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PubMedDate not supplied

Meningococcal meningitis among Rwandan refugees: diagnosis, management, and outcome in a field hospital.

OBJECTIVE: To study the diagnostic process, clinical course, and outcome of Rwandan refugees with meningococcal meningitis, treated in an Israeli field hospital in Goma, Zaire, in the summer of 1994. METHODS: Patient hospital charts and laboratory records were reviewed with critical evaluation of clinical presentation and diagnostic tests. Patients were treated as part of a disaster relief effort in a refugee camp experiencing several coexisting lethal epidemics. RESULTS: A total of 65 patients were identified as having group A meningococcal meningitis. Latex agglutination test for Neisseria meningitidis soluble antigen in the cerebrospinal fluid was found to be a superior diagnostic tool, as compared to Gram stain, and at least as effective as culture. The mortality rate was 14%; mortality was markedly affected by co-morbidity (e.g., dysentery, pneumonia, and malnutrition). CONCLUSIONS: The outcome of patients with meningococcal meningitis, treated in referral centers within a disaster area may be favorable, despite overwhelming coexisting epidemics, and may be comparable to that achieved in advanced medical facilities. Encephalopathy may be a diagnostic pitfall in the perspective of coexisting epidemics, requiring a high index of suspicion and routine lumbar puncture. The latex agglutination test is highly useful in achieving prompt diagnosis of meningococcal meningitis, in particular when sample handling for culture and microscopy is suboptimal.

Adolescent↗
PubMed1986

Measuring psychiatric disorder among Southeast Asian refugees.

Four measures of mental health--Panic, Depression, Somatization and Well-Being--have been developed for use in a population of Southeast Asian refugees. The scales, a product of work with 1348 refugees, demonstrate conceptual significance, good reliability, concurrent validity and stability of structure across samples. They are culturally sensitive, enabling intra-cultural study as well as screening for clinical purposes. The measures also permit comparisons, for research purposes, with non-Asians.

Adaptation, Psychological↗
PubMed2001

Trauma and loss as determinants of medically unexplained epidemic illness in a Bhutanese refugee camp.

BACKGROUND: We sought to identify personal factors that placed people at risk during an epidemic of medically unexplained illness in a Bhutanese refugee camp in southeastern Nepal. METHODS: We conducted a case-control study, involving 68 cases and 66 controls. Caseness was defined as experiencing at least one attack of medically unexplained fainting or dizziness during the time of the epidemic. We performed hierarchical logistic regression analysis to identify significant predictors of case status. RESULTS: In terms of Western psychiatric constructs, the illness involved somatoform symptoms of both acute anxiety and dissociation. Sixty per cent reported visual and 28% reported auditory hallucinatory experiences. Cases and controls were similar on all demographic variables, school performance, number of attacks witnessed and psychopathology before the onset of the epidemic. Recent loss, early loss, childhood trauma and pulse-rate were predictors of case status. CONCLUSION: We identified trauma, early loss and, especially, recent loss as predictors of attacks during medically unexplained epidemic illness in a Bhutanese refugee community.

Adolescent↗
PubMed1999

Measles in Vietnamese refugee children in Hong Kong.

From September 1991-January 1992, there was a measles epidemic in an established refugee camp for 7000 Vietnamese 'Boat People' living in Hong Kong. This 16 week outbreak occurred against a backdrop of poor uptake of measles vaccination and overcrowded living conditions. Two hundred and sixty-two children were affected (155 boys, 107 girls); 235 children (89.7 %) were < 2 years old, age range 5-39 months. Children age 6-11 months had the highest crude attack rate (AR) of 54.3%. The highest age specific crude AR was 83.8% in children aged 14 months. Measles complications affected 234 (89.3%) children. Sixty-six children (25.2%) were admitted to hospital. There were two deaths from pneumonia, giving a case fatality rate of 0.76%. Measles control in refugee camps continues to be a public health challenge.

