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PubMed2004

The inflammatory markers C-reactive protein and serum amyloid A in refugees with and without posttraumatic stress disorder.

BACKGROUND: "Stress" is associated with changes in many systems of the body. The aim was to study the markers of the innate immune system, Serum amyloid A (SAA) and C-reactive protein (CRP), in subjects with and without posttraumatic stress disorder (PTSD). METHODS: Subjects were refugees from Iraq in the age range of 18-48 years who participated in a longitudinal study focusing on life events. Blood samples were taken in the morning and analysed for Serum amyloid A and high sensitivity C-reactive protein (hsCRP). RESULTS: Contrary to expectations, serum SAA and hsCRP were lower in PTSD than in non-PTSD subjects. Levels of SAA and CRP were further inversely correlated with serum DHEA-s, but not with cortisol. In cases with PTSD at baseline, there was an inverse relationship between difference in self-rated symptoms of PTSD and difference in log-transformed SAA-thus increasing PTSD intensity was associated with decreasing SAA. No such patterns were obvious with regard to CRP. CONCLUSIONS: Changes in the innate immune system, as measured by acute phase proteins of hepatic origin, seem to be a feature of PTSD. Further, the inverse correlation between DHEA-s, which has been shown to be changed in PTSD, and the acute phase proteins is of interest.

Adolescent↗
PubMedDate not supplied

Psychometric properties of a Russian version of the SF-12 Health Survey in a refugee population.

This project examined psychometric properties of a Russian translation of the 12-item Short-Form health survey questionnaire (SF-12) to assess physical and mental health status in members of the Russian-speaking refugee population. Translation and adaptation included (a) cross-cultural adaptation; (b) translation; (c) pre-testing; and (d) analysis of validity, reliability, and internal consistency. Seventeen Russian-speaking patients at a Russian psychiatric clinic were recruited for the study and were compared to a sample of 42 Russian-speaking members of the community. The instrument showed internal consistency when evaluated with coefficient alpha. As compared with community subjects, clinic patients had significantly lower scores, reflecting poorer physical and mental well being.

Adolescent↗
PubMedDate not supplied

Olfactory-triggered panic attacks among Cambodian refugees attending a psychiatric clinic.

Olfactory panic attacks have not been systematically assessed in a psychiatric population by any previous studies. Among Cambodian refugees attending a psychiatric clinic, the present investigation determines the following: (a) 1-month current prevalence of olfactory-triggered panic attacks, (b) associated psychopathology (Hopkins Symptom Checklist and the Structured Clinical Interview for DSM-IV-diagnosed posttraumatic stress disorder [PTSD]), and (c) frequency in events of olfactory panic of catastrophic cognitions (Panic Attack Cognitions Scale [PACQ]) and flashbacks (Clinician-Administered PTSD flashback scale). Forty-five percent of 100 consecutive psychiatric patients were found to have suffered an olfactory-triggered panic attack in the previous month; having current olfactory panic attacks was highly correlated with psychopathology (e.g., to PTSD diagnosis: and chi(2)=50.0; df=1; p<.001); and during olfactory-triggered panic attacks, catastrophic cognitions and flashbacks were common. Possible mechanisms for generation of high rates of olfactory-triggered panic attacks in this population are discussed (the "traumatic memory/catastrophic cognitions/interoceptive conditioning/escalating arousal" or "TCIE" model of panic generation) as are treatment implications.

Adult↗
PubMed2005

Post-migration geographical mobility, mental health and health service utilisation among Somali refugees in the UK: a qualitative study.

Migration is known to be associated with poor health outcomes for certain marginalised and socially disadvantaged populations. This paper reviews a number of reasons why residential mobility in the 'host' country may be associated with poor mental health for refugee populations and reports on a qualitative study of Somalis living in London, UK, and their beliefs about the relationship between residential mobility, poor health and health service use. Two discussion groups were undertaken with 13 Somali professionals and four groups with 21 lay Somalis in East and South London, UK. Lay Somalis did not wish to move accommodation but felt they were forced to move. Some Somali professionals believed that the nomadic history of Somalis made them more likely to elect to move in order to escape problems of living, but this was not supported by the lay group. Frequent geographical movements were seen as stressful and undesirable, disrupted family life and child development and were detrimental to well being. Residential mobility was also perceived to interfere with health care receipt and therefore should be more comprehensively assessed in larger quantitative studies.

Adult↗
PubMed2004

Female genital mutilation, asylum seekers and refugees: the need for an integrated European Union agenda.

