed reported that the doctor developed good rapport, but in 35% of assessments reported that there were some experiences they felt unable to disclose. In 70% of assessments, doctors felt that rapport was not as good compared to face-to-face. In the majority of assessments, doctors were unable to gain a full account of the torture or its impact. They reported feeling cautious about pressing for more information on the telephone, mindful of individuals' vulnerability and the difficulty of providing support remotely. Nevertheless, in 85% of assessments doctors felt able to assess the consistency of the account of torture with the psychological findings, in accordance with the Istanbul Protocol (United Nations, 2004). Factors that hindered the assessment included the inability to observe body language, the person's ill health, and confidentiality concerns. CONCLUSION: This research indicates that psychological medico-legal reports can safely be produced by telephone assessment, but are more likely to be incomplete in terms of both full disclosure of torture experiences and psychological assessment. The limitations underline the need for a follow-up face-to-face assessment to expand the psychological assessment as well as undertake a physical assessment.


Assuntos
COVID-19/epidemiologia , Relações Médico-Paciente/ética , Refugiados/psicologia , Consulta Remota/ética , Telefone , Tortura , Humanos , Anamnese , Pandemias , Exame Físico , SARS-CoV-2 , Reino Unido/epidemiologia
19.
Torture ; 31(1): 53-63, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34606477

RESUMO

INTRODUCTION: This study was conducted to address a lack of information in the literature regarding the frequency and consequences of specific types of torture and abuse among Eritreans seeking asylum in the United States. METHODS: Cross-sectional study of Eritreans seeking asylum in the United States presenting to a human rights clinic for forensic medical and psychological evaluations based on Istanbul Protocol. Reports were eligible for inclusion if subjects: 1) immigrated from Eritrea 2) reported torture and abuse in Eritrea, 3) were 18 or older. 59 reports met inclusion criteria. Demographic features of individuals, reported history and specific types of torture, and physical and psychological sequelae were analyzed. RESULTS: Over 300 instances of torture were reported, an average of about 6 per person. The primary forms of torture reported were beating (87.7%) and forced positioning (57.9%). 90% of asylum seekers examined had physical findings which were consistent with the torture they reported, some of which had clinical as well as forensic significance. 86% of asylum seekers met diagnostic criteria for post-traumatic stress disorder. CONCLUSION: Eritreans seeking asylum in the United States bear a high burden of post-traumatic physical and psychological morbidity.


Assuntos
Refugiados , Transtornos de Estresse Pós-Traumáticos , Tortura , Estudos Transversais , Eritreia/epidemiologia , Humanos , Masculino , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Estados Unidos
20.
Torture ; 31(1): 88-92, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34606480

RESUMO

In front of the current ongoing debate on the need to actively engaging torture survivors in the global fight against torture, IRCT held a webinar at the request of IRCT member centres. The webinar examined torture survivor engagement in the rehabilitation process of rebuilding lives, seeking justice and torture prevention. Lived experience can be emancipating and also paralysing, but foremost, it is precious to combat what has been suffered in the first person (Henry, 2021). How to recognise that contribution and engage torture survivors in the global fight against torture? What role do survivors play in society? How to involve survivors in advocacy and policy-making processes? What are the existing power (in)balances at play? Who gets to decide whether a survivor should speak up or not? Acknowledging that it can prompt some organisational, therapeutic, and professional considerations, what are the limits? How do we ensure that the survivor's well-being is protected along the process? To what extend should survivors be engaged in our organisation's decision-making? Léonce Byimana, Feride Rushiti, Kolbassia Haoussou and Vasfije Karsniqi-Goodman walked us through these questions. The discussion was enhanced with inputs from other IRCT-members.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Tortura , Humanos , Justiça Social , Sobreviventes , Caminhada
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