The psychological and medical sequelae of war in Central American refugee mothers and children

OBJECTIVE

To investigate the physical and mainly psychological sequelae of exposure to war in Central American children and their mothers who immigrated to the United States on average 4 years before the study began.

DESIGN

Interview study.

PARTICIPANTS

Twenty-two immigrant Central American women caretakers and 1 of their children aged 5 to 13 years.

MAIN OUTCOME MEASURES

Standardized and new measures were administered to assess children's physical and mental health symptoms and exposure to political violence.

RESULTS

Eighteen of the 22 children had chronic health problems. Fifteen children and all of the adults had observed traumatic events, including bombings and homicides. Thirteen of the children showed mental health symptom profiles above established norms, although only 2 met the criteria for posttraumatic stress disorder according to their own reports. Many of the caretakers were unaware of their child's psychological distress. Four of the mothers exhibited posttraumatic stress disorder, and their symptoms predicted their child's mental health.

CONCLUSIONS

Pediatricians are sometimes the first and only contacts these families have with health care providers. Caretakers' reports of children's mental health are often incomplete. It is therefore important for physicians to probe for "hidden" symptoms in refugee children. These family members may need referrals to social and psychological services, and pediatricians can open the gates to existing community networks of support. Because we found that maternal mental health influences the child's, the child's interests are well served when pediatricians also encourage the mother to contact services for herself if she confides that she is experiencing some of the severe psychological sequelae reported by the women in this study.

Factors predicting participant attrition in a community-based, culturally specific smoking-cessation program for Hispanic smokers

Factors predicting participant attrition in a community-based, culturally specific smoking-cessation program enrolling 93 Hispanic smokers were examined. Analysis of univariate predictors showed noncompleters (n = 18) to have lower incomes, to have expressed greater initial confidence in their ability to stop smoking, and to have perceived themselves to be in poorer general health and poorer health in relation to peers, than completers. Noncompleters were also more likely to have reported cardiovascular problems. Multivariate logistic regression analysis showed that confidence in stopping smoking, health compared with that of peers, and reported cardiovascular problems contributed significantly to prediction while controlling for other significant univariate predictors. The results are discussed in terms of factors that might mitigate premature termination in community-based smoking-cessation interventions targeting Hispanic smokers.

Respiratory symptoms in urban Hispanic and non-Hispanic white women

The prevalence and predictors of wheeze syndromes, including asthma, were examined among 475 non-Hispanic (NH) white and 371 Hispanic pregnant women enrolled in a population-based study in East Boston, Massachusetts. Respiratory symptoms and risk factors were ascertained by questionnaire early in pregnancy. Hispanic and NH white women were of similar age (mean +/- SD, 26 +/- 5 yr), but Hispanics reported less schooling (30 versus 50% completed high school), a lower frequency of household pets (4 versus 47%), and a lower frequency of parental asthma (6 versus 12%). Hispanics smoked significantly less than NH whites did, both in prevalence (8 versus 50%) and number of cigarettes per day among current smokers (12 +/- 9 versus 22 +/- 10; p < 0.0001). Hispanics reported a lower frequency than NH whites did of doctor-diagnosed asthma (6 versus 12%), persistent wheeze (5 versus 19%), and either persistent wheeze or asthma (11 versus 30%). In multivariate analysis, active cigarette smoking and parental history of asthma were associated most strongly with wheeze syndromes. When these two factors as well as educational level, presence of household pets, and height2-adjusted FEV1 were controlled, Hispanics remained at lower risk of asthma (odds ratio [OR] 0.71; 95% confidence interval [CI], 0.37-1.37) and persistent wheeze (OR 0.48; 95% CI, 0.25-0.95) than NH whites. These results suggest that chronic wheeze syndromes are common among young urban women and are associated with both active smoking and a parental history of asthma. Hispanic women from Central and South America living in urban environments in the United States may be at less risk for these conditions than NH white women, in contrast to those from Puerto Rico.