Asylum seekers and refugees (ASRs) are a heterogeneous population with distinct physical and psychological needs. ASRs with additional health needs are girls and women who have undergone, or are at risk of undergoing, female genital mutilation (FGM). Across the European Union (EU), variation exists in Member States' anti-FGM and asylum legislation, the rigour of existing research programmes, and the operational coherence of the multiple agencies combating the practice. ASRs' needs are, consequently, not being addressed satisfactorily. This paper proposes an integrated future agenda, applicable in all EU countries, capable of meeting these girls' and women's needs.

Circumcision, Female↗
PubMed2006

Anxiety sensitivity among Cambodian refugees with panic disorder: A factor analytic investigation.

Among Cambodian refugees with panic disorder (N = 208), we performed two factor analyses, one with the ASI, another with an Augmented ASI (consisting of the 16-item ASI supplemented with a 9-item addendum that assesses additional Cambodian concerns about anxiety-related sensations). The principal component analysis of the ASI yielded a 3-factor solution (I, "Weak Heart Concerns"; II, "Social Concerns"; III, "Control Concerns"); the Augmented ASI, a 4-factor solution: I, "Wind Attack Concerns"; II, "Weak Heart Concerns"; III, "Social Concerns"; and IV, "Control Concerns." The item clustering within the factor solution of both the ASI and Augmented ASI illustrates the role of cultural syndromes in generating fear of mental and bodily events.

Anxiety↗
PubMed2006

Gastrointestinal-focused panic attacks among Cambodian refugees: associated psychopathology, flashbacks, and catastrophic cognitions.

Among Cambodian refugees attending a psychiatric clinic, we assessed psychopathology associated with gastrointestinal panic (GIP), and investigated possible causal mechanisms, including "fear of fear" and GIP-associated flashbacks and catastrophic cognitions. GIP (n=46) patients had greater psychopathology (Clinician-Administered PTSD Scale [CAPS] and Symptom Checklist-90-R [SCL]) and "fear of fear" (Anxiety Sensitivity Index [ASI]) than did non-GIP patients (n=84). Logistic regression revealed that general psychopathology (SCL; odds ratio=4.1) and fear of anxiety-related sensations (ASI; odds ratio=2.4) predicted the presence of GIP. Among GIP patients, a hierarchical regression revealed that GIP-associated trauma recall and catastrophic cognitions explained variance in GIP severity beyond a measure of general psychopathology (SCL). A mediational analysis indicated that SCL's effect on GIP severity was mediated by GIP-associated flashbacks and catastrophic cognitions.

Adolescent↗
PubMed2006

Heat stroke and multi-organ failure with liver involvement in an asylum-seeking refugee.

Heat stroke is the result of exposure to high environmental temperature and strenuous exercise representing a medical emergency characterized by an elevated core body temperature and central nervous system disorders. Slightly elevated liver enzymes, lacking clinical significance, seem to be frequent in heat stroke, whereas severe, clinically relevant, hepatocellular injury has been observed in only a minority of cases. In the present report we describe the case of an otherwise healthy young asylum-seeking refugee from East Timor, who developed severe heat stroke during his transportation to Greece in a closed container on a ship under unusually high temperatures. He was admitted to the hospital with severe multi-organ failure. After a short period of initial improvement, he developed severe hepatocellular injury and hepatic encephalopathy. Other causes of liver damage were excluded. The patient completely recovered.

Adult↗
PubMedDate not supplied

Somali refugee women speak out about their needs for care during pregnancy and delivery.

More than half of all Somali refugees in the United States live in Minnesota. To obtain information to develop culturally sensitive health education materials, we conducted two focus groups with 14 Somali women who had each given birth to one child in Minnesota. Overall, women thought that their childbirth experience was positive. They also reported racial stereotyping, apprehension of cesarean births, and concern about the competence of medical interpreters. Women wanted more information about events in the delivery room, pain medications, prenatal visits, interpreters, and roles of hospital staff. The most desirable educational formats were a videotape, audiotapes, printed materials, and birth center tours. To increase their attendance at prenatal appointments, participants said they needed reminder telephone calls, transportation, and childcare.

Adult↗
PubMedDate not supplied

Pregnancy and childbirth care following conflict and displacement: care for refugee women in low-resource settings.

Women in developing countries experience the same problems during pregnancy and childbirth and die of the same complications, regardless of whether they live in stable situations or in situations of conflict and displacement. They need services and/or care during pregnancy and childbirth wherever they are and in whatever circumstances prevail. This article provides an overview of the Safe Motherhood Initiative, including the recent directions taken to prevent maternal and neonatal mortality and morbidity. In addition, pregnancy and childbirth care in complex humanitarian emergencies is examined, highlighting the experiences in refugee settings. In some of these settings, pregnancy outcomes have been better than in host or home countries. The challenge remains to ensure that good-quality pregnancy and childbirth care, in line with the global standards set for achieving safe motherhood, is consistently available and accessible to women affected by complex humanitarian emergencies.

