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Prevalence study of different hepatitis markers among pregnant Albanian refugees in Greece.

Aim of the study was to record the prevalence of the various types of viral hepatitis, especially hepatitis B, in pregnant Albanian refugees in Greece. The study comprised 500 pregnant refugees of mean age 25.1 +/- 4.6 years. In Albania, all women had lived in overcrowded houses and had been exposed to non throw-away needles and syringes. Various indices for all hepatitis types were determined. The prevalence of HBsAg was 13.4%, of anti-HBs 53%, of total anti-HBc 70.8%, of anti-HBc IgM 0.4%, of HBeAg 1.2%, of anti-HBe 58.6%, of anti-HAV 96.2%, of anti-HAV IgM 1%, of anti-HDV 0.4%, of anti-HCV 0.6% and of anti-HEV 2%. HBeAg was found positive in 7.5% of HBsAg carriers. Prevalence of hepatitis B markers, as determined by HBsAg and/or anti-HBs and/or total anti-HBc was significantly higher in those with a history of previous hospitalization in Albania (p = 0.01) and those with previous history of hepatitis (p = 0.02). The high prevalence of hepatitis B markers in pregnant Albanian refugees proves that HBV infection is highly endemic in Albania and the possibility of perinatal transmission to the offsprings urges for HBV vaccination programmes. On the other hand improvements in the socioeconomic conditions and the sanitation system in Albania is anticipated to reduce the incidence of HAV and HBV infections.

Adolescent↗

[Asylum seekers and refugees in the medical polyclinic: a comparison between the Basel, Bern and Geneva polyclinics].

This cross-sectional study describes the state of health of asylum seekers and refugees and the health services provided to them by the medical outpatient departments of three major Swiss university hospitals, Basel, Berne and Geneva. The comparison of outpatient departments differing in organisational structure facilitated the identification of positive and negative determinants of health service provision. Questionnaires have been filled in by all physicians of the three medical outpatient departments (Basel: 10, Berne: 1, Geneva: 36). All consultations of asylum seekers and refugees have been recorded during the study period (Basel: 42, Berne: 93, Geneva: 187). Interviews have been done with the physicians who coordinated the study. During the study period the majority of the patients originated from former Yugoslavia, Turkey, Sri Lanka, Somalia, Angola and Zaire. One of the most prominent features of the population investigated has been its diversity in respect to countries of origin, languages, ability to communicate and education. Diversity and low consultation rates per physician could explain many of the problems which have been observed, e.g. the lack of experience in specific approaches to these patients or difficulties to provide interpreters. To improve the health care for this group of patients in medical outpatient departments small teams of physicians should be selected. By these means adequate levels of experience could be achieved and organizational problems could be dealt with more effectively. In addition, the relationship between specific problems of asylum seekers and refugees and more general issues of the interaction between physicians and patients are discussed in view of tasks in research and training.

Adolescent↗

[Asylum seekers and refugees in the emergency department].

This cross-sectional study describes the health problems and the health care of asylum seekers and refugees from the point of view of accident & emergency (A & E) physicians at the major hospital in St. Gallen, Switzerland. The physicians filled in a detailed questionnaire and documented all consultations of asylum seekers/refugees and of a control group of patients during eleven weeks (2 x 98 consultations). 76% of these asylum seekers/refugees originated from former Yugoslavia. The distribution of the main ICD-coded diagnoses did not differ between asylum seekers/refugees and the control group after correction for age. In comparison with the asylum seekers and refugees attending GPs, injuries were much more common in the A & E department attenders (37% vs. 8%). Asylum seekers/refugees and the patients in the control group did not differ in respect to being classified as an emergency case (58% vs. 65%). There were also no differences in hospitalisation rates (29% vs. 36%). Asylum seekers/refugees who were registered with a GP attended the A & E department more often during the night than during the day compared to patients who were not registered with a GP. Consultations which have been classified as emergencies occurred more frequently during the day than at night time. The time of residence in Switzerland was negatively associated with the registration with a GP and with being classified as an emergency case. A lack of experience in caring for asylum seekers and refugees and of specific training in this field has been the major complaint by the A & E physicians. Asylum seekers should be introduced to the tasks and functions of the various sectors of the national health care system as early as possible. Registration with a GP in the community should be promoted.

