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[Panorama of infections among refugees--the risk of epidemics from the East].

The article consists in an account of the numbers of reported cases of infectious diseases among approximately 10,000 refugees who came to the Stockholm area, primarily from the former Yugoslavia, Africa, Asia and Irak during the period 1992-1993. High prevalences were noted of hepatitis B and tuberculosis, and in certain groups high prevalences of HIV. Hitherto there has been no increase in the spread of infections to the general population. In the event of a wave of refugees from Russia and the Baltic countries, it is primarily diphtheria and tuberculosis that will entail vigilance.

Adolescent↗

Malaria in Montagnard refugees--North Carolina, 1992.

Refugee groups emigrating from some areas of the world may have increased prevalences of exotic and potentially life-threatening diseases, challenging the diagnostic and case-management capacities of local and state health departments. This report summarizes efforts by public health officials and clinical health-care providers to diagnose and manage cases of malaria among a group of 402 Montagnard refugees who resettled to three counties in North Carolina in November 1992.

Cambodia↗

Using explanatory models to understand chronic symptoms of Cambodian refugees.

BACKGROUND: Case reports indicate that understanding patients' "explanatory models" can improve diagnosis, patient compliance, and satisfaction. However, few studies have examined explanatory models within specific cultural groups to understand their symptoms. METHODS: Seventy-six older Cambodian refugees were interviewed using measures of symptom frequency, explanatory models, help-seeking patterns, and use of traditional Cambodian remedies. Psychiatric patients were compared with non-patients. RESULTS: Headache was the most common symptom, reported by 58% of those interviewed, and also the most frequent chief complaint (41%). Headache was reported in both groups but was reported by significantly more psychiatric patients. Headache was positively associated with the diagnosis of depression. More than half explained their headaches as a result of sadness, grief, and anxiety. Explanatory models did not differ significantly between groups. All participants maintained Cambodian medical beliefs, and 83% used traditional Cambodian remedies. CONCLUSIONS: Results suggest a high prevalence of headache among older Cambodian refugees, for whom it may be a manifestation of depression. Emphasis on this somatic complaint does not preclude patients' recognition of psychological factors. Addressing explanatory models can help clinicians determine underlying etiology and understand challenging patients.

Cambodia↗

Malaria control using permethrin applied to tents of nomadic Afghan refugees in northern Pakistan.

Malaria control among nomadic populations has, in the past, posed serious logistic difficulties. Presented in this article are the results of a pilot study in which permethrin was sprayed on the tents of over 26000 nomadic Afghan refugees in an area of Pakistan where seasonal malaria outbreaks occur. In this area Anopheles culicifacies and A. stephensi are the malaria vectors. Population surveys in the year of the study, before and at the end of the transmission season, showed that the increase in the Plasmodium falciparum prevalence among the Afghan nomads was on average significantly less (increase from 6.4% to 15.3%) than that among the resident Pakistani population (from 3.2% to 45.6%). Surveys at the end of the transmission season among primary schoolchildren the year before and the year of the permethrin trial showed that the P. falciparum prevalence among nomadic children decreased significantly (from 46.9% to 16.3%), whereas an increase was observed among the local Pakistani children. The results show that spraying tents with permethrin was a safe and culturally acceptable intervention for the Afghan refugees and that the findings warrant further investigation.

Adolescent↗

Caring for Myanmar refugees in Thailand.

Massive refugee movements continue due to conflicts between and within nations. To combat the major causes of mortality in refugee camps--undernutrition, measles, diarrhoea, pneumonia and malaria13--nurses are following the principles of primary health care and are promoting adequate food, safe drinking water, shelter, environmental sanitation and immunization.

Adult↗

[Acculturation, identity and well-being: the adjustment of Somalian refugees].

This study examines the links between acculturation and psychological adjustment of 94 Somalian refugee women. On a group level, the preferred mode of acculturation is integration. Somalian women who have lived the longest in Canada identify more as Canadians and perceive more discrimination against themselves and against Somalians in general. Moreover, the endorsement of the mode of acculturation by integration implies a refusal of other modes such as assimilation, rejection and marginalization. Important links are also established between age, the desire to take part in Canadian society and mental health. Young women especially distinguish themselves from the group as they have a tendency to have a higher level of depression. Moreover, those refugees who have emigrated for political reasons wish to return to their homeland and are less satisfied with their life in Canada.

