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Mycobacterium avium-intracellulare from a Vietnamese refugee.

Mycobacterium avium-intracellulare grew from the sputum of a Vietnamese woman, a recent immigrant, seen at a tuberculosis clinic in Birmingham, Alabama. The possibility that she had acquired this Mycobacterium in her native Vietname was considered, since current literature, indicates these agents have no predictable geographic patterns of distribution. Data indicate that outside the United States group III mycobacterial isolates are most common in Japan, Western Australia, and parts of Canada. No data are available for Vietnam. US physicians should be alert for possible nontuberculous mycobacteria in the 115,768 Vietnamese immigrants known to have entered the United States in the mid-1970s.

Aged↗

Sequential disseminated tuberculosis and toxoplasmosis in a Haitian refugee.

A 27-year-old previously healthy male Haitian had sequential disseminated tuberculosis and toxoplasmosis during a three-month period. The former appeared to respond to antituberculous therapy; the latter proved fatal and was diagnosed only at autopsy. We suspect acquired immune deficiency syndrome (AIDS) as the underlying problem, which emphasizes the danger of sequential unusual infections in patients from groups with a high incidence of AIDS. This case also illustrates some of the difficulties of diagnosing toxoplasmosis and the advisability of early empiric therapy in such patients.

Acquired Immunodeficiency Syndrome↗

Mental health service utilization by Ethiopian immigrants and refugees in Toronto.

The purpose of this study was to examine the mental health service utilization patterns of Ethiopians in Toronto. A cross-sectional epidemiological survey of 342 randomly selected adults was conducted, based on a conceptual model of healthcare utilization suggested by Anderson and Newman. The results suggested that 5% of the respondents sought mental health services from healthcare professionals and 8% consulted nonhealthcare professionals. Although Ethiopians' utilization rate of mental health services did not greatly differ from the rates of the general population of Ontario (6%), only a small proportion (12.5%) of Ethiopians with mental disorders used services from healthcare professionals, mostly family physicians. The data also suggested that Ethiopians were more likely to consult traditional healers than healthcare professionals for mental health problems (18.8% vs. 12.5%). In multivariate logistic regression analyses, while the number of somatic symptoms experienced was positively associated with increased mental healthcare utilization (OR = 1.515, p < 0.05), having a mental disorder was associated with decreased mental healthcare utilization (OR = 0.784, p < 0.01). Our findings have important implications for mental health services. On the one hand, the findings suggest that somatic symptoms could lead to increased use of mental health services, particularly family physicians' services. On the other hand, the data suggested that although the mental healthcare needs of Ethiopians are high, they use fewer mental health services from healthcare professionals. It would seem that family physicians could play important role in identifying and treating Ethiopian clients with somatic symptoms, as these symptoms may reflect mental disorder.

Adolescent↗

Migrants, refugees and insecurity. Current threats to peace?

Since the early 1980s, international migration has moved beyond humanitarian, economic development, labor market and societal integration concerns, raising complex interactive security implications for governments of migrant sending, receiving and transit countries, as well as for multilateral bodies. This article examines the effects of international migration on varied understandings and perceptions of international security. It discusses why international migration has come to be perceived as a security issue, both in industrialized and developing countries. Questions are raised on the migration-security nexus and the way in which the concepts "security" and "migration" are used. The real and perceived impacts of international migration upon national and regional security, both in industrialized and developing countries, are analyzed. The policies developed by governments and multilateral agencies since the mid-1980s to mitigate the destabilizing effects of certain kinds of international population movement and human displacement are examined. The conclusions stress the need for the establishment of a comprehensive framework of international cooperation among origin and receiving countries and international organizations to address the destabilizing implications of international migration.

Demography↗

An entomological investigation of the likely impact of cattle ownership on malaria in an Afghan refugee camp in the North West Frontier Province of Pakistan.

Field trials were undertaken to determine the effect of close proximity of humans to livestock on the human biting rates exhibited by various anophelines. The results indicate that proximity to cattle and to goats increases the subject's chances of being bitten by anophelines. Man-biting by Anopheles stephensi rose by 38% (8-68% CI) in the presence of a cow, and by 50% (16-84% CI) in the presence of two goats. Other species exhibited similar trends. These findings explain the results of an earlier trial which revealed that malaria prevalence was higher amongst families that kept cattle than those that did not. The findings are discussed in relation to existing information regarding the host preferences of local anophelines and classic theories regarding zooprophylaxis. Our findings suggest that animals are only likely to have a worthwhile prophylactic affect when the vector is zoophilic, and then only when the animals are deployed to form a barrier between that vector and man. In situations where deployment of livestock to form a zoobarrier is impractical, the livestock should be located as far from man as possible.

Afghanistan↗