Developing Countries↗
PubMed2006

Ethnic identity, resettlement stress and depressive affect among Southeast Asian refugees in Canada.

Does commitment to an ethnic identity enhance or jeopardize psychological well-being? Using data from a study of Southeast Asian "Boat People", this study examined the mental health effects of ethnic identification as the former refugees confronted common resettlement stressors in Canada--unemployment, discrimination and lack of fluency in the dominant society language. The study team administered a questionnaire to 647 respondents covering ethnic identification, demographic and employment information, language fluency, experiences with discrimination, and depressive affect. Context helped determine the relationship between ethnic identification and depressive affect. When the Southeast Asians encountered racial discrimination or unemployment, ethnic identity attachment amplified the risk of depressive affect. By contrast, a strongly held ethnic identity provided a psychological advantage for individuals experiencing difficulties with the dominant language.

Acculturation↗
PubMed2004

Epidemiology of anthroponotic cutaneous leishmaniasis in Afghan refugee camps in northwest Pakistan.

During November and December 1998, 16 Afghan refugee camps were surveyed for anthroponotic cutaneous leishmaniasis (ACL). Prevalence of active lesions and scars amongst the population was 2.7% and 2.4%, respectively. Between camps the prevalence of active lesions varied from 0.3 to 8.8% and that of scars from 0.3 to 5.8%. Random-effects logistic regression indicated that risk of active ACL was associated with age but not gender. This model also indicated a significant clustering at the household level. The average annual force of ACL infection was estimated to be 0.046 per year (4.6 cases/1000 persons/year) over the past 10 years. Based on the evidence from this study an intervention strategy was formulated for all camps with reported ACL cases. This includes targeting of active cases with insecticide-treated nets, sold at a highly subsidised price.

Adolescent↗
PubMed2001

The impact of indoor residual spraying with malathion on malaria in refugee camps in eastern Sudan.

An exploratory trial of the efficacy of indoor spraying with malathion on morbidity and mortality in refugee camps in eastern Sudan was conducted during the rainy season of 1997. The interior walls of houses from a randomly selected group of five camps were sprayed with malathion in mid-September and morbidity and mortality rates in the camps for the months October to December compared with rates in five controls. Pyrethrum spray collection and human landing catches were performed in two collection rounds. An exophagic but endophilic population of Anopheles arabiensis was the most common mosquito collected. The mean human blood index of 242 mosquitoes from eight camps was 0.51. Only two of 1040 mosquitoes examined harboured sporozoites. Blood samples of 83 putative malaria patients were examined for parasites by PCR. Mortality rates in the 3 months following spraying were significantly lower in sprayed camps although differences in clinical malaria incidence between sprayed and non-sprayed camps were not significant.

Animals↗
PubMed2003

Anger-associated panic attacks in Cambodian refugees with PTSD; a multiple baseline examination of clinical data.

Despite the increasing recognition of the importance of anger as a key aspect of post-traumatic stress disorder (PTSD), the presence of anger-induced panic attacks has been understudied in traumatized groups. The present investigation determines the prevalence of anger-associated panic attacks among Cambodian refugees suffering from PTSD. Specific characteristics of these episodes that were examined included frequency, symptoms, and cognitions (in particular, fear of death from bodily dysfunction). In a survey of 100 Khmer patients suffering PTSD, 58% reported anger-associated panic attacks in the last month. These attacks occurred at a mean rate of 6.2 attacks a month and were characterized by extreme arousal and in 81% of these cases, fears of death due to bodily dysfunction during the anger-induced panic. Mechanisms for this high rate of fear of death during anger arousal are discussed with a focus on culture-specific catastrophic cognitions.

Adult↗
PubMed1983

Anemia and hemoglobinopathies in Southeast Asian refugee children.

Hematologic evaluations of 254 Southeast Asian refugee children from 163 families are reported. Hemoglobin E trait was common in Cambodians (19%) and Laotians (18%), but rare in Vietnamese (1%). beta-Thalassemia trait was most prevalent in Vietnamese (8%), and less common in Cambodians and Laotians (3%). alpha-Thalassemia was prevalent in all three groups. Hemoglobin concentrations and mean corpuscular volumes seen with hemoglobinopathies were compared with those of Southeast Asian children with normal hemoglobin. Both Hb AE and Hb EE were shown to be benign conditions resulting in microcytosis and mild, if any, anemia. In children with Hb AE, mean corpuscular volume ranged from 64 to 78 ft and Hb E from 27% to 34%. In those with Hb EE, microcytosis was more marked (50 to 63 ft). In 15 children with Hb EE, there was a delayed fall in fetal hemoglobin, which can cause diagnostic difficulties in infants.