Acculturation↗

Predictors of English fluency among Hmong refugees in Minnesota: a longitudinal study.

The objective of this study was to assess factors associated with later acquisition of English language fluency among Hmong refugees in Minnesota. Fluency in a society's lingua franca is a critical skill in psychosocial adaptation and mental health. A longitudinal study design was used, in which premigration and early postmigration factors were related to subsequent English fluency. The first group of 102 Hmong refugees located in Minnesota by the Immigration and Naturalization Service participated, and were interviewed in their homes. Hmong research assistants collected data using a questionnaire format at 1.5 years following resettlement in the U.S. Eight years later, two measures of English language competence were obtained: a self-assessment and an objective measure of English language fluency. Self-assessed fluency and performance on a brief English test showed good correlation. Greater English fluency on both measures was predicted by the following: younger age, male gender, education or vocational training in Laos prior to migration, occupation in Laos requiring literacy, study of English while in Asia, less proximity to other Hmong households in the U.S., any educational involvement in the U.S. (except English as a second language or ESL training), and not receiving welfare. Self-assessment of English fluency appeared to be a valid measure of competence in English. Demographic characteristics, certain premigration experiences, and early postmigration experiences predicted English fluency after 10 years in the U.S. ESL training was not associated with eventual English fluency on either self-assessment or objective testing. Recommendations are made to enhance English fluency, and hence the psychosocial adaptation of refuguees and other immigrants to the U.S.

Adolescent↗

[Asylum seekers and refugees in ambulatory health care: communication between physician and patient].

Communication between asylum seekers/refugees and general practitioners/physicians of the three main outpatient sectors for the Swiss national Health System (general practice, medical outpatient and accident & emergency departments) are being described and analysed. The data have been collected during three cross-sectional studies investigating the health status of asylum seekers and refugees and the health services provided to them. These studies addressed the problem exclusively from the point of view of the health care providers. Data on language capabilities, sociocultural aspects of communication and the necessity and availability of interpreters have been collected with questionnaires. The main results of the questionnaires have been followed up in group discussions with general practitioners. The majority of general practitioners/physicians felt that most of the communication problems were related to speaking a common language. Only about one out of two adult asylum seekers/refugees knew German, French, Italian or English. Particularly during the group discussions it was brought forward that cultural and social factors additionally complicate communication during patient-doctor interactions. When the data of the outpatient consultations of the main studies were analysed, it became obvious that interpreters were significantly more often present in consultations with patients with psychological/psychosocial diagnoses than those with somatic diagnoses (72% vs. 55%). This can be interpreted in two ways: (1) if a patient suffers from a psychological/psychosocial problem, it is more likely that an interpreter will be asked to assist during the consultation or (2) if an interpreter is present during a consultation, it is more likely that a psychological/psychosocial problem will be detected. With the exception of children, most of the general practitioners/physicians felt that non-professional interpreters (relatives, friends) were adequate for coping with most of the tasks. The following areas for improvements were identified: (1) availability of professional interpreters and quality as well as organisational issues related to interpretation, (2) language training for asylum seekers and refugees and (3) creation of awareness among general practitioners/physicians towards cultural and socioeconomic determinants of patient-doctor interactions and training.

Adult↗

Early diagnosis and treatment of malaria in a refugee population in Sri Lanka.