Age Distribution↗
PubMedDate not supplied

Israeli Defense Forces Medical Corps humanitarian mission for Kosovo's refugees.

In April 1999, during the crisis in Kosovo, the Israeli government launched a medical, field hospital in order to provide humanitarian aid to the Albanian refugees that fled from their homes in Kosovo. This facility was set up by the Medical Corps of the Israeli Defense Forces, in a refugee camp located in Northern Macedonia. During the 16 days during which the hospital functioned, the medical staff treated 1,560 patients and hospitalized >100. The field hospital served as a referral center for all of the other primary clinics that were hastily erected in the camp and its surroundings. This communication elaborates on the various aspects of the humanitarian medical aid that were provided by this medical facility and the conclusions that learned from such a mission.

Albania↗
PubMedDate not supplied

The challenges facing mental health programs for post-conflict and refugee communities.

The majority of refugees and communities exposed to warfare and oppression live in low-income countries with few resources or special skills. Yet, epidemiological studies have identified high levels of traumatic stress reactions in such populations. These stress reactions can be intensified by harsh policies aimed at deterring survivors from seeking refuge in technologically advanced societies. The scale of the problem of mass violence and displacement creates formidable challenges for mental health professionals in their efforts to develop practical frameworks for responding to the extensive needs of displaced persons. In this article, a model is proposed for low-income, post-conflict countries, based on a two-tiered formulation. At the eco-social level, mental health professionals can play a supportive, but not a lead, role in facilitating recovery of core adaptive systems that hasten natural recovery from stress for the majority of the population. Where small-scale, community mental health services are established, the emphasis should be on assisting persons and their families who are at greatest survival and adaptive risk. Training and promotion of local workers to assume leadership in such programs are essential. In technologically advanced societies in which refugees are in a minority, torture and trauma services can focus more specifically on traumatic stress reactions, acculturation, and resettlement. In a historical epoch in which displaced persons are facing particularly harsh treatment, there is a pressing need for consensus amongst mental health professionals in advocating for their needs.

Humans↗
PubMed2000

Effects of posttraumatic stress and acculturation on marital functioning in Bosnian refugee couples.

Forty Bosnian refugee couples living in the United States completed a translated version of the PTSD Symptom Scale--Self Report, the Behavioral Acculturation Scale, the Marital Satisfaction Inventory--Revised, and a demographic questionnaire. Posttraumatic stress disorder (PTSD) symptomatology was the best predictor of marital functioning and was related negatively to acculturation. After controlling for PTSD, acculturation did not predict marital functioning. Wives' marital satisfaction was best predicted by husbands' PTSD, husbands' acculturation, and their own PTSD. Husbands' marital satisfaction was not predicted significantly by any of these variables. These findings suggest several implications for mental health professionals dealing with refugees and other traumatized populations.

Acculturation↗
PubMed2001

Western conceptualizations and Eastern experience: a cross-cultural study of traumatic stress reactions among Tibetan refugees in India.

This study investigated the nature and impact of traumatic experiences among Tibetan refugees in India. It explored the applicability of western conceptualizations of reactions to traumatic events among this cultural group. A randomly selected sample of refugee camp students was assessed on measures of psychological and physical complaints, and on impact as well as severity of traumatic experiences. Respondents had experienced multiple traumatic events. The majority reported ongoing health problems. More than half demonstrated symptoms of intrusion-avoidance. Those with more traumatic experiences reported more symptoms of anxiety and depression (psychologically and, particularly, somatically manifested). Cultural differences in types of experienced traumatic events and manifestations of distress are discussed, as are implications for cross-cultural trauma research using western conceptualizations and instruments.

Adolescent↗
PubMed2002

War-related trauma and symptoms of posttraumatic stress disorder among adult Kosovar refugees.

