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PubMed2004

Infectious disease screening for refugees resettled in the United States.

Refugees resettling in the United States carry a significant burden of infectious diseases as a result of exposures in their countries of origin and the circumstances of their migration. Overseas screening is required before entry, but it incompletely assesses infectious diseases in refugees. Domestic health assessment has the potential to provide more comprehensive assessment for infectious diseases. Screening protocols ideally should test for tuberculosis, hepatitis B, and intestinal and other parasites and should include mechanisms for providing or updating immunizations. Testing for other infectious diseases, including malaria, hepatitis C, human immunodeficiency virus, and sexually transmitted diseases, can be performed on the basis of clinical signs and symptoms. This article reviews the current status of overseas and domestic health screening for refugees, infectious disease burdens, and future goals for health assessment of refugees and other immigrants.

Communicable Disease Control↗
PubMed1983

Intestinal parasites among Southeast Asian refugees in Massachusetts.

This laboratory examined 2,158 stool specimens for intestinal parasites from 1,478 Southeast Asian refugees who immigrated to Massachusetts between September 1981 and April 1982. Seventy-five per cent of refugees harbored one or more of 20 different species of intestinal parasites. Multiple infections occurred in 49% of refugees. Twenty-one per cent had pathogenic protozoa, which are transmissible from person to person. Six per cent had nonpathogenic protozoa only. Entamoeba polecki, an ameba rarely seen in the United States, was found in 5% of refugees.

Asia, Southeastern↗
PubMed2005

Age at menarche and its influencing factors in North Korean female refugees.

BACKGROUND: Age at menarche is known to be regulated by genetic and environmental factors. To date, no menarcheal data are available on North Korean women. In this cross-sectional survey, we investigated age at menarche and its possible influencing factors in North Korean refugees. METHODS: Four hundred and eleven North Korean refugees were surveyed at a North Korean female refugee camp using a structured questionnaire within 3 months of immigration. Menarcheal age was requested and the data obtained were analysed with respect to age at interview, region of residence in North Korea, education, food preference and sleep duration. RESULTS: Mean age at menarche was 16.0+/-2.1 years (mean+/-SD). Univariate analysis demonstrated a significant difference in the menarcheal age among the different food preference groups (P=0.0236). Sleep duration was found to be significantly and negatively correlated with age at menarche (R=-0.23, P<0.0001). However, generalized linear model (GLM) analysis revealed that region of residence at menarche (P=0.0209) and sleep duration (P=0.0007) were significant determinants. Food preference played a role as an effect modifier in the relationship between the region of residence at menarche and age at menarche. CONCLUSION: Age at menarche seemed to be delayed in North Korean refugees. GLM analysis showed that sleep duration and region of residence at menarche were significant influencing factors of age at menarche in this study population.

Adolescent↗
PubMed1991

Mortality and cancer incidence in Vietnamese refugees in England and Wales: a follow-up study.

Mortality and cancer incidence were analysed in follow-up of a cohort of 3327 Vietnamese refugees who came to Britain after the end of the Vietnam war. Overall mortality of the refugees was very low compared to expectations based on England and Wales national rates: the all-cause standardized mortality ratio for males was 64 (95% confidence interval 52-77) and for females was 56 (95% confidence interval 44-71). This resulted particularly from very low mortality from ischaemic heart disease and colorectal cancer in each sex, and breast cancer in women. Mortality in the refugees was greatly increased for tuberculosis, cancer of the stomach in both sexes, cancers of the nasopharynx and liver in males, and peptic ulcer in females. Cancer incidence data showed in addition an excess of cancer of the penis. Despite the great trauma and stress of their flight, the only indication of a possible effect of the migration on the mortality of the refugees who survived to reach Britain was the excess of peptic ulcer deaths in women.

Adult↗
PubMed1998

The effect of soap distribution on diarrhoea: Nyamithuthu Refugee Camp.

BACKGROUND: In January 1993, Nyamithuthu Camp in Malawi housed 64000 Mozambican refugees. Communicable diseases, primarily diarrhoea, pneumonia, malaria and measles, contribute to substantially higher mortality rates in refugee populations compared to similar non-displaced populations. METHOD: A systematic sample of 402 households in one portion of the camp were surveyed for diarrhoeal risk factors, and then interviewed twice weekly for 4 months regarding new diarrhoea episodes and the presence of soap in the household. Two-hundred grams of soap per person was distributed monthly. RESULTS: Households had soap on average only 38% of the interview days. Soap was used primarily for bathing and washing clothes (86%). Although 81% of mothers reported washing their children's hands, only 28% of those mothers used soap for that purpose. The presence of soap in a household showed a significant protective effect: there were 27% less episodes of diarrhoea in households when soap was present compared to when no soap was present (RR = 0.73, 95% CI: 0.54 < RR < 0.98). Potential confounding factors were assessed and did not appear to be responsible for the association between the presence of soap and reductions in diarrhoea incidence. CONCLUSION: In summary, our findings suggest that the provision of regular and adequate soap rations, even in the absence of a behaviour modification or education programme, can play an important role in reducing diarrhoea in refugee populations. If subsequent study confirms the soap as a cheap and effective measure to reduce diarrhoea, its provision in adequate amounts should be a high priority in refugee settings.