To provide early diagnosis and prompt treatment for malaria, two interventions were compared in refugee camps in Kalpitiya, Sri Lanka. Community health volunteers (HV's) were trained in diagnosis and management of malaria on clinical grounds, while a field laboratory was established in another group of camps providing treatment after laboratory confirmation of a malarial infection. Patients with fever sought treatment from HV's on average after 2.74 days and from the field laboratory after 3.20 days. Although acceptance of both interventions was high, the effective catchment areas, especially of the HV's were small. Large numbers of health volunteers would be needed to cover all families, making it difficult to sustain supervision and necessary logistic support. For every malaria patient treated by HV's, three others would receive anti-malarial drugs unnecessarily. The maintenance of a field laboratory with a microscopist of the Anti-Malaria Campaign is not an economically viable option. Training of HV's in microscopy with a mechanism for cost recovery should be given serious consideration. HV's and diagnosis and treatment centers should be able to handle a wide spectrum of common diseases. A better option for Sri Lanka in the short term might be to improve existing general health facilities that are accessible to the refugee population.

Adult↗

[Mental health among refugees. Connection between symptoms, traumatization and exile].

Traumatization and psychiatric symptoms among 346 refugees admitted to the outpatient unit at the Psychosocial Centre for Refugees from 1992 to 1996 were registered and analysed by means of systematic, clinical interviews. More than 50% reported exposure to physical torture, and more than 50% had also been involved in serious war actions. Most patients had experienced many forms of persecution. Approximately 10% of the patients had employment in their host country and 20-30% attended school or participated in language courses. Almost 40% were neither employed nor engaged in any kind of studies. 50% were diagnosed as having post-traumatic stress disorder. The relationship between demographic background, traumatization and exile situation, and symptoms and social dysfunction is illustrated by case histories.

Adult↗

Medical care for immigrants and refugees.

Refugees and other immigrants often present with clinical problems that are as varied as their previous experiences. Clinical presentations may range from unusual infectious diseases to problems with transition. This article describes medical conditions associated with immigrants, as well as specific screening recommendations, including history, physical examination and laboratory tests, and some of the challenges encountered by family physicians caring for refugees.

Cultural Characteristics↗

Austrian medical refugees in Great Britain: from marginal aliens to established professionals.

About 360 Austrian physicians were refugees in the UK between 1938 and 1945. This paper traces their experiences. Apart from a scheme to admit only fifty physicians and forty dental surgeons, support ranged from domestic service permits to the backing from scientists keen to modernize British medicine. After the wave of internments in 1940, it was possible for physicians to be placed on the Temporary Register of Medical Practitioners. Three case studies of three types of Austrian contributions to child health are presented. The position improved after World War 2 when full registration of Austrian qualifications became possible, and the National Health Service provided career opportunities for clinical specialists. Only circa 10% of the medical refugees from Austria returned there eventually. Examples are given of successful careers in a wide range of medical specialties.

Austria↗

[Occurrence and type of traumatic experiences among young Bosnian refugees in Denmark].

Prior research has shown that young refugees may be especially traumatised. The study includes 123 young Bosnian refugees, living at two Bosnian boarding-schools in Denmark who were given a revised version of the Harvard Trauma Questionnaire (HTQ). The subjects themselves have on average experienced seven traumatic events, and have either witnessed or had a family member experience an additional six events. Three-quarters have been shot at, have lost their homes and private possession and have been exposed to violence in the form of harassment or humiliation. Two-thirds have lost friends. Three-fifths have lived with uncertainty as to whether friends and family were alive or dead. More than half have seen dead and wounded people, have had their lives threatened and have thought that they would die. More than a third have lost close family members, have been wounded and have had their homes destroyed. Just under a third have been exposed to physical violence or have witnessed somebody being killed. A quarter have starved and been ill without being able to receive treatment. About a fifth have experienced captivity, torture and forced labour. 6% have been raped or exposed to other forms of sexual abuse. It is concluded that the young Bosnians examined are a multitraumatised group. Use of the HTQ increased the number of traumatic events quite considerably compared to the case notes.

Adolescent↗

Trauma, time and mental health: a study of temporal reintegration and Depressive Disorder among Southeast Asian refugees.