Adolescent↗

Prevalence of depressive symptoms among established Vietnamese refugees in the United States: detection in a primary care setting.

OBJECTIVE: To determine the prevalence of depressive symptoms among Vietnamese refugees who have lived in the United States for at least two months. DESIGN: A prospective and descriptive study using the Vietnamese Depression Scale (VDS). Scores of > or = 13 on the VDS were considered indicative of depression. SETTING: Ten public health clinics in four states. PATIENTS/PARTICIPANTS: Four hundred seventy-six consecutive adult Vietnamese refugees presenting for primary care. INTERVENTIONS: The VDS, an 18-item culture-specific self-report measure, was used to screen for depressive symptoms. MEASUREMENTS AND MAIN RESULTS: Twenty percent of these patients had scores of 13 or above. Although being female; being older; being divorced, separated, or widowed; and being poorly educated were significant univariate risk factors for screening positive, only the latter two were significant in a multivariate model. Physical complaints were common and induced considerable anxiety about health status, but psychological and emotional symptoms were even more prevalent. Patients scoring 13 or higher had a higher rate of endorsement for every item in the scale than did those scoring lower than 13. CONCLUSIONS: This study substantiates the feasibility and importance of screening for depressive symptoms among Vietnamese refugees, particularly in primary care settings where they are most likely to seek care for both medical and psychological problems.

Adolescent↗

Screening for major depression in Vietnamese refugees: a validation and comparison of two instruments in a health screening population.

OBJECTIVES: 1) Using standard cutoffs, to determine the accuracy of two Vietnamese-language depression screening instruments for major depression in a nonpsychiatric setting, 2) to examine the utility of other cutoffs, and 3) to compare the instruments' overall accuracies. DESIGN: 1) A research assistant administered the Vietnamese Depression Scale (VDS) and the Indochinese Hopkins Symptom Checklist Depression Subscale (HSCL-D) to all subjects. 2) The "gold standard" was determined by a native Vietnamese-speaking psychiatrist using a written translation of a standard semistructured clinical interview. SETTING: A health screening clinic at a large public hospital. PATIENTS: A convenience sample of 206 newly arrived adult Vietnamese refugees undergoing routine, mandatory health screening. RESULTS: The psychiatrist diagnosed 7% of the refugees as having major depression. At standard cutoffs, the VDS had a 64% sensitivity, a 98% specificity, a 75% positive predictive value, and a 97% negative predictive value. Corresponding results for the HSCL-D were 86%, 93%, 48%, and 99%. More than half of the patients who had false-positive results had other clinical disorders. For each instrument, adjusting the cutoff improved sensitivity and positive predictive value. Receiver operating characteristic (ROC) curve analysis showed no difference in accuracy between the two instruments. Each instrument took approximately 5-10 minutes to administer. CONCLUSIONS: These instruments accurately identified Vietnamese refugees with major depression and should be of use to clinicians in primary care settings. Standard cutoffs may need to be adjusted in nonpsychiatric settings.

Adult↗

Psychological disorder amongst refugee and migrant schoolchildren in London.

BACKGROUND: Refugee and migrant children are likely to be exposed to many of the risk factors for emotional and behavioural problems. These children form a significant proportion of the school population in London and other inner cities in the UK. However, there are very little epidemiological data available on their mental health. In this study, we aimed to examine the prevalence of psychological problems among refugee and migrant schoolchildren compared to their UK-born peers. METHOD: A cross-sectional investigation using the Strengths and Difficulties Questionnaire (SDQ) examined in association with socio-demographic variables including language preference. RESULTS: Almost a quarter of schoolchildren might be described as having a need, with migrant and refugee children showing greater psychological distress on a number of the sub-scales of the SDQ. Language appears to be an important variable associated with distress.

Adolescent↗

Cross-cultural use of the predetermined scale cutoff points in refugee mental health research.