Adolescent↗
PubMed1977

Acute hemorrhagic conjunctivitis: a mixed virus outbreak among Vietnamese refugees on Guam.

In May 1975 the authors investigated an outbreak of acute hemorrhagic conjunctivitis that affected an estimated 29,000 refugees from South Vietnam who stayed on Guam while en route to the United States. Illness usually lasted6-10 days and was characterized by conjunctival injection (100%), lid edema (84%), eye irritation (81%) and subconjunctival hemorrhages (45%). Conjunctival swabs and paired serum specimens on a limited number of patients implicated enterovirus 70 as a major etiologic agent and adenovirus 11 as a less frequent agent. Adenovirus 8 and herpes simplex virus caused concurrent, sporadic cases of keratoconjunctivitis. Forty-three per cent of the refugees in a sample of 604 refugees were affected, and the attack rate was highest on evacuation vessels where crowding and poor sanitation facilitated person-to-person spread of infection. Because the outbreak subsided on Guam, and because infection was transmitted there to only 13 of about 1300 Americans in frequent contact with affected refugees, the risk of secondary outbreaks inthe United States appeared small.

Acute Disease↗
PubMed1998

The Indochinese Psychiatry Clinic: trauma and refugee mental health treatment in the 1990s.

The Indochinese Psychiatry Clinic (IPC), located in Boston, was founded in 1981 to meet the special needs of traumatized Cambodian, Vietnamese, and Laotian refugees resettling in the Boston area. Over the past 16 years, IPC has pioneered the field of refugee mental health and the treatment of the psychological and social sequelae of mass violence and torture. IPC developed the bicultural model of psychiatric treatment of refugees suffering from trauma-related mental disorders, which utilizes a multidisciplinary, bicultural team approach that emphasizes understanding the patient's trauma history within the appropriate cultural, social, and political context. This article summarizes IPC's background, patient profile, clinical approach, service elements, and funding structure. Recent immigration and welfare reform legislation will have a harsh impact on the population of refugees who are disabled due to the psychosocial consequences of their traumatic experiences. This legislation and the restrictions on mental health care imposed by public managed care will also affect the providers of their mental health care.

Adult↗
PubMed1996

The Khmer Adolescent Project: III. A study of trauma from Thailand's Site II refugee camp.

OBJECTIVE: To determine the prevalence rates of posttraumatic stress disorder (PTSD) and depression in a sample of 99 Cambodian youths, aged 18 to 25 years, living in the Site II refugee camps along the Thai-Cambodian border; to compare these rates to data collected in a similarly aged sample of Cambodian refugees living in the United States; and to illustrate the findings with case vignettes and a brief description of the refugee camp at Site II. METHOD: The senior author describes the main features of life in the Site II camp while being employed in one of its medical clinics. A Khmer translated version of the depression section of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version and the PTSD section of Diagnostic Interview Schedule for Children and Adolescents were used in interview format by trained bilingual research assistants. Khmer versions of the Beck Depression Inventory and the Impact of Events Scale were also administered. RESULTS: The enduring nature of PTSD was evident in this sample of Khmer youths who had survived the Pol Pot regime as children. Similar rates of Pol Pot-related PTSD were found when compared to rates from the US sample. Subclinical forms of PTSD were found in those who reported their worst trauma during life in the camp, while the full PTSD syndrome was associated with those who reported trauma occurring during the earlier Pol Pot regime. Extremely high rates of depressive disorder were found which were interpreted as related to the repatriation back to Cambodia as this study was undertaken. CONCLUSION: PTSD in this sample appears to be specifically related to earlier war trauma, while depressive symptoms appear more related to recent stressors. As with other findings from the Khmer adolescent project, this study reaffirms the strong connection between the diagnosis of current PTSD and earlier war trauma in an additional sample of youths at Site II, Thailand. Depressive symptoms, on the other hand, appear to be related to the vicissitudes of recent stressful events in this refugee population.

Adolescent↗
PubMed1997

Does PTSD transcend cultural barriers? A study from the Khmer Adolescent Refugee Project.

