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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).
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Humanos , Feminino , Adulto , Refugiados , Saúde da Mulher , Migração Humana , Vulnerabilidade Social , Acessibilidade aos Serviços de Saúde , Portugal/epidemiologia , Entrevistas como Assunto , Pesquisa Qualitativa , Direitos Humanos , Programas Nacionais de SaúdeRESUMO
BACKGROUND: The economic burden of rare diseases on health systems is still not widely measured, with the generation of accurate information about the costs with medical care for subjects with rare diseases being crucial when defining health policies. Duchenne Muscular Dystrophy (DMD) is the most common form of muscular dystrophy, with new technologies recently being studied for its management. Information about the costs related to the disease in Latin America is scarce, and the objective of this study is to evaluate the annual hospital, home care and transportation costs per patient with DMD treatment in Brazil. RESULTS: Data from 27 patients were included, the median annual cost per patient was R$ 17,121 (IQR R$ 6,786; 25,621). Home care expenditures accounted for 92% of the total costs, followed by hospital costs (6%) and transportation costs (2%). Medications and loss of family, and patient's productivity are among the most representative consumption items. When disease worsening due to loss of the ability to walk was incorporated to the analysis, it was shown that wheelchair users account for an incremental cost of 23% compared with non-wheelchair users. CONCLUSIONS: This is an original study in Latin America to measure DMD costs using the micro-costing technique. Generating accurate information about costs is crucial to provide health managers with information that could help establish more sustainable policies when deciding upon rare diseases in emerging countries.
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Efeitos Psicossociais da Doença , Distrofia Muscular de Duchenne , Humanos , Doenças Raras , Distrofia Muscular de Duchenne/terapia , Brasil , Custos de Cuidados de SaúdeRESUMO
SARS-CoV-2 surveillance of viral populations in wastewater samples is recognized as a useful tool for monitoring epidemic waves and boosting health preparedness. Next generation sequencing of viral RNA isolated from wastewater is a convenient and cost-effective strategy to understand the molecular epidemiology of SARS-CoV-2 and provide insights on the population dynamics of viral variants at the community level. However, in low- and middle-income countries, isolated groups have performed wastewater monitoring and data has not been extensively shared in the scientific community. Here we report the results of monitoring the co-circulation and abundance of variants of concern (VOCs) of SARS-CoV-2 in Uruguay, a small country in Latin America, between November 2020-July 2021 using wastewater surveillance. RNA isolated from wastewater was characterized by targeted sequencing of the Receptor Binding Domain region within the spike gene. Two computational approaches were used to track the viral variants. The results of the wastewater analysis showed the transition in the overall predominance of viral variants in wastewater from No-VOCs to successive VOCs, in agreement with clinical surveillance from sequencing of nasal swabs. The mutations K417T, E484K and N501Y, that characterize the Gamma VOC, were detected as early as December 2020, several weeks before the first clinical case was reported. Interestingly, a non-synonymous mutation described in the Delta VOC, L452R, was detected at a very low frequency since April 2021 when using a recently described sequence analysis tool (SAM Refiner). Wastewater NGS-based surveillance of SARS-CoV-2 is a reliable and complementary tool for monitoring the introduction and prevalence of VOCs at a community level allowing early public health decisions. This approach allows the tracking of symptomatic and asymptomatic individuals, who are generally under-reported in countries with limited clinical testing capacity. Our results suggests that wastewater-based epidemiology can contribute to improving public health responses in low- and middle-income countries.
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COVID-19 , Águas Residuárias , Humanos , SARS-CoV-2/genética , Vigilância Epidemiológica Baseada em Águas Residuárias , COVID-19/epidemiologia , Genômica , Sequenciamento de Nucleotídeos em Larga EscalaRESUMO
A methodological approach based on reverse transcription (RT)-multiplex PCR followed by next-generation sequencing (NGS) was implemented to identify multiple respiratory RNA viruses simultaneously. A convenience sampling from respiratory surveillance and SARS-CoV-2 diagnosis in 2020 and 2021 in Montevideo, Uruguay, was analyzed. The results revealed the cocirculation of SARS-CoV-2 with human rhinovirus (hRV) A, B and C, human respiratory syncytial virus (hRSV) B, influenza A virus, and metapneumovirus B1. SARS-CoV-2 coinfections with hRV or hRSV B and influenza A virus coinfections with hRV C were identified in adults and/or children. This methodology combines the benefits of multiplex genomic amplification with the sensitivity and information provided by NGS. An advantage is that additional viral targets can be incorporated, making it a helpful tool to investigate the cocirculation and coinfections of respiratory viruses in pandemic and post-pandemic contexts.
