Journal articles on the topic 'Socio-therapeutic environment'

Abstract This article presents a proposal to categorise stimuli that influence well-being in therapeutic environments following Complementary and Integrative Practices (CIPs). With the broader aim of understanding which environmental stimuli influence the well-being of CIP therapeutic environment users, this qualitative research adopted a multimethod approach: bibliographic and documentary research; walkthrough analysis; exploratory visits; environment observations; and finally, interviews. After cross-referencing a literature review and an environmental assessment of three case studies during 2017, a categorisation was drawn up, and it suggests that the stimuli which most influence well-being in CIP environments are: Artistic, Auditory, Biological, Luminous and Hygrothermal Comfort, Energetic, Spatial, Natural, Olfactory, Social and Socio-Spatial stimuli. Included in a broader debate on creating environments favourable to users’ health, and in line with an increasing demand of CIPs in Brazil, this categorisation aims at contributing to the knowledge of CIP environment-specific necessities and improving the quality from the early stage of project idealisation.

The connection the Māori, the Indigenous people of Aotearoa-New Zealand, have to the land is threatened by the effects of colonisation, urbanisation and other factors. In particular, many Māori suffer significant health and wellbeing inequalities compared to the non-Māori population. In an effort to reduce such inequalities, there is a growing consciousness of the need to better understand the cultural and place-specific determinants that affect the health and wellbeing of population groups in different environments. This article explores how environmental and cultural connections to land enable the development of place-specific and culturally-driven principles that promote the health and wellbeing of Māori populations. It argues that concepts of place, belonging, landscape and wellbeing play an important role in linking environment and culture as well as in contributing to creating therapeutic spatial environments that promote both human health and ecosystems. A set of principles is developed that allows for the landscape design of such therapeutic environments while accommodating the socio-cultural and environmental values that promote health and wellbeing of both Māori and non-Māori people.

Objective:The therapeutic community is an established psychiatric treatment method which may be in decline. This paper reviews the nature of inpatient therapeutic community treatment, and re-evaluates its role. Method:The principles and practice of such treatment are summarised, with a focus on the functions of staff. Results:The inpatient therapeutic community is conceptualised as combining socio-therapeutic treatment, psychotherapeutic treatment, and the advantages of the inpatient setting. This unique treatment environment allows for therapeutic regression while mitigating against anti-therapeutic behavioural regression. Research evidence supports the efficacy of therapeutic community treatment for patients with borderline personality disorder. Conclusion:Further research is needed to assess its efficacy for other diagnostic groups. This intensive treatment approach may be most appropriate for patients who have proved treatment resistant by other means. Possible reasons for the marginal-ization of therapeutic community treatment are considered. Access to quality inpatient therapeutic community treatment is essential in the provision of a comprehensive psychiatric service.

The article deals with the problem of forming an adaptive "therapeutic" environment for the system of maternity hospitals and perinatal centers that has developed in the country. This problem is considered in a comprehensive manner, highlighting several aspects, such as: socio-historical-cultural, functional planning, architectural-spatial, figurative-semantic aspect. On this basis, the study proposes several promising approaches to creating an adaptive therapeutic environment for maternity facilities using various architectural modernization tools and identifying a number of typological models of such an environment. The following approaches are presented: "urban planning approach", which takes into account the optimization of various options for urban planning placement of maternity hospitals and perinatal centers; “environmental approach”, which allows considering perinatal centers as a set of exterior and interior spaces, commensurate with a person, his behavioral stereotypes, emotional state. "Ecological approach" - involves the introduction of natural components into the interior and exterior of the complex, which makes the period of rehabilitation of women in labor effective. "Architectural and planning approach" - is aimed at improving the functional and planning links of the objects of the perinatal center. "Scenario-functional approach" in the formation of a comfortable therapeutic environment of a medical institution allows us to consider communications in the space of a medical institution as a kind of spatio-temporal scenario on the way of the main routes of movement inside the interiors and exteriors along the "axis": entrance area - admission department - lobby, hall, etc. .d. The "artistic-figurative approach" assumes that a "typical" ward in medical institutions should not be limited only by the technological and functional component, and the comfort of patients' stay should take into account their emotional state. The "compositional approach" to the formation of the therapeutic environment of maternity facilities takes into account the "competent" formation of the architectural space, taking into account the laws of architectural harmonization, aesthetic and compositional principles. The systematization of the identified approaches and directions for designing a comfortable architectural "therapeutic" environment for perinatal centers creates a methodological basis for the development of promising architectural and typological models of these objects, taking into account their modernization and new construction

Natural products endowed of biological activity represent a primary source of commodities ranging from nutrition to therapeutic agents, as well as cosmetic tools and recreational principles. These natural means have been used by mankind for centuries, if not millennia. They are commonly used all over the world in socio-economical contexts, but are particularly attractive in disadvantaged areas or economically emerging situations all over the world. This is very likely due to the relatively easy recovery of these bioactive principles from the environment, at a low if any cost, as well as ease of administration and the general popular compliance concerning their consumption/ingestion. In this concise review, we focus on some popular bioactive principles of botanical origin which find a wide use in the Madagascan populations. However, due to space limitations, only some of the most common and largely diffused principles in this country are considered. Finally, a possible nanotechnological administration is discussed in the case where a potential therapeutic usage is envisaged.

The development of a ‘smart’ drug capable of distinguishing tumor from host cells has been sought for centuries, but the microenvironment of solid tumors continues to confound therapeutics. Solid tumors present several challenges for current oncotherapeutics, including aberrant vascularization, hypoxia, necrosis, abnormally high pH and local immune suppression. While traditional chemotherapeutics are limited by such an environment, oncolytic microbes are drawn to it – having an innate ability to selectively infect, colonize and eradicate solid tumors. Development of an oncolytic species would represent a shift in the cancer therapeutic paradigm, with ramifications reaching from the medical into the socio-economic. Modern genetic engineering techniques could be implemented to customize ‘Frankenstein’ bacteria with advantageous characteristics from several species.

Neurodegenerative diseases are characterized by the progressive loss of structure and/or function of both neurons and glial cells, leading to different degrees of pathology and loss of cognition. The hypothesis of circuit reconstruction in the damaged brain via direct cell replacement has been pursued extensively so far. In this context, stem cells represent a useful option since they provide tissue restoration through the substitution of damaged neuronal cells with exogenous stem cells and create a neuro-protective environment through the release of bioactive molecules for healthy neurons, as well. These peculiar properties of stem cells are opening to potential therapeutic strategies for the treatment of severe neurodegenerative disorders, for which the absence of effective treatment options leads to an increasingly socio-economic burden. Currently, the introduction of new technologies in the field of stem cells and the implementation of alternative cell tissues sources are pointing to exciting frontiers in this area of research. Here, we provide an update of the current knowledge about source and administration routes of stem cells, and review light and shadows of cells replacement therapy for the treatment of the three main neurodegenerative disorders (Amyotrophic lateral sclerosis, Parkinson’s, and Alzheimer’s disease).

AimsDepression is the single largest contributor to global disability. However, effective treatments are currently lacking, resulting in a significant burden of treatment-resistant depression (TRD). Psilocybin, a serotonergic psychedelic, found as the active compound in 'magic mushrooms', has been proposed as a novel therapeutic avenue for TRD. We aimed to evaluate the future feasibility and implications of psilocybin as a new antidepressant therapy.MethodWe reviewed and critically analysed the available literature on the efficacy and safety of psilocybin as a treatment for depression, and the potential pharmacological and psychological mechanisms of the therapeutic benefit. We discussed the relative contributions to this therapeutic effect of the pharmacological drug treatment, placebo effects, and the context and parameters of the psychotherapeutic experience. We reviewed legal, social, and economic barriers to primary research and clinical implementation.ResultPsilocybin in combination with psychotherapy has been shown to be safe and effective in TRD. Its mechanism of action in TRD has not been fully elucidated, however reviewing functional neuroimaging studies demonstrated disparate short and long-term modifications of default mode network connectivity, suggested to represent a ‘reset’ mechanism of acute modular disintegration and subsequent reintegration which restores normal function, reviving emotional responsiveness.Research suggests psychedelic treatment induces lasting personality, belief and attitude changes. The psychedelic drug itself, the context of the psychotherapeutic experience, and the post-drug integration therapy all appear to have a significant role. Preparation prior to treatment, the environment, context and support during the psychedelic experience itself, and the following long-term integration and support process must be considered.Despite novel findings Psilocybin is a Schedule I drug; this imposes a persisting ethical barrier to clinical use. Prohibition of psilocybin results in high costs of drug supply, and potential for harmful drug-seeking behaviours. Therefore, complex socio-political factors currently limit wider implementation.ConclusionPsilocybin in combination with psychotherapy is safe and effective in TRD. The interacting and elusive therapeutic mechanisms have implications for clinical implementation. Preparation prior to treatment, the physical and social environment in which the psychedelic experience takes place, and long-term integration and support are considered to play a significant role. Optimisation of these parameters and cost-benefit analyses are required prior to this being feasible as a widely available therapy. Systemic legislative, political and social change will also be key to enable widespread clinical use. The promise of this therapy on a background of inadequate current antidepressant treatments indicates these must be a priority.

The onset of the COVID-19 in the UK has resulted in an inordinate amount of deaths affecting Black, Asian and Ethnic Minority (BAME) healthcare workers. The occupational risk to this group is thought to be a contributory factor, but other factors include race, genetics, medical co-morbidities, socio-economic status, and access to personal protection equipment. Why COVID-19 appears to be more deadly in BAME members remains unknown, but the UK government is investigating this now. It does appear that certain factors may worsen the disease process in BAME members, but which ones are pertinent to prevention remain to be determined, until a vaccine is available. Thus, the onus should rest on risk prevention, education, and support for all. Some of the safety strategies that may be instituted to help guide those in the workplace include education, treating potential therapeutic targets and ensuring protection in the working environment. The consideration of a compensation scheme, for families of healthcare workers that have suffered because of COVID-19, would go some way to support the recovery process.

Discursive inequality in the construction of the »speech-language deficit« of deprived families and children In the second half of the 20th century, disciplines such as linguistics, sociolinguistics, and sociology were the first to inquire into the connection between the social position (of families) and the linguistic dispositions of children – these authors were also the ones who provided theoretical and methodological means to support the research. But the recent decades have seen a slow change in the ‘leading’ disciplines – with the greater role given to developmental psychology, speech therapy, pedagogy and neuroscience. This has brought some accompanying changes: the corpus of gathered data has rapidly grown and the correlation between socio-economic status and child development was given more focus (and was more concisely outlined) than ever before. And alongside that – the authors have shifted attention toward factors of early familial environments and their role in ‘social reproduction’: in the social inheritance of developmental deficits in disadvantaged children. But this growing body of data (gathered with standardized instruments and new technology) has allowed some theoretical “fluidity”. Previous models were replaced with less coherent descriptive categories. For example; the social class was transformed into “socio-economic index” or “status” and has lately dispersed to numerous descriptive remarks on the “quality” of familial environment and parenting strategies (of privileged/disadvantaged parents). Considering linguistic categories: authors have dropped attempts to study semantic, semiotic, and contextual aspects of language use and have focused solely on the lexical and syntactical attributes of particular environments and speakers. These changes have abruptly broken the line of causality that was developed by Bernstein and systemic functional linguistics. The “stream” of discursive reproduction of inequality has lost its previous interpretative power. But not only that – the new research has unforeseen consequences. For example, individualisation of social inequality; the blaming of (poor) parents for their seeming inability to provide enough linguistic stimulation. And lastly the reduction of complex relations of social inequality on some (calculable) developmental pathologies in disadvantaged children – that one can measure and “repair” thorough pedagogic/therapeutic means. Key words: discursive inequality, speech and language development, disadvantaged social groups, individualisation, social inequality, social reproduction

Undefined cultural factors cannot be dismissed and significantly contribute to the worldwide incidence of death by suicide. Culture is an all embracing term and defines the relationship of an individual to his environment. This study seeks to investigate the effect of culture on suicide both regionally and internationally. Culture-bound syndrome with suicidal behaviours specific to a particular culture or geographical region are discussed. Opinions are divided as to the status of religious martyrs. The law itself is silent on many aspects of suicidal behaviour and despite decriminalization of suicide as self-murder, the latter remains on the statutes of many developing countries. The Caribbean region is of concern due to its steady rise in mean suicide rate, especially in Trinidad and Tobago where socio-cultural factors are instrumental in influencing suicidal behaviour. These include transgenerational cultural conflicts, psycho-social problems, media exposure, unemployment, social distress, religion and family structure. The methods used are attributed to accessibility and lethality. Ingestion of poisonous substances is most popular followed by hanging. The gender differences seen with regard to suicidality can also be attributed to gender related psychopathology and psychosocial differences in help-seeking behaviour. These are influenced by the cultural environment to which the individual is exposed. Culture provides coping strategies to individuals; as civilization advances many of these coping mechanisms are lost unclothing the genetic predisposition of vulnerable groups. In the management of suicidal behaviour, a system of therapeutic re-culturation is needed with an emphasis on relevant culture- based therapies.