BACKGROUND: Cross-cultural use of the cutoff points determined in Indo-Chinese refugees of the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire (HTQ) is common in refugee mental health research but it might have caused misclassifications. METHODS: We assessed the validity of the predetermined cutoff points in identifying depression and post-traumatic stress disorder (PTSD) cases among Afghan refugees, with the algorithm method as a gold standard. We estimated the prevalence of depression and PTSD, using the HSCL-25 and the HTQ with the cutoff points and the algorithm method, and calculated sensitivity, specificity, positive and negative predictive values of the cutoff points. RESULTS: Nine in ten PTSD cases/non-cases were correctly identified as cases/non-cases, and nine in ten respondents classified as PTSD cases/non-cases were actually cases/non-cases. In contrast, only one in three non-depression cases was correctly identified as a non-case, and three in five respondents who were classified as depression cases was actually a case. The prevalence of depression was estimated to be 86% with the cutoff points and 53% with the algorithm method, and that of PTSD 46% and 44%, respectively. CONCLUSIONS: The cutoff point approach might have low specificity and positive predictive value particularly for depression in our study. Cross-cultural use of the scale cutoff points determined in one cultural group to another needs to be reconsidered.

Afghanistan↗

Characteristics and needs of asylum seekers and refugees in contact with London community mental health teams: a descriptive investigation.

BACKGROUND: Asylum seekers and refugees may have substantial needs for mental health care, to which both pre-migration and post-migration traumas are likely to contribute. However, there is a paucity of data available to guide appropriate service development. AIMS: To ascertain numbers and describe the characteristics and needs of asylum seekers and refugees in contact with London Community Mental Health Teams (CMHTs). METHOD: Data were obtained from staff and clinical records regarding socio-demographic and clinical characteristics and service use. Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) and Health of the Nation Outcome Scales (HoNOS) were completed. RESULTS: A total of 104 (11%) of the CMHT population were asylum seekers or refugees. Co-morbidity was frequent, and psychiatrists reported significant diagnostic uncertainty for 30%. The most common diagnoses were depression (50%) and post-traumatic stress disorder (PTSD) (41%), and just over half had a psychotic diagnosis (53%). Social isolation was common, levels of unmet need were high (mean of 6.8 unmet needs each using CANSAS) and the group used few services other than CMHTs. CONCLUSIONS: The combination of high levels of need and limited service use suggests a need to develop more effective services. High rates of diagnostic uncertainty suggest a need for a clearer understanding of the complex clinical syndromes afflicting this group.

Adult↗

Self-image, war psychotrauma and refugee status in adolescents.

The aim of this study was to assess how war psychotrauma, refugee status and other factors relate to self-image. Psychotherapeutic-psychiatric interview, the Offer Self-Image Questionnaire (OSIQ), questionnaires for measuring war stressors, posttraumatic stress reactions (PTS-reactions), depression and general data were administered. A total of 322 adolescents from Bosnia-Herzegovina and Croatia were included in the study. In 60.32% of the examinees, more than four war stressors were encountered. In 13.68% of the examinees, high PTS-reactions occurred. The refugees had nearly four times higher odds (aOR=3.66; 95% CI=1.63-8.2; p<0.01) of having a higher Offer score for the sexual attitudes subscale. Lower war stress had 0.28 times lower odds (aOR=0.28; 95% CI=0.11-0.71; p<0.01) of having a higher Offer score for the sexual attitudes subscale. More severe PTS-reactions had six times higher odds (aOR=6.15; 95% CI=1.7-22.2; p<0.01) of reaching a higher Offer score for the emotional tone subscale. War psychotrauma and refugee status are related to poorer adjustment only in some of the OSIQ subscales. Practical measures of joined sexually preventive/therapeutic activities are proposed, as well as educational and preventive/therapeutic psychotrauma models.

Adolescent↗

Food security and child hunger among recently resettled Liberian refugees and asylum seekers: a pilot study.

Little is known about the food insecurity situation among families resettled into the United States as part of the refugee resettlement program. This paper reports on a pilot study examining food insecurity among recently arrived refugee families (n=33). Objectives were to evaluate the usefulness and feasibility of methods to assess the prevalence of food insecurity and child hunger, and to examine associations between child hunger and measures of socio-economic status and measures of acculturation. Results indicated that 85% of households were food insecure, and 42% experienced child hunger. Hunger was more likely to be indicated in households using foods stamps, with lower income, and lower education. Hunger was also more likely to be indicated in households where the primary shopper experienced difficulty shopping and with language. Results are in broad agreement with those reported in other studies and highlight economic and information barriers to achieving food security. These data suggest that further study of food insecurity is warranted among recently resettled refugee communities resettled in the United States.

