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PubMed1998

[Psychiatric symptoms in refugees reported to the Psychiatric Center De Vonk].

OBJECTIVE: To determine traumatic experiences and psychological symptoms in refugees reported to the psychiatric centre De Vonk, and the relationship between biographical data, experiences of violence and post-traumatic stress symptoms on the one hand and the referral or admission policy on the other. DESIGN: Descriptive. SETTING: Centre '45, refugee unit De Vonk (department for the treatment of traumatized refugees and asylum seekers), Noordwijkerhout, the Netherlands. The psychiatric centre De Vonk comprises, apart from an outpatient clinic and a daytime clinic, a department created for the clinical treatment of refugees with symptoms related to traumatization. METHODS: The main biographical and background data were collected. The first interview was routinely preceded by the Harvard trauma questionnaire (HTQ) and the Hopkins symptom checklist (HSCL-25), if necessary with the aid of an interpreter. The HTQ measures experiences of violence and post-traumatic stress symptoms; the HSCL-25 comprises an anxiety scale and a depression scale. RESULTS: Biographical data were obtained from 232 patients and questionnaire data from 169 patients. The population was heterogeneous as regards region of origin, duration of the stay in the Netherlands, education and age. Serious forms of violence were reported, such as abuse, torture and war violence, and many symptoms of anxiety and depression were mentioned. The scores for posttraumatic stress symptoms exceeded the clinical reference values in 82% in the group examined. Of the referred patients, 37% were admitted to the clinic. CONCLUSION: In spite of the diversity of language, culture and education among the refugees/asylum seekers referred to De Vonk, it proved adequately possible in practice to use standardized psychological and psychiatric instruments in this group of patients. The symptom level of the patients referred was particularly high.

Adult↗
PubMed1998

Cost-effectiveness of oral cholera vaccine in a stable refugee population at risk for epidemic cholera and in a population with endemic cholera.

Recent large epidemics of cholera with high incidence and associated mortality among refugees have raised the question of whether oral cholera vaccines should be considered as an additional preventive measure in high-risk populations. The potential impact of oral cholera vaccines on populations prone to seasonal endemic cholera has also been questioned. This article reviews the potential cost-effectiveness of B-subunit, killed whole-cell (BS-WC) oral cholera vaccine in a stable refugee population and in a population with endemic cholera. In the population at risk for endemic cholera, mass vaccination with BS-WC vaccine is the least cost-effective intervention compared with the provision of safe drinking-water and sanitation or with treatment of the disease. In a refugee population at risk for epidemic disease, the cost-effectiveness of vaccination is similar to that of providing safe drinking-water and sanitation alone, though less cost-effective than treatment alone or treatment combined with the provision of water and sanitation. The implications of these data for public health decision-makers and programme managers are discussed. There is a need for better information on the feasibility and costs of administering oral cholera vaccine in refugee populations and populations with endemic cholera.

Administration, Oral↗
PubMed1998

[Health situation of refugee children in Münster].

The unique opportunities of databased community health promotion in cooperation with local community health authorities are pointed out. Especially within the local refugee population many organisational and psychological obstacles to otherwise widely distributed health services are obvious. Population-focused community health practice involves home health care with interdisciplinary collaboration, and promotes clients's responsibility and self-care. Health promotion depends on communal health reporting focused on specific needs of subpopulations. Health and population data concerning the refugees in Muenster show a considerably higher proportion of children than among the general population of the town, thus indicating special needs for the paediatric care of this group. Communal data concerning health-relevant indicators such as vaccination rates or routine paediatric checkup coverage illustrate the necessity for improving low levels of health care for the communal refugee population. The concept of transcultural community health nursing with vice versa information about health traditions and practices improves health services and care for the refugee population and the health-related communal culture in general.

Child↗
PubMed2001

Prevalence of hepatitis virus infections in Kosovar refugees.

