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PubMed2006

Factors associated with mental health service need and utilization among unaccompanied refugee adolescents.

This study is the first to address the need for mental health Care (MHC) and the patterns of utilization of MHC services among Unaccompanied Refugee Minors (URM). Information concerning the well being, mental health need, and utilization of services of URM was collected from three informants, the minors themselves (n = 920), their legal guardians (n = 557), and their teachers (n = 496). The well-being, need and utilization of MHC services of URM was compared with those of a representative Dutch adolescent sample (n = 1059). The findings of this study indicated that URM that report a mental health care need (57.8%) also report higher levels of emotional distress than Dutch adolescents who report a similar need for MHC (8.2%). In addition, guardians and teachers detect emotional distress and mental health care needs in only a small percentage (30%) of URM. The referral of URM to mental health care services does not appear to be driven by the reported needs of the URM, but by the need and emotional distress as observed and perceived by guardians. This resulted in the fact that 48.7% of the URM total sample reported that their need for mental health care was unmet.

Adolescent↗
PubMed2003

Prevalence rates of viral hepatitis infections in refugee Kurds from Iraq and Turkey.

BACKGROUND: Since little is known about the burden of viral hepatitis in Kurds, the prevalence of infection with hepatitis A virus (HAV), hepatitis E virus (HEV), hepatitis B virus (HBV) and hepatitis C virus (HCV) was investigated in a sample of refugee Kurds from Iraq and Turkey. PATIENTS AND METHODS: A cross-sectional study was carried out. Serological markers to hepatitis viruses were determined for 1,005 subjects from all age-groups of which 36.6% were from Turkey and 63.4% from Iraq. RESULTS: Overall seroprevalence for anti-HAV was 94.4% and 14.8% for anti-HEV. A significantly higher prevalence for anti-HEV was found among Iraqis (17.5%) compared to Turkish immigrants (10.0%). The prevalence of hepatitis B surface antigen (HBsAg) and total anti-HBc (core) was 6.8% and 35.6% in Turkish Kurds and 2.2% and 12.7% in Iraqis, respectively. Only 10% of children aged up to 10 years and 2.8% of subjects aged 11-20 years had been vaccinated against HBV, the majority of them coming from Iraq. One subject was confirmed as positive for anti-HCV (0.1%) and HCV-RNA and analysis showed a 4c/4d genotype. CONCLUSION: This survey shows a high prevalence of enterically transmitted viral hepatitis in Kurds. HBV infection is moderately endemic, while the prevalence of HCV infection is low. There is a need for a universal immunization strategy for HBV in the Kurd population.

Adult↗
PubMed1995

Children's head injuries in the Vietnamese refugee population in Hong Kong.

All Vietnamese patients with head injuries from two of the largest refugee camps in Hong Kong are routinely referred to the Neurosurgical Unit of the Prince of Wales Hospital for management. In order to determine the epidemiology of head injuries in this population group, we have retrospectively reviewed all hospitalized cases over a 4 year period from January 1990 to December 1993. We have found a unique social situation in this population group, with an unusually high proportion of paediatric cases (2253 per 100,000 children aged 5 years or less), compared with other epidemiological studies. The most common mechanism of injury in between 57 and 75 per cent of cases was a fall from bed. Based on this information, appropriate preventive measures have been recommended and have successfully decreased the incidence of head injuries. This study demonstrates the value and effectiveness of epidemiological studies in identifying a previously unrecognized health risk in a specified population group.

Age Factors↗
PubMed1990

Obstetric outcome among Vietnamese refugees in Hong Kong: an age-matched case-controlled study.

The obstetric performance of 308 Vietnamese refugees is compared with that of 308 age-matched Hong Kong Chinese patients. Vietnamese women were of higher parity and had an increased incidence of late booking and unreliable dates. Significant differences were found in the incidence of previous termination of pregnancy, iron-deficiency anemia, parasitic infestation, tuberculosis (TB) and syphilis. There was no significant difference in the mean birthweight between the two groups. However, there were twice as many low birthweight (less than 2500 g) infants amongst the Vietnamese whereas the Chinese patients had a higher incidence of macrosomic (greater than 4 kg) infants. There were no perinatal deaths and no significant perinatal morbidity.

Adult↗
PubMed1982

Role of water and sanitation in the incidence of cholera in refugee camps.

