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Resumo Estima-se que no mundo, atualmente, haja 89,3 milhões de pessoas em deslocamentos forçados, incluindo 27,1 milhões de refugiados. Entre as razões para essas migrações forçadas estão a tortura e outras formas de violência, embora a prevalência de violências antes e durante a migração ainda seja pouco conhecida. O objetivo deste estudo é analisar a prevalência e alguns fatores associados às violências relatadas por solicitantes de refúgio no Rio de Janeiro. Foram coletados dados preenchidos nos formulários de solicitação de refúgio do Comitê Nacional para Refugiados de 2010 a 2017 e em entrevistas adicionais conduzidas na Cáritas Arquiocesana-RJ. Foram incluídos 1.546 solicitantes de refúgio com idade mediana de 30 anos (faixa 15-72 anos), dos quais 65% eram homens. Um terço informou ter sofrido violência antes de chegar ao Brasil, com chances de violência relatada entre 20 e 40 vezes maiores entre migrantes oriundos de Paquistão, Congo, Colômbia, República Democrática do Congo e Guiné. Violência física/tortura, ameaça e violência psicológica foram as mais frequentes (relatadas por 10%, 7% e 6% da população estudada, respectivamente). Entre as mulheres, a violência sexual foi a modalidade mais frequente (9%). Conclui-se que a história de violência entre os solicitantes de refúgio no Brasil é frequente, em particular para alguns grupos nacionais, aspecto a ser considerado no acolhimento e na prestação de serviços a essa população em situação de extrema vulnerabilidade. Abstract Currently, the world has 89.3 million forcibly displaced people, including 27.1 million refugees. Among the reasons for displacement are torture and other forms of violence, but the real prevalence of violence before and during migration is poorly reported. The aim of this study is to analyze the prevalence of reported violence among asylum seekers in Rio de Janeiro and its associated factors. We collected secondary data from individuals who filled out the National Committee for Refugees’ asylum application forms from 2010 to 2017 and responded to the social interview at Cáritas-RJ. We included 1,546 asylum seekers with a mean age of 30 (range 15-72), 65% of whom were men. One third reported experiencing violence before arriving in Brazil. Chances of experiencing violence were 20 to 40 times higher among refugees arriving from Pakistan, Congo, Colombia, the Democratic Republic of Congo and Guinea. Physical violence/torture and psychological threats were the most frequent forms (10%, 7% and 6% of the population, respectively). Among women, sexual violence was the most frequent form of violence (9% of women). We conclude that asylum seekers in Brazil frequently suffered violence before their arrival, particularly some groups. This needs to be addressed when providing services to this extremely vulnerable population. Resumen Actualmente, hay en el mundo 89,3 millones de personas desplazadas por la fuerza, incluidos 27,1 millones de refugiados. Entre las razones de desplazamiento forzado están la tortura y otras formas de violencia, pero la prevalencia real de la violencia antes y durante la migración ha sido poco estudiada. El objetivo de este estudio es analizar la prevalencia de violencia reportada entre los solicitantes de asilo en Río de Janeiro y los factores asociados a esta. Recolectamos datos secundarios de personas que completaron los formularios de solicitud de asilo del Comité Nacional para Refugiados desde 2010 hasta 2017 y de entrevistas adicionales en Cáritas RJ. Incluimos a 1546 solicitantes de asilo con una edad media de 30 (15-72) años, de los cuales 65 % eran hombres. Un tercio informó haber experimentado violencia antes de llegar a Brasil, con posibilidades de violencia de entre 20 a 40 veces mayores para entre migrantes oriundos de Pakistán, Congo, Colombia, República Democrática del Congo y Guinea. Violencia/tortura física, amenazas y violencia psicológica son las formas más frecuentes (10 %, 7 % y 6 % respectivamente) relatadas. Entre las mujeres, la más frecuente fue la violencia sexual (9 % de los relatos). Concluimos que la historia de violencia entre los solicitantes de asilo en Brasil es frecuente, sobre todo en algunos grupos nacionales en particular, aspecto que se debe considerar al prestarle servicios a esta población extremadamente vulnerada.