OBJECTIVES: To assess the prevalence of viral hepatitis infections in a sample of Kosovar refugees having arrived in southern Italy as a result of the 1999 war in the Balkans. METHODS: The 526 subjects who enrolled on voluntary basis from all age groups were tested for the prevalence of serologic markers for hepatitis virus types A, B, C, D, and E (HAV, HBV, HCV, HDV, HEV). RESULTS: Among the 526 refugees, the prevalence of total anti-HAV antibodies was 81%. A relevant finding was the presence of total anti-HAV antibodies in 61% of the children up to 10 years of age. The prevalence of anti-HEV antibodies was 2.5% among the subjects. Fifteen subjects (2.9%) were positive for hepatitis B surface antigen (HBsAg), whereas 17.5% tested positive for anti-hepatitis B core antigen (anti-HBc). In children up to 10 years of age, the prevalence of HBsAg and anti-HBc was found to be 0.4% and 6%, respectively. In subjects aged 11 to 20 years, 4.2% tested positive for HBsAg and 20.2% for anti-HBc. In the age group 21 to 30 years, 7.1% of the subjects were found to be HBsAg carriers, whereas 25.9% were found to be positive for anti-HBc. Among the refugees over 30 years of age, the prevalence of HBsAg was 4.2%, whereas anti-HBc was 43.7%. None of the refugees tested positive for anti-HDV. The prevalence of anti-HCV antibodies was 0.7%. CONCLUSIONS: The results of this seroepidemiologic study indicate a high circulation of HAV in the Kosovar population, whereas the prevalence of HEV antibodies was low and comparable to that of other European countries. The HBV infection seems to be at an intermediate level of endemicity and an immunization policy against HBV infection, through vaccination of all newborns and children before adolescence, may be advisable. Results of this study indicate that the level of endemicity of HCV infection in the Kosovar population is low.

Adolescent↗
PubMed2003

Do parental rearing and personality characteristics have a buffering effect against psychopathological manifestations among Iranian refugees in Sweden?

The aim of the study was to investigate relationships between temperament, character and perceived parental rearing among Iranian refugees resettled in Sweden. Our hypothesis was that temperament, character and parental rearing exert buffering effect against post-traumatic stress disorder (PTSD) with the particular impact of specific factors. One hundred refugees participated in the project. They were assessed by means of the SCL-90-R, the Beck Depression Inventory (BDI), the EMBU and the Temperament and Character Inventory (TCI). A high level of self-directedness appeared as having a possible buffering effect against PTSD after several severe traumata. Furthermore, we found specific effects of other personality characteristics and of parental rearing in determining the relationships between the experience of several traumatic events and later psychopathological manifestations among the refugees. The educational level and the length of living in Sweden represented important socio-cultural factors in decreasing psychological disturbances. Even more, we found that despite the experience of an extreme trauma some of the refugees did not suffer from severe depression or other psychosomatic complaints.

Acculturation↗
PubMed2005

Australian health policy on access to medical care for refugees and asylum seekers.

Since the tightening of Australian policy for protection visa applicants began in the 1990s, access to health care has been increasingly restricted to asylum seekers on a range of different visa types. This paper summarises those legislative changes and discusses their implications for health policy relating to refugees and asylum seekers in Australia. Of particular concern are asylum seekers on Bridging Visas with no work rights and no access to Medicare. The paper examines several key questions: What is the current state of play, in terms of health screening and medical care policies, for asylum seekers and refugees? Relatedly, how has current policy changed from that of the past? How does Australia compare with other countries in relation to health policy for asylum seekers and refugees? These questions are addressed with the aim of providing a clear description of the current situation concerning Australian health policy on access to medical care for asylum seekers and refugees. Issues concerning lack of access to appropriate health care and related services are raised, ethical and practical issues are explored, and current policy gaps are investigated.

Journal Article↗
PubMed1993

[Transylvanian refugees and the plague in 1708-1709].

