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PubMed2000

Organized violence and mental health of refugee children in exile: a six-year follow-up.

UNLABELLED: In an earlier study we described a high rate of poor mental health in 63 refugee children from Chile and the Middle East during the first 18 mo of exile. In this follow-up study the mental health of 49 of these children is described in parent, teacher and child interviews 6-7 y after settlement in Sweden. The level of poor mental health in parent interviews has improved from 47% 18 mo after settlement to 22% (p < 0.01 in paired t-test) at follow-up. CONCLUSIONS: Eighteen percent of 34 children still in primary school were judged by their teachers to show deviant behaviour in the classroom. Three children were found to suffer from either reexperience or avoidance of painful memories, whereas only one neurologically impaired child fulfilled the criteria of PTSD according to DSM-IV. Recent stress in the family sphere and exposure to acts of organized violence in the country of origin are identified as the major determinants of poor mental health.

Child↗
PubMed2001

Life situation and posttraumatic symptoms: a follow-up study of refugees from the former Yugoslavia living in Sweden.

Posttraumatic symptoms were assessed by means of the Harvard Trauma Questionnaire among 27 severely traumatized refugees from the former Yugoslavia in psychiatric treatment and then 3 years later, after an average of 5.5 years in Sweden. At follow-up the subjects also answered a questionnaire about their life situations. No significant change in average symptom level had taken place at follow-up. Seventeen subjects met the DSM IV criteria for posttraumatic stress disorder (PTSD) at both times. However, five subjects who met the PTSD criteria in the first study did not at follow-up, and the opposite was true for another five subjects. Fifteen subjects reported contact with psychiatric care during the past year. Unemployment and dependence on social welfare were high at follow-up. The unemployment rate of 32% was almost six times greater than that for the regular Swedish labor force but comparable to that of the whole Bosnian labor force in Sweden. Social contacts with the majority population were as common as with compatriots, but two-thirds of the subjects expressed a wish for more social contacts outside the family. Positive factors in the subjects' life situations were the housing situation and the fact that most subjects had at least reasonable knowledge of the majority language. However, a minority of the group still had no formal competence in Swedish, with negative consequences for labor market integration and social contact with Swedes. Two-thirds of the group had made no definite decision to stay in Sweden.

Adult↗
PubMed2003

Cognitive abilities related to post-traumatic symptoms among refugees from the former Yugoslavia in psychiatric treatment.

The overall aim was to study the relationship between post-traumatic symptoms and cognitive abilities among traumatized refugees from the former Yugoslavia, in psychiatric treatment. The results showed that a diagnosis of post-traumatic stress disorder (PTSD), as well as a higher level of post-traumatic symptoms, was significantly associated with poorer average cognitive performance. Three of four tests of fluid intelligence, and the Benton Visual Retention Test, assessing episodic memory, were the most discriminating. A specific constellation of PTSD symptoms, dominated by arousal and intrusive symptoms, had a significant overall correlation with intellectual performance. One implication of the study is that assessment of cognitive abilities might be advisable in this patient group, in particular when arousal and re-experiencing symptoms are frequent.

Adult↗
PubMed2004

Alexithymia, emotions and PTSD; findings from a longitudinal study of refugees.

The objective of the present study was to assess alexithymia by means of the Toronto Alexithymia Scale (TAS-20) and The Emotion Protocol (EP) in a group of refugees. Eighty-six subjects were willing to participate. At last follow-up, 33 non-PTSD and 22 PTSD subjects had complete data. Subjects with PTSD had higher scores on the TAS-20 (F = 4.314, df = 77, p = 0.041), but on the subscale level, this was significant only with regard to Factor I, difficulties identifying feelings (F = 5.316, df = 77, p = 0.024). TAS Factor I and to a lower extent TAS Factor II (difficulties naming feelings) were significantly associated with the self-rated presence of dysphoric affects. At follow-up, an increase in TAS Factor I score was associated with increased prevalence of self-rated symptoms of PTSD, but not depression. Decrease in prolactin was associated with significant increase of TAS Factor I (rho = -0.396, n = 54, p = 0.003). The present study indicates that alexithymia as measured by TAS-20 is indeed associated with symptoms of PTSD. This association is almost exclusively explained by the TAS Factor I subscale and is in turn associated with a high level of self-reported dysphoric affect. The longitudinal inverse correlation with prolactin points to the possibility of an underlying disturbance in serotonergic and/or dopaminergic systems. The results thus indicate that secondary, or post-traumatic, alexithymia is a measure of suppressed or warded-off negative affects.

