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PubMed2006

Immunisation of refugee and migrant young people: can schools do the job?

OBJECTIVES: To assess immunisation needs, primary health care (PHC) use and trial a school-based immunisation service for refugee and migrant young people attending an Intensive English Centre (IEC) high school in Western Sydney. METHODS: We surveyed students attending an IEC in Western Sydney, assessing self-reported immunisation status and use of PHC services via questionnaires translated in six languages. Those students who were not immunised for hepatitis B and measles-mumps-rubella (MMR) were provided the first and second dose of a three-dose hepatitis B immunisation schedule and a single dose of MMR vaccine. We compared the immunisation requirements for MMR and hepatitis B with utilisation of PHC. RESULTS: One-hundred and sixty-five students (85%) returned the questionnaire. Forty-nine students (30%) reported previous immunisation with MMR and 29 (18%) with hepatitis B. As part of the school immunisation program, 142 (74%) received MMR vaccine, 151 (78%) received the first dose of hepatitis B vaccine, 144 (95%) received the second dose of hepatitis B, and 34 (23%) received the third hepatitis B dose elsewhere. Sixty-six students (40%) reported seeing a doctor in the past year. Students who had not seen a doctor in the previous year were significantly more likely to request immunisation (p < 0.01). CONCLUSIONS AND IMPLICATIONS: Refugee and migrant young people attending an IEC in Western Sydney report low immunisation rates. Our study highlights the urgent need for education and health to work together to provide specialised immunisation services for refugee and migrant young people.

Adolescent↗
PubMed1994

The effects of violence on health and adjustment of Southeast Asian refugee children: an integrative review.

Public health nurses have historically been on the front line in meeting the needs of refugees in their practice communities. Little nursing research has been focused on the needs of refugees, however. The purpose of this integrative literature review was to clarify research focused on the needs of one refugee group, southeast Asian. The integrating factors reviewed were the instruments used, sampling procedures, statistical methods, and clarification of independent and dependent variables. Power analyses were computed on three of the studies to critique further the appropriateness of sample size. Findings indicate that premigration experiences, especially violence, play an important role in health status and adaptation after settling in the United States. Since health problems are often manifested in cultural ways different from Western norms, public health nurses would benefit from continued research clarifying the needs of individuals from other cultures.

Adaptation, Psychological↗
PubMed2005

Action responses of Congolese refugee women.

PURPOSE: To describe Congolese refugee women's action responses to difficult living situations. DESIGN: Interpretive qualitative. METHODS: Narrative data were collected from 14 Congolese refugee women using minimally structured interviews and were analyzed for patterns in their responses to their difficult situations. FINDINGS: The narratives about participants' difficult circumstances indicated six action responses: refiguration, advocacy, resistance, resignation, sorrow, and faith. CONCLUSIONS: When encountering difficult life circumstances, refugee participants demonstrated actions with varying influence on their agency.

Activities of Daily Living↗
PubMed1984

Prevalence of dental caries in a group of adult Vietnamese refugees in Norway.

About 3500 Vietnamese refugees have settled in Norway since 1975. The purpose of this survey was to investigate the dental health of 200 Vietnamese refugees, 142 males and 58 females above the age of 12 years. The clinical examinations were done 3 weeks after arrival in Norway and included decayed, extracted and filled surfaces and teeth (DMFS and DMFT). The sample was divided into four age groups, 12-19, 20-29, 30-39 and 40+. Only 9% of the sample was cariesfree. Mean DMFT ranged from 8.7 in the youngest age group to 11.5 in the oldest. DMFS scores consisted primarily of decayed surfaces and mean DS did not vary much in the different age groups. The examinations revealed a higher prevalence of caries in the permanent second molars than in the permanent first molars in all age groups. The present study seems to support previous reports on the caries situation of the Vietnamese which have indicated a dramatic rise in the caries prevalence. In this study the average DMFT was similar to other Asian populations, but less than Norwegians of comparable age. The results suggest a high treatment need in the Vietnamese refugees.

Adolescent↗
PubMed1997

STD rapid assessment in Rwandan refugee camps in Tanzania.