OBJECTIVE: To determine whether the factor structure of the posttraumatic stress disorder (PTSD) syndrome in Cambodian refugee youth resembles earlier reported factor studies in Caucasian samples. METHOD: 194 Khmer adolescent refugees who reported prior significant trauma (most of it massive war trauma as children) were administered the PTSD module of the Diagnostic interview for Children and Adolescents, as part of an epidemiological study on the effects of war on this group of refugees. RESULTS: The following four factors were found: arousal, avoidance, intrusion, and numbing. A confirmatory factor analysis using data from the parents of this sample yielded a good fit for the four-factor solution based on the youth data. CONCLUSIONS: The four-factor solution from this sample resembled earlier studies on traumatized Caucasian and African-American adults. These results lend further credibility to the veracity of this diagnosis with refugee samples. PTSD as a result of prior war trauma appears to surmount the barriers of culture and language in this sample.

Adolescent↗
PubMed2004

Review of child and adolescent refugee mental health.

OBJECTIVE: To review stressful experiences and stress reactions among child and adolescent refugees, as well as interventions and ethical considerations in research and clinical work, within the framework of the chronological experiences of child refugees; namely, the phases of preflight, flight, and resettlement. Highlighted are special refugee populations such as unaccompanied minors, asylum seekers, and former child soldiers. Pertinent medical findings are summarized. METHOD: The authors reviewed articles from 1990 to 2003 addressing the topics above. Literature was gathered from databases including PsycINFO, Medline, and SocioFile. Pertinent earlier papers and those from other disciplines cited in database-identified articles were also included. RESULTS: Child and adolescent refugees suffer from significant conflict-related exposures. Reactions to stress may be mediated by coping strategies, belief systems, and social relations. CONCLUSIONS: More research is needed on interventions, specifically on efficacy and cultural relevance. Interventions that have an impact on multiple ecological levels need further development and evaluation.

Adaptation, Psychological↗
PubMed1993

DSM-III-R disorders in Vietnamese refugees. Prevalence and correlates.

This study's purpose was a) to determine the prevalence of DSM-III-R disorders in newly arrived ethnic Vietnamese and ethnic Chinese refugees from Vietnam and b) to determine the correlates of DSM-III-R disorders. A Vietnamese-speaking psychiatrist administered translated sections of the Structured Clinical Interview for DSM-III-R to 201 Vietnamese new arrivals undergoing mandatory health screening. Overall, 18.4% had one or more current disorders: 8.5% had adjustment disorder and 5.5% had major depression. Ethnic Vietnamese, compared with ethnic Chinese, had significantly (p < .05) higher rates of current posttraumatic stress disorder and generalized anxiety disorder. Ethnic differences in psychopathology were largely explained by the fact that ethnic Vietnamese refugees had experienced more traumatic events and separation from family. After adjusting for ethnicity, refugees who reported traumatic events, refugees who were married, and veterans were significantly (p < .05) more likely to have one or more psychiatric disorders.

Adult↗
PubMed1997

Predictors of depression among refugees from Vietnam: a longitudinal study of new arrivals.

The present study examined the impact of prearrival traumatic experiences and sociodemographic characteristics on future depression among Vietnamese and Chinese refugees from Vietnam. This is a longitudinal study of newly arrived refugees from Vietnam undergoing a mandatory health screening. A stratified consecutive sample of ethnic Chinese and ethnic Vietnamese refugees was drawn. The depression subscale of the Indochinese Hopkins symptoms checklist was administered to 114 refugees within the first 6 months after arrival in the United States and 12 to 18 months later. Ethnic Vietnamese reported more prearrival trauma compared with ethnic Chinese. Age was strongly correlated with time 2 depression among ethnic Vietnamese but not among ethnic Chinese. Multivariate linear regression analysis revealed that being a veteran, older, unattached, less proficient in English, ethnic Vietnamese, and more depressed at baseline predicted higher depression at follow-up. Although prearrival trauma predicted future depression, other sociodemographic characteristics assumed more importance with time.

Adult↗
PubMed2000

The Sierra Leonean refugee experience: traumatic events and psychiatric sequelae.

Although a number of studies address the mental health status of refugees from a variety of regions in the world, there are no studies of the mental health status of West African refugees. It was the purpose of this study to determine the prevalence of various traumatic events to which a sample of Sierra Leonean refugees have been exposed as well as psychiatric sequelae associated with such exposure. A procedure of probability sampling was used to identify and assess a sample of 55 Sierra Leonean refugees residing in a UNHCR-sponsored camp in The Gambia, West Africa. The Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 served as survey instruments. The findings clearly indicate the presence of disturbingly high prevalence rates for various traumatic experiences and psychiatric sequelae. It appears that a significant mental health problem exists that begs to be addressed.