The purpose of this study was to determine the prevalence of cholera in two groups: (i) people using covered latrine and piped water; (ii) people using uncovered surface latrine and pond and tubewell water. The study population consisted of cholera cases admitted to the ICDDR, B hospital from three refugee camps. In the one camp with sanitation facilities, the cholera rate was 1.6 per 1,000, whereas in the two camps without facilities the rates were 4.0 and 4.3 per 1,000. Following demolition of the camps, the cholera rates decreased significantly in the camps geographical zones. Cholera was not totally eliminated, even in the one camp with sanitation facilities, suggesting that health education, as well as proper sanitation, is necessary to eradicate cholera.

Bangladesh↗
PubMed1984

Treatment of Schistosoma mekongi with praziquantel in Cambodian refugees in holding centres in Prachinburi Province, Thailand.

Eighty-four cases of schistosomiasis mekongi among Cambodian refugees in holding centres in Thailand received praziquantel at 30 mg/kg body-weight orally twice in one day. Those treated were admitted to hospital in order to observe side effects for 24 hours. Assessment of the efficacy of praziquantel was based on cure rates. Side effects observed consisted primarily of abdominal pain, anorexia, nausea, emesis and headache. These were generally mild and transient. Physical signs revealed mild hepatomegaly and splenomegaly. The cure rate obtained one month after treatment was 97.5% and by 2 to 12 months after treatment reached 100%.

Adolescent↗
PubMedDate not supplied

Sensitivity of Plasmodium falciparum in vivo to chloroquine and pyrimethamine-sulfadoxine in Rwandan patients in a refugee camp in Zaire.

Resistance of Plasmodium falciparum to available antimalarial drugs is now thought to be spreading progressively throughout sub-Sahara Africa. In this study we measured the susceptibility of P. falciparum to chloroquine and pyrimethamine-sulfadoxine in vivo in Rwandan patients living in Kibumba refugee camp in Goma, Zaire. Of the 39 cases treated with chloroquine, only 8 (20.5%) showed sensitive or RI (delayed) response and 31 (79.5%) demonstrated resistance at RI (30.8%), RII (33.3%( and RIII (15.4%) levels. Of the 38 individuals receiving pyrimethamine-sulfadoxine, 13 (34.2%) showed sensitive or RI (delayed) responses, and 25 (65.%) showed resistance at RI (26.3%), RII (36.8%) and RIII (2.6%) levels. Both chloroquine and pyrimethamine-sulfadoxine reduced parasite counts by at least 75% in the majority of the patients within 2 d of treatment. A greater proportion of children with malnutrition showed a higher mean geometric parasite density and slower parasite clearance in vivo than those without malnutrition. Moreover, the frequency and degree of resistance were more pronounced in children with malnutrition. Moreover, the frequency and degree of resistance were more pronounced in children with malnutrition. The results suggest the existence of resistance to chloroquine and pyrimethamine-sulfadoxine. However, the drugs are still effective in significantly reducing parasitaemia and they can still be used as drugs of first and second choice in the region, even in the face of some degree of resistance.

Adolescent↗
PubMed1985

Tuberculosis in an Indochinese refugee camp: epidemiology, management and therapeutic results.

In a 3-year period tuberculosis was diagnosed in 629 patients in Thailand's largest camp for Kampuchean refugees: 62% had pulmonary disease and 38% extrapulmonary forms. Tuberculosis of lymph nodes was the most important extrapulmonary manifestation (50%). The mean annual notification rates were 0.5% and 0.24% for all forms and smear-positive pulmonary tuberculosis respectively. There was a steep rise in the annual notification rate with increasing age. A 6-month course of fully supervised chemotherapy efficiently counteracted defaulting, early absconding and initial drug resistance. Seventy-three per cent of all patients remained on chemotherapy for the planned period; only 2% of the smear-positive patients failed bacteriologically on chemotherapy. Of the patients with the most common forms of extrapulmonary disease, 90% showed a favourable response to chemotherapy.

Adolescent↗
PubMed1988

The management of tuberculosis in refugees along the Thai-Kampuchean border.

The treatment of tuberculosis in refugees living in campus along the Thai-Kampuchean border has remained a controversial issue since the beginning of the Khmer relief operation in 1979. During the 1984-85 dry season, war-related disruptions forced the evacuation of the 240,000 residents of 21 camps into evacuation sites in Thailand. Seven tuberculosis treatment programmes, using a fully supervised, daily protocol of isoniazid(H), rifampicin(R), pyrazinamide(Z) and streptomycin(S) 3 HRZS/HR, (6 months for pulmonary and 9 months for extrapulmonary tuberculosis), were able to continue operation, with acceptably low rates of default from therapy. During the 18 month period beginning in July 1984, 984 patients were started on treatment: 755 completed a full course while 86 defaulted. The programme design and organisation are described.