OBJECTIVE: To obtain baseline information on sexually transmitted diseases (STDs) in the Rwandan refugees camps in Tanzania, prior to establishment of STD services. SETTING: The largest camps of Rwandan refugees in the Ngara District of Tanzania (estimated population 300,000). The study was carried out in 8 days in August 1994. SUBJECTS AND METHODS: A rapid assessment technique was used to measure STD prevalences among: (i) 100 antenatal clinic attenders (ANC); (ii) 239 men from outpatient clinics (OPD); and (iii) 289 men from the community. Interviews (by questionnaire) and genital examination were performed for all participants; sampling for females included genital swabs for the the diagnosis of Neisseria gonorrhoeae (NG), Candida albicans (CA), Trichomonas vaginalis (TV), bacterial vaginosis (BV) and a blood sample for syphilis serology. Men provided urine samples which were screened for leucocytes using the leucocyte esterase (LE) dipstick; urethral swabs for Gram stain were taken from men with a reactive LE test and from those with symptoms or signs of urethritis. OPD males provided a blood sample for syphilis serology. RESULTS: All groups reported frequent experience with STDs and engaging in risky sexual behaviour prior to the survey. During the establishment of the camps, sexual activity was reportedly low. Over 50% of ANC attenders were infected with agents causing vaginitis (TV/BV/CA) and 3% were infected with NG. The prevalence of active syphilis was 4%. In the male outpatients, the prevalence of urethritis was 2.6% and of serological syphilis was 6.1%. Among males in the community, the prevalence of urethritis was 2.9% (the majority being asymptomatic infections). We noted frequent over-reporting of STD symptoms, unconfirmed clinically or biologically. CONCLUSIONS: STD case detection and management should be improved by training health workers in using the WHO syndromic approach, and through IEC campaigns encouraging attendance at clinics. Rapid epidemiological methods provide quick and useful information at low cost in refugee camps.

Adolescent↗
PubMedDate not supplied

Language acquisition in relation to cumulative posttraumatic stress disorder symptom load over time in a sample of re-settled refugees.

OBJECTIVE: To study the effects of symptoms of posttraumatic stress disorder (PTSD), depression and dissociation as well as cumulative symptom load on language learning during the introduction phase in re-settled refugees. METHOD: Participants were re-settled refugees of Iraqi origin. They were assessed by means of a structured interview for PTSD at baseline as well as self-rating questionnaires. Language acquisition was studied by means of register data from the school system. Five levels of language proficiency were recorded. Self-reported symptom scores for PTSD, depression and dissociation (Impact of Events Scale-22, Hopkins Symptom Checklist-25, Dissociative Experiences Scale) were measured at four time points during 9 months immediately after resettlement. In 49 participants in a longitudinal study, data regarding progress in language studies were accessible. RESULTS: The results of the study indicate that the speed of language acquisition - the number of levels taken during the study, adjusted to hours of school presence - is related to the cumulative PTSD symptom load over time (Events Scale-22), but is not related neither to the symptom load of depression and dissociation, nor to the number of previous school years. CONCLUSION: The study shows that the symptom load of PTSD during the follow-up period is significantly inversely related to the speed of language acquisition in refugees. This implies that treatment as well as preventive measures against worsening of PTSD symptoms are important in order to minimise harmful post-migration stress for the facilitation of integration.

Adult↗
PubMed1994

Boosting of tuberculin sensitivity among Southeast Asian refugees.

Following an initial negative Mantoux tuberculin skin test, a second test, given as soon as 1 wk later, has been shown to elicit markedly larger reactions (boosting) in 20 to 40% of refugees tested in the United States. We conducted a study to determine the explanation for this phenomenon. Using the Mantoux method of intradermal skin testing, 2,469 refugees from Southeast Asia were initially tested with tuberculin followed by sequential retesting 7 and/or 90 d later. They were also tested initially with nontuberculous mycobacterial antigens. A high proportion (35.5%) of Southeast Asian refugees had reactions (> or = 10 mm induration) to an initial tuberculin test, and 30.9% of the nonreactors exhibited boosting on a subsequent tuberculin test. Boosting, unlike reactivity to the initial tuberculin test, was not associated with exposure to a person with tuberculosis. However, boosting was associated with reactivity to nontuberculous mycobacterial antigens and a history of bacille Calmette-Guérin (BCG) vaccination. Boosting in this population is therefore attributable to environmental exposure to nontuberculous mycobacteria that are endemic in Southeast Asia or to BCG vaccination, rather than to remote infection with Mycobacterium tuberculosis. Sequential tuberculin screening and preventive therapy of persons with boosted reactions is not recommended as a tuberculosis prevention strategy in this population.