Adult↗
PubMed1983

Health service utilization by Indochinese refugees.

In this article the utilization of medical services by Indochinese refugees is examined. A representative sample of the refugee population in one resettlement site provides basic data on health service utilization behaviors. The analysis focuses on the situational and attitudinal determinants of hospital contact, physician contact, and the volume of utilization of both services. The findings indicate that length of residence and ethnicity are important predictors of utilization behaviors. The most recently arrived refugees and the Hmong are low utilizers of physician and hospital services. A regression analysis of situational and attitudinal variables shows that effects of length of residence and ethnicity do not diminish when the effects of the other variables are considered. Although the results are similar to previous utilization studies, they do suggest that Indochinese refugees require more information about United States health services to utilize them properly.

Asia, Southeastern↗
PubMed1979

Health and nutritional status of Vietnamese refugees.

There are presently more than 7,000 Vietnamese refugees living in the greater New Orleans area. This paper summarizes the health and information on nutrition now available regarding Vietnamese refugees living in the United States. It is hoped that this effort will add to the documentation of the health changes occurring in migrant populations, and also stimulate the development of programs which will improve the health of the Vietnamese refugees in the United States. Although information on both the national and local level is limited, the following problems are found frequently in the Vietnamese refugee population in this country: dental caries, skin infestations, lack of adequate immunizations, and tuberculosis. Very little information is available concerning dietary habits and their relation to growth and development. There is some evidence that American nutritional patterns are being superimposed on traditional Vietnamese patterns. Target areas for further research are suggested.

Adult↗
PubMed2003

The TAFES multi-family group intervention for Kosovar refugees: a feasibility study.

The object of this study was to describe a feasibility study of the Tea and Families Education and Support (TAFES) intervention used in a group of newly resettled adult refugees from Kosova. The subjects were 86 newly resettled Kosovar refugees in Chicago who gave informed consent to participate in an investigation of the TAFES intervention. All subjects received family home visits, and most participated in the TAFES multi-family groups. The instruments were administered to adult participants before and 3 months after the intervention. The TAFES program had contact with 61 Kosovar refugee families, of which 42 families (69%) engaged in TAFES groups, including families with educated and working members. Several characteristics were associated with engaging in TAFES groups and included lower monthly family income and higher age of the first child. The uncontrolled postintervention assessments demonstrated increases in social support and psychiatric service use associated with engagement in the TAFES group. Participants also showed time changes in scale scores assessing trauma mental health knowledge, trauma mental health attitudes, and family hardiness. This study provides preliminary evidence that multi-family support and education groups are a feasible and possibly beneficial intervention for newly resettled refugees and indicates the need for further studies.

Acculturation↗
PubMed2003

Personality related to coping and social support among Iranian refugees in Sweden.

The aim of this study was to investigate the interrelatedness between temperament and character according to Cloninger's biosocial theory of personality, coping behavior, and social support among traumatized refugees. Personality, psychopathological disturbances, coping resources, and social support were assessed in 100 Iranian refugees resettled in Sweden who had been exposed to various extreme traumatic life events in Iran before their escape. Individuals traumatized by war experiences as soldiers, with low Beck Depression Inventory scores showed the lowest scores in Harm Avoidance and the highest in Self-Directedness and Cooperativeness. Concerning coping resources and social support, these subjects scored slightly higher and the traumatized refugees with high Beck Depression Inventory scores scored slightly lower compared with nontraumatized subjects. Resilient refugees are characterized by low harm avoidance, high self-directedness, and high cooperativeness scores which enables them to develop effective coping strategies to obtain sufficient social support and thus to become more resistant against severe trauma.

Adaptation, Psychological↗
PubMed2002

Environmental refugees: a growing phenomenon of the 21st century.

There is a new phenomenon in the global arena: environmental refugees. These are people who can no longer gain a secure livelihood in their homelands because of drought, soil erosion, desertification, deforestation and other environmental problems, together with the associated problems of population pressures and profound poverty. In their desperation, these people feel they have no alternative but to seek sanctuary elsewhere, however hazardous the attempt. Not all of them have fled their countries, many being internally displaced. But all have abandoned their homelands on a semi-permanent if not permanent basis, with little hope of a foreseeable return. In 1995, environmental refugees totalled at least 25 million people, compared with 27 million traditional refugees (people fleeing political oppression, religious persecution and ethnic troubles). The total number of environmental refugees could well double by the year 2010, and increase steadily for a good while thereafter as growing numbers of impoverished people press ever harder on overloaded environments. When global warming takes hold, there could be as many as 200 million people overtaken by sea-level rise and coastal flooding, by disruptions of monsoon systems and other rainfall regimes, and by droughts of unprecedented severity and duration.

Disasters↗