One of the techniques utilised in the management of cancer in all stages is multiple biomedical imaging. Imaging as an important part of cancer clinical protocols can provide a variety of information about morphology, structure, metabolism and functions. Application of imaging technics together with other investigative apparatus including in fluids analysis and vitro tissue would help clinical decision-making. Mixed imaging techniques can provide supplementary information used to improve staging and therapy planning. Imaging aimed to find minimally invasive therapy to make better results and reduce side effects. Probably, the most important factor in reducing mortality of certain cancers is an early diagnosis of cancer via screening based on imaging. The most common cancer in women is breast cancer. It is considered as the second major cause of cancer deaths in females, and therefore it remained as an important medical and socio-economic issue. Medical imaging has always formed part of breast cancer care and has used in all phases of cancer management from detection and staging to therapy monitoring and post-therapeutic follow-up. An essential action to be performed in the preoperative staging of breast cancer based on breast imaging. The general term of breast imaging refers to breast sonography, mammography, and magnetic resonance tomography (MRT) of the breast (magnetic resonance mammography, MRM). Further development in technology will lead to increase imaging speed to meet physiological processes requirements. One of the issues in the diagnosis of breast cancer is sensitivity limitation. To overcome this limitation, complementary imaging examinations are utilised that traditionally includes screening ultrasound, and combined mammography and ultrasound. Development in targeted imaging and therapeutic agents calls for close cooperation among academic environment and industries such as biotechnological, IT and pharmaceutical industries.

Malocclusion is defined as irregularity of the teeth or a mal-relationship of the dental arches beyond the range of what is accepted as normal occlusion. Maloccluded teeth can cause psychological problems that are related to impaired dentofacial esthetics. Malocclusion may also cause serious problems related to oral health. This is a multifactorial defect caused by factors such as environment, lifestyle, health, genetics, socio-economic status etc. Clear aligners are orthodontic therapeutic options which are preferred for the correction of maloccluded teeth. The main aim of the study was to find out the awareness of the patients towards the preference of clear aligners as orthodontic treatment options. A University based setting was conducted. A sample size of hundred patients was taken for the survey. The survey was done by distributing an online questionnaire through Google forms consisting of 11 questions and circulated among the participants. The participants comprise both male and female patients. To eliminate bias, a randomized sampling method was used. The data was collected over a period of one week. All the 11 questions of the survey were close ended questions. Chi square test was applied to find the association between the parameters and the level of significance. This study shows the patients have a moderate understanding of clear aligners and their acceptance of it as an orthodontic treatment option.

Many refugees will face unique socio-emotional stressors before, during, and after resettling in their new home country. The program presented herein focuses on the use of para-professionals, peer educators, from within refugee communities to build upon the Center for Torture and Trauma Survivors Clubhouse model. Group leaders seek to provide supports that will: 1) decrease feelings of isolation; 2) build community networks and; 3) increase feelings of empowerment within the community. To accurately represent the fluidity of the refugee population in this metropolitan region, background is presented on an established refugee population from Iraq and a more recent influx of refugees of Bhutan (ethnic Nepali). The juxtaposition of the two groups underscores the importance of presenting a dynamic program that is peer-led to provide the supports necessary to acclimate to their new environment. Program evaluation results from groups run in 2016-2017 indicate that the groups have been successful in helping participants make friends, get information, become more independent, and feel better about life in America. Additionally, participants report a significantly higher number of individuals who they can “talk to about problems or worries” and connect to with a sense of trust within their ethnic community. Finally, the utility of other therapeutic and support processes, such as horticultural and expressive arts therapies, are discussed apropos work with refugee populations.

This review focused on data on the prevalence of diabetes mellitus especially type 2 diabetes mellitus (T2DM) in Africa, where the current number of diabetes individuals has reached 19 million. There appears to be heterogeneity in the data between countries with a trend towards the development of diabetes at an earlier age, high socio-economic impact but also limited financial resources given that the majority of African countries are developing countries with low to middle income. Africa is not spared the universal risk factors for T2DM, but the influence of the environment (urbanization), inadequate diets and sedentary lifestyle, often leading to overweight and obesity, remains a major concern. This is reflected in projections and estimates by the International Diabetes Federation (IDF), which predicts a 143% increase in the number of people with diabetes in Africa by 2045. Other factors have a negative impact on diabetes management, such as difficult access to medication and lack of education programs. Overall and individual awareness raising in collaboration with health authorities, governments and the media remains the most appropriate. Pending the implementation of national programs for the prevention of diabetes and its complications, it is necessary to strengthen therapeutic education and improve the quality of primary care in order to fight the scourge of diabetes. Keywords: Type 2 diabetes mellitus, epidemiology, prevalence, risk factors, Africa.

Background: The coronavirus disease 2019 pandemic has affected millions of people worldwide, compromising the responsiveness of governments and states and thus generating anxiety and fear at the population level. Objective: To assess the level of anxiety and fear of coronavirus disease 2019 in a Spanish adult population group. Methods: A descriptive cross-sectional study, using the anxiety and fear of COVID-19 assessment scale (AMICO, for its acronym in Spanish). The sample was composed of 1038 subjects. Univariate and bivariate statistical analyses were performed, after analysis of normality in the data distribution. Categorical regression analyses were also executed. Findings: The total sample size was 1036 subjects, 56.3% was made up of females, with a mean age of 48.11 years (SD = 15.13). The mean score obtained on the AMICO scale was 5.54 points (SD = 1.83), with a score range between 1.22 and 10. Bivariate analysis only demonstrated statistically significant differences in the mean score of the scale and the variables: sex, marital status, work area and academic level. The executed categorical regression analysis revealed an R2 value of 0.75 and a significance of p = 0.00. Conclusions: The results obtained show that the Spanish population presents moderate anxiety levels to coronavirus disease 2019. Women, married, with primary and/or secondary education level, and working in the public transport, services and/or hospitality sectors are more likely to have high levels of fear and anxiety. Application to Practice: These results could be used for therapeutic and preventive psychological interventions, and also to plan new research under sex perspective and observing the socio-economic environment.

Background Acinetobacter species have been a leading cause of nosocomial infections, causing significant morbidity and mortality over the entire world including Ethiopia. The most important features of A. baumannii are its ability to persist in the hospital environment and rapidly develop resistance to a wide variety of antibiotics. This study aimed to determine trend of antimicrobial resistance in Acinetobacter species over a five years period. Method A retrospective data regarding occurrence and antimicrobial resistance of Acinetobacter species recovered from clinical specimens referred to the national reference laboratory was extracted from microbiology laboratory data source covering a time range from 2014 to 2018. Socio-demographic characteristics and laboratory record data was analyzed using SPSS 20. Results A total of 102 strains of Acinetobacter species were analyzed from various clinical specimens. Majority of them were from pus (33.3%) followed by blood (23.5%), urine (15.6%) and body fluid (11.7%). Significant ascending trends of antimicrobial resistance was shown for meropenem (12.5% to 60.7%), ceftazidime (82.1% to 100%), ciprofloxacin (59.4% to 74.4%), ceftriaxone (87.1% to 98.6%), cefepime (80.0% to 93.3%) and pipracillin- tazobactam (67.8% to 96.3%). However, there was descending trend of antimicrobial resistance for tobramycin (56.5% to 42.8%), amikacin (42.1% to 31.4%) and trimethoprim-sulfamethoxazole (79.0 to 68.2%). The overall rate of carbapenem non-susceptible and multidrug resistance rates in Acinetobacter species were 56.7% and 71.6%.respectively. Conclusion A five year antimicrobial resistance trend analysis of Acinetobacter species showed increasing MDR and resistance to high potent antimicrobial agents posing therapeutic challenge in our Hospitals and health care settings. Continuous surveillance and appropriate infection prevention and control strategies need to be strengthened to circumvent the spread of multidrug resistant pathogens in health care facilities.

Immune responses that control tolerance to self, tolerance to conceptus during pregnancy, and defense against cancer and pathogens are governed by dendritic cells (DC), that are key immune cell types that integrate environment signals and direct T and B cell immune responses. Different DC subtypes exist in mice that each trigger a specific type of immune response, such as cytotoxicity, antibody production, and regulatory processes. Interestingly in mice, it is possible to target specific DC subtypes with antigenised antibodies and obtain a desired type of immune response. However this conceptual breakthrough in vaccinology and immune regulation manipulation may only be valid for laboratory mice, as unfortunately often encountered in the process of bench to bed side translation. Furthermore, whether DC subsets knowledge and manipulation can be translated to human and to animal of socio-economical importance is still not known. We adressed this question in pigs and ruminants. The interest of these species over mice are that (1) they are the direct target species for vaccines, (2) they present genetic diversities and live in an open environment, (3) they present physiological similarities with human such as skin for pigs with skin being a main site for vaccination, (4) skin migrated DC and DC subsets can be collected from lymph after surgical catheterisation of lymph ducts in these species, and not in mice. We studied the molecular characterisation profiles of DC subsets from skin in ruminant and swine and evaluated how they compare to mouse and human DC subsets, based on comparative transcriptomic analyses. We assessed whether ruminant and swine DC subsets share functional similarities and differences with the corresponding murine subsets, and whether these properties translate into novel vaccine developements. Overall our work unravel conserved molecular and functional features that allow characterization of dendritic cell subtypes across mammals and possibly across vertebrates. In the past few decades, a tremendous amount of effort has been invested in developing gene and cell therapies for inherited genetic diseases such as Huntington's disease (HD). However, progress in their clinical application has been very limited. One of the major barriers is the lack of appropriate animal models that allow precise prediction patterns in human patients. Most of the animal models used for gene and cell therapy study are primarily focused on safety and toxicity evaluation, while therapeutic efficacy cannot be fully addressed because they do not carry the same human diseases. Although mouse models of human diseases are available and have been widely used for the development of new therapies, mice are not good predictors for humans because of the fundamental differences (genome composition, body size, life span and metabolic mechanism) between humans and rodents. Although monkeys are one of the best models for studying pharmacokinetics and overall impact of treatment, they are primarily used for safety and toxicity evaluation. Even HD monkey models, created by chemical induction or focal gene transfer in the brain, develop similar cellular pathology, therapeutic efficacy and systemic evaluation cannot be determined, which is one of the major barriers in drug and therapeutic development. The development of transgenic HD monkeys has opened the door for a new paradigm of animal modeling for the advancement of novel gene and cell therapy. HD monkeys not only carry the genetic defect that leads to human HD, they also develop clinical features comparable to humans that no other animal model does. While testing in HD monkeys has yet to be achieved until a cohort of well characterized HD monkeys was established, iPS cell lines derived from HD monkeys with a board spectrum of HD pathology and clinical features are a unique in vitro model for studying HD pathogenesis and the development of novel therapeutic approaches. New knowledge and treatments generated from iPS cells can next be translated and applied in HD monkeys from whom the stem cells were derived, thus the goal of personalized medicine can also be evaluated. This work was funded by a grant from NCRR/NIH (R24RR018827).

The surveys on the epidemiology of drug addiction have shown that the number of people abusing substances, to which disease dependence may occur is constantly increasing. Lasting and more significant results for drug addiction limitation can be expected and gained only from the coordinated efforts of government bodies, society, family, school, and individuals. The resocialization of drug addicts is a process that helps them reintegrate into the social system. This requires a precise diagnosis of the causes that have led to detachment from the environment (family, friendship, professional), to understand the individual characteristics of the persons themselves, to select communication-specific and therapeutic support measures, specific to the given personality. The paper discusses the socio-psychological approaches for resocialization of persons with drug addiction. The aim of the study is to determine the influence of personality peculiarities of the drug addicts on their motivation for resocialization. The study involved 20 drug addicts aged 19-27 years included in the methadone program, psychotherapeutic procedures for drug withdrawal in the Military Medical Academy, Sofia. Methods: documentary method – studied are national and European documents, as well as scientific literature on the research topic; sociological method - standardized interview; multi-factor personal questionnaire - Mini Mult for express diagnosis of the personality type in screening studies on MMPI scales; statistical methods. Results: Characteristic for the studied drug addicts are hysteria (70%), followed by the occurrence of schizoidia (65%) and the same proportion of manifestations of psychopathy and hypomania (55%). Hypochondriacal attitudes (0%) were not noted in the respondents. Only 10% of them have a tendency to depression and 40% have psychotic disorders. 70% of the surveyed have marked behavioral abnormalities. The high values on the “hysteria” and “psychopathy” scale create a "favorable protective" factor - a certain power of the self and an interest to social groups. From the results of the interview conducted with regard to the motivation for resocialization of the drug addicts it is noticeable that most of the respondents (92,8%) want and try to overcome the difficulties that their dependency creates. This is a good motivational precondition for resocialization. Two-thirds of respondents noted a significant striving for a positive personal change and efforts to overcome dependence. Resocialization is a process that, depending on the individual's circumstances and personality particularities, takes place at a different intensity and in too long time limits. It depends on both the good will and the moral attitude of the individual, as well as on the empathic understanding, the support of the family, friends, the environment and the institutions that have a significant role in the process of resocialization.