Since 1999, almost 16,000 Kosovar refugees have entered the United States. Few studies have investigated trauma and symptoms of posttraumatic stress disorder (PTSD) in this population. We conducted a caseworker-assisted survey of 129 Kosovar refugees (aged 18 to 79 years, 55% male). Of these individuals, 78 (60.5%) showed the likely presence of PTSD. The mean number of war-related traumatic events reported was 15 (SD = 4.5). Higher PTSD scores were associated with more traumatic events and female gender.

Adult↗
PubMed2002

Acculturation and adaptation of Soviet Jewish refugee adolescents: predictors of adjustment across life domains.

This study explores how acculturation is related to adaptation across different life spheres for 162 Soviet Jewish refugee adolescents in a suburban community in Maryland. Because the different contexts of refugee adolescents' lives vary in acculturative demands, different patterns of acculturation should be related to adaptation in different life spheres. The study uses a multidimensional measure of acculturation and assesses acculturation to both American and Russian cultures as it relates to psychological adaptation, peer relations, and school and family outcomes. Findings support the general ecological thesis that acculturation to different cultures is differentially related to adaptation across life domains. Acculturation to American culture predicted better grades and perceived support from American peers. Acculturation to Russian culture predicted perceived support from Russian peers. Both American acculturation and Russian acculturation predicted reduced loneliness and perceived support from parents. Further, different dimensions of acculturation, such as language and identity, were differentially related to adaptation. Implications for acculturation theory and measurement are drawn, and cautions are offered about the interpretation of acculturation studies using single proxies such as language use or preference.

Acculturation↗
PubMed2002

The relative contribution of war experiences and exile-related stressors to levels of psychological distress among Bosnian refugees.

This study examined the relative contribution of 2 exile-related variables--social isolation and daily activity level--and war experiences of violence and loss, to levels of PTSD and depressive symptomatology in 2 groups of Bosnian refugees, 1 clinical group (N = 59) and the other a nonclinical community (N = 40) group. As hypothesized, exposure to war-related violence was highly predictive of PTSD symptoms in both groups; in addition, social isolation was significantly related to PTSD symptomatology in the community group. In contrast, depressive symptomatology was accounted for primarily by the exile-related stressors. For the clinical group, depressive symptoms were also accounted for by experiences of war-related loss. The implications of these findings for mental health interventions with refugees are considered.

Activities of Daily Living↗
PubMed1997

Psychological dysfunction in Southeast Asian refugees as mediated by sense of coherence.

Investigated Antonovky's (1979, 1987) construct of sense of coherence (i.e., an individual's belief that the world was comprehensible, manageable, and meaningful) as the internal psychological mechanism mediating the effects of external stressors (generalized resistance deficits) and resources on psychological dysfunction (measured by depression, anxiety, and psychosocial dysfunction) in 2,234 Vietnamese, Cambodian, Laotian, Hmong, and Chinese-Vietnamese refugees. Generalized resistance and deficits significantly predicted sense of coherence as well as psychological dysfunction. The amount of variance accounted for increased significantly when the mediating effect of sense of coherence was tested using a path analysis. Sense of coherence significantly reduced the predictive power of generalized resistance and deficits in the psychological dysfunction models. Results support the hypothesized mediating role of sense of coherence. Thus, interventions aiming to enhance Southeast Asian refugees' functioning may gain in effectiveness by targeting and promoting their sense of coherence.

Adolescent↗
PubMed1999

Pathways from war trauma to posttraumatic stress symptoms among Tamil asylum seekers, refugees, and immigrants.

Path analysis was used to examine the antecedents of posttraumatic stress (PTS) symptoms in Tamil asylum-seekers, refugees, and immigrants in Australia. The Harvard Trauma Questionnaire and a postmigration living difficulties questionnaire were completed by 62 asylum-seekers, 30 refugees, and 104 immigrants who responded to a mail-out. Demographic characteristics, residency status, and measures of trauma and postmigration stress were fitted to a structural model in PTS symptoms. Premigration trauma exposure accounted for 20% of the variance of PTS symptoms. Postmigration stress contributed 14% of the variance. Although limited by sampling constraints and retrospective measurement, the study supports the notion that both traumatic and posttraumatic events contribute to the expression of PTS symptoms.