Adolescent↗
PubMed1996

Tuberculosis screening for immigrants and refugees. Diagnostic outcomes in the state of Hawaii.

The effectiveness of the required overseas tuberculosis (TB) screening for immigrants and refugees to the United States has not been evaluated since new guidelines were introduced in 1991. Using data from the Hawaii State TB register for 1992-1993, patient records, and data from the U.S. government notifications of suspect TB among aliens, we determined the percentage of persons either classified as having active TB (B1), inactive TB (B2), or considered "normal" overseas, who were evaluated and subsequently diagnosed with active TB within 1 yr of arrival in the United States. Of the 124 TB cases among immigrants and refugees evaluated within 1 yr of arrival, 78 (63%) had been classified overseas as B1, 17 (14%) as B2, and 29 (23%) as "normal." The proportion of TB cases diagnosed after arrival in the United States was 14.0% for B1s and 2.1% for B2s. This proportion decreased with increasing age. A positive skin test was a strong predictor (OR: 10.7; 95% CI: 1.4-80.1) of culture-confirmed TB. These data document that immigrants and refugees with B1 and B2 TB status have a high prevalence of active TB. They should be promptly evaluated after arrival in the United States to determine the need for curative or preventive therapy.

Adolescent↗
PubMed1988

Tuberculosis in a cohort of Southeast Asian Refugees. A five-year surveillance study.

Morbidity caused by tuberculosis was determined in a cohort of 9,328 refugees from Southeast Asia during the first 5 yr after their immigration to the United States. The entire cohort was screened at the time of entry, and isoniazid preventive therapy was offered according to ATS-CDC guidelines. During the period of study, 25 cases of tuberculosis were reported from the cohort. The 5-yr cumulative incidence of tuberculosis (26.8 cases per 10,000 in the entire cohort) was greatest in tuberculin-positive refugees who had abnormal screening chest roentgenograms (324.3 cases per 10,000) and least in those with nonsignificant tuberculin reactions (5.0 cases per 10,000). The annual incidence of tuberculosis in the cohort decreased from an estimated 30.6 cases per 10,000 at the time of immigration to less than 5 cases per 10,000 during the fourth and fifth years. The prevalence of resistance to isoniazid was greater in culture-positive cases arising after immigration (7 of 22, 32%) than in those diagnosed at the time of immigration (5 of 36, 14%), probably because of a reduction in isoniazid-susceptible cases by isoniazid preventive therapy. Currently recommended screening and preventive services may be favorably impacting tuberculosis morbidity in newly arriving refugees from Southeast Asia.

Age Factors↗
PubMed1977

Problems of Southeast Asian children in a refugee camp.

The authors describe the efforts made to meet the mental health needs of Vietnamese children and their families in a large refugee camp. Many of the children received strong emotional support from the multigenerational Vietnamese families, and they adapted well to the new environment. However, children separated from their families demonstrated increased emotional vulnerability, and foster placement of children without families presented a serious problem. The authors suggest that our national commitment to these refugees may have ended when they left the confines of the refugee camp.

Acculturation↗
PubMed1980

An Indochinese refugee psychiatric clinic: culturally accepted treatment approaches.

In 1978 the authors established a weekly psychiatric clinic for Indochinese refugees. During the first 20 months, 50 patients were evaluated and treated at the clinic; a Vietnamese psychiatric resident and several native Indochinese mental health counselors bridged the language and cultural barriers between patients and clinic personnel. Most of the patients seen at the beginning of the program were psychotic and severely impaired. However, patients seen later suffered from a wider variety of problems. A flexible approach to treatment was adopted that would be compatible with the cultural expectations of the refugees. This resulted in the use of different forms of therapy and special emphasis on the medical approach of the physician, a role familiar to Indochinese patients. Gradually the clinic gained acceptance by members of the local refugee community.