The assumptions of the own research presented in the article refer to the socio-interactive approach that assumes that learning and proper language acquisition by a child require cognitive activity, proper progress in cognitive development, and active - resulting from social relations - observation of adult speech. The research assumptions also take into account the importance of the autoregulatory function of language and systemic understanding of the concept of family. The aim of the study was to check the presence of the relationship between speech understanding by children with delayed verbal development and the various dimensions of their family functioning and ego-resiliency of parents. The study included a group of 72 well-cognitively functioning Polish children aged 5-7 with a diagnosis of delayed verbal development and their families selected using random and nonprobability sampling. The children were examined using the Polish Picture Vocabulary Test – Comprehension - version A (PPVT-C). Functioning of the families of the examined children was operationalized by the results of FACES IV by D. Olson (the Polish version of the scale was used); while the Ego Resiliency Scale was used to study resilience. The results of the conducted research indicate, among others, that families of children with lower scores on speech understanding present less favorable functioning profiles in the scope of selected dimensions of FACES -IV: Family Communication, Cohesion, Disengaged and Family Satisfaction. However, the relationship between the child's understanding of speech and other demographic variables such as parent's age, parent's gender, parent's education, marital status has not been confirmed. It was recognized that the results of the research will allow in the future to optimize the therapeutic services offered to children with verbal development disorders and their families in their natural environment, as well as to allow the presentation of appropriate strategies to support speech development (especially speech understanding abilities) in children. The creation of a group representing a certain type of language disorder will allow a better adaptation of the training program to the specific difficulties experienced by a child, as well as allow for more effective involvement of parents in preventive measures.

Background. The usage of psychoactive substances (PS) is one of the most urgent among other medical and social problems of nowadays. One of the aspects of menacing nature of this phenomenon is psychological and somatic consequences, so called comorbid conditions, which in the future lead to severe psychosomatic disorders, more significant in young or old age. Contemporary medical reform in Ukraine has reoriented for family doctors general medical care to somatic patients, which, in turn, requires the creation of professional scientific and practical developments to provide them with qualified assistance. Objective – to develop of the system of diagnostic and medical care for somatic patients who use PS in the practice of family medicine. Materials and methods. In accordance with the relevant methods (clinical, anamnestic, socio-demographic, psychodiagnostic, clinical-psychopathological and statistical), 220 thematic patients who applied with somatic complaints to the family doctor were examined. All these patients take different kinds of PS. Results. Characteristic features of the examined patients were such as: prevailing age group was the senior group of people (60%), the youngest was 38%; a large proportion of respondents were educated in dysfunctional families (42%); the families in which the parents use of PS, in the families in which there where systematic conflicts, material and everyday problems, burdened heredity, concomitant somatic diseases (28%), etc. Most of these surveyed began to use PS in the age of teenagers (66%), a significantly smaller number was that one who had begun to use PS in elderly age. The motivation for the usage of surfactant in the younger group was dominated by the negative impact of the micro-environment, at the elder age we diagnostic the subjective deprivation of the patients from difficult social circumstances, improvement of general mental and physical conditions. The complaints of these patients who need a help of family doctors were formed by us in the form of the main profiles of somatic pathology: cardiovascular, pulmonary-respiratory, gastro-intestinal. In the mental plan these patients had depressive, disturbing, asthenic states in different proportions. Most of them who use PS prefer tobacco and alcohol or combined forms (72%), much less patients use PS. The developed system of early diagnostics of comorbid pathology is based on a four-level clinical characteristic of psychosomatic pathology with the appropriate correlation between the type and level of PS which had been used. Conclusions. The main profiles of somatization in these cases were outlined (48% of patients have the problems with the cardiovascular system, with the digestive tract – 32%, with the pulmonary-respiratory system – 20% of patients), which were combined with mental illnesses. The system of early diagnostics of the usage of psychoactive substances by somatic patients was developed with the help of corresponding AUDIT-tests, a number of parallel psycho-diagnostic methods and laboratory data. On the basis of characteristic features of anamnesis, socio-demographic, clinical psycho-pathological and somatic data, a system of psycho-therapeutic, rehabilitation and psycho-prophylaxis assistance to the patients in the practice of family medicine was developed.

Interest in the different diagnostic groups of the mentally retarded started in the 19th century, but this made little contribution toward better treatment and care. Medical interest was mainly focused on the prevention of mental retardation. It was not until the 1950's and 60's that interest in research in the care and treatment of these persons intensified. The next step, study of the interaction between handicapped persons and the environment is the key to a better understanding of how to plan for work with the handicapped. New members of the therapeutic team (e. g., psychologists, and sociologists) will take over (Edgerton, 1984) if medical groups, especially psychiatrists, do not become more aware of the importance of the interaction between the handicapped and the environment.

ABSTRACT Objective: to analyze the actions to control TB in a João Pessoa-PB’s detention unity, the reports of detainees were used. Methodology: this is a qualitative study, performed with 13 detainees in treatment, after approval by the Ethics and Research Comitee of the Faculdade de Enfermagem Nova Esperança, under protocol n. 039/07. Was chosen as the technique of semi-structured interview, using a voice recorder. The material was analyzed through the technique of content analysis, thematic modality. Result: the detainees reported that the principal actors involved in actions to control and treatment of TB are: the nursing staff, family, and is the most valued by them and prisoners who work in socio-educational activities to reduce penalty. The natural environment in the prison is violent and hostile actions favoring the gaps in control and in addition. The containment includes a greater number of weaknesses. Conclusion: the treatment is purely therapeutic consisting solely in drug intake, and yet, failing, featuring the interruption of treatment and promoting drug-resistant tuberculosis. Furthermore, professionals must be able to experience the unique culture of the place. Descriptors: tuberculosis, pulmonary; tuberculosis, multidrug-resistant; prisons.RESUMOObjetivo: analisar as ações de controle da TB em uma unidade prisional de João Pessoa-PB, a partir de relatos dos detentos assistidos. Metodologia: estudo qualitativo, realizado com 13 detentos em tratamento, após aprovação do Comitê de Ética e Pesquisa da Faculdade de Enfermagem Nova Esperança, sob o protocolo de n. 039/07. Elegeu-se a técnica de entrevista semiestruturada, utilizando um gravador de voz. O material foi analisado através da Técnica de Análise de Conteúdo, modalidade temática. Resultado: os detentos relataram que os principais envolvidos nas ações de controle e tratamento da TB, são: a equipe de enfermagem; a família, sendo que é a mais valorizada por eles e, os presos que atuam em atividades socioeducativas para redução da pena. O ambiente natural do presídio é violento e hostil, favorecendo lacunas nas ações de controle. Além disso, o confinamento contempla um maior número de fragilidades. Conclusão: o atendimento é puramente terapêutico consistindo unicamente na ingestão de medicamentos e, ainda sim, apresentando falhas, caracterizando a interrupção do tratamento e favorecendo a tuberculose multirresistente. Além disso, os profissionais devem ser capacitados para vivenciar a cultura própria do local. Descritores: tuberculose pulmonar; tuberculose resistente a múltiplos medicamentos; prisões.RESUMEN Objetivo: analizar las acciones de control de la tuberculosis en una prisión de João Pessoa, en Paraíba, desde los relatos de los reclusos atendidos. Metodología: estudio cualitativo, hecho con 13 reclusos en tratamiento, después de la aprobación del Comité de Ética en Investigación de la Faculdade de Enfermagem Nova Esperança, proceso 039/07. La entrevista fue semiestructurada, utilizando una grabadora de voz. El material fue analizado mediante la técnica de Análisis de Contenido, una modalidad temática. Resultado: los reclusos relataron que los principales envueltos en las acciones de control y tratamiento de la tuberculosis son: el equipo de enfermería; la familia, siendo esta la más valorada por ellos, y los reclusos que hacen actividades socio-educativas para reducción del riesgo. El medio ambiente natural en el presidio es violento y hostil, favoreciendo el surgimiento de lagunas en las acciones de control y, también, el confinamiento contempla un mayor número de fragilidades. Conclusión: el atendimiento es sólo terapéutico y consiste solamente en la ingestión de medicamentos, pero presenta fallas, caracterizando la interrupción del tratamiento y favoreciendo la tuberculosis multi-resistente. Además, los profesionales deben ser capaces de lidiar con la cultura propia del lugar. Descriptores: tuberculosis pulmonar; tuberculosis resistente a múltiples medicamentos; prisiones.

Background: Chronic disease is a common public health problem worldwide. Adherence to long-term treatment is a key determinant of therapeutic success in patients with chronic diseases. Aim & Objective: The purpose of the study was to know the people’s attitude towards intake of drug, medication adherence and their relationship with socio demographic profile. Settings and Design: Data were collected from 729 individuals chronic disease sufferers chosen randomly from all 81 villages of Amdanga Block West Bengal through a household-based survey in a cross- sectional design. Methods and Material: A pre designed, pre tested, semi structured schedule containing socio-demographic profile and attitude among the respondents regarding adherence to long-term treatment. Statistical analysis used: To compare Attitude scores among different groups, median (IQR) attitude score was calculated and compared with Mann-Whitney U test and Kruskal-Wallis test to know the level of significance of variables. p–value < 0.05 considered statistically significant. Results: Attitude towards long-term adherence to treatment to chronic diseases were significantly associated to caste (p=0.043), education (p=0.001) and occupation (p=0.001) of the study subject. Conclusions: Attitude towards long-term adherence to treatment to chronic diseases were significantly associated to caste, education and occupation.

The objective of this study was to describe patterns of medication use among homeless adults from the city of Porto, Portugal. We recruited 146 homeless participants in four social services institutions. Data on the use of medicines in the previous week were collected using face-to-face interviews. We described the prevalence and main correlates of use of medicines from different Anatomical Therapeutic Chemical classification (ATC) groups. A total of 56.8% of the homeless reported to have used at least one medicine in the previous week. The most frequently reported were benzodiazepines (21.9%) and antipsychotics (15.1%); socio-demographic characteristics, lifestyle variables and use of health care were not found to be significantly associated with their use. The prevalence was 1.4% for anti-inflammatory and antirheumatic products, and 6.2% for antihypertensives, diuretics and beta-blocking agents. Medicines pertaining to the nervous system ATC group were by far the most frequently used, while those for the treatment of other common chronic and acute conditions seem to be underused.

Abstract INTRODUCTION Acute leukemia (AL) accounts for one third of childhood cancers. Cardiovascular conditions are serious long-term complications of childhood AL. However, few studies have investigated the risk of metabolic syndrome (MetS), a known predictor of cardiovascular disease, in patients treated without hematopoietic stem cell transplantation (HSCT). We describe the overall and age-specific prevalence, and risk factors for MetS and its components in the L.E.A. French cohort of childhood AL survivors treated without HSCT. METHODS L.E.A. is a long-term follow-up program involving all childhood AL survivors treated in the French participating centers since 1980 (clinicaltrials.gov identifier: NCT 01756599). MetS was defined according to the National Cholesterol Education Program - Adult Treatment Panel III (NCEP-ATPIII) criteria revised in 2005. RESULTS The study included 650 adult patients. The mean age at evaluation was 24.2 years and the mean follow-up after leukemia diagnosis was 16.0 years. Central nervous system (CNS) irradiation was performed in 18.0% of patients (n=117). The prevalence of MetS was 6.9% (95% CI 5.1-9.2). The age-specific cumulative prevalence at 20, 25, 30 and 35 years of age was 1.3%, 6.1%, 10.8% and 22.4%, respectively, as shown in the Figure. The prevalence of decreased HDL-cholesterol, increased triglycerides, increased fasting glucose, increased blood pressure and increased abdominal circumference was 26.8%, 11.7%, 5.8%, 36.7% and 16.7%, respectively. The risk factors significantly associated with metabolic syndrome in the multivariate analysis were male gender, older age at last evaluation and higher body mass index at diagnosis, as shown in the Table. Cumulative steroid dose was not a significant risk factor. CNS-irradiated and non-irradiated patients exhibited different patterns of metabolic abnormalities, with more frequent abdominal obesity in irradiated patients and more frequent hypertension in non-irradiated patients. DISCUSSION Our study aimed to precisely describe the overall and age-specific prevalence, and risk factors of MetS in a large cohort of childhood AL survivors treated without HSCT. Notably, the subgroup treated with chemotherapy alone is one of the largest ever published, which is of particular interest as current protocols include very limited CNS irradiation indications. The prevalence of MetS was approximately two-fold higher than that observed in the adult French general population under 40 years of age. Moreover, the prevalence of MetS was found to increase markedly with age. An increased BMI at diagnosis was a risk factor for MetS. Children with an elevated BMI at diagnosis may have a genetic predisposition to metabolic disturbances or a socio-familial environment that renders them more vulnerable to metabolic complications. CNS irradiation was not found to be a risk factor for MetS. In the literature however, brain irradiation has been frequently reported as a risk factor for MetS. This variation with our study can probably be explained in part by the observation that our irradiated patients displayed a lower risk of elevated blood pressure along with a greater risk of increased abdominal circumference. The irradiated patients may therefore have a different metabolic risk profile compared with the non-irradiated patients, thereby suggesting varying mechanisms of pathogenesis. The results of our study confirm the need for early and prolonged follow-up of adult survivors of childhood AL even when treated without HSCT and without CNS irradiation. This prerequisite could enable both early detection of metabolic abnormalities and implementation of appropriate therapeutic procedures to reduce the morbidity and mortality associated with cardiovascular complications in such patients. Table. Multivariate analysis of potential risk factors for the metabolic syndrome OR: odds ratio; CI: confidence interval; BMI: body mass index; CNS: central nervous system; † OR per each additional year of follow-up; ‡ OR per each additional z-score unit; *significant values (p < 0.05) Table. Multivariate analysis of potential risk factors for the metabolic syndrome. / OR: odds ratio; CI: confidence interval; BMI: body mass index; CNS: central nervous system; † OR per each additional year of follow-up; ‡ OR per each additional z-score unit; *significant values (p < 0.05) Figure. Age-specific cumulative prevalence of the metabolic syndrome Figure. Age-specific cumulative prevalence of the metabolic syndrome Disclosures No relevant conflicts of interest to declare.