Adolescent↗
PubMed1985

Entamoeba polecki infection in Southeast Asian refugees: multiple cases of a rarely reported parasite.

Recently, Entamoeba polecki was identified for the first time in our parasitology laboratory in stool specimens from eight Southeast Asian refugees. This ameba has been reported infrequently in the Western world; most reported cases have been from the New Guinea region. In most previously described patients and in our patients, no definite gastrointestinal symptoms could be directly attributed to E. polecki infection. Morphologically, E. polecki may mimic the pathogen E. histolytica and also nonpathogens such as E. coli. These species are most readily distinguished by studying encysted forms. In contrast to E. histolytica and E. coli, E. polecki characteristically has uninucleate cysts. Both pigs and monkeys naturally harbor E. polecki, but four of the patients in this series had no apparent contact with these animals. Other modes of infection may be human-to-human transmission or acquisition from other domestic animals. Six of our eight patients were treated successfully with one course of metronidazole in a regimen similar to that used for E. histolytica infection. In the two other patients, repeated courses of therapy eradicated the infection. Because of the recent increase in number of Southeast Asian immigrants to the United States, E. polecki may be identified more frequently than in the past. Physicians and laboratory personnel should be familiar with this organism, because it may be confused with E. histolytica or may act as a pathogen.

Adolescent↗
PubMedDate not supplied

Pyrethroid-impregnated bed nets for personal protection against malaria for Afghan refugees.

A field trial of permethrin-impregnated bed nets (PIBs) was conducted in 2 Afghan refugee villages in Pakistan. Nets were issued to only 10% of families (= 1398 people); this simulated a situation in which bed nets are gradually adopted by villagers in Afghanistan. A further 10% lacking bed nets were selected as controls from the same villages. An initial survey showed that 86% of household heads were aware that malaria was transmitted by mosquito bites, but only 2% had used bed nets before. Trial families were encouraged to attend the village health centres if they fell ill. Microscopy records showed that, between July and December 1991, 22.4% of the control group became infected with Plasmodium vivax and 13.0% contracted P. falciparum while in the intervention group only 9.9% contracted P. vivax (relative risk 0.58, confidence interval [CI] 95% 0.49-0.68) and only 3.8% contracted P. falciparum (relative risk 0.39, 95% CI 0.29-0.53). A single treatment of the nets with permethrin at 0.5g/m2 remained protective throughout the 6 months' transmission season. 73% of families claimed to use their nets every night; members of families who claimed to use nets less regularly showed an incidence similar to that of the control group. There was no sex or age difference in net use or protective efficacy. Headlouse infestation rates were reduced in PIB users. Few nets were washed, given away or sold. The prospect for PIBs as personal protection appears good, despite people's lack of previous experience.

Adolescent↗
PubMedDate not supplied

Randomized controlled trials of 5- and 14-days primaquine therapy against relapses of vivax malaria in an Afghan refugee settlement in Pakistan.

Primaquine is the only drug available that can eliminate hypnozoites from the liver and prevent relapses of vivax malaria. The World Health Organization recommends a course of 14-21 days depending on region and strain. The National Malaria Control and Eradication Programmes of Pakistan and India have adhered to a 5-day course as their standard as it is deemed more practical to implement and because facility for detecting glucose 6-phosphate dehydrogenase (G6PD) deficiency is seldom available at the periphery. Evidence for the efficacy of the 5-day regimen is controversial or lacking. Two, year-long, randomized controlled trials were undertaken in an Afghan refugee camp in north-western Pakistan using a process of passive case detection and treatment at the camp's clinic: the first trial compared treatment with chloroquine alone versus chloroquine plus 5-days primaquine, the second trial compared chloroquine alone versus chloroquine plus 14-days primaquine. Chloroquine is not hypnozoitocidal and was administered to eliminate the erythrocytic stages and to alleviate clinical symptoms. The daily primaquine dose was 0.25 mg/kg bodyweight and the total chloroquine dose was 25 mg/kg over 3 days. During the first trial 52% (129/250) of the non-primaquine group recorded a 2nd clinical-parasitaemic episode and 23% recorded a 3rd, whereas 51% (128/250) of the 5-days primaquine group reported a 2nd episode and 21% recorded a 3rd. During the second trial 49% (49/100) of the non-primaquine group recorded a 2nd episode and 25% recorded a 3rd, whereas only 32% (32/100) of the 14-days primaquine group recorded a 2nd and only 2% recorded a 3rd. The 5-days primaquine regimen has no value as an anti-relapse therapy and should be abandoned. In extended tests in vivo in which vivax cases (n = 31) were treated with chloroquine 25 mg/kg and 14-days primaquine, there was no parasite recrudescence within 28 days and hence no evidence of resistance to chloroquine.

Adolescent↗