Background In 2018, there were 70.8 million refugees, asylum seekers and persons displaced by wars and conflicts worldwide. Many of these individuals face a high risk for tuberculosis in their country of origin, which may be accentuated by adverse conditions endured during their journey. We summarised the prevalence of active and latent tuberculosis infection in refugees and asylum seekers through a systematic literature review and meta-analyses by country of origin and host continent. Methods Articles published in Medline, EMBASE, Web of Science and LILACS from January 2000 to August 2017 were searched for, without language restriction. Two independent authors performed the study selection, data extraction and quality assessment. Random effect models were used to estimate average measures of active and latent tuberculosis prevalence. Sub-group meta-analyses were performed according to country of origin and host continent. Results Sixty-seven out of 767 identified articles were included, of which 16 entered the meta-analyses. Average prevalence of active and latent tuberculosis was 1331 per 100 thousand inhabitants [95% confidence interval (CI) = 542–2384] and 37% (95% CI = 23–52%), respectively, both with high level of heterogeneity (variation in estimative attributable to heterogeneity [I2] = 98.2 and 99.8%). Prevalence varied more according to countries of origin than host continent. Ninety-one per cent of studies reported routine screening of recently arrived immigrants in the host country; two-thirds confirmed tuberculosis bacteriologically. Many studies failed to provide relevant information. Conclusion Tuberculosis is a major health problem among refugees and asylum seekers and should be given special attention in any host continent. To protect this vulnerable population, ensuring access to healthcare for early detection for prevention and treatment of the disease is essential.

To analyze the sociodemographic profile and self-reported health conditions of asylum-seekers in Rio de Janeiro.A cross-sectional study of secondary data, collected from asylum claims forms completed in 2016 and 2017, at Cáritas Arquidiocesana do Rio de Janeiro (Cáritas-RJ). Descriptive analyses were performed and absolute and relative frequencies and 95% confidence intervals were calculated.Claims completed by 818 asylum-seekers from 49 different countries were identified, of whom 126 (20.3%) were stateless, 510 (62.7%) were male, 797 (97.4%) were adults, with a mean age of 30.5 years, 551 (73.5%) were single, 340 (44.1%) had higher education, and 27 (4.0%) were unemployed in their country of origin before coming to Brazil. Fear of persecution for political opinion, violation of human rights, and risk of torture stood out among the reasons stated for requesting asylum. To reach Brazil, 629 (80.5%) traveled only by plane. Regarding health conditions, 216 (29.0%) reported having some symptom, disease or health problem, the most frequent being pain, vision problems, infectious diseases (including HIV/AIDS), and hypertension. Only 15 individuals (2.2%) reported being in some medical or psychological treatment; 42 (6.0%) reported visual impairments, 14 (2.0%) reported physical impairments and 4 (0.6%) hearing impairments.Unlike other countries, where forced migrants with a low level of education enter clandestinely by sea or land, asylum-seekers residing in Rio de Janeiro between 2016 and 2017 were mostly adults with higher education who migrated using air transport. They had primary care-sensitive health conditions that could be treated via access to public primary health care services.

OBJETIVO Analisar o perfil sociodemográfico e as condições de saúde autorrelatadas por solicitantes de refúgio no Rio de Janeiro. MÉTODOS Estudo transversal de dados secundários, coletados de formulários de solicitação de refúgio preenchidos em 2016 e 2017, na Cáritas Arquidiocesana do Rio de Janeiro (Cáritas-RJ). Foram realizadas análises descritivas e calculadas frequências absolutas, relativas e intervalos de 95% de confiança. RESULTADOS Foram identificados formulários preenchidos por 818 solicitantes de refúgio, originários de 49 países diferentes, dos quais 126 (20,3%) eram apátridas, 510 (62,7%) do sexo masculino, 797 (97,4%) adultos, com idade média de 30,5 anos, 551 (73,5%) solteiros, 340 (44,1%) com ensino superior e 27 (4,0%) desempregados no país de origem antes da vinda para o Brasil. Entre os motivos declarados para solicitação de refúgio, destacaram-se o temor de perseguição por opinião política, violação de direitos humanos e risco de tortura. Para chegar ao Brasil, 629 (80,5%) viajaram somente de avião. Em relação às condições de saúde, 216 (29,0%) afirmaram ter algum sintoma, doença ou agravo em saúde, sendo as mais frequentes dores, problemas de visão, doenças infecciosas (incluindo HIV/aids) e hipertensão. Apenas 15 indivíduos (2,2%) relataram estar em algum tratamento médico ou psicológico; 42 (6,0%) relataram deficiências visuais, 14 (2,0%) relataram deficiências físicas e 4 (0,6%) deficiências auditivas. CONCLUSÕES Diferentemente de outros países, onde migrantes forçados de baixo grau de instrução entram por vias clandestinas marítimas ou terrestres, os solicitantes de refúgio residentes no Rio de Janeiro entre 2016 e 2017, eram, em sua maioria, adultos com ensino superior que migraram usando transporte aéreo. Apresentavam condições de saúde sensíveis à atenção primária que poderiam ser tratadas via acesso aos serviços públicos da atenção primária em saúde.