Patterns in the use of medicines are expected to reflect distinct health features between populations. This study aimed to describe the self-reported use of medication by a sample of university students in Maputo, Mozambique. We conducted a survey of 797 students in a private university in Maputo. Participants completed a questionnaire including socio-demographic data and pattern of medication use in the preceding month. Information was collected on the number and names of drugs, duration of use, and prescription. The drugs were grouped according to therapeutic indication. In the previous month, 56% of students had used at least one pharmaceutical drug, with higher prevalence for women (65.2% vs. 42.2%) and men attending health-related courses (67.4% vs. 53.2%). The most commonly used medicines were anti-inflammatory/analgesic drugs (62.2%), anti-infectives (25.9%), and vitamins/minerals (13.6%). The most frequently used single drugs were paracetamol (42.8%), amoxicillin (12.6%), and ibuprofen (8.4%). Duration of use was lowest for anti-inflammatory/analgesic drugs and highest for oral contraceptives. Use of medication by Mozambican students was similar to that observed in other university populations.

Background A high prevalence of epilepsy has been observed in several onchocerciasis-endemic villages in the Sanaga River basin, Cameroon. Recent studies suggest that ivermectin, a drug that is distributed annually with the aim of eliminating onchocerciasis, may have a protective effect against acquiring onchocerciasis-associated epilepsy (OAE). This study, therefore, provides an in-depth understanding of both the complex therapeutic landscape for epilepsy as well as the experiences related to the ‘community-directed treatment with ivermectin’ (CDTI) campaign in order to identify a more trenchant path forward in the fight against epilepsy. Methodology/Principal findings Based on a mixed methods study combining a qualitative strand with a quantitative survey, we found that epilepsy was perceived to have had an epidemic emergence in the past and was still considered an important health issue in the study area. Socio-economic status, availability and accessibility of drugs and practitioners, as well as perceived aetiology shaped therapeutic itineraries for epilepsy, which included frequenting (in)formal biomedical health care providers, indigenous and/or faith healing practitioners. Ivermectin uptake for onchocerciasis was generally well known and well regarded. The CDTI faced structural and logistical bottlenecks undermining equal access and optimal adherence to the drug. Conclusions/Significance Locally accessible, uninterrupted, sustainable and comprehensive health-service delivery is essential to help alleviate the epilepsy burden on afflicted households. Addressing structural challenges of CDTI and communicating the potential link with epilepsy to local populations at risk could optimize the uptake of this potentially significant tool in OAE prevention.

SummaryThis study seeks to explore and explain the socio-cultural factors responsible for the incidence of infant malnutrition in Cameroon with particular emphasis on northern Cameroon where it is most accentuated. It combines quantitative data drawn from the 1991, 1998, 2004 and 2011 Cameroon Demographic and Health Surveys, as well as a literature review of publications by the WHO and UNICEF. This is further complemented with qualitative data from various regions of Cameroon, partly from a national ethnographic study on the ethno-medical causes of infertility in Cameroon conducted between 1999 and 2000. Whereas socio-cultural factors related to child feeding and maternal health (breast-feeding, food taboos and representations of the colostrum as dangerous for infants) are widespread throughout Cameroon, poverty-related factors (lack of education for mothers, natural disaster, unprecedented influx of refugees, inaccessibility and inequity in the distribution of health care services) are pervasive in northern Cameroon. This conjunction of factors accounts for the higher incidence of infant malnutrition and mortality in northern Cameroon. The study suggests the need for women's empowerment and for health care personnel in transcultural situations to understand local cultural beliefs, practices and sentiments before initiating change efforts in infant feeding practices and maternal health. Biomedical services should be tailored to the social and cultural needs of the target population – particularly women – since beliefs and practices underpin therapeutic recourse. Whereas infant diarrhoea might be believed to be the result of sexual contact, in reality, it is caused by unhygienic conditions. Similarly, weaning foods aimed at transmitting ethnic identity might not meet a child's age-specific food needs and might instead give rise to malnutrition.

For almost 25 years generalist community nurses have provided professional services and developed many innovative programs in response to the needs of Victorian communities. They have established a Primary Health Care role in the co-ordination and management of preventative and therapeutic programs, as well as undertaking their more traditional duties of support and nursing care. At the present time there is unprecedented change occurring in both the structure and practice of community nursing, due, in large part, to measures aimed at achieving economic goals and reducing the high cost of illness care. These changes are creating ethical dilemmas for generalist community nurses who believe that the social costs of economic management might, in the long term, outweigh the gains. At a time of growing socio-dislocation when the community is exhibiting symptoms of alienation, experienced generalist community nurses are needed more than ever to provide a voice for those whose needs are not being met. The dilemma for nurses is how to provide the services that the community needs, cope with increasing and more complex caseloads, meet the demands of the bureaucracy, and become involved in the politics of decision making to influence health policy. The ethical stance of generalist community nurses and the rational stance of politico-economic decision makers are explored, and it is suggested that it is vital for nurses to value their professional ethics and to reaffirm their role if they are to survive the next 25 years.

The objective of this qualitative study was to examine extrinsic barriers to substance abuse treatment among pregnant and parenting women enrolled in residential perinatal substance abuse treatment programs in Northern California. Life history interviews were conducted with 36 women to examine help-seeking behaviors before treatment enrollment. Data analysis used the analytic framework of Mandelbaum (1973) to describe dimensions, turnings, and adaptations of participants. Results indicated that the majority (n = 34) of participants sought prenatal care but identified fear of punitive actions from helping institutions and individuals as a major barrier. Other extrinsic barriers included substance abuse treatment program barriers, partners, the status of opiate dependency, and the status of pregnancy. Biological, socio-cultural, and psychosocial dimensions of participants' care-seeking experiences were identified. The turning was pregnancy and adaptations included preserving the family, managing fear and manifesting faith. Findings describe the transformation of the therapeutic alliance and the gendered impact of two decades of the War on Drugs in the United States. Participants' coping strategies suggest that the desire for child custody and concern for fetal and child well-being was a priority and motivated care seeking despite extrinsic barriers perceived to be threatening to the woman's safety and autonomy.

There are presented results of a comprehensive study of the life quality of representatives of three reference groups of servicemen on contract: cadets of military high schools (n = 400), contracted servicemen of the units of power ministries and departments (n = 453), common soldiers and junior commanders (n = 357). The study was executed with the aid of the public survey, the performing of both psychological and functional load tests. This work is notable for the complexation of indices which characterize socio-hygienic, psychological and medical aspects of the life quality, life values, life satisfaction, and specific features of the military profession. Results of the study, which differ from the prior investigation by inclusion of indices characterizing the specific features of military-professional activity, lifestyle and spirituality, for the first time made it possible to assess the life quality related to health, taking into account the axiological values in life and important needs of the studied population. Changes in the life quality indices of contract servicemen were shown to be more sensitive to changes in their health than the traditional clinical-laboratory and instrumental data, which allows to recommend a wide practical use of the monitoring the life quality for professional selection and medical support of the military service, including the implementation of measures on optimization of psychological climate in military units, and the personification of the complex of therapeutic-recreational measures. The results allow us to recommend to military medical commissions of military commissariats in the call of citizens for military service under contract to carry out studies of quality and lifestyle of recruits for the early detection of groups of risk for their health. The program of in-depth medical examinations of military-contract there is recommended to include research aimed at identifying adverse social and hygienic factors of service and living conditions, psychopathological personality traits, rehabilitation and psychological climate in a military collective, execution of a personalized set of therapeutic measures.

Population registries consolidate information about cases of disease among the geographically limited population at the national, regional or municipal levels. The main tasks of registries are to monitor the levels of prevalence, to study risk factors, and to evaluate effectiveness of therapeutic or preventive measures. Currently, in the Russian Federation there is a lot of federal registries of various such diseases, like diabetes, cancer, congenital malformations, chronic skin diseases, cardiovascular diseases, bronchial asthma, orphan diseases, and others. These registries allow obtaining the necessary information about the prevalence, clinical course of disease, its complications, associated conditions, socio-demographic characteristics of patients, effect of a particular treatment on the course and outcomes of the disease.The article provides information about cancer registry, county birth registry and injury registry in the Arkhangelsk region. The advantages and limitations of population registries for epidemiological studies are given. Using registries in epidemiological studies is based on complete data collection, saving resources, taking into account confounding factors that are accessible to entire population. Register-based research has a large sample size, which makes it possible to study rare exposures and outcomes. The long collection of information in time allows studying diseases with a long latent period after exposure. The limitations of the registry data for epidemiological study include the fact that data is collected by the registrar and not by the researcher. The registries don’t contain information about specific confounding factors, which doesn’t allow correcting them. It is difficult to assess quality of registry data, as there is no “gold standard” for the comparement with the registry database The exchange of data between registries should be promising, as it will combine efforts to achieve common scientific and organizational goals.