Adolescent↗
PubMed1991

Trauma experiences, posttraumatic stress, dissociation, and depression in Cambodian refugees.

OBJECTIVE: The authors' goal was to determine the levels of trauma and psychiatric symptoms in a randomly selected group of Cambodian refugees and to determine the relationship between the amount of trauma experienced and subsequent psychiatric symptoms. METHOD: Data on traumatic experiences and symptoms of posttraumatic stress, dissociation, depression, and anxiety were collected on 50 randomly selected Cambodian refugees who had resettled in the United States. RESULTS: Subjects experienced multiple and severe traumas and showed high levels of all symptoms measured. Forty-three (86%) of the subjects met DSM-III-R criteria for posttraumatic stress disorder, 48 (96%) had high dissociation scores, and 40 (80%) could be classified as suffering from clinical depression. Correlations between trauma scores and symptom scores and among symptom scores were moderate to large. CONCLUSIONS: These results indicate that a high proportion of Cambodian refugees who are not psychiatric patients suffer from severe psychiatric symptoms and that there is a relationship between the amount of trauma they experienced and the severity of these symptoms.

Adult↗
PubMed1997

Refugees' time perspective and mental health.

OBJECTIVE: The authors' goal was to investigate factors protective of the mental health of refugees, with a particular focus on time splitting and suppression of the past. METHOD: Structured interviews covering premigration and postmigration stresses, personal and social resources, and mental health were given to 1,348 Southeast Asian refugees resettled in Vancouver, British Columbia, and to a comparison sample of 319 residents of Vancouver. Both groups of subjects also performed a task designed to measure orientation toward past, present, and future. RESULTS: Compared with resident Canadians, refugees were more likely to exhibit an atomistic time perspective in which past, present, and future are split. Temporal atomism and avoidance of nostalgia were associated with a lower risk of depression than were other time perspectives. CONCLUSIONS: Under conditions of extreme adversity, time splitting and suppression of the past may be adaptive strategies, mitigating the risk of depression.

Acculturation↗
PubMed2002

Posttraumatic stress disorder among Cuban children and adolescents after release from a refugee camp.

OBJECTIVE: The authors compared self-reported symptoms of posttraumatic stress disorder (PTSD) in a cohort of Cuban children and adolescents with assessments of internalizing and externalizing behaviors by the children's teachers. METHODS: Eighty-seven children and adolescents who had left Cuba by sea in the summer of 1994 and who had been confined to refugee camps for up to eight months before arriving in the United States were evaluated four to six months later. Self-reported symptoms of PTSD were assessed with the Post-Traumatic Stress Disorder Reactive Index, and internalizing and externalizing behaviors were assessed with the Child Behavioral Check List-Teacher Report Form. RESULTS: A majority of the children reported moderate to severe PTSD symptoms. The most common symptom clusters were avoidance (67 percent), regressive behaviors (64 percent), reexperiencing the traumatic events (60 percent), somatic symptoms (52 percent), and hyperarousal (51 percent). Eighty-six percent of the children reported that the refugee experience had severely affected most of their peers. A statistically significant dose-effect relationship was found between the number of stressors and the severity of self-reported PTSD symptoms. There was a modest relationship between withdrawn behavior and children's feelings that they would die at sea and witnessing violence at the camps. Age and witnessing violence in the camps were moderately associated with PTSD. Teachers' overall ratings of externalizing and internalizing behaviors did not produce any clinically significant findings. CONCLUSIONS: PTSD symptoms among refugee children and adolescents who have been exposed to multiple and prolonged stressors may continue unabated after the stressors are removed. The symptoms are experienced subjectively and may go unnoticed by adults.

Adolescent↗
PubMed2003

Gambling participation and problems among South East Asian refugees to the United States.