BACKGROUND: Prior research suggested that time splitting--suppressing the past and dissociating it from present and future--protected refugee mental health in the aftermath of catastrophe. The current study investigates temporal reintegration, defined as cognitive recapture of the past and reconnecting it with present and future, the mental health effects of temporal reintegration, and factors moderating the associated risk for Depressive Disorder. METHOD: A community sample of 608 Southeast Asian refugees, resettled in Vancouver British Columbia between 1979 and 1981, were interviewed on three separate occasions over a 10-year period. Participants performed a temporal orientation task and responded to questions about employment, social relations and mental health. Depressive Disorder, measured by a typology derived from Grade of Membership analysis of symptoms, constituted the dependent variable. Latent Growth Curve Analysis was used to examine both levels and rates of change in the probability of Depressive Disorder as predicted by changes in temporal reintegration, as well as the contribution of putative social and psychological moderators to explaining variations in growth parameters. RESULTS: Time relatedness increased over the duration of the study. Temporal reintegration jeopardized mental health. Employment and relational stability each moderated the mental health effects of temporal reintegration. CONCLUSIONS: Although time splitting may be effective in coping with adversity over the short-term, eventual temporal reintegration is probably ineluctable. Stability in love and work are protective factors, mitigating the mental health vicissitudes of temporal reintegration. Implications for optimal timing of clinical interventions are discussed.

Adult↗

A household survey of older Iu-Mien refugees in rural California.

There is a very sparse literature on the distinct named cultural groups that migrated from Southeast Asia to the USA in recent years, especially on the elderly. People aged 60 or more years from one specific group, Iu-Mien refugees primarily from the highlands of Laos, are discussed here, through: (a) a review of available information about the traditional roles of older people and adjustment to life in the USA, and (b) a household survey of one community of Iu-Mien in Merced, California. Older people comprise a larger than expected proportion (7%) of the Iu-Mien community. The large households remain traditional in composition with many older men acting as patriarchs to several generations of lineal kin. Women, who are usually widows, tend to live with the families of sons or sons-in-law. Intergenerational disaffection has been reported in the literature, in part due to the status losses by older people and role reversals so common among refugees.

Journal Article↗

The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: examination of comorbidity with anxiety and depression.

Previous research has indicated a relationship between posttraumatic stress disorder (PTSD) and somatic complaints. We examined whether this relationship is a result of shared comorbidity with anxiety and depression. Local doctors interviewed a random, community sample of 526 tortured and 526 nontortured Bhutanese refugees living in U.N. refugee camps in Nepal. The interview covered demographics, torture, somatic complaints, and PTSD, depression, and anxiety measures. Number of PTSD symptoms, independent of depression and anxiety, predicted both number of reported somatic complaints and number of organ systems involving such complaints. Physicians need to screen for PTSD when survivors of extreme stressors present nonspecific somatic complaints.

Adult↗

Health of Cambodian refugees.

Cambodian refugees have been entering the United States since 1975, with the largest numbers arriving in the early 1980s. While many adjusted satisfactorily to their new environment, many continue having severe difficulty with the resettlement. Studies show that Cambodians are suffering more physical and mental distress than Vietnamese, Hmong, and Laotians. They are experiencing more financial and social distress, as well. This paper describes a small neighborhood home visiting program established 13 years ago to provide follow-up care for Cambodian refugees seen in a University Medical Center and later serving as a community experience for fourth-year medical students. These close contacts with the Cambodian community indicate that for many, especially those who are aging, both health and adjustment appear to be deteriorating. Chronic illnesses and prolonged severe depression are taking the place of the infectious diseases and the personal health problems, like dental disease, that they brought with them when they resettled in America.

Journal Article↗

Fatal hypokalemic thyrotoxic periodic paralysis presenting as the sudden, unexplained death of a Cambodian refugee.

For the last decade, death investigators have been aware of an unexplained syndrome of sudden death occurring among young adult Southeast Asian refugees. Presented here is a rare instance of fatal hypokalemic periodic paralysis associated with thyrotoxicosis masquerading as the sudden, unexplained death of a Cambodian refugee. The usual features of this syndrome were present, including relatively occult thyrotoxicosis, paralysis upon awakening following a high-carbohydrate meal, and hypokalemia. This case illustrates the value of thorough background death investigation and also illustrates the potential of misinterpreting traditional folk medicine coin rubbing (Cao Gio) as signs of physical abuse.

Adult↗