<p><strong>List of abstracts and authors:</strong></p><p><strong>1. Bipolar disorder not otherwise specified -overdiagnosed or underdiagnosed?</strong></p><p>E Allers</p><p><strong>2. The prognosis of major depression untreated and treated: Does the data reflect the true picture of the prognosis of this very common disorder?</strong></p><p>E Allers</p><p><strong>3. Can we prolong our patients' life expectancy? Providing a better quality of life for patients with severe mental illness</strong></p><p>O A Betencourt</p><p><strong>4. The scope of ECT practice in South Africa</strong></p><p>J Benson-Martin, P Milligan</p><p><strong>5. Biomarkers for schizophrenia: Can we evolve like cancer therapeutics?</strong></p><p>P Buckley<strong></strong></p><p><strong>6. Relapse in schizophrenis: Major challenges in prediction and prevention</strong></p><p>P Buckley</p><p><strong>7. Informed consent in biological treatments: The right to know the duty to inform</strong></p><p><strong></strong>I Chetty</p><p><strong>8. Effectiveness of a long-acting injectable antipsychotic plus an assertive monitoring programme in first-episode schizophrenia</strong></p><p><strong></strong>B Chiliza, L Asmal, O Esan, A Ojagbemi, O Gureje, R Emsley</p><p><strong>9. Name, shame, fame</strong></p><p>P Cilliers</p><p><strong>10. Can we manage the increasing incidence of violent raging children? We have to!</strong></p><p>H Clark</p><p><strong>11. Serotonin, depression and antidepressant action</strong></p><p>P Cowen</p><p><strong>12. Prevalence and correlates of comorbid psychiatris illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit</strong></p><p>L Dannatt, K J Cloete, M Kidd, L Weich</p><p><strong>13. Investigating the association between diabetes mellitus, depression and psychological distress in a cohort of South African teachers</strong></p><p>A K Domingo, S Seedat, T M Esterhuizen, C Laurence, J Volmink, L Asmal</p><p><strong>14. Neuropeptide S -emerging evidence for a role in anxiety</strong></p><p>K Domschke</p><p><strong>15. Pathogenetics of anxiety</strong></p><p>K Domschke</p><p><strong>16. The effects of HIV on the fronto-striatal system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>17. Effects of acute antipsychotic treatment on brain morphology in schizophrenia</strong></p><p>R Emsley, L Asmal, B Chiliza, S du Plessis, J Carr, A Goosen, M Kidd, M Vink, R Kahn</p><p><strong>18. Development of a genetic database resource for monitoring of breast cancer patients at risk of physical and psychological complications</strong></p><p>K Grant, F J Cronje, K Botha, J P Apffelstaedt, M J Kotze</p><p><strong>19. Unipolar mania reconsidered: Evidence from a South African study</strong></p><p><strong></strong>C Grobler</p><p><strong>20. Antipsychotic-induced movement disorders: Occurence and management</strong></p><p>P Haddad</p><p><strong>21. The place of observational studies in assessing the effectiveness of long-acting injectable antipsychotics</strong></p><p>P Haddad</p><p><strong>22. Molecular mechanisms of d-cycloserine in fear extinction: Insights from RNS sequencing</strong></p><p>S Hemmings, S Malan-Muller, L Fairbairn, M Jalali, E J Oakeley, J Gamieldien, M Kidd, S Seedat</p><p><strong>23. Schizophrenia: The role of inflammation</strong></p><p>DC Henderson</p><p><strong>24. Addictions: Emergent trends and innovations</strong></p><p>V Hitzeroth</p><p><strong>25. The socio-cultural-religious context of biological psychiatric practice</strong></p><p>B Janse van Rensburg</p><p><strong>26. Biochemical markers for identifying risk factors for disability progression in multiple sclerosis</strong></p><p><strong></strong>S Janse van Rensburg, M J Kotze, F J Cronje, W Davis, K Moremi, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>27. Alcohol-induced psychotic disorder: Brain perfusion and psychopathology - before and after antipsychotic treatment</strong></p><p>G Jordaan, J M Warwick, D G Nel, R Hewlett, R Emsley</p><p><strong>28.'Pump and dump': Harm reduction strategies for breastfeeding while using substances</strong></p><p>L Kramer</p><p><strong>29. Adolescent neuropsychiatry - an emerging field in South African adolescent psychiatric services</strong></p><p>A Lachman</p><p><strong>30. Recovery versus remission, or what it means to be healthy for a psychiatric patient?</strong></p><p>B Latecki</p><p><strong>31. Holistic methods utilised to normalise behaviours in youth diagnosed with neuro-biochemical disorders</strong></p><p>P Macqueen</p><p><strong>32. Candidate genes and novel polymorphisms for anxiety disorder in a South African cohort</strong></p><p>N McGregor, J Dimatelis, S M J Hemmings, C J Kinnear, D Stein, V Russel, C Lochner</p><p><strong>33. Higher visual functioning</strong></p><p>A Moodley</p><p><strong>34. The effects of prenatal methylmercury exposure on trace element and antioxidant levels in rat offspring following 6-hydroxydopamine-induced neuronal insult</strong></p><p>Z M Moosa, W M U Daniels, M V Mabandla</p><p><strong>35. Paediatric neuropsychiatric movement disorders</strong></p><p>L Mubaiwa</p><p><strong>36. The South African national female offenders study</strong></p><p>M Nagdee, L Artz, C de Clercq, P de Wet, H Erlacher, S Kaliski, C Kotze, L Kowalski, J Naidoo, S Naidoo, J Pretorius, M Roffey, F Sokudela, U Subramaney</p><p><strong>37. Neurobiological consequences of child abuse</strong></p><p>C Nemeroff</p><p><strong>38. What do Stellenbosch Unviversity medical students think about psychiatry - and why should we care?</strong></p><p>G Nortje, S Suliman, K Seed, G Lydall, S Seedat</p><p><strong>39. Neurological soft skins in Nigerian Africans with first episode schizophrenia: Factor structure and clinical correlates</strong></p><p><strong></strong>A Ojagbemi, O Esan, O Gureje, R Emsley</p><p><strong>40. Should psychiatric patients know their MTHFR status?</strong></p><p>E Peter</p><p><strong>41. Clinical and functional outcome of treatment refractory first-episode schizophrenia</strong></p><p>L Phahladira, R Emsley, L Asmal, B Chiliza</p><p><strong>42. Bioethics by case discussion</strong></p><p>W Pienaar</p><p><strong>43. Reviewing our social contract pertaining to psychiatric research in children, research in developing countries and distributive justice in pharmacy</strong></p><p>W Pienaar</p><p><strong>44. The performance of the MMSE in a heterogenous elderly South African population</strong></p><p>S Ramlall, J Chipps, A I Bhigjee, B J Pillay</p><p><strong>45. Biological basis addiction (alocohol and drug addiction)</strong></p><p>S Rataemane</p><p><strong>46. Volumetric brain changes in prenatal methamphetamine-exposed children compared with healthy unexposed controls</strong></p><p><strong></strong>A Roos, K Donald, G Jones, D J Stein</p><p><strong>47. Single voxel proton magnetic resonance spectroscopy of the amygdala in social anxiety disorder in the context of early developmental trauma</strong></p><p>D Rosenstein, A Hess, S Seedat, E Meintjies</p><p><strong>48. Discussion of HDAC inhibitors, with specific reference to supliride and its use during breastfeeding</strong></p><p>J Roux</p><p><strong>49. Prevalence and clinical correlates of police contact prior to a first diagnosis of schizophrenia</strong></p><p>C Schumann, L Asmal, K Cloete, B Chiliza, R Emsley</p><p><strong>50. Are dreams meaningless?</strong></p><p>M Solms</p><p><strong>51. The conscious id</strong></p><p>M Solms<strong></strong></p><p><strong>52. Depression and resilience in HIV-infected women with early life stress: Does trauma play a mediating role?</strong></p><p>G Spies, S Seedat</p><p><strong>53. State of affairs analysis for forensic psychiatry in SA</strong></p><p>U Subramaney</p><p><strong>54. Escitalopram in the prevention of post-traumatic stress disorder: A pilot randomised controlled trial</strong></p><p>S Suliman, S Seedat, J Pingo, T Sutherland, J Zohar, D J Stein</p><p><strong>55. Epigenetic consequences of adverse early social experiences in primates</strong></p><p>S Suomi</p><p><strong>56. Risk, resilience, and gene x environment interactions in primates</strong></p><p>S Suomi</p><p><strong>57. Biological aspects of anorexia nervosa</strong></p><p>C Szabo</p><p><strong>58. Agents used and profiles of non-fatal suicidal behaviour in East London</strong></p><p>H Uys</p><p><strong>59. The contributions of G-protein coupled receptor signalling to opioid dependence</strong></p><p>J van Tonder</p><p><strong>60. Emerging trend and innovation in PTSD and OCD</strong></p><p>J Zohar</p><p><strong>61. Making the SASOP treatment guidelines operational</strong></p><p>E Allers</p><p><strong>Poster Presentations</strong></p><p><strong>62. Neuropsychological deficits in social anxiety disorder in the context of early developmental trauma</strong></p><p><strong></strong>S Bakelaar, D Rosenstein, S Seedat</p><p><strong>63.Social anxiety disorder in patients with or without early childhood trauma: Relationship to behavioral inhibition and activation and quality of life</strong></p><p><strong></strong>S Bakelaar, C Bruijnen, A Sambeth, S Seedat</p><p><strong>64. Exploring altered affective processing in obssessive compulsive disorder symptom subtypes</strong></p><p>E Breet, J Ipser, D Stein, C Lochner<strong><br /></strong></p><p><strong>65. To investigate the bias toward recognising the facial expression of disgust in obsessive compulsive disorder as well as the effect of escitalopram</strong></p><p>E Breet, J Ipser, D Stein, C Lochner</p><p><strong>66. A fatal-case of nevirapine-induced Stevens-Johnson's syndrome in HIV mania</strong></p><p>A Bronkhorst, Z Zingela, W M Qwesha, B P Magigaba<strong></strong></p><p><strong>67. Association of the COMT G472A (met/met) genotype with lower disability in people diagnosed with multiple sclerosis</strong></p><p>W Davis, S J van Rensburg, L Fisher, F J Cronje, D Geiger, M J Kotze</p><p><strong>68. Homocycsteine levels are associated with the fat mass and obesity associated gene FTO(intron 1 T&gt;A) polymorphism in MS patients</strong></p><p>W Davis, S J Van Rensburg, M J Kotze, L Fisher, M Jalali, F J Cronje, K Moremi, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>69. Analysis of the COMT 472 G&gt;A (rs4680) polymorphism in relation to environmental influences as contributing factors in patients with schizophrenia</strong></p><p>D de Klerk, S J van Rensburg, R A Emsley, D Geiger, M Rensburg, R T Erasmus, M J Kotze</p><p><strong>70. Dietary folate intake, homocysteine levels and MTHFR mutation detection in South African patients with depression: Test development for clinical application </strong></p><p>D Delport, N vand der Merwe, R Schoeman, M J Kotze</p><p><strong>71. The use ofexome sequencing for antipsychotic pharmacogenomic applications in South African schizophrenia patients</strong></p><p>B Drogmoller, D Niehaus, G Wright, B Chiliza, L Asmal, R Emsley, L Warnich</p><p><strong>72. The effects of HIV on the ventral-striatal reward system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>73. Xenomelia relates to asymmetrical insular activity: A case study of fMRI</strong></p><p>S du Plessis, M Vink, L Asmal</p><p><strong>74. Maternal mental helath: A prospective naturalistic study of the outcome of pregancy in women with major psychiatric disorders in an African country</strong></p><p>E du Toit, L Koen, D Niehaus, B Vythilingum, E Jordaan, J Leppanen</p><p><strong>75. Prefrontal cortical thinning and subcortical volume decrease in HIV-positive children with encephalopathy</strong></p><p>J P Fouche, B Spottiswoode, K Donald, D Stein, J Hoare</p><p><strong>76. H-magnetic resonance spectroscopy metabolites in schizophrenia</strong></p><p>F Howells, J Hsieh, H Temmingh, D J Stein</p><p><strong>77. Hypothesis for the development of persistent methamphetamine-induced psychosis</strong></p><p><strong></strong> J Hsieh, D J Stein, F M Howells</p><p><strong>78. Culture, religion, spirituality and psychiatric practice: The SASOP Spirituality and Psychiatry Special Interest Group Action Plan for 2012-2014</strong></p><p>B Janse van Rensburg</p><p><strong>79. Cocaine reduces the efficiency of dopamine uptake in a rodent model of attention-deficit/hyperactivity disorder: An <em>in vivo</em> electrochemical study</strong></p><p><strong></strong>L Kellaway, J S Womersley, D J Stein, G A Gerhardt, V A Russell</p><p><strong>80. Kleine-Levin syndrome: Case in an adolescent psychiatric unit</strong></p><p>A Lachman</p><p><strong>81. Increased inflammatory stress specific clinical, lifestyle and therapeutic variables in patients receiving treatment for stress, anxiety or depressive symptoms</strong></p><p>H Luckhoff, M Kotze, S Janse van Rensburg, D Geiger</p><p><strong>82. Catatonia: An eight-case series report</strong></p><p>M Mabenge, Z Zingela, S van Wyk</p><p><strong>83. Relationship between anxiety sensitivity and childhood trauma in a random sample of adolescents from secondary schools in Cape Town</strong></p><p>L Martin, M Viljoen, S Seedat</p><p><strong>84. 'Making ethics real'. An overview of an ethics course presented by Fraser Health Ethics Services, BC, Canada</strong></p><p>JJ McCallaghan</p><p><strong>85. Clozapine discontinuation rates in a public healthcare setting</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>86. Retrospective review of clozapine monitoring in a publica sector psychiatric hospital and associated clinics</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>87. Association of an iron-related TMPRSS6 genetic variant c.2007 C&gt;7 (rs855791) with functional iron deficiency and its effect on multiple sclerosis risk in the South African population</strong></p><p>K Moremi, S J van Rensburg, L R Fisher, W Davis, F J Cronje, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus, M Kidd, M J Kotze</p><p><strong>88. Identifying molecular mechanisms of apormophine-induced addictive behaviours</strong></p><p>Z Ndlazi, W Daniels, M Mabandla</p><p><strong>89. Effects of lifestyle factors and biochemistry on the major neck blood vessels in patients with mutiple sclerosis</strong></p><p>M Nelson, S J van Rensburg, M J Kotze, F Isaacs, S Hassan</p><p><strong>90. Nicotine protects against dopamine neurodegenration and improves motor deficits in a Parkinsonian rat model</strong></p><p>N Ngema, P Ngema, M Mabandla, W Daniels</p><p><strong>91. Cognition: Probing anatomical substrates</strong></p><p>H Nowbath</p><p><strong>92. Chronic exposure to light reverses the effects of maternal separation on the rat prefrontal cortex</strong></p><p>V Russel, J Dimatelis</p><p><strong>93. Evaluating a new drug to combat Alzheimer's disease</strong></p><p>S Sibiya, W M U Daniels, M V Mabandla</p><p><strong>94. Structural brain changes in HIV-infected women with and without childhood trauma</strong></p><p>G Spies, F Ahmed, C Fennema-Notestine, S Archibald, S Seedat</p><p><strong>95. Nicotine-stimulated release of hippocampal norepinephrine is reduced in an animal model of attention-deficit/ hyperactivity disorder: the spontaneously hypertensive rat</strong></p><p>T Sterley</p><p><strong>96. Brain-derive neurotrophic factor (BDNF) protein levels in anxiety disorders: Systematic review and meta-regression analysis</strong></p><p>S Suliman, S M J Hemmings, S Seedat</p><p><strong>97. A 12-month retrospective audit of the demographic and clinical profile of mental healthcare users admitted to a district level hospital in the Western Cape, South Africa</strong></p><p>E Thomas, K J Cloete, M Kidd, H Lategan</p><p><strong>98. Magnesium recurarization: A comparison between reversal of neuromuscular block with sugammadex v. neostigmine/ glycopyrrolate in an <em>in vivo</em> rat model</strong></p><p><strong></strong>M van den Berg, M F M James, L A Kellaway</p><p><strong>99. Identification of breast cancer patients at increased risk of 'chemobrain': Case study and review of the literature</strong></p><p>N van der Merwe, R Pienaar, S J van Rensburg, J Bezuidenhout, M J Kotze</p><p><strong>100. The protective role of HAART and NAZA in HIV Tat protein-induced hippocampal cell death</strong></p><p>S Zulu, W M U Daniels, M V Mabandla</p>