Antitubercular Agents↗
PubMed1994

Psychological and endocrine abnormalities in refugees from East Germany: Part II. Serum levels of cortisol, prolactin, luteinizing hormone, follicle stimulating hormone, and testosterone.

We investigated afternoon serum levels of cortisol, prolactin, luteinizing hormone (LH), follicle stimulating hormone (FSH), and testosterone in a group of 84 refugees who had fled from East to West Germany and suffered from psychiatric disorders within 6 weeks of their arrival in West Berlin. The mean hormone levels were compared with those of healthy control subjects. Cortisol levels were lower and LH levels were higher in the patients than in the control subjects, but only at trend levels of significance. No differences were found between the prolactin, FSH, or testosterone concentrations of the two groups. The patients with major depressive disorder (MDD) had a significantly higher mean cortisol level than the mean levels in the subgroups in whom posttraumatic stress disorder, dysthymia, and adjustment disorder were diagnosed. It can be concluded that the hypothalamic-pituitary-adrenal axis may "adapt" during severe long-term psychological stress and that long-term stress may be only one of the neurochemical mechanisms underlying the hypercortisolemia in patients with MDD.

Depressive Disorder↗
PubMed1984

Acculturation and mental health: a study of Hmong refugees at 1.5 and 3.5 years postmigration.

This study of Hmong refugees at 1.5 and 3.5 years following arrival in the United States showed considerable improvement on psychiatric self-rating scales. Social changes over the 2 year interim (including a high unemployment rate) were few. Earlier premigration and postmigration variables correlated with high symptom levels at 1.5 years were not correlated with these symptoms at 3.5 years. Events in the acculturation process which accompany, and perhaps account for some of these observations are indicated.

Acculturation↗
PubMed1985

Depressive symptomatology among Namibian adolescent refugees.

Symptoms of depression have been considered rare in sub-Saharan populations. Using a standard assessment measure of depressive symptomatology, the Beck Depression Inventory, the prevalence of symptoms of depression was obtained from a group (N = 56) of Namibian refugees residing in a sub-Saharan host country. Contrary to expectations, the rates of self-reported symptoms were quite frequent, with many symptoms reported as moderate or severe by a large proportion of these youths. Using a stress model to explore these data, it was demonstrated that social support ameliorated the effects of chronic stress, as represented by the length of time in exile. It is argued that adaptation, acculturation, and adolescent developmental demands result in self-reports of depressive symptoms. These demands, however, are lessened in intensity by a strong social support system that is especially helpful early in the exile period.

Adolescent↗
PubMed1987

Tai Dam health care practices: Asian refugee women in Iowa.

This study discusses several aspects of health care utilization and health care practices for a group of Tai Dam refugee women who today are living in central Iowa. Several important variables examined in this discussion include: ideas about illness etiology, choice and use of health care providers, birth control practices, and the use of preventive health care in the form of prenatal health care visits. Salient findings include: Tai Dam belief that the majority of illnesses are caused by temperature and weather changes or bad food and water, or that illnesses are caused by the supernatural. Two-thirds of the women do not use and have never used any form of birth control. Although the average Tai Dam woman had been living in the U.S. for seven years at the time of the study, communications with physicians and understanding of written medicine instructions is difficult for many due to language problems. One-quarter of the women are not covered by medical insurance of any kind.

Adolescent↗
PubMed1987

Relationship of chronic stress, social support, and coping style to health among Namibian refugees.

This study investigates how social support and coping style affect the relationship between a traumatic chronic stressor and health status. A population of 88 Namibian refugees living in an equatorial region of Africa participated in the study. The central hypothesis was that social support and coping style moderate the relationship between length of stay in exile (a proxy measure of chronic stress) and health status (symptoms of generalized anxiety disorders, self-reported physical health status and length of stay in hospital). The results show that when social support is high the relationship between length of stay in exile and all three health outcomes is substantially reduced. When social support is low, the relation between stress and poor health outcomes is high. Coping style moderates the relationship between length of stay in exile and period of hospitalization but has no effect on level of anxiety or perceived health status. When both social support and coping style are simultaneously considered, the best results emerge.