OBJECTIVE: To synthesize data about the prevalence of sexual violence (SV) among refugees around the world. METHODS: A systematic review was conducted from the search in seven bibliographic databases. Studies on the prevalence of SV among refugees and asylum seekers of any country, sex or age, whether in English, French, Spanish and Portuguese, were eligible. RESULTS: Of the 2,906 titles found, 60 articles were selected. The reported prevalence of SV was largely variable (0% to 99.8%). Reports of SV were collected in all continents, with 42% of the articles mentioning it in refugees from Africa (prevalence from 1.3% to 100%). The rape was the most reported SV in 65% of the studies (prevalence from 0% to 90.9%). The main victims were women in 89% of the studies, all the way, especially when still in the countries of origin. The SV was perpetrated particularly by intimate partners, but also by agents of supposed protection. Few studies have reported SV in men and children; the prevalence reached up to 39.3% and 90.9%, respectively. Approximately one-third of the studies (32%) were carried out in refugee camps and more than half (52%) in health services using mental health assessment tools. No study has addressed the most recent migratory crisis. Meta-analysis was not performed due to the methodological heterogeneity of the studies. CONCLUSIONS: SV is a prevalent problem affecting refugees of both sexes, of all ages, throughout the migratory journey, particularly those from Africa. Protection measures are urgently needed, and further studies, with more appropriate tools, may better measure the current magnitude of the problem.

Background: In 2017, there were 68·5 million refugees, asylum seekers and persons displaced by wars and conflicts worldwide. Tuberculosis prevalence in the country of origin and adverse conditions endured during their journey may increase their risk for tuberculosis. We summarized the prevalence of active and latent tuberculosis infection (LTBI) among refugees and asylum seekers through a literature systematic review and meta-analysis by country of origin. Methods: Articles published in Medline, EMBASE, Web of Science and LILACS from 2000 to August 2017 were searched for, without language restriction. Two independent reviewers performed all review steps. Random effect models were used to estimate pooled measures of active and latent tuberculosis infection (LTBI) prevalence. Sub-group analyses were performed according to the country of origin and host continent. Findings: Sixty-seven out of 767 identified papers were included, of which 16 entered the meta-analysis. Pooled prevalence by contry of origin of active and latent tuberculosis were 0·01 [95% confidence interval (CI)=0·00-0·02] and 0·41 (95% CI=0·25-0·57), respectively, both with high level of heterogeneity (I2=98·2% and 99·8%). Ninety-one per cent of studies reported routine screening of recently arrived immigrants in the host country; two-thirds confirmed tuberculosis bacteriologically. Interpretation: Tuberculosis is a major health problem among refugees and asylum seekers and should be given special attention. The high prevalence of active and latent tuberculosis indicates the need for ensuring access to healthcare for early detection, treatment and prevention of the disease, aiming protection of this vulnerable population. Funding: Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES). RP has had a study grant from the Brazilian Coordination for the Improvement of Higher Education Personnel (CAPES). CAPES is not responsible for any statement in this manuscript. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The authors declare: "Not applicable."