Abstract Environment affects quality of care. Yet there are very few evaluation methods to address such issues. The SCP model is a user-inclusive, multi-paramentric method for the planning, design and evaluation of psychiatric facilities. Its application to psychiatric wards indicated hiatus between top-down (designers, building commissioning authorities) vs bottom up (patients and staff) understanding of what constitutes a therapeutic environment. That generated the need to investigate the socio-spatial context of psychiatric wards. This research aimed to promote our understanding of psychiatric space in relation to social interaction. Two acute wards in the UK provided the locus. Each was evaluated using the SCP model institutional vs domestic checklist, open-ended interviews with 10 staff and 12 patients and auditing of the spaces. Then, a Space Syntax analysis using depthmap was employed to model social activity inside the wards. The SCP model analysis indicated that the wards, one of them new and purpose built and the other part of an old psychiatric campus soon to be replaced, demonstrated strong institutional features, even compared to previous samples using the same tools. The juxtaposition with space syntax demonstrated that areas mapped as integrated, i.e., socio-friendly, were areas where antisocial behaviours were observed. This could be interpreted by Goffman's theory on total institutions, as institutional spaces might be the context of reverse socio-spatial norms according to Hillier's social logic of space. Thus, institutional spaces could still house mental health provision. Integrated approaches for evaluating healthcare facilities for fit for purpose and social integration need to become part of a healthcare evaluation system. Healthcare provision should be evaluated for ecopsychosocially supportive environments. Key messages The project raised the question of the appropriateness of mental healthcare environments. The spaces for the treatment and care of psychiatric patients might not be fit for their social re-integration.

The interior of the room is influenced by user perceptions of psychological security, closeness, self-disclosure, the ability to form therapeutic connections, and the feeling of the Persons in the environment. Poor treatment spatial design may increase emotions of otherness, hinder agency development, restrict communication, and result in poor service user outcomes and experiences. In this paper, we have discussed the influence of interior design of clinic or home space on therapeutic process. Architectural elements are the generally permanent components of an environment in which a clinic or the house is located such as the physical design, design, size and form of the furniture, closets or other equipment, and the materials used in its construction. Low lighting may have a pleasant and calming impact on an individual’s perceived attraction and customer self-disclosure. The findings show that the interior design of the counselling room may have an impact on communication and other human interactions. The environment of the room may also influence communication. Sommer (1969) found that the discussion of female geriatric participants rose in a pleasant or socio-fugal setting, including flowers, magazines, vase and others. From a practical point of view, knowing environmental variables in advice like lighting effects enables advisors more effectively to undertake therapy. We see counselling contexts as overlapping areas, as do other scholars. The connection between environmental and clinical psychology should be made clear to counsellors, clinicians, psychiatrists and their organisations. They are more conscious of environmental effects throughout their treatment sessions.

The article discusses the problems of the architectural environment of the system of maternity hospitals and perinatal centers of our country. Various approaches to the modernization of such institutions are described, including on the basis of the formation of an “optimal” architectural and spatial environment that has a therapeutic and therapeutic effect on the patient. The methodological base of the study is determined, which allows to assess the state of the architectural environment of obstetric facilities using the example of individual cities in southern Russia. Field surveys are carried out based on the methodology of complex pre-project studies, covering the action of various factors, and including: urban planning analysis; architectural and landscape analysis; social, historical and cultural analysis. During the examination, the characteristic qualities of the external and internal environment of obstetric care institutions are identified and systematized, including: a) at the city-planning level, the geographical and city-planning location of some objects with a perinatal function, the convenience of their placement and layout of buildings, and zoning of the territory are assessed; b) at the level of architectural and landscape analysis, the presence of natural components, recreational and green zones in the areas was determined; c) at the level of socio-historical, cultural, and compositional analysis, the plasticity and scale of the facade solutions of perinatal centers are assessed, the style and imaginative-emotional qualities of their interiors are analyzed, and the prevailing level of visual “comfort” of the architectural spaces of maternity hospitals with physical, emotional rehabilitation of patients is assessed. The results obtained allows to outline ways of modernizing objects with a perinatal function and forming a new therapeutic architectural environment in them.

Abstract In the context of the current UK prison reform agenda and concern about the high incidence of violence, substance misuse, self-harm and suicide, prison-based horticulture can make a significant contribution to the creation of safe, secure, supportive and health-enhancing environments. By joining up health and justice agendas, therapeutic programmes have the potential to serve as powerful catalysts for wider systemic change, tackling inequalities and social exclusion within societies across the globe. This presentation critically discusses findings from evaluative research, ‘Greener on the Outside for Prisons’ (GOOP), delivered in prisons in North West England. It aims to illustrate impacts of prisoners’ participation in an innovative social and therapeutic horticultural programme. The qualitative study was informed by a theoretical exploration on socio-ecological model of health emphasising interconnections between environment, behaviour and wellbeing, recognising the dynamic interplay between situational and personal factors; by a psychosocial perspective, positioning the individual in networks of interpersonal relationships, organisations, and social, political and economic systems; and by insights from the Biophilia Hypothesis. Findings suggest that engagement in GOOP were important to improvements in health and wellbeing with wider context-specific benefits. Working across key agendas of health, education and resettlement, GOOP has effectively demonstrated the potential of horticulture to impact positively on mental wellbeing, physical activity and healthier eating. Additionally, it contributes towards social inclusion through the development of key transferable skills, life competencies, processes of socialisation, and preparation for successful resettlement and employment beyond prison, which are ultimately key determinants of future health and life chances.

South Africa has one of the highest crime and recidivism rates in the world. Although widely accepted that crime is a complex and multi-nodal social phenomenon, it is indubitably causally linked to South Africa’s historical and current socio-political circumstances, poverty and unemployment, as well as the ineffective rehabilitation and treatment of offenders. Anecdotal evidence suggests that offenders are often apportioned the blame for reoffending and written off as incorrigible, without any real reflection on the efficiency and/or relevance of the prison programmes to which they were subjected to begin with. Accurate and relevant assessment of criminogenic risk factors is not only connected to the major outcomes of meta-analyses, but forms the foundation for treatment-planning and decision-making pertaining to risk and safety, and ultimately abstinence from aberrant behaviour. This article critically addresses the issue of South African needs-based offender rehabilitation in a systemic and diagnostic manner by aligning theory with relevant case scenarios in order to expose the essence of the therapeutic challenges in the South African custodial environment.

Background: The intention of antiretroviral therapy (ART) and regular clinic visits is to engender safe sex attitudes among HIV-infected individuals. However, this may not be the case due to the perceived therapeutic benefits of ART and may result in exposure to drug-resistant HIV strains. Objective: We aimed to determine the prevalence and predict the factors associated with risky sexual behaviors among ART users in a resource-limited environment. Methods: Two hundred and ninety-one sexually active ART users aged 18-50 years and seeking care at the HIV clinic in Dodoma, Tanzania, participated in this study. The outcome variables modeled in a logistic regression were condom use, multiple sex partners, casual sex partners, and payment for sex. The predictors included in the models were the patients' socio-demographic characteristics. In addition, a new variable, sexual risk scores, was generated by culminating all the outcome variables. Finally, multiple Poisson regression with the socio-demographic variables of the participants was used to model the sexual risk scores. Results: Patients reported inconsistent/no condom use (44%), payment for sex (4%), casual sex encounters (13%), multiple sex partners (21%), and STD symptoms (15%). While having a casual sexual partner was significantly associated with age group in a Pearson Chi-square (p=0.0147), participants ≤35 years old were less likely to have single-sex partners than older participants (AOR: 0.188, 95 C.I: 0.042-0.849). Meanwhile, the likelihood of condom use was higher among participants with no HIV-infected family members (AOR= 2.409, 95% C.I:1.236,4.697) and among participants who have single-sex partners (AOR= 2.721, 95% C.I.: 1.115,6.640); these participants were less likely to report STD symptoms (AOR=0.265, 95% C.I.: 0.081-0.865). Adjusted analysis showed that estimated mean sexual risk scores significantly increased (mean, λ=1.61, 95% C.I:1.0817-2.4063) for recent ART recipients (within 1-3 years vs. ≥eight years). However, sexual risk scores of participants with HIV stage 3 were 38.8% lower than participants at stage 4 (95% C.I.: 0.3910-0.9558), and non-alcohol drinkers had an adjusted mean sexual risk score 29% lower than participants who were alcohol drinkers (95% C.I.: 0.5102-0.9879). Conclusion: Researchers should prioritize patients at HIV CTC for education concerning safe sexual practices for those characterized by alcohol consumption, younger age (less than 35 years old), HIV stage 4, or commencement of ART within three years.

Abstract Background Breast cancer is the most common cancer in women and the first cancer concerning mortality. Metastatic breast cancer remains a disease with a poor prognosis and about 30% of women diagnosed with an early stage will have a secondary progression. Metastatic breast cancer is an incurable disease despite significant therapeutic advances in both supportive cares and targeted specific therapies. In the management of a metastatic patient, each clinician follows a highly complex and strictly personal decision making process. It is based on a number of objective and subjective parameters which guides therapeutic choice in the most individualized or adapted manner. Methods/design The main objective is to integrate massive and heterogeneous data concerning the patient’s environment, personal and familial history, clinical and biological data, imaging, histological results (with multi-omics data), and microbiota analysis. These characteristics are multiple and in dynamic interaction overtime. With the help of mathematical units with biological competences and scientific collaborations, our project is to improve the comprehension of treatment response, based on health clinical and molecular heterogeneous big data investigation. Discussion Our project is to prove feasibility of creation of a clinico-biological database prospectively by collecting epidemiological, socio-economic, clinical, biological, pathological, multi-omic data and to identify characteristics related to the overall survival status before treatment and within 15 years after treatment start from a cohort of 300 patients with a metastatic breast cancer treated in the institution. Trial registration ClinicalTrials.gov identifier (NCT number): NCT03958136. Registration 21st of May, 2019; retrospectively registered.

The Cerrado is the second largest biome in Brazil and presents an immeasurable and still underexplored ecological diversity. Despite the exuberance of its endemic species, it is one of the 25 global hotspots, due to a high natural biodiversity wealth along with an expressive environment destruction. In this study, we surveyed the knowledge on medicinal use of Cerrado plants held by individuals living in a predominantly Cerrado region. A semi-structured individual questionnaire for qualitative socio-economic characterization and medicinal use of plants was applied to Public Health Service users of the city of Assis, State of Sao Paulo, Brazil. This study was approved by the Ethics Committee of the Assis Regional Hospital (Protocol 4812010). Out of 149 respondents, 90.6% reported knowledge and/or use of plants for therapeutic purposes. Among 115 mentioned plant species, only 11.4% belong to the Cerrado. We also evaluated how matching were the reported uses and the respective published data from scientific studies on the plants’ medicinal properties. It was verified that for the few Cerrado plants cited, the respondents described several medicinal applications not scientifically described. More precisely, 60.5% of all medicinal applications were not found in the scientific literature. Besides that, many of the therapeutic effects described in the literature for the Cerrado species were not cited by the interviewed population. Our results indicate a relative unawareness of people on the medicinal potential of the native species of their residence region. We suggest that strengthening connection between popular and scientific knowledge, along with spreading such knowledge, could contribute for an improved valuation about the Cerrado biome and consecutive preservation of it.