Hispanic subgroup differences in prenatal care

Within SES categories in the United States, racial and ethnic minorities generally fare less well on a variety of health-related indicators than do majority groups. Important differences exist within subgroups, however, and at present, these differences are poorly understood. In this paper we address Hispanic subgroup (Cuban American, Mexican American. Puerto Rican, and Central/South American) differences in utilization of prenatal care. Data from the 1986 and 1987 national Linked Birth/Infant Death files are used to assess patterns of prenatal care utilization across subgroups. Using Kotelchuck's Adequacy of Prenatal Care Utilization Index, we find that when controlling for other factors, Cuban American and Puerto Rican women are more likely to obtain adequate care than are Hispanic women of Mexican or Central/South American origin. Other factors important in understanding utilization patterns include marital status, education level, birthplace, and region of the country. We conclude with a discussion of the relatively weak link between prenatal care and birth outcomes and identify important cultural factors that may be important in understanding why this relationship is not stronger.

High frequency of acute promyelocytic leukemia among Latinos with acute myeloid leukemia

A high frequency (24%) of acute promyelocytic leukemia (APL) was noted among acute myelocytic leukemia (AML) cases at the Los Angeles County-University of Southern California (LAC-USC) Medical Center, in comparison with the expected frequency of 5% to 15%. Because of the high proportion of Latinos in this center, we questioned if APL is more common in this ethnic group. The proportion of APL among the 80 AML patients of Latino origin was significantly higher (30; 37.5%) when compared with the 62 non-Latinos (4; 6.5%) (P = .00001). In an attempt to verify this finding on a larger group of patients, we analyzed 276 pathologically verified cases of AML in patients aged 30 to 69 years from the entire County of Los Angeles, registered on an ongoing population-based epidemiologic study of AML. APL was more frequent among the 47 Latinos (24.3%) than in the 229 non-Latinos (8.3%) (P = .0075). APL is seen in younger patients with AML, but Latino AML patients also had a higher frequency of APL after accounting for their younger age (age-adjusted odds ratio for APL among Latinos in LAC-USC Medical Center, 9.4 [95% confidence interval (CI) 2.9, 30] P = .0002; among Latinos in the population-based study, 3.0 [95% CI 1.3 to 6.9] P = .01). The different ethnic distribution of AML was found to be due to a higher proportion of APL cases per se, and not to a lower proportion of any other French-American-British subtype (P = .0004). These results, from two different populations of AML patients, indicate that Latinos with AML have a higher likelihood of the APL subtype of disease, which may suggest a genetic predisposition to APL and/or exposure to distinct environmental factor(s).

Tuberculosis among foreign-born persons who had recently arrived in the United States--Hawaii, 1992-1993, and Los Angeles County, 1993

During 1986-1994, the number of tuberculosis (TB) cases reported annually among foreign-born persons in the United States increased 55% (from 4925 to 7627), and the proportion of all cases accounted for by persons who were foreign-born increased from 22% to 32%--increases that reflect, in part, effects of recent immigration (1). The largest numbers of foreign-born persons with TB originated from Mexico, Philippines, and Vietnam; persons from these countries currently account for the largest numbers of recent immigrants to the United States (2). This report summarizes a review of foreign-born persons in whom TB was diagnosed in Hawaii during 1992-1993 and in Los Angeles County during 1993 and assesses the impact of screening on the identification of TB among foreign-born persons residing in the United States for < or = 1 year at the time of diagnosis.

Estimating mortality in the Hispanic population of Connecticut, 1990 to 1991

Among all deaths to Connecticut residents (1990/91), 1260 were acceptable Spanish-surname matches (using father's surname for females), of which only 793 (62.9%) were identified as Hispanic origin on the death certificate. Certificates also identified 127 non-Spanish-surnamed Hispanics. With death rates for non-Hispanics used as the standard, the standardized mortality ratio for Hispanics based on the 920 (793 plus 127) deaths identified by the Hispanic-origin item was lower (by 33% in males and 36% in females) than that based on all 1387 (1260 plus 127) Hispanics. Spanish-surname matching should improve estimation of mortality rates in some Hispanic populations.

Association between Vogt-Koyanagi-Harada syndrome and HLA-DR1 and -DR4 in Hispanic patients living in southern California

BACKGROUND

Vogt-Koyanagi-Harada (VKH) syndrome is associated with human leukocyte antigen (HLA)-B54, -DR4, -DR beta 1*0405, -DQ4, and -DR53 in Japanese patients. Disease-associated HLA specificities may differ among races. This study examined HLA associations with VKH syndrome in Hispanic patients living in southern California, a racial subgroup at increased risk for the disease.