Adaptation, Psychological↗
PubMed1989

A programme of mental health for political refugees: dealing with the invisible pain of political exile.

Political persecution, state terrorism, torture, political assassinations, kidnapping and forced exile have become common occurrences in many parts of the world. Several researchers have tried to determine the impact of these situations on the mental health of those affected. At the same time, different types of aid programmes have been developed to prevent and treat the effects of violence on mental health. In this article we present clinical materials collected for 10 years by the Latin American Collective of Psychosocial Work [Colectivo Latinamericano de Trabajo Psicosocial (Colat)], a medical-psychosocial assistance programme for political refugees. The programme was under the academic supervision of the Catholic Universities of Leuven (KUL, ULC), Belgium. The concept of identity is the central theme of a model which tries to understand and explain the suffering of exiles. We try to identify and expose the mechanisms of political violence that have traumatized an individual's self-esteem and disordered his familial and social bonds. In the second part of this article, the central ideas which support the medical-psychosocial practice of the programme are presented. This programme seeks to heal the damage caused by repression and exile through the active participation of those affected. Only in a context of communal action is it possible to develop a therapy to promote an individual recovery. It is in this sense that the strategic goal of the programme is to permit elaboration of the suffering at an individual, familial and group level, and to facilitate group dynamics which can trigger the potential of the exiles to transform the conditions of violence that originated and maintain their pain.

Belgium↗
PubMed1991

Treating psychiatric disorders among Mien refugees from highland Laos.

The Mien, a Southeast Asian hill people, have immigrated to various countries throughout the world since the mid-1970s. They have brought their ancient culture with them, including beliefs and practices related to health, illness, and healing. During the last several decades they have suffered much war-related trauma, including extensive human, material and symbolic losses. This report describes our clinical experience with Mien refugees in the Indochinese Psychiatric Program of the Oregon Health Sciences University. We discuss symptom presentation among this group of patients, diagnostic and treatment issues, and the impact of cultural health beliefs upon illness and treatment. Major depression and post-traumatic stress disorder have been the most commonly encountered psychiatric diagnoses, usually revealed through somatic symptoms. Not only must clinicians take careful medical and psychiatric histories, but they must also be alert to the high probability of an extensive history of trauma. Clinical improvement in response to psychotropic medications has been limited. As a result, psychosocial and psychotherapeutic approaches to treatment have been developed and expanded and now are commonly employed, effectively combining support and education in the creation of a holding environment that includes both individual and group formats. Two case histories are presented which describe symptom presentation, health belief systems and therapeutic issues involved in treating Mien patients. They also illustrate that traditional and Western healing approaches can co-exist in the optimal care of these patients.

Adult↗
PubMed1995

Acculturation as a risk factor for chronic disease among Cambodian refugees in the United States.

Although the concept of acculturation originated within anthropology, in recent years it has assumed a prominent role within epidemiology as a risk factor for chronic disease. However, these studies often consider acculturation in structural terms, reflected in differences between groups assumed to lie along the same continuum, all moving in the same direction toward greater acculturation to the values and behaviors of the dominant society. This paper addresses how acculturation should be conceptualized when examining it as a potential risk factor for chronic disease and how it should be measured so that it becomes both theoretically and clinically meaningful. Four case studies of Cambodian refugees of San Diego, California are used to illustrate the following: (1) the importance of integrating an acculturation-as-process perspective with an acculturation-as-structure perspective; (2) viewing acculturation as both individual and group experience of conflict and negotiation between two systems of behavior and belief; (3) measuring it longitudinally and as narrative; and (4) understanding that rather than being an inherent health risk, it may also promote health by creating access to certain forms of health care unavailable in the country of origin and by contributing to the abandonment of risky health-related behaviors and the adoption of behaviors that promote good health.

Acculturation↗
PubMed1995

Refugee stress and folk belief: Hmong sudden deaths.

Since the first reported death in 1977, scores of seemingly healthy Hmong refugees have died mysteriously and without warning from what has come to be known as Sudden Unexpected Nocturnal Death Syndrome (SUNDS). To date medical research has provided no adequate explanation for these sudden deaths. This study is an investigation into the changing impact of traditional beliefs as they manifest during the stress of traumatic relocation. In Stockton, California, 118 Hmong men and women were interviewed regarding their awareness of and personal experience with a traditional nocturnal spirit encounter. An analysis of this data reveals that the supranormal attack acts as a trigger for Hmong SUNDS.

Adult↗