Owing to the overwhelming military power of the Habsburg forces Transylvanian sympathizers fled twice to Hungary during the Rákóczi uprising (1704-1711): first in 1704-1706 and then in 1707-1711. In the autumn of 1707 they numbered as much as ten thousand people, and according to the decrees of the diet at Kisvárda, they were settled down in smaller units in around Szabolcs, Szatmár, Bereg, Ung, Ugocsa and Máramaros counties. Though always short of money, the leaders of the ukprising created a system that satisfied the basic needs of these refugees. By the end of the rebellion, nevertheless, as the territory controlled by Rákóczi's armies decreased considerably, the refugees were forced to move on and on, which certainly led to a corruption of their food supplies, accommodation and hygienic conditions. The worst among all came with the plague. The author examines the effects of the epidemic and the counter-measures taken by the individual and the authorities of the uprising. Kis has consulted the main Hungarian books of that age that referred to black death (among others Anna Zay's Herbarium [1719], Samuel Köleséri's Pestis Daicae, György Komáromi Csipkés's Pestis pestise, Ferenc Pápai Páriz's Pax Corporis and A [estos betegség etc., and Máté Tsanaki's A Döghalálról, etc.), as well as many archival papers (the correspondence of Count Sándor Károlyi with his wife Krisztina Barkóczy, thos of General Bercsényi to his wife and Prince Rákóczi, and some doctors' reports, etc.). His main source, however, is Zsigmond Szaniszló's diary. Szaniszló was a former fobiró (chief-sheriff) of the Transsylvanian Torda city, an Anti-Trinitarian stronghold, and remained a leader of his people during the emigration. According to his notes, which the author has compared with the data given by the others, there were hardly any measures taken against plague in this community. Although Szaniszló gives detailed descriptions about the everyday life of the refugees he almost entirely omits to mention anything that could be considered as anti-plague measure, except, perhaps, turning to the Almighty. This unreasonable conduct is often supposed to be the manifestation of fanaticism. Kis, however, prefers another explanation, because, as he argues, in lack of an elaborated knowledge of the mentalité of the Transsylvanian Anti-Trinitarian communities, and according to the insufficient number of original sources it would be unsafe to reason this striking phenomenon exclusively by unquestioning faith. So, Kis concludes that it was caused rather by the fact that plague had been virtually unknown in the remote cityof Torda, therefore these refugees did not know any sort of counter-measures that could have been taken. For them the epidemic was unexpected, uncontrollably fast and devastating. As a consequence, having but the last refuge, all they could do was praying.

Emigration and Immigration↗
PubMedDate not supplied

Refugee dynamics: Angolans in Zambia 1966 to 1972.

"The following study of Angolan refugees in Zambia examines the decision-making dynamics of refugee movements, documents a case of extensive self-settlement, describes the background to the refugee movement, and briefly compares the welfare of self-settling refugees and those who are in government schemes."

Africa↗
PubMed1985

Cuba's exiles: portrait of a refugee migration.

"This article provides a portrait of Cuba's exiles [in the United States] that encompasses all their waves of migration, while utilizing the Cuban exodus to shed light on the broader phenomenon of refugee migration. It argues that to understand the changing social characteristics of the exiles over twenty years of migration, we need to understand the changing phases of the Cuban revolution. Utilizing the Cuban exodus as data, the article uses Egon F. Kunz's...theoretical framework for refugee migration to shed light on the refugees' varying experiences, while also using the actual Cuban refugee experience to react to Kunz's abstract model."

Americas↗
PubMed2002

[The psychopathology of immigrants and refugees].

The twentieth century witnessed major waves of emigration, exile and taking refuge abroad. In this paper, a review of the psychiatric literature published between 1990 and 2000 in English and Turkish is presented. Although refugees are considered to differ from economic migrants in a number of respects, they both experience culture and language change and may experience family disruption, social isolation, and hostility from the population of the host country. Accordingly, all refugees and immigrants go through stages of resettlement and need to integrate their past cultural experiences into their new life and culture. The process of integration depends on the subjects' age, mental integrity, and on the conditions he/she lives in. Research indicates that children acculturate more quickly and learn language faster than elders; but they may suffer from role reversal when they are expected to be linguistic and cultural translators for their parents. Young adults at the stage of identity formation can be cut off and feel alienated. Elderly persons have a higher risk of culture shock as they leave behind more memories and connections. These trigger different types of anxieties. The literature shows high levels of acculturative distress, and psychiatric disorders such as post-traumatic stress disorder, anxiety and depression, and refugees are considered to be at risk for suicidal behavior. The complex social and psychological needs of refugee and immigrant families place demands on special services for children, adolescents and adults.

English Abstract↗
PubMedDate not supplied

High fertility among Indochinese refugees.