Adult↗
PubMed2003

Impact of housing conditions on the health of the people at al-Ama'ri refugee camp in the West Bank of Palestine.

Al-Ama'ri camp is situated to the south of Ramallah city in the West Bank of Palestine. It is densely populated, with a total population of 4046, divided into 760 households, on a surface area of 93 dunums (93000 m(2)). In this research, the relationship between the housing conditions at Ama'ri camp and the prevalence and incidence rates of upper respiratory tract diseases has been studied. The diseases and symptoms most encountered in winter, and those include: common cold, cough, pharyngitis, influenza, ear infection, asthma and bronchitis have been studied. It was found that these are diseases directly related to poor housing conditions. Cold housing, presence of dampness and moulds, dust and smoke, burning of biomass fuel, crowding, poor ventilation and inadequate lighting problems are commonly found in the houses of this refugee camp.

Adolescent↗
PubMedDate not supplied

Traumatized refugee children: a challenge for mental rehabilitation.

The problems of rehabilitating traumatized refugee children are considered in the light of Swedish experience in aiding victims of the Holocaust of the Second World War. An active rehabilitation programme, taking into account changes in family relationships, is needed. It is important to break the silence of repression, but also to understand the variable degree of resilience of survivors of trauma.

Child↗
PubMed2002

Seroprevalence of measles, rubella, and varicella in refugees.

Immigrant children who enter the United States without immunization records may be required to receive vaccines for diseases to which they are already immune or for which they have previously received immunization. We tested 669 newly arrived refugees (age range, 0-20 years) for antibody to measles, rubella, and varicella, to determine the seroprevalence of antibodies to these diseases in this group of immigrants. Five hundred forty-nine (82%) of 669 patients had antibody to measles, 545 (82%) of 668 had antibody to rubella, and 430 (64%) of 668 had antibody to varicella. Antibody to all 3 diseases increased with increasing age. No clinically significant differences in presence of antibody were noted by region of origin.

Adolescent↗
PubMed2004

Spread fortified with vitamins and minerals induces catch-up growth and eradicates severe anemia in stunted refugee children aged 3-6 y.

BACKGROUND: Multiple micronutrient deficiencies are often the basic causative factor in stunting and anemia, 2 conditions that affect entire generations of children in deprived populations. No generally accepted recommendations for micronutrient intakes for recovery from stunting are available. OBJECTIVE: The objective was to assess the effect of a highly nutrient-dense spread fortified with vitamins and minerals, with or without antiparasitic metronidazole treatment, in correcting retarded linear growth and reducing anemia in stunted children. DESIGN: Saharawi refugee children (n = 374) aged 3-6 y with initial height-for-age z scores <-2 were assigned to 1 of 5 groups: fortified spread (FS), fortified spread plus metronidazole (FS+M), unfortified spread (US), unfortified spread plus metronidazole (US+M), or control. Supervised supplementation was given daily for 6 mo. Weight, height, knee-heel length, hematologic indexes, parasitic infections, and morbidity were assessed at 0, 3, and 6 mo. RESULTS: Linear growth of children fed FS was 30% faster at 3 mo than in US and control groups, after which height-for-age z scores increased only slightly in the FS group and remained unchanged in the other groups. No additional benefits from metronidazole were observed. Increase in hemoglobin concentrations in the FS group at 6 mo was twofold that in the US and control groups (37 +/- 40, 19 +/- 15, and 16 +/- 17 g/L, respectively; P < 0.0001), and anemia was reduced by nearly 90%. CONCLUSIONS: FS, and not US, induces catch-up growth in stunted children whose diets are poor in micronutrients. Our trial provides support for delivering multiple micronutrients to reverse stunting and reduce anemia in children up to age 6 y.