Submitted by Boris Flegr (boris@uerj.br) on 2020-07-05T16:09:25Z No. of bitstreams: 1 RaquelProenca dissertacao.pdf: 1669414 bytes, checksum: ef11a54a95ab016998ad159d9955fe3a (MD5) Made available in DSpace on 2020-07-05T16:09:25Z (GMT). No. of bitstreams: 1 RaquelProenca dissertacao.pdf: 1669414 bytes, checksum: ef11a54a95ab016998ad159d9955fe3a (MD5) Previous issue date: 2017-03-21 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior In 2015, there were around 65.3 million refugees displaced by wars and conflicts, with 5.8 million more than in 2014, thus showing an increasing pattern. Compared with other categories of immigration visas, refugees and asylum seekers are at increased risk for tuberculosis (TB) as a result of the prevalence of the disease in their country of origin, exposure during migration and adverse conditions during this period. The main objective of this study was to analyse the prevalence and incidence of active and latent tuberculosis infection (LTBI) in refugees and asylum seekers through a systematic review of the literature. We conducted a search in Medline, EMBASE, Web of Science and LILACS of studies published from 2000 to August 2016, including cross-sectional, longitudinal studies or trials that described the prevalence and/or incidence of both active TB and/or LTBI among refugee and asylum seekers, without linguistic restriction. Studies with population of less than 30 individuals were excluded. The study selection, data extraction and assessment of the report quality were carried out by two independent reviewers and the differences were solved by a third reviewer. Six-hundred and twenty-four studies were identified, of which 54 were included in the review. Screening for TB (active or LTBI) of the individuals who arrived in the host country accounted for the reasons why individuals were screened in 94.3% of studies. We identify a high incidence rate (between 482 and 3,810 cases per 100,000 inhabitants) and prevalence (50% of studies between 500 and 2,500 per 100,000 inhabitants) of active TB. Regrading LTBI, 50% of the studies showed a prevalence ranging from 15 to 42%, reaching 85%. The prevalence of active and latent TB was higher among men, refugees from countries with high TB incidence, and low-income countries. The countries of origin with the largest number of refugees captured in the studies were: Iraq, Afghanistan, Thailand, Myanmar, and Bhutan. Twenty-one studies were conducted in the US, which has a restrictive immigration policy. Regarding the quality of the study reports, 87.5% of the cross-sectional studies and 92.9% of the cohort studies fulfilled at least 50% of the Strengthening the Reporting of Observacional Studies in Epidemiology (STROBE) criteria. These findings point to TB as a public health problem for this population, as it is necessary to ensure rapid access to refugees and health care in the host country, as well as to ensure that the non-refoulement principle stated at Genebra Convention (1951) will be respected. Em 2015 existiam cerca de 65,3 milhões de refugiados deslocados por guerras e conflitos, com 5,8 milhões de pessoas a mais do que em 2014, mostrando assim um padrão crescente. Comparado com os portadores das demais categorias de visto de imigração, os refugiados e requerentes de asilo possuem um risco aumentado para tuberculose (TB) como consequência da prevalência da doença em seu país de origem, exposição durante a migração e condições adversas nesse período. O objetivo desse estudo foi analisar dados disponíveis sobre a prevalência e a incidência da infeção latente por tuberculose (ILTB) e da TB ativa entre refugiados e requerentes de asilo por meio de uma revisão sistemática da literatura. Realizamos uma busca no Medline, EMBASE, Web of Science e LILACS até agosto de 2016, incluindo estudos observacionais transversais, longitudinais ou ensaios clínicos publicados desde 2000 que descreveram a prevalência e/ou incidência de TB ativa e/ou ILTB em imigrantes refugiados e requerentes de asilo, sem restrição linguística. Estudos com população de estudo inferior a 30 indivíduos foram excluídos. A seleção dos estudos, extração dos dados e avaliação da qualidade do relato foram realizadas por dois revisores independentes e as divergências foram resolvidas por um terceiro revisor. Foram identificados 624 estudos, sendo 54 desses incluídos. A triagem para TB (ativa ou ILTB) ao chegar ao país de acolhimento foi o motivo da captação em 94,3% dos estudos. Identificamos alta taxa de incidência (entre 482 e 3.810 casos por 100 mil habitantes) e de prevalência (50% dos estudos entre 500 e 2.500 casos por 100 mil habitantes) de TB ativa. Em relação à prevalência de ILTB, 50% dos estudos mostram entre 15 e 42%, chegando a 85%. Tanto TB ativa quanto ILTB foram mais frequentes entre os homens, entre refugiados provenientes de países de alta incidência de TB e de países de baixa renda. Os países de origem com maior número de refugiados foram Iraque, Afeganistão, Tailândia, Myanmar e Butão. Vinte e um estudos foram conduzidos nos EUA, que tem uma política restritiva de imigração. Quanto à avaliação da qualidade do relato dos estudos 87,5% dos estudos transversais e 92,9% dos estudos de coorte atenderam a pelo menos 50% dos critérios do Strengthening the Reporting of Observacional Studies in Epidemiology (STROBE). Os achados desse estudo apontam para a TB como um problema de saúde pública para essa população. Desta forma, é preciso assegurar o rápido acesso dos refugiados à assistência à saúde no país de acolhimento, bem como garantir que não serão devolvidos , como diz a Convenção de Genebra (1951).