Ethiopia is endowed with a huge potential of medicinal plants and their uses that make available extensive part to the treatment of human and livestock aliments. There was underprivileged employment and management of therapeutic undergrowth. Role of indigenous knowledge systems in the conservation of forest resources, that is extremely significant for medicinal plants willingness. Indigenous knowledge is the exceptional acquaintance restricted to a meticulous background or society. It is also acknowledged as home information, folk facts, working class understanding, long-established understanding, or long-established knowledge. This information is engendered and put out by community, more than time, in an exertion to muddle through with their own agro ecological and socio economic environment. It is generate through a methodical process of observe experimentation with explanation and readapting until that time recognized solution to customized ecological, socio-economic and technical situations. Home-based in sequence is conventional from generation to generation, more often than not by word of mouth and enlightening rituals, and has been the basis for agriculture, food groundwork and conservation, health care, education, and the wide range of other activities that maintain going at the social order and its background in countless parts of the world for many centuries. Indigenous information on traditional rules and regulations regarding sustainable management of medicinal forest resources should be well communicated, especially to the infancy and that administration should employ an incorporated approach within reach of that take into thoughtfulness technical and indigenous facts system to natural possessions organization. Traditional medicinal plants wrapped in strand fur area with group of people base preservation and inspiring the use of residence foundation for crop mounting of multitalented vegetation were required. Native populace and their community, and other restricted community, encompass a very significant position in management medicinal plants and expansion for the reason that of their facts and conventional practice

Abstract Background In France during the last 15 years, precariousness among women has increased. In breast cancer, precariousness has been associated with an increase in mortality, but the links between precariousness, stage at diagnosis and care pathway are little explored. Our study aims to evaluate the impact of precariousness on care pathways, treatment and recovery phase according to a multidisciplinary analysis. Methods and design Comparative prospective observational multicenter study of exposed / unexposed category. Patients with breast cancer are recruited in the Ile de France area. Three scores are used to identify precarious patients. Precarious patients are matched to non-precarious patients by age group. Questionnaires are distributed to patients at different times of care. The main objective is to compare the stage of the disease at diagnosis between two groups. The secondary objectives are: comparison of socio-economic and geographical characteristics, direct and indirect costs, personal trajectories of care and health. Analysis include multidisciplinary approaches. A geographical information systems method will evaluate the accessibility to health facilities and the characteristics of the places of residence of the patients. An anthropological analysis will be conducted through observation of consultations and semi-directed interviews with patients. These methods will allow to analyze the diagnostic and therapeutic routes, placing it in a life history and an economic, socio-cultural and health environment. The economic analysis will include a comparison of direct, indirect costs and out-off pocket costs, from the patient’s point of view and from the societal perspective. Discussion Conducted in a clinical setting and coupled with a qualitative study, this study will provide a better understanding of how contextual factors, combined with individual factors, can influence the course of health and thus the stage of the disease at diagnosis. The multidisciplinary approach, involving clinicians, geographers, an anthropologist, an economist and a health epidemiologist, will allow a multidimensional approach to the impact of precariousness on breast cancer. Trial registration ClinicalTrials.gov Identifier: NCT02948478 registered October 28, 2016. ID RCB: 2016-A00589–42. protocol version: 2.1. decembre 13, 2018.

Comorbidity rates in Bipolar disorder rank highest among major mental disorders, especially comorbid substance use. Besides cannabis, alcohol is the most frequent substance of abuse as it is societally accepted and can be purchased and consumed legally. Estimates for lifetime comorbidity of bipolar disorder and alcohol use disorder are substantial and in the range of 40–70%, both for Bipolar I and II disorder, and with male preponderance. Alcohol use disorder and bipolarity significantly influence each other's severity and prognosis with a more complicated course of both disorders. Modern treatment concepts acknowledge the interplay between these disorders using an integrated therapy approach where both disorders are tackled in the same setting by a multi-professional team. Motivational interviewing, cognitive behavioral and socio- therapies incorporating the family and social environment are cornerstones in psychotherapy whereas the accompanying pharmacological treatment aims to reduce craving and to optimize mood stability. Adding valproate to lithium may reduce alcohol consumption whereas studies with antipsychotics or naltrexone and acamprosate did not affect mood fluctuations or drinking patterns. In summary, there is a continuous need for more research in order to develop evidence-based approaches for integrated treatment of this frequent comorbidity.

Problem setting. The article examines the role of the media in social and psychological adaptation of internally displaced persons. It is proved that social and psychological adaptation is a multi-faceted phenomenon, the most significant characteristics of which are the following ones: social and psychological adaptation is the process of “entering” of an individual into a social environment; is a two-way interaction between the individual and the group, the result of which is changes both in the personality and in the group; getting into a new group, the person changes his/her status and key characteristics; in the process of social and psychological adaptation the goals, expectations, requirements of the person and the group are agreed; the components of value-motivational sphere; the successful realization of social and psychological adaptation requires the presence of positive social settings (“social interest”) of the individual and group, the interest of the parties in the interaction; activity of the person is necessary for effective social and psychological adaptation (“social activity”), its personal qualities (maturity, self-actualization, etc.), relevant psychological resource. It is revealed that in addition to public authorities, local governments, public organizations, the mass media is the regulator of adaptation of the internally displaced persons. The indicated media function allows them to be included into the system of multilevel IDP adaptation management. Recent research and publications analysis. A conclusion is drawn regarding the negative impact of the media on the description of events related to the situation with IDPs. In connection with this the following outcomes are indicated: Contacts of journalists with the internally displaced persons. Often, while interviewing, the journalists try to get a description of “the most terrible” facts that caused the forced relocation. This leads to the so-called “secondary traumatism”. Interpretation of events. Often the emphasis is on unresolved issues, lack of support, and thus a feeling of helplessness and impotence appear. In practice, the media often use techniques to worsen the effects of forced relocation. Focusing on finding the causes and perpetrators of what has happened. This is a dead end situation, because it focuses on the past, which can not be changed. This search only reinforces the feeling of hopelessness, guilt and hatred. The media almost never emphasize “how” to make sure that this will not happen in the future. It is noted that in this period of time to talk about the socio-therapeutic function of the media, which should be aimed at treating people from frustration, the formation of a tolerant, tolerant attitude towards people who “are not like us.” As noted in the literature, tolerance – is tolerance, indulgence in the shortcomings of others, the ability of man, society, state to hear and respect the opinions of others, to be hostile to opinions that are different from their own, the ability to understand another person, care and understand other people’s feelings. Used as an antipode to aggression, malice and irritability. Highlighting previously unsettled parts of the general problem. In this regard, it is proposed to consider unacceptable: “shooting” a person “unexpectedly” at the time of acute grief or despair (such favorite video scene shows in Ukrainian media, when they talk about their losses through their tears); showing a person in a situation of humiliation that offends him/her human dignity (a demonstration of the terrible places of resettlement of the internally displaced persons, the arrival of “high guests” and “meeting with the people”, etc.); demonstration of moral and physical bullying; direct or indirect justification for actions that have caused the suffering of internally displaced persons; direct or indirect condemnation of the internally displaced persons; an appeal to collective repentance, a requirement for the internally displaced persons to recognize themselves as guests and behave accordingly; sarcasm or humor regarding internally displaced persons. Paper main body. It is determined that in order to provide information-psychological safety of the IDPs, potentially stress-related information should correspond to a number of conditions: constructive description of problems (showing people in a state of active overcoming of existing problems); analysis of possible means of constructive overcoming of difficulties; informing on the progress of the solution of the problem and its solution; provision of psychological support to internally displaced persons (demonstration of social approval and assistance). Materials about internally displaced persons should not end with statements such as “Who will help?”, “Who responds to other humans?”, “Where to search for justice?”. That creates an effect of incomplete action and may turn into a loss of hope and faith. Conclusions of the research and prospects for further studies. It is concluded that the media influence the social attitudes of its audience, changing opinions, shaping evaluation and stimulating behavior. The image of social reality created by the media influences the audience, forming a subjective image. Depending on the nature of the image created, perceptions of what is happening change, which can lead either to the assimilation of social norms, values, patterns of acceptable behavior, or to the rejection of social reality. In the process of social and psychological adaptation, forced internally displaced persons, representatives of the group with which they are in contact, form social attitudes towards each other, which can either be consolidated or adjusted through the media. The image created will be influenced not only by the objective social situation, but also by the subjective social attitudes of journalists, through the prism of which information material is created. representatives of the contact group and ultimately – in the process of socio-psychological adaptation. The conclusion is made on the necessity of indirect regulation of the description of internally displaced persons by the media from the state authorities (Ministry of Information Policy of Ukraine, Ministry of Reintegration of the Temporarily Occupied Territories of Ukraine), local self-government bodies, NGOs and journalists’ associations.

Abstract Background and Aims Percutaneous renal biopsy (PRB) guided by ultrasound is the gold standard for the diagnosis of nephropathies and glomerulopathies. Sometimes, comorbidity and relative contraindications for PRB could condition us to consider clinical diagnosis as sufficient to treat renal pathology. This is a continuous challenge for the nephrologist due to the prognostic and therapeutic diversity of the different types of nephropathies. Therefore, we wonder if in most cases it is still necessary to perform PRB, or clinical diagnosis would be enough in a significant number of them. We decided to assess our PRB series over 15 years, comparing clinical and biopsy diagnosis, and learning about the complications associated with the technique. Method Cross-sectional analysis of the 262 PRB conducted between January 2003 and December 2018. In our department, before performing the PRB, doctors always make a clinical report with different diagnostic possibilities that facilitates the pathologist's work. For this study the first diagnostic option, being the most clinically compatible with the patient, was always taken. We also collected socio-demographic data, clinical data (hypertension and diabetes mellitus), pre and post-biopsy diagnosis, and complications associated with the technique. For the statistical analysis, the SPSS 15 program was used to calculate frequencies, and the Kappa coefficient for diagnostic concordance. Results 262 PRB were performed, of which 149 (56.9%) were performed in men and 113 (43.1%) in women. Average age: 58.6 ± 19.2 years. 173 patients were hypertensive (66%) and 50 had DM (19.1%). Renal pathologies by age are similar to the data reported by Spanish Society. The table shows the concordance measured by the kappa coefficient in the pre and post-PRB diagnosis of the most frequent nephropathies. There were 15 PRB with complications (5.8%): 12 minors (4.6%, haematuria and hematoma); and 3 major: 2 haemorrhages (0.8%) and 1 nephrectomy (0.4%). 33 PRB (12.6%) were inconclusive due to insufficient material. Conclusion From the data obtained, a high mismatch was observed in very common nephropathies in our environment, such as IgA nephropath and pauci-immune focal and segmental necrotizing glomerulonephritis. In contrast, PRB showed more cases of diabetic nephropathy and tubulointerstitial nephropathy. In the case of the pathologies due to nephrotic syndrome (table) we find a high discordance. This may be due to the fact that in all of those cases there was an initial nephrotic syndrome, and our clinical diagnosis was partly based on the frequency of glomerulopathies in the adult. In conclusion, the different concordances between pre and post-biopsy diagnoses show us that clinical diagnosis is not enough to obtain a final diagnosis. In most cases PRB is necessary for the definitive diagnosis. In addition, after the introduction of the ultrasound, complications have decreased, especially when the biopsy is performed by the nephrologist.