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COVID-19 , Coinfecção , Vírus da Influenza A , Influenza Humana , Vírus de RNA , Vírus Sincicial Respiratório Humano , Infecções Respiratórias , Criança , Adulto , Humanos , COVID-19/diagnóstico , COVID-19/epidemiologia , Pandemias , RNA , Teste para COVID-19 , Coinfecção/diagnóstico , Coinfecção/epidemiologia , SARS-CoV-2/genética , Vírus de RNA/genética , Vírus Sincicial Respiratório Humano/genética , Vírus da Influenza A/genética , Sequenciamento de Nucleotídeos em Larga Escala , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Influenza Humana/epidemiologiaRESUMO
Torque Teno Virus (TTV) was initially associated with post-transfusion hepatitis, but growing evidence of its ubiquity in humans is compatible to no apparent clinical significance. TTV is a small non-enveloped virus with a circular single-negative-stranded DNA genome, belonging to the Anelloviridae family. Currently, TTVs are divided in seven phylogenetic groups and are further classified into 21 species. Studies about diversity of TTV in different conditions are receiving increasing interest and in this sense, sequencing of whole genomes for better genetic characterization becomes even more important. Since its discovery in 1997, few TTV complete genomes have been reported worldwide. This is probably due, among other reasons, to the great genetic heterogeneity among TTV strains that prevents its amplification and sequencing by conventional PCR and cloning methods. In addition, although metagenomics approach is useful in these cases, it remains a challenging tool for viromic analysis. With the aim of contributing to the expansion of the TTV whole genomes dataset and to study intra-host variants, we employed a methodology that combined a rolling-circle amplification approach followed by EcoRI digestion, generating a DNA fragment of â¼4Kb consistent with TTV genome length which was sequenced by Illumina next generation sequencing. A genogroup 3 full-length consensus TTV genome was obtained and co-infection with other species (at least those with a single EcoRI cleavage site) was not identified. Additionally, bioinformatics analysis allowed to identify the spectrum of TTV intra-host variants which provides evidence of a complex evolution dynamics of these DNA circular viruses, similarly to what occurs with RNA viruses.
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Este artigo é fruto de pesquisa de iniciação científica da PUC Minas sobre trabalho doméstico e pandemia. Em junho de 2020, morreu Miguel, de cinco anos, filho da empregada doméstica Mirtes Renata, que trabalhava durante a pandemia de covid-19. Miguel caiu do edifício enquanto estava sob os cuidados da patroa de Mirtes. A partir do estudo de caso do "caso Miguel", aliado à bibliografia sobre trabalhadoras domésticas e relações étnico-raciais, buscou-se: (1) observar as relações entre raça, classe e gênero e a naturalização da precarização deste trabalho; (2) analisar o caso Miguel em sua relação com a profissão e movimentos de resistência na luta por direitos, reconhecimento e justiça. Como resultados, observa-se a potência das mobilizações de coalizão entre movimentos sociais e redes de solidariedade para a identificação do caráter estrutural do fenômeno, atuando em forma ampla pela justiça e transformação dessas estruturas. Conclui-se que a pandemia de covid-19 evidenciou a linha direta entre precarização da profissão e a desvalorização das vidas das trabalhadoras domésticas, sendo a morte de Miguel uma consequência da violência e precarização histórica do lugar da mulher negra
This article is the result of PUC Minas' scientific initiation research on domestic work and pandemic. In June 2020, five-year-old Miguel, son of the domestic worker Mirtes Renata, who was working during the COVID-19 pandemic, died. Miguel fell of the building while in the care of Mirtes' employer. From the case study of "Caso Miguel," combined with the bibliography on domestic workers and ethnic racial relations, we sought to: (1) observe the relationships between race, class, and gender and the naturalization of the precariousness of this work; (2) analyse Miguel's case related with the profession and with resistance movements in the fight for rights, recognition, and justice. As results the potential of coalition mobilizations between social movements and solidarity networks to identify the structural character of the phenomenon, acting broadly for justice and transformation of these structures, is observed. In conclusion, the COVID-19 pandemic evidenced the direct line between the profession precarization and the devaluation of the domestic workers lives, with Miguel's death a consequence of violence and historical precarization of black women place
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Humanos , Masculino , Feminino , Pré-Escolar , Adulto , Relações Raciais/psicologia , COVID-19/psicologia , Condições de Trabalho/psicologia , Categorias de Trabalhadores , Emprego , Coesão Social , Zeladoria , Direitos HumanosRESUMO
Introdução: O Transtorno do Desenvolvimento da Coordenação (TDC) tem prevalência de 5% a 6% nas crianças em idade escolar de cinco a onze anos. No Brasil, o TDC ainda é pouco reconhecido e as crianças, geralmente, recebem pouca ou nenhuma assistência. O transtorno pode persistir na adolescência e idade adulta. Tecnologias emergentes, como realidade virtual e videogames, têm sido o foco de pesquisas recentes de intervenção. Objetivos: Revisar a literatura para identificar estudos que abordam o uso de jogos ativos com crianças e adolescentes com transtorno do desenvolvimento da coordenação. Método: Revisão de escopo, cuja busca foi realizada entre os meses de maio e julho de 2021, na base de dados PubMed, com recorte de 10 anos de publicação, em inglês, português e espanhol, descritores "motor skills disorder", "virtual reality" e "transtorno do desenvolvimento da coordenação" nas três revistas brasileiras de Terapia Ocupacional. Foram excluídos editoriais e estudos com crianças e adolescentes com autismo associado. Resultados: Foram encontrados 16 artigos. Embora a literatura ainda seja escassa neste sentido, os estudos relataram ganhos significativos no desempenho motor de crianças com TDC. Foram identificadas algumas dificuldades em apontar e esclarecer sobre o jogo, instrumento ou mecanismo responsável pelas mudanças no desempenho. Conclusão: A utilização de protocolos sistematizados pode levar ao desenvolvimento de novos estudos para avaliar a eficácia dessas intervenções, bem como a sustentabilidade das melhorias obtidas a longo prazo.