Dissertação de Mestrado Integrado em Medicina Veterinária Helicobacter pullorum (H. pullorum), uma bactéria inicialmente isolada a partir das fezes e do fígado de aves de capoeira, tem sido associada a doenças gastrintestinais e hepáticas no Homem. Dada a dificuldade na identificação desta bactéria, devido à proximidade fenotípica com Campylobacter spp., pensa-se que as infeções derivadas estejam subestimadas. Este estudo teve como objetivo avaliar a presença de H. pullorum e Campylobacter spp. em frangos destinados ao consumo humano, ao nível de um matadouro em Portugal. Para tal, foram recolhidas amostras provenientes de conteúdo cecal e pele do pescoço de frangos de produção extensiva (cinco bandos) e intensiva (quatro bandos), num total de 18 amostras de cada tipo, representando 29.245 aves. As amostras foram testadas para H. pullorum e Campylobacter spp. por PCR e por cultura utilizando o método modificado do filtro. Os resultados demonstram uma elevada frequência dos dois microrganismos ao nível do trato intestinal dos frangos nos bandos testados: H. pullorum foi detetado em cinco dos nove bandos de frangos analisados ao nível deste matadouro (55,6%) e Campylobacter spp. em seis dos nove bandos (66,7%), considerando ambas as técnicas. Ambos os agentes patogénicos foram mais frequentes nos frangos de produção extensiva indoor do que nos frangos de produção intensiva: H. pullorum, 80% e 50%, respetivamente e Campylobacter spp., 100% e 75%, respetivamente. No geral, foi obtida maior taxa de positividade nas amostras de conteúdo cecal. Foi observada elevada frequência de codeteção por estes dois agentes patogénicos nas amostras recolhidas no matadouro: em cinco dos nove bandos ao nível das amostras cecais, e num dos bandos de frangos ao nível da pele do pescoço. O gene hcp, marcador do sistema de secreção do tipo VI (T6SS), foi encontrado em oito das 21 estirpes de H. pullorum testadas (38%), sugerindo uma virulência aumentada destes isolados para as aves e seres humanos. Sendo H. pullorum um agente patogénico emergente de origem alimentar, o estudo torna-se relevante no âmbito da saúde pública. Este tema engloba uma vasta área de interesses, ao nível da medicina veterinária e humana, saúde pública e segurança dos alimentos. ABSTRACT - HELICOBACTER PULLORUM AND CAMPYLOBACTER SPP. CODETECTION ON POULTRY MATERIALS - Helicobacter pullorum (H. pullorum), a bacterium initially isolated from the feces and livers of poultry, has been associated with gastrointestinal and liver diseases in humans. Due to the difficulty in identifying this bacterium, because of the phenotypic concordance between Helicobacter and Campylobacter genus, it is considered an underestimated infection. This study aimed to assess the presence of H. pullorum and Campylobacter spp. in broilers for human consumption at the slaughterhouse level in Portugal. In order to carry out the experiment, samples from cecal contents and neck skins from extensive indoor (five flocks) and intensive production (four flocks) were collected, totaling 18 pools of each type, representing 29.245 birds. Samples were tested for H. pullorum and Campylobacter spp. by PCR and by culture using the modified filter method. The results showed a high frequency of the two microorganisms in flocks, at the gastrointestinal level: H. pullorum was detected in fiveof the nine flocks (55,6%) and Campylobacter spp. in eight of the nine flocks (66,7%) of chickens analyzed from the slaughterhouse, considering both technics. Both pathogens were more frequently detected in extensive indoor chickens than in intensive production chickens: H. pullorum, 80% and 50%, respectively, and Campylobacter spp., 100% and 75%, respectively. Overall, higher rate of positivity was observed for ceca samples for both pathogens. Most of the broiler intestines and neck skin samples from slaughterhouse presented co-infection/colonization with both these pathogens: at the level of cecal samples, in five of the nine flocks, and in the neck skin samples, in one flock. The hcp gene, marker of the type secretion system VI (T6SS), was detected in eight of the 21 (38%) strains of H. pullorum, suggesting an increased virulence in these isolates for poltry and humans. This subject covers a wide area of interests at the level of veterinary and human medicine, public health and food quality and safety.