This article explores resilience as it is experienced by refugees in the context of a relational community, visiting the notions of trauma, a thicker description of resilience and the trajectory toward positive growth through community. It calls for going beyond a Western biomedical therapeutic approach of exploration and adopting more of an emic perspective incorporating the worldview of the refugees. The challenge is for service providers working with refugees (who have experienced trauma) to move forward from a ‘harm minimisation’ model of care to recognition of a facilitative, productive community of people who are in a transitional phase between homelands. Contextualising Trauma Prior to the 1980s, the term ‘trauma’ was not widely used in literature on refugees and refugee mental health, hardly existing as a topic of inquiry until the mid-1980’s (Summerfield 422). It first gained prominence in relation to soldiers who had returned from Vietnam and in need of medical attention after being traumatised by war. The term then expanded to include victims of wars and those who had witnessed traumatic events. Seahorn and Seahorn outline that severe trauma “paralyses you with numbness and uses denial, avoidance, isolation as coping mechanisms so you don’t have to deal with your memories”, impacting a person‘s ability to risk being connected to others, detaching and withdrawing; resulting in extreme loneliness, emptiness, sadness, anxiety and depression (6). During the Civil War in the USA the impact of trauma was referred to as Irritable Heart and then World War I and II referred to it as Shell Shock, Neurosis, Combat Fatigue, or Combat Exhaustion (Seahorn & Seahorn 66, 67). During the twenty-five years following the Vietnam War, the medicalisation of trauma intensified and Post Traumatic Stress Disorder (PTSD) became recognised as a medical-psychiatric disorder in 1980 in the American Psychiatric Association international diagnostic tool Diagnostic Statistical Manual (DSM–III). An expanded description and diagnosis of PTSD appears in the DSM-IV, influenced by the writings of Harvard psychologist and scholar, Judith Herman (Scheper-Hughes 38) The Diagnostic and Statistical Manual (DSM-IV) of Mental Disorders (American Psychiatric Association, 2000) outlines that experiencing the threat of death, injury to oneself or another or finding out about an unexpected or violent death, serious harm, or threat of the same kind to a family member or close person are considered traumatic events (Chung 11); including domestic violence, incest and rape (Scheper-Hughes 38). Another significant development in the medicalisation of trauma occurred in 1998 when the Victorian Foundation for Survivors of Torture (VFST) released an influential report titled ‘Rebuilding Shattered Lives’. This then gave clinical practice a clearer direction in helping people who had experienced war, trauma and forced migration by providing a framework for therapeutic work. The emphasis became strongly linked to personal recovery of individuals suffering trauma, using case management as the preferred intervention strategy. A whole industry soon developed around medical intervention treating people suffering from trauma related problems (Eyber). Though there was increased recognition for the medicalised discourse of trauma and post-traumatic stress, there was critique of an over-reliance of psychiatric models of trauma (Bracken, et al. 15, Summerfield 421, 423). There was also expressed concern that an overemphasis on individual recovery overlooked the socio-political aspects that amplify trauma (Bracken et al. 8). The DSM-IV criteria for PTSD model began to be questioned regarding the category of symptoms being culturally defined from a Western perspective. Weiss et al. assert that large numbers of traumatized people also did not meet the DSM-III-R criteria for PTSD (366). To categorize refugees’ experiences into recognizable, generalisable psychological conditions overlooked a more localized culturally specific understanding of trauma. The meanings given to collective experience and the healing strategies vary across different socio-cultural groupings (Eyber). For example, some people interpret suffering as a normal part of life in bringing them closer to God and in helping gain a better understanding of the level of trauma in the lives of others. Scheper-Hughes raise concern that the PTSD model is “based on a conception of human nature and human life as fundamentally vulnerable, frail, and humans as endowed with few and faulty defence mechanisms”, and underestimates the human capacity to not only survive but to thrive during and following adversity (37, 42). As a helping modality, biomedical intervention may have limitations through its lack of focus regarding people’s agency, coping strategies and local cultural understandings of distress (Eyber). The benefits of a Western therapeutic model might be minimal when some may have their own culturally relevant coping strategies that may vary to Western models. Bracken et al. document case studies where the burial rituals in Mozambique, obligations to the dead in Cambodia, shared solidarity in prison and the mending of relationships after rape in Uganda all contributed to the healing process of distress (8). Orosa et al. (1) asserts that belief systems have contributed in helping refugees deal with trauma; Brune et al. (1) points to belief systems being a protective factor against post-traumatic disorders; and Peres et al. highlight that a religious worldview gives hope, purpose and meaning within suffering. Adopting a Thicker Description of Resilience Service providers working with refugees often talk of refugees as ‘vulnerable’ or ‘at risk’ populations and strive for ‘harm minimisation’ among the population within their care. This follows a critical psychological tradition, what (Ungar, Constructionist) refers to as a positivist mode of inquiry that emphasises the predictable relationship between risk and protective factors (risk and coping strategies) being based on a ‘deficient’ outlook rather than a ‘future potential’ viewpoint and lacking reference to notions of resilience or self-empowerment (342). At-risk discourses tend to focus upon antisocial behaviours and appropriate treatment for relieving suffering rather than cultural competencies that may be developing in the midst of challenging circumstances. Mares and Newman document how the lives of many refugee advocates have been changed through the relational contribution asylum seekers have made personally to them in an Australian context (159). Individuals may find meaning in communal obligations, contributing to the lives of others and a heightened solidarity (Wilson 42, 44) in contrast to an individual striving for happiness and self-fulfilment. Early naturalistic accounts of mental health, influenced by the traditions of Western psychology, presented thin descriptions of resilience as a quality innate to individuals that made them invulnerable or strong, despite exposure to substantial risk (Ungar, Thicker 91). The interest then moved towards a non-naturalistic contextually relevant understanding of resilience viewed in the social context of people’s lives. Authors such as Benson, Tricket and Birman (qtd. in Ungar, Thicker) started focusing upon community resilience, community capacity and asset-building communities; looking at areas such as - “spending time with friends, exercising control over aspects of their lives, seeking meaningful involvement in their community, attaching to others and avoiding threats to self-esteem” (91). In so doing far more emphasis was given in developing what Ungar (Thicker) refers to as ‘a thicker description of resilience’ as it relates to the lives of refugees that considers more than an ability to survive and thrive or an internal psychological state of wellbeing (89). Ungar (Thicker) describes a thicker description of resilience as revealing “a seamless set of negotiations between individuals who take initiative, and an environment with crisscrossing resources that impact one on the other in endless and unpredictable combinations” (95). A thicker description of resilience means adopting more of what Eyber proposes as an emic approach, taking on an ‘insider perspective’, incorporating the worldview of the people experiencing the distress; in contrast to an etic perspective using a Western biomedical understanding of distress, examined from a position outside the social or cultural system in which it takes place. Drawing on a more anthropological tradition, intervention is able to be built with local resources and strategies that people can utilize with attention being given to cultural traditions within a socio-cultural understanding. Developing an emic approach is to engage in intercultural dialogue, raise dilemmas, test assumptions, document hopes and beliefs and explore their implications. Under this approach, healing is more about developing intelligibility through one’s own cultural and social matrix (Bracken, qtd. in Westoby and Ingamells 1767). This then moves beyond using a Western therapeutic approach of exploration which may draw on the rhetoric of resilience, but the coping strategies of the vulnerable are often disempowered through adopting a ‘therapy culture’ (Furedi, qtd. in Westoby and Ingamells 1769). Westoby and Ingamells point out that the danger is by using a “therapeutic gaze that interprets emotions through the prism of disease and pathology”, it then “replaces a socio-political interpretation of situations” (1769). This is not to dismiss the importance of restoring individual well-being, but to broaden the approach adopted in contextualising it within a socio-cultural frame. The Relational Aspect of Resilience Previously, the concept of the ‘resilient individual’ has been of interest within the psychological and self-help literature (Garmezy, qtd. in Wilson) giving weight to the aspect of it being an innate trait that individuals possess or harness (258). Yet there is a need to explore the relational aspect of resilience as it is embedded in the network of relationships within social settings. A person’s identity and well-being is better understood in observing their capacity to manage their responses to adverse circumstances in an interpersonal community through the networks of relationships. Brison, highlights the collective strength of individuals in social networks and the importance of social support in the process of recovery from trauma, that the self is vulnerable to be affected by violence but resilient to be reconstructed through the help of others (qtd. in Wilson 125). This calls for what Wilson refers to as a more interdisciplinary perspective drawing on cultural studies and sociology (2). It also acknowledges that although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. To date, within sociology and cultural studies, there is not a well-developed perspective on the topic of resilience. Resilience involves a complex ongoing interaction between individuals and their social worlds (Wilson 16) that helps them make sense of their world and adjust to the context of resettlement. It includes developing a perspective of people drawing upon negative experiences as productive cultural resources for growth, which involves seeing themselves as agents of their own future rather than suffering from a sense of victimhood (Wilson 46, 258). Wilson further outlines the display of a resilience-related capacity to positively interpret and derive meaning from what might have been otherwise negative migration experiences (Wilson 47). Wu refers to ‘imagineering’ alternative futures, for people to see beyond the current adverse circumstances and to imagine other possibilities. People respond to and navigate their experience of trauma in unique, unexpected and productive ways (Wilson 29). Trauma can cripple individual potential and yet individuals can also learn to turn such an experience into a positive, productive resource for personal growth. Grief, despair and powerlessness can be channelled into hope for improved life opportunities. Social networks can act as protection against adversity and trauma; meaningful interpersonal relationships and a sense of belonging assist individuals in recovering from emotional strain. Wilson asserts that social capabilities assist people in turning what would otherwise be negative experiences into productive cultural resources (13). Graybeal (238) and Saleeby (297) explore resilience as a strength-based practice, where individuals, families and communities are seen in relation to their capacities, talents, competencies, possibilities, visions, values and hopes; rather than through their deficiencies, pathologies or disorders. This does not present an idea of invulnerability to adversity but points to resources for navigating adversity. Resilience is not merely an individual trait or a set of intrinsic behaviours that can be displayed in ‘resilient individuals’. Resilience, rather than being an unchanging attribute, is a complex socio-cultural phenomenon, a relational concept of a dynamic nature that is situated in interpersonal relations (Wilson 258). Positive Growth through a Community Based Approach Through migrating to another country (in the context of refugees), Falicov, points out that people often experience a profound loss of their social network and cultural roots, resulting in a sense of homelessness between two worlds, belonging to neither (qtd. in Walsh 220). In the ideological narratives of refugee movements and diasporas, the exile present may be collectively portrayed as a liminality, outside normal time and place, a passage between past and future (Eastmond 255). The concept of the ‘liminal’ was popularised by Victor Turner, who proposed that different kinds of marginalised people and communities go through phases of separation, ‘liminali’ (state of limbo) and reincorporation (qtd. in Tofighian 101). Difficulties arise when there is no closure of the liminal period (fleeing their former country and yet not being able to integrate in the country of destination). If there is no reincorporation into mainstream society then people become unsettled and feel displaced. This has implications for their sense of identity as they suffer from possible cultural destabilisation, not being able to integrate into the host society. The loss of social supports may be especially severe and long-lasting in the context of displacement. In gaining an understanding of resilience in the context of displacement, it is important to consider social settings and person-environment transactions as displaced people seek to experience a sense of community in alternative ways. Mays proposed that alternative forms of community are central to community survival and resilience. Community is a source of wellbeing for building and strengthening positive relations and networks (Mays 590). Cottrell, uses the concept of ‘community competence’, where a community provides opportunities and conditions that enable groups to navigate their problems and develop capacity and resourcefulness to cope positively with adversity (qtd. in Sonn and Fisher 4, 5). Chaskin, sees community as a resilient entity, countering adversity and promoting the well-being of its members (qtd. in Canavan 6). As a point of departure from the concept of community in the conventional sense, I am interested in what Ahmed and Fortier state as moments or sites of connection between people who would normally not have such connection (254). The participants may come together without any presumptions of ‘being in common’ or ‘being uncommon’ (Ahmed and Fortier 254). This community shows little differentiation between those who are welcome and those who are not in the demarcation of the boundaries of community. The community I refer to presents the idea as ‘common ground’ rather than commonality. Ahmed and Fortier make reference to a ‘moral community’, a “community of care and responsibility, where members readily acknowledge the ‘social obligations’ and willingness to assist the other” (Home office, qtd. in Ahmed and Fortier 253). Ahmed and Fortier note that strong communities produce caring citizens who ensure the future of caring communities (253). Community can also be referred to as the ‘soul’, something that stems out of the struggle that creates a sense of solidarity and cohesion among group members (Keil, qtd. in Sonn and Fisher 17). Often shared experiences of despair can intensify connections between people. These settings modify the impact of oppression through people maintaining positive experiences of belonging and develop a positive sense of identity. This has enabled people to hold onto and reconstruct the sociocultural supplies that have come under threat (Sonn and Fisher 17). People are able to feel valued as human beings, form positive attachments, experience community, a sense of belonging, reconstruct group identities and develop skills to cope with the outside world (Sonn and Fisher, 20). Community networks are significant in contributing to personal transformation. Walsh states that “community networks can be essential resources in trauma recovery when their strengths and potential are mobilised” (208). Walsh also points out that the suffering and struggle to recover after a traumatic experience often results in remarkable transformation and positive growth (208). Studies in post-traumatic growth (Calhoun & Tedeschi) have found positive changes such as: the emergence of new opportunities, the formation of deeper relationships and compassion for others, feelings strengthened to meet future life challenges, reordered priorities, fuller appreciation of life and a deepening spirituality (in Walsh 208). As Walsh explains “The effects of trauma depend greatly on whether those wounded can seek comfort, reassurance and safety with others. Strong connections with trust that others will be there for them when needed, counteract feelings of insecurity, hopelessness, and meaninglessness” (208). Wilson (256) developed a new paradigm in shifting the focus from an individualised approach to trauma recovery, to a community-based approach in his research of young Sudanese refugees. Rutter and Walsh, stress that mental health professionals can best foster trauma recovery by shifting from a predominantly individual pathology focus to other treatment approaches, utilising communities as a capacity for healing and resilience (qtd. in Walsh 208). Walsh highlights that “coming to terms with traumatic loss involves making meaning of the trauma experience, putting it in perspective, and weaving the experience of loss and recovery into the fabric of individual and collective identity and life passage” (210). Landau and Saul, have found that community resilience involves building community and enhancing social connectedness by strengthening the system of social support, coalition building and information and resource sharing, collective storytelling, and re-establishing the rhythms and routines of life (qtd. in Walsh 219). Bracken et al. suggest that one of the fundamental principles in recovery over time is intrinsically linked to reconstruction of social networks (15). This is not expecting resolution in some complete ‘once and for all’ getting over it, getting closure of something, or simply recovering and moving on, but tapping into a collective recovery approach, being a gradual process over time. Conclusion A focus on biomedical intervention using a biomedical understanding of distress may be limiting as a helping modality for refugees. Such an approach can undermine peoples’ agency, coping strategies and local cultural understandings of distress. Drawing on sociology and cultural studies, utilising a more emic approach, brings new insights to understanding resilience and how people respond to trauma in unique, unexpected and productive ways for positive personal growth while navigating the experience. This includes considering social settings and person-environment transactions in gaining an understanding of resilience. Although individual traits influence the action of resilience, it can be learned and developed in adverse situations through social interactions. Social networks and capabilities can act as a protection against adversity and trauma, assisting people to turn what would otherwise be negative experiences into productive cultural resources (Wilson 13) for improved life opportunities. The promotion of social competence is viewed as a preventative intervention to promote resilient outcomes, as social skill facilitates social integration (Nettles and Mason 363). As Wilson (258) asserts that resilience is not merely an individual trait or a set of intrinsic behaviours that ‘resilient individuals’ display; it is a complex, socio-cultural phenomenon that is situated in interpersonal relations within a community setting. References Ahmed, Sara, and Anne-Marie Fortier. “Re-Imagining Communities.” International of Cultural Studies 6.3 (2003): 251-59. Bracken, Patrick. J., Joan E. Giller, and Derek Summerfield. Psychological Response to War and Atrocity: The Limitations of Current Concepts. 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