Algeria↗
PubMed1983

A fatal eosinophilic process in a Laotian refugee.

A 17-year-old Laotian refugee developed an ultimately fatal disease process characterized by formation of an abdominal eosinophilic mass, peripheral eosinophilia, and elevated serum IgE. No parasitic pathogens that could explain her disease were isolated during life or identified at autopsy. Furthermore, the disease was not consistent with previously described neoplastic, inflammatory, or idiopathic diseases. We believe this process represents a unique, aggressive variation of the hypereosinophilic syndrome, and that immunosuppressive therapy may be warranted.

Adolescent↗
PubMed1995

The role of an anaesthetist in a field hospital during the cholera epidemic among Rwandan refugees in Goma.

In 1849 John Snow, already the leading anaesthetic practitioner and innovator of his day, made a historic contribution to the epidemiology of infectious disease by his famous study of the distribution of cholera around the area of Broad Street in London. We report on our experience as anaesthetists in a field hospital, dispatched as part of the international rescue effort to Goma, Zaire, to help combat the effects of cholera among the Rwandan refugees.

Ambulatory Care Facilities↗
PubMed1996

Overseas screening for tuberculosis in immigrants and refugees to the United States: current status.

The number of reported cases of tuberculosis (TB) in foreign-born persons in the United States during 1995 was 8,042, 36% of the national total. The overseas screening of immigrants and refugee visa applicants, which relies on a chest radiograph and smear microscopy, is designed to identify future U.S. residents who have active TB or who are at high risk for TB. In this commentary, we summarize current policies and review retrospective evaluations of the screening system currently in place. The system appears to detect most persons who have active TB at the time of screening. However, active TB is actually diagnosed in < 15% of persons who are identified by screening as having suspected TB and who are evaluated in the United States. To improve the system, more sensitive and specific techniques as well as improved means of data transmission to state and local health departments are needed.

Emigration and Immigration↗
PubMed1990

Language acculturation among older Vietnamese refugee adults.

The purpose of this study was to examine the English language acculturation among older Vietnamese refugees (aged 40 and over) in a nationwide sample. The findings reveal that age, sex, education in Vietnam, health, and length of residence in the U.S. had some significant relationships with language acculturation. In particular, older Vietnamese people had more problems with language acculturation than their younger counterparts, and Vietnamese women had more language acculturation problems than men.

Acculturation↗
PubMed1987

Eosinophilia in Southeast Asian refugees: evaluation at a referral center.

We determined the cause of persistent eosinophilia in 128 Indochinese refugees for whom initial comprehensive routine screening had failed to yield an explanation. Intestinal parasitism with one or multiple organisms was the cause of eosinophilia in all but six of these patients. Hookworm and Strongyloides stercoralis were among the potentially pathogenic organisms most frequently implicated (55% and 38%, respectively). There was no correlation between the age or sex of the patients and the type of infecting organism. We also confirmed the usefulness of a previously described serological test for diagnosing infection with Strongyloides stercoralis and examined the test's ability to distinguish between infected and noninfected individuals and to determine parasitological cure.

Adult↗
PubMed1985

Immune responses to hepatitis B virus and tuberculosis infections in Southeast Asian refugees.

Both Mycobacterium tuberculosis and hepatitis B virus infections are common in the Philadelphia Southeast Asian refugee population. Among 224 hepatitis B carriers identified between January 1, 1982 and March 31, 1984, there was a statistically significant association between a negative tuberculin skin test (purified protein derivative (PPD)) and viral replication (hepatitis B e antigen positivity (HBeAg)). This finding suggests that bacille Calmette Guérin (BCG) vaccination might reduce the prevalence of infectious carriers, thereby ultimately reducing the incidence of hepatitis B infection.