From 1975 to 1988, nearly 900,000 Indochinese refugees were resettled in the United States. This paper examines patterns of fertility among these refugees from Cambodia, Laos, and Vietnam who have exhibited high levels of reproduction since their arrival. Data are drawn from sample surveys in San Diego and San Francisco, CA. Fertility levels were found to exceed five children per ever-married woman, a level that is consistent with perceptions of ideal family size in the homeland. Fertility levels were significantly higher among rural second-wave refugees than in the more urban first-wave groups. One explanation for the high fertility is that couples have migrated from areas where fertility is high, and they have not yet adapted their reproductive behavior to the low fertility environment of the United States. This possibility is reinforced by a general gender preference for boys and exacerbated by the fact that, while a majority of women are aware of methods of fertility control, access is still limited by cultural and financial barriers, and the motivation to use family planning still appears to be relatively low. The data suggest that this refugee population will continue to put pressure on maternal and child health resources, and that continued residence in the United States could lead to desires to limit family size, thus increasing demand for methods of fertility control.

Adult↗
PubMed1993

An outbreak of pellagra related to changes in dietary niacin among Mozambican refugees in Malawi.

Between February and October 1990, 18,276 cases of pellagra dermatitis (due to niacin deficiency) were reported among 285,942 Mozambican refugees in Malawi. Overall, 6.3% of the refugee population developed pellagra and the attack rate was 7.8 times higher among women than men. This outbreak followed a 5-month cessation of groundnut distribution (the major source of niacin) to refugees. A matched-pair case-control study confirmed the protective role of the daily consumption of groundnuts (Odds Ratio [OR] = 0.08), as well as the independent role of garden ownership (OR = 0.34), and home maize milling (OR = 0.3). Recommended corrective action included early case finding and treatment, distribution of niacin tablets, prompt identification of groundnut supply on the world market, fortification with niacin of the food ration and diversification of the food basket through access to local markets.

Adolescent↗
PubMed1989

The evolution of the international refugee system.

This article examines the evolution of the current international system for responding to refugee problems and the climate within which the legal and institutional framework has developed. It reviews the background and handling of some of the key refugee movements since World War II and traces the legal and institutional adjustments that have been made to deal with new refugee movements that have occurred predominantly, but not exclusively, in the developing world. Finally, it assesses the adequacy of the present system to meet the challenges ahead.

Africa↗
PubMed1982

Health screening of Indochinese refugee children.

The first 100 Indochinese refugee patients screened at Oakland (Calif) Children's Hospital had a remarkably high incidence of treatable infectious and parasitic diseases. The PPD skin tests were positive in 28%, and stool parasites were present in 65%. There were wide differences among the various ethnic groups in prevalence of stool parasites, anemia, and hemoglobin E trait, with a higher rate among Cambodians accounting for these differences. There were also differences in stool parasite patterns when the refugees were separated by ethnic origin. Cambodians had predominantly hookworm and Strongyloides, Laotians harbored hookworm and Trichuris, and Vietnamese were infested with Trichuris and Giardia. Malaria. Pott's disease, and congenital syphilis were among the uncommonly encountered diseases. Results of screening will vary with ethnic origin, but health screening has a high yield for all Indochinese refugees.

Adolescent↗
PubMed1984

Height and weight status of Indochinese refugee children. An anthropometric study of 1,650 children.

To provide guidelines for assessing growth status of Indochinese refugee children, height and weight measurements were obtained from 1,650 children residing in Lao refugee camps, Cambodian refugee camps, and surrounding Thai villages. These are compared with the few existing growth references for Asian children. In comparison to US growth standards (National Center for Health Statistics/Centers for Disease Control) for children, the mean weight for age and mean height for age of the studied groups are approximately 2 SDs below US means. Weight for height is 0.7 SD below US means. This marked difference in growth status appears to be due to nutritional factors related more to cultural or economic issues affecting these children than to their genetic background. The US growth standards can serve as reference tools in evaluating the growth status of newly arrived Southeast Asian children, if used with the perspective that Southeast Asian children, on a group basis, have different distributions on US growth curves.

Age Factors↗
PubMed2005

Mental health of Cambodian refugees 2 decades after resettlement in the United States.