Acculturation↗

The sero-prevalence of antibodies to trypanosoma cruzi in Latin American refugees and immigrants to Canada.

BACKGROUND: Chagas' disease is caused by infection with the protozoan agent Trypanosoma cruzi. An estimated sixteen to eighteen million people are infected in Latin America. Outside of endemic regions, Chagas' disease may be transmitted through the transfusion of infected blood components, congenital infection and organ transplantation. We sought to determine the sero-prevalence of antibodies to T. cruzi in a community sample of Latin American refugees and immigrants to Canada. METHODS: This was a sero-prevalence study in Latin American refugees and immigrants living in Canada. Eligible subjects were born in South America, Central America or in Mexico. Participants were recruited from a variety of community settings, as well as from medical clinics. Serum was tested by enzyme-linked immunoassay for antibodies to T. cruzi. RESULTS: A total of 102 participants were enrolled. One sample tested positive for antibodies for T. cruzi. The seroprevalence in our sample was 1.0% (95% CI: 0.2%- 5.3%). INTERPRETATION: We found a low sero-prevalence of Chagas' disease in a community sample of Latin American immigrants and refugees. Physicians who treat Latin American immigrants should consider the risk profile and clinical status of the individual in their decision to screen for Chagas' disease.

Adolescent↗

Serological survey of human cysticercosis in Irianese refugee camps in Papua New Guinea.

In 1984, over 10,000 refugees left the Indonesian province of Irian Jaya, and thus possibly imported Taenia solium taeniasis/cysticercosis into Papua New Guinea, which was believed to be free of T. solium until 1966. In a serological survey carried out in 1986, 50 refugees originating from areas endemic for T. solium and 171 patients from other areas with symptoms suggesting the possibility of cysticercosis were examined. As a sensitive prescreening technique an ELISA was used with a crude antigen extract obtained from T. solium metacestodes of pig origin. Of 221 persons investigated, 79 (36%) were positive in ELISA. For excluding frequently occurring cross-reactions in ELISA, Western-blotting (or EITB, enzyme-linked immunoelectrotransfer blot) was employed. In this test the demonstration of antibody activity to the 26 or the 8 kilodalton band has been proved to be species-specific for T. solium cysticercosis. One from 79 patients positive in ELISA was simultaneously positive (26 and 8 kDa) in Western blot, corresponding to the first case found in Papua New Guinea with a highly probable T. solium cysticercosis. This patient, originating from an endemic area in Irian Jaya, had immigrated into Papua New Guinea in 1980. The present work emphasizes the need for using highly specific immunodiagnostic techniques in seroepidemiology of larval cestode infections. T. solium taeniasis/cysticercosis remains a risk for Papua New Guinea, and refugees originating from endemic areas should be regarded as potential carriers of T. solium.

Animals↗

Expectations in giving and receiving help among nurses and Russian refugees.

Stimulated by the emergence of a new refugee group that is unknown and vulnerable to misunderstanding by health care providers, and the exigency in nursing to understand potential variance in nurse and client assumptions about helping, this paper reports exploratory research comparing helping orientations of Russian Protestant Pentecostal refugees (N = 28) with professional nurses (N = 32) in the United States. Findings based on the Brickman et al. (1982) theory of helping, which addresses attribution of responsibility in helping interactions, indicated differences among the nurse and Russian orientations. Contrasting with the nurses' primary selection of the moral orientation, which assumes high individual responsibility for the causes and solutions of problems, the Russian refugee group's first selection was the medical orientation, which assumes low individual responsibility for the causes and solutions of problems. The two groups' differing orientations are considered in the context of nurse-client interactions and divergent cultural values bearing on assumptions of individual responsibility.

Adult↗

Prevalence and clinical presentation of glucose-6-phosphate dehydrogenase deficiency in Pakistani Pathan and Afghan refugee communities in Pakistan; implications for the use of primaquine in regional malaria control programmes.

Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency surveys in Afghan refugees and a local community in the North-West Frontier Province, Pakistan, showed that this trait was most common among Pathan and Uzbak refugees (15.8% and 9.1% respectively). The prevalence among Pakistani Pathans was 7.0%, and that in Tajik and Turkoman refugees was 2.9% and 2.1% respectively. Hospital studies showed that the type of G-6-PD deficiency in Pathans could cause severe haemolytic crises. The potentially fatal side effects of primaquine treatment in the Pathan communities, and the high risk of re-infection, render the anti-relapse treatment policy for Plasmodium vivax obsolete. However, epidemic conditions of P. falciparum malaria may justify the use of primaquine as a gametocidal drug, administered as a single dose, during the transmission season. These findings necessitate revision of the recommendations for the use of primaquine in the area.

Adolescent↗

Persecution and behavior: a report of refugee children from Chile.

A Swedish study of 50 newly resettled refugee children from Chile describes the children's experiences of persecution in their home country and coping patterns in the receiving country. Thirty-six children had experiences directly related to persecution, and seven of these had been victims of physical assault for political reasons. Sleep disturbances and dependency were behaviors significantly associated with experiences of persecution. Resettled refugee families need to be approached by concerned professionals as symptoms of trauma in refugee children are often recognized only in the family sphere.

Acculturation↗

Catastrophic stress and factors affecting its consequences among Southeast Asian refugees.

Effects on mental health of the stress of being interned in a refugee camp were assessed in a community survey of 1348 Southeast Asians. The impact on depressive mood proved significant but short-lived. Social support derived from the ethnic community and from an intact marriage moderated the risk of developing depressive symptoms, apparently by enhancing a sense of identity and belongingness. A psychological coping mechanism--avoidance of the past--buffered the impact of camp stress on depressive symptoms. While refugees brought into the country under private sponsorship were expected to have a mental health advantage compared to those admitted under government sponsorship, this hypothesis was not confirmed. Private sponsorship, carried out by individuals or groups whose religion differed from the refugees they were supporting, acted as a source of stress.

Acculturation↗

Health and social problems of refugees.

Today over 15 million refugees are scattered around the world, most of them in poor Third World countries [New Sci., pp. 14-15, September 1991]. But whether they seek 'safe havens' in rich or poor countries they continue to suffer from the malaise of being uprooted, struggling to survive in new and alien environments. Their health and social problems extend beyond the obvious emergency short-term phase. It is now clear that the number of refugees has increased beyond expectations and most have stayed long enough to expect final resettlement in their countries of asylum, a process which requires wider, more comprehensive and long-term management and rehabilitation interventions. This paper will attempt to highlight issues of health and social problems in their wider context, surveying comprehensive and integrated approaches in assessing the needs of refugees, whether they are in developing or industrialised countries, with emphasis on the latter and, when appropriate, using the United Kingdom experience as an example.

Acculturation↗

Predictors of psychological distress among southeast Asian refugees.

This paper analyzed data from one of the first needs assessment projects on a representative non-clinical population of Southeast Asian refugees in the United States in order to test two hypotheses: (1) whether or not premigration experiences still have an effect on psychological distress beyond the initial resettlement period and (2) whether or not interethnic group differences existed in the predictors of psychological distress between three Southeast Asian refugee groups, the Vietnamese, Cambodians and Lao. The results of the analysis of 2180 subjects supported both hypotheses. Regardless of ethnicity and the number of years in the U.S., premigration trauma events and refugee camp experiences were significant predictors of psychological distress even 5 years or more after migration and significant group differences in the types of postmigration distress predictors were also found. Acculturation concerns for the Vietnamese and Lao were influenced by both premigration and postmigration variables. In contrast, the primary concerns of the Cambodians were still related to premigration issues. The results also indicated that Vietnamese and Lao women were more likely to experience distress than their male counterparts, but no gender differences emerged for the Cambodians. Age predicted distress for Vietnamese and Cambodians, but not Lao. Similar to previous findings in the literature, Cambodians reported the highest levels of distress, followed by Lao and then Vietnamese. Interpretations of these results for this community sample are proposed.

Adolescent↗