Adolescent↗
PubMed1988

Application of DNA hybridization techniques in the assessment of diarrheal disease among refugees in Thailand.

The epidemiology and etiology of acute diarrheal disease were determined in a Hmong refugee camp on the Thai-Laotian border from April 11 to May 14, 1985. DNA hybridization techniques were used to detect Shigella species, enteroinvasive Escherichia coli, and enterotoxigenic E. coli. A monoclonal enzyme-linked immunosorbent assay was used to detect rotavirus, and standard microbiology was used to detect other enteropathogens. The age-specific diarrheal disease rates were 47 episodes per month per 1,000 children less than five years old and 113 episodes per month per 1,000 children less than one year old. Rotavirus, enterotoxigenic E. coli, Campylobacter, and Cryptosporidium were the predominant pathogens in children less than two years old. The DNA probe hybridized with 94% of 31 specimens identified as enterotoxigenic E. coli by the standard assays and with none of the specimens in which the standard assays were negative. The probe for Shigella and enteroinvasive E. coli hybridized in eight of 10 stools that contained Shigella and four of 314 stools from which Shigella and enteroinvasive E. coli were not isolated. The use of DNA probes allows specimens to be collected in remote areas with a minimum amount of equipment and technical expertise so that they can be easily transported to a central laboratory for further processing.

Acute Disease↗
PubMed1990

Seroepidemiology of Strongyloides infection in the Southeast Asian refugee population in Canada.

As part of a screening and treatment program for intestinal parasite infections offered to newly arrived Southeast Asian refugees in Canada between July 1982 and February 1983, a total of 232 sera were tested for Strongyloides infection using an enzyme-linked immunosorbent assay (immunoglobulin G). These results were compared with coprologic results and eosinophil counts. The seroprevalence was 76.6% (131 of 171) among Kampucheans, 55.6% (15 of 27) among Laotians, and 11.8% (4 of 34) among Vietnamese. A statistically significant relation (p less than 0.001) was found between Strongyloides serology and Strongyloides infection on stool examination (prevalence, 24.7%) among Kampucheans. Eosinophilia (greater than or equal to 10%) was found to be significantly associated with both infection measures. Using coprologic results as the "gold standard," the properties of the serologic test were estimated to be: sensitivity (95%), specificity (29%), positive predictive value (30%), and negative predictive value (95%). These estimates should be regarded as minimal values, as stool examination for Strongyloides infection can be an unreliable diagnostic reference. Further evaluation of the discrepancies observed between coprologic and serologic testing is required to determine the usefulness of these tests in epidemiologic studies.

Adolescent↗
PubMed1986

Hereditary red cell disorders in Southeast Asian refugees and the effect on the prevalence of thalassemia disorders in the United States.

This investigation established the frequency and prevalence of hemoglobin E, alpha and beta thalassemia, and glucose-6-phosphate dehydrogenase deficiency in a group of Southeast Asian individuals and determined the impact upon the prevalence of thalassemia disorders in the United States. The resettlement program of Southeast Asian refugees has significantly increased the total number of serious thalassemic disorders in the United States. For several generations Southeast Asian children will be the principal thalassemic group.

Asia, Southeastern↗
PubMed1993

A 6-year follow-up study of Cambodian refugee adolescents traumatized as children.

Seventy-three percent of a sample of 46 Cambodian youth interviewed in 1984 and 1987 were reinterviewed in 1990 as part of a pretest for a multisite study of Cambodian refugee trauma now under way. An additional sample of convenience of 38 youth were also interviewed to determine reliability and validity of the diagnostic instruments chosen for the larger study. The DSM-III-R diagnosis of post-traumatic stress disorder (PTSD) was found to persist, but the symptoms appeared less intense over time. In contrast, the prevalence of depression dropped markedly since 1987. Subjects remained largely free of comorbid conditions. Diagnostic reliability and validity were satisfactory. The follow-up sample appeared to be functioning well despite their PTSD profiles. The findings are discussed in light of several current controversies surrounding the concept and measurement of PTSD.

Adolescent↗