Adult↗
PubMed1999

The effects of exposure to community violence on Khmer refugee adolescents.

The aim of the study was to examine the relationship between exposure to violence and mental health outcomes among Khmer refugee adolescents. Seventy-six Khmer junior and senior high school students and their parents participated in a cross-sectional survey study. Half of the adolescents survived violence directed at them, and two thirds witnessed violence. Although approximately one quarter either partially or fully met the criteria for posttraumatic stress disorder (PTSD), most were functioning adequately. Ordinary least squares regression analyses indicated that the number of violent events they were exposed to in their lifetime significantly predicted their level of functioning and PTSD. Recommendations for future research and implications for clinicians and educators working with Khmer and other refugee adolescents are discussed.

Adolescent↗
PubMed1997

The validity of posttraumatic stress disorder among Vietnamese refugees.

The aim of this study was to examine the validity of posttraumatic stress disorder (PTSD) among Vietnamese refugees. The study population included 74 Vietnamese refugees who had resettled in the metropolitan Boston area. The previously validated Harvard Trauma Questionnaire was used to assess traumatic events and trauma-related symptoms. The number of traumatic events experienced was positively correlated with the severity of PTSD-related symptoms in this population. Internal consistency estimates and principal components analysis provided results that generally supported DSM-IV symptom dimensions of arousal, avoidance, and reexperiencing. However, the emergence of two separate dimensions of avoidance reflected the important contribution of depression to the traumatic response.

Adult↗
PubMed2003

Identifying best practices of community participation in providing services to refugee survivors of torture: a case description.

There is an increased interest in best practices in the design and implementation of specialized programs for refugee survivors of torture. The processes taking place in the development of such a program also warrant assessment. In particular, this paper addresses the importance of community participation. Using the Host Support Program for Survivors of Torture as a case study, we identify the community participation practices that emerged during stages of program development and describe how these practices have made possible a collaborative service delivery model and facilitated community capacity building that addresses the complex needs of refugee survivors of torture. The process of community collaboration is discussed as central to the process of effective community participation and organizing. The illustrated benefits of community participation position this model as a best practice.

Alberta↗
PubMed2004

Bringing order out of chaos: a culturally competent approach to managing the problems of refugees and victims of organized violence.

The collaborative program of the Transcultural Psychosocial Organization (TPO) provides a community-oriented and culturally sensitive public health response to the psychosocial problems of refugees and victims of organized violence. This paper describes the 9-step model that TPO has developed as a blueprint for each new intervention. Beneficiaries participate in determining priorities and there is an orientation toward culturally competent training, capacity-building, and sustainability. Two cases, one related to Sudanese refugees in Uganda and the other to internally displaced persons and returnees in postwar Cambodia, show how the TPO intervention protocol is adapted to local settings. The paper provides preliminary evaluative comments on the model's performance.

Cambodia↗
PubMed2000

The prevalence of mental health problems in Rwandan and Burundese refugee camps.

OBJECTIVE: We examined the prevalence of mental health problems in refugees living in camps that emerged in Tanzania during the Rwanda crisis that started in 1994. METHOD: Using the 28-item version of the General Health Questionnaire (GHQ-28), we examined two samples: a random sample (n = 854) and a sample of clients of a psychosocial support programme in these camps (n = 23). Sensitivity, specificity and positive- and negative predictive values were estimated for several cut-off scores of the GHQ-28. RESULTS: The prevalence of serious mental health problems was estimated at 50% (SE 12%). When using the GHQ-28 as a screener, a cut-off score of 14 is recommended. CONCLUSION: Given the high prevalence of mental health problems, psychosocial programmes for large refugee populations should aim at strengthening community structures and supporting groups instead of focusing at individuals. The screening capacity of the GHQ-28 could be used to identify mentally vulnerable groups.

Adolescent↗