OBJECTIVE: Gambling is common among South East Asian refugees, but no known studies have evaluated the prevalence of pathological gambling in these populations. The purpose of this study was to assess rates of gambling participation and gambling problems among South East Asian refugees. METHODS: Ninety-six immigrants to the United States from Laos, Cambodia, and Vietnam who attended community service organizations for these ethnic groups in Connecticut were asked to complete the South Oaks Gambling Screen (SOGS), which had been translated into their native languages. Demographic information as well as data on recent gambling activities were also obtained. RESULTS: The SOGS retained high internal consistency in the sample, with a Cronbach's alpha of .90. The lifetime prevalence of pathological gambling was 59 percent. Rates of gambling problems did not differ across the three ethnic groups. However, being male, divorced or separated, and younger were significant predictors of pathological gambling. More than half of all the respondents had gambled within two weeks of the interview, and 42 percent had wagered more than 500 US dollars in the previous two months. CONCLUSIONS: These data call for more research into the social, environmental, and cultural context of gambling among South East Asian refugees. Ethnically sensitive prevention and intervention strategies are needed to address the extraordinarily high rates of gambling problems in this population.

Adult↗
PubMed1994

Psychotherapy with Southeast Asian refugees: implications for treatment of Western patients.

Working with Southeast Asian refugees in psychotherapy can teach Western psychotherapists how our culture-impacted notions of health, psychopathology, and psychotherapy influence the way we hear, understand, and respond to our patients. Western conceptions of individual boundaries, family ties, the relationship of mind and body, and ways of knowing are among the issues that arise for the Western psychotherapist who works with Southeast Asian refugees. While we in the West have seen rapid technological advances, we also have suffered dislocations, change, and the loss of traditional bases of meaning. Yet despite the differences, there are also elements within Western culture that resonate with what are usually considered "Asian" ways. These include the self-in-relation concepts described by feminist writers and the attitude of therapist as learner described by some contemporary psychoanalysts as well as by a contemporary Western philosopher. Refugees and Western patients alike want their unique faces "seen" and hope to birth new and expanded meanings in their psychotherapeutic dialogues.

Adult↗
PubMed1984

"Race related illness in Vietnamese refugees".

The author worked for six weeks in September 1982, as a Medical Practitioner and Psychiatrist at the first Asylum Centre Puerto-Princessa, Palawan, Philippines. This paper relates relevant aspects of Mental Health needs of Vietnamese refugees related to racism, aftermath of war, leaving home-land without preparation, perilous escape, prolonged stay in cramped refugee camps, and move on to unsettled, unsure future in another country with alien culture and environment. Changes of life situation, loss of business, property or occupation, loss of loved ones, separation from friends, disruption of family relationships are related to racism and persecution elements in 'Boat People'. The most frequent psychiatric illnesses among the refugees are: depression, anxiety state, psychosomatic disease and psychosis. A special mental health project is needed to train health workers, provide service and consultation and to organising research activities. On the preventive aspects, primary prevention may be achieved by less stress on rapid assimilation and the reduced likelihood of discrimination, hostility and prejudice. Secondary prevention consists of early detection of the disease and early initiation of treatment and tertiary prevention consists of the elimination or reduction of residual disability after an illness.

Adult↗
PubMed1994

Psychopathology and long-term adjustment after crises in refugees from East Germany.

OBJECTIVE: In this study we examined psychopathology, diagnoses, social adjustment and the course of symptoms over two and a half years in East German refugees who suffered a crisis immediately after migrating to West Berlin just prior to or shortly after the breaching of the Wall in autumn 1989. METHODS: One hundred and twenty two refugees seeking crisis intervention in a psychiatric outpatient unit after arrival were investigated. Six months later 59% and two and a half years after migration 30% of the patients were re-examined. RESULTS: The patients had been exposed to prolonged stress situations in East Germany and were suffering from anxious-depressive syndrome with vegetative complaints. Sixty patients required more than one crisis intervention during the first six months after resettlement. During the follow-up period symptoms decreased significantly. At the second follow-up interview 81% of the patients had a satisfactory job, and 89% acceptable accommodation. CONCLUSIONS: Satisfactory classification of the psychiatric disorders induced in East German refugees by prolonged stress was not possible according to the DSM-III-R criteria. Initial crises are not necessarily associated with poor long-term adjustment after migration.

Acculturation↗