Introduction. Developmental Coordination Disorder (DCD) has a prevalence of 5 to 6% in school-aged children from five to eleven years old. In Brazil, TDC is still poorly recognized, and children generally receive little or no assistance. The disorder can persist into adolescence and adulthood. Emerging technologies such as virtual reality and video games have been the focus of recent intervention research. Objectives. To perform a literature review to identify studies which used active games with children and adolescents with DCD. Method. Scoping review, between May and July 2021, at PubMed database, within 10 years of publication in English, Portuguese and Spanish, terms "motor skills disorder", "virtual reality", and "developmental coordination disorder" in the three Brazilian Occupational Therapy journals. Editorials and studies with children and adolescents with associated autism were excluded. Results. 16 articles were found. Although the literature is still scarce, studies have reported significant gains in the motor performance of children with DCD. Some difficulties were identified in pointing out and clarifying about the game, instrument or mechanism responsible for changes in performance. Conclusion. The use of systematized protocols can lead to the development of new studies to assess the effectiveness of these interventions as well as the sustainability of the improvements obtained in the long term.
Introducción. El trastorno del desarrollo de la coordinación (DCD) tiene una prevalencia del 5 al 6% en niños en edad escolar de cinco a once años. En Brasil, el DCD todavía es poco reconocido y los niños generalmente reciben poca o ninguna asistencia. El trastorno puede persistir hasta la adolescencia y la edad adulta. Las tecnologías emergentes, como la realidad virtual y los videojuegos, han sido el foco de investigaciones recientes sobre intervenciones. Metas. Revisar la literatura para identificar estudios que aborden el uso de juegos activos con niños y adolescentes con trastorno del desarrollo de la coordinación . Método. Revisión del alcance, cuya búsqueda se realizó entre mayo y julio de 2021, en la base de datos PubMed, con 10 años de publicación en inglés, portugués y español, descriptores "trastorno de las habilidades motoras", "realidad virtual" y "trastorno del desarrollo de la coordinación". en las tres revistas brasileñas de Terapia Ocupacional. Se excluyeron las editoriales y los estudios con niños y adolescentes con autismo asociado. Resultados. Se encontraron 16 artículos. Aunque la literatura todavía es escasa al respecto, los estudios han reportado ganancias significativas en el desempeño motor de los niños con DCD. Se identificaron algunas dificultades para señalar y aclarar sobre el juego, instrumento o mecanismo responsable de los cambios en el rendimiento. Conclusión. El uso de protocolos sistematizados puede conducir al desarrollo de nuevos estudios para evaluar la efectividad de estas intervenciones así como la sostenibilidad de las mejoras obtenidas en el largo plazo.
Assuntos
Terapia OcupacionalRESUMO
Data regarding PRRSV-2 in South America are scant and a coordinated criterion for molecular characterization is needed. A phylogenetic analysis was performed using a dataset of 76 ORF5 sequences from South America, and results showed the identification of lineage 5 in the early 2000s and the predominance of lineage 1 at least since 2013. Lineage 1 sequences were further classified into sub-lineages according to a recent molecular characterization study of PRRSV-2 in United States. Our results revealed the recent identification in Uruguay of PRRSV-2 ORF5 sequences of lineage 1 sub-lineage C. Two additional sub-lineages were identified in South America, 1G in Chile and 1A in Peru. Continuous updating the molecular epidemiology of circulating viruses with coordinated investigations among countries is required to control and prevent the emergence of genetic variants of PRRSV-2.