CONTEXT: Little is known about the long-term mental health of trauma-exposed refugees years after permanent resettlement in host countries. OBJECTIVE: To assess the prevalence, comorbidity, and correlates of psychiatric disorders in the US Cambodian refugee community. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, face-to-face interview conducted in Khmer language on a random sample of households from the Cambodian community in Long Beach, Calif, the largest such community in the United States, between October 2003 and February 2005. A total of 586 adults aged 35 to 75 years who lived in Cambodia during the Khmer Rouge reign and immigrated to the United States prior to 1993 were selected. One eligible individual was randomly sampled from each household, with an overall response rate (eligibility screening and interview) of 87% (n = 490). MAIN OUTCOME MEASURES: Exposure to trauma and violence before and after immigration (using the Harvard Trauma Questionnaire and Survey of Exposure to Community Violence); weighted past-year prevalence rates of posttraumatic stress disorder (PTSD) and major depression (using the Composite International Diagnostic Interview version 2.1); and alcohol use disorder (by the Alcohol Use Disorders Identification Test). RESULTS: All participants had been exposed to trauma before immigration. Ninety-nine percent (n = 483) experienced near-death due to starvation and 90% (n = 437) had a family member or friend murdered. Seventy percent (n = 338) reported exposure to violence after settlement in the United States. High rates of PTSD (62%, weighted), major depression (51%, weighted), and low rates of alcohol use disorder were found (4%, weighted). PTSD and major depression were highly comorbid in this population (n = 209; 42%, weighted) and each showed a strong dose-response relationship with measures of traumatic exposure. In bivariate analyses, older age, having poor English-speaking proficiency, unemployment, being retired or disabled, and living in poverty were also associated with higher rates of PTSD and major depression. Following multivariate analyses, premigration trauma remained associated with PTSD (odds ratio [OR], 2.08; 95% CI, 1.37-3.16) and major depression (OR, 1.56; 95% CI, 1.24-1.97); postmigration trauma with PTSD (OR, 1.65; 95% CI, 1.21-2.26) and major depression (OR, 1.45; 95% CI, 1.12-1.86); and older age with PTSD (OR, 1.76; 95% CI, 1.46-2.13) and major depression (OR, 1.47; 95% CI, 1.15-1.89). CONCLUSION: More than 2 decades have passed since the end of the Cambodian civil war and the subsequent resettlement of refugees in the United States; however, this population continues to have high rates of psychiatric disorders associated with trauma.

Adult↗
PubMed1991

The state construction of affect: political ethos and mental health among Salvadoran refugees.

This essay seeks to extend current anthropological theorizing on emotion. Although anthropologists have convincingly established the specifically cultural status of emotion, recognition also of "state" (including sociopolitical institutions of nation-states) constructions of affect has been slow in coming. The present essay seeks to expand the emerging scholarly discourse on the emotions by examining the nexus among the role of the state in constructing a political ethos, the personal emotions of those who dwell in that ethos, and the mental health consequences for refugees. This analysis is intended as a bridge between analyses of the state construction of affect, on the one hand, and the phenomenology of those affects, on the other. To illustrate, I examine the state construction of affect and its traces in the narrative and clinical presentations of Salvadoran refugees in North America. The saliency of fear and anxiety among a group of psychiatric out-patients is framed by bodily experience, knowledge of illness, and the ethnopsychology of emotion within the context of chronic political violence and poverty. Distinctions between terror and torture, distress and disease are proposed as essential to an account of refugee experience. Future directions for the study of the "state construction of affect" are suggested.

Adaptation, Psychological↗
PubMed1991

Emotional distress and its socio-political correlates in Salvadoran refugees: analysis of a clinical sample.

The emotional distress responses of refugees cannot be adequately understood using the traditional notions of stress and adaptation. In these populations it is necessary to consider the relations between emotional distress and socio-political context, particularly the processes of terror and intimidation and the conditions of migratory illegality and social marginality. This study analyses the patterns of emotional distress in a clinical sample of 71 Salvadoran refugees in an urban center of the United States. Case histories are presented and patterns of trauma, distress and associated life problems analyzed. It is argued that distress patterns reflect the particular socio-political conditions of women and men and represent the embodiment of the conflicts that refugees face. The concept of illness is used to link distress patterns and socio-political context and to avoid the reductionism of psychiatric categories.

Adult↗