METHODS

Human leukocyte antigen specificities were determined on 25 Hispanic patients with VKH syndrome and compared with HLA specificities of 217 healthy Hispanic control subjects. Inclusion criteria for study patients were nontraumatic panuveitis with exudative retinal detachments, with or without extraocular manifestations. Tests were performed using standard cytotoxic assays.

RESULTS

HLA-DR4 was present in 14 (56%) patients with VKH syndrome and in 62(29%) control subjects (relative risk = 1.96). HLA-DR1 was present in 9 (36%) patients with VKH syndrome and in 19 (9%) control subjects (relative risk = 4.11). HLA-DR1 and DR4 share a common epitope within the DR beta 1 gene. HLA-DR1 and/or DR4 were present in 21 (84%) patients with VKH syndrome and in 76 (35%) control subjects (relative risk = 2.40).

CONCLUSIONS

HLA-DR1 and -DR4 were found in a significantly disproportionate number of Hispanic patients with VKH syndrome living in southern California. HLA-DR4, although not HLA-DR1, has been previously associated with VKH syndrome in other groups. These associations suggest a common immunogenic predisposition to VKH among different racial groups, and suggest that a common epitope shared by DR1 and DR4 may be involved in the pathogenesis of the disease.

The role of gender and acculturation on determining the consumption of alcoholic beverages among Mexican-Americans and Central Americans in the United States

This study analyzed the responses of 391 Mexican-Americans (44.9% males) and 531 Central Americans (40.2% males) who were between 21 and 65 years of age and resided in San Francisco, California. In general, Mexican-Americans were found to have a lower proportion of abstainers (56.8%) than Central Americans (64.4%). Mexican-Americans reported drinking more often and in greater quantities than Central Americans, and the proportion of "high" drinkers was higher among Mexican-American men and women than among the Central American respondents. Despite this diversity in the topography of alcoholic beverage consumption between Mexican-Americans and Central Americans, the role of gender and acculturation on shaping those variables was fairly consistent across groups. The acculturation level of the respondents was found to significantly affect the proportion of abstainers in both groups. Furthermore, gender was an important determinant of frequency, total number of drinks, and volume of drinking for Mexican-Americans and for Central Americans.

[Description of morbidity notified in the epidemiologic surveillance system of the XVII Central American and Caribbean Sport Games, Puerto Rico, 1993]

The objective of the epidemiological surveillance system for the XVII Central American and Caribbean Sports Games in 1993 in Puerto Rico was to estimate the morbidity related to infectious diseases and sports injuries during the competitions. In the village hospital a total of 794 medical consultations were reported; 57.7% of the patients were athletes. Among athletes, the rate of consultation was 10.4 for every 100 participants. The consultations were more frequent in males (535, 67.4%). The analysis by country of origin revealed that the athletes from Guatemala (42, 9.2%) and Jamaica (35, 7.6%) used the services more frequently. The incidence of consultations by sport was higher in field hockey (47, 10.3%), followed by athletics (46, 10%), and softball (36, 7.9%). The most frequent diagnoses were injuries--302, 38.04%; of these 229 (75.8%) were athletes--,conditions of the respiratory system (180, 22.67%), problems of the skin and mucous membranes (85, 10.71%), and problems of the gastrointestinal tract (56, 7.05%). The severity of the majority of the conditions was mild and required primary care health professionals.

[Development of a system for epidemiologic surveillance for the XVII Central American and Caribbean Sport Games, Puerto Rico, 1993]

The probability of recording infectious diseases and injuries to the musculoskeletal system during sports events with a large number of participants is very high. From an historical perspective the distribution and trends of diseases that have an impact on public health have been evaluated by means of epidemiological surveillance systems. However, the application of these epidemiological methods to sports medicine is relatively recent. The utilization of an epidemiological surveillance system during sports events with a large number of participating athletes and countries has been reported in a limited number of competitions. In this article we describe the design of a system for epidemiological surveillance utilized during the XVII Central American and Caribbean Sports Games held in Puerto Rico in 1993, as an example of a surveillance system that could be regularly established in this type of event.

Virologic and genetic studies relate Amerind origins to the indigenous people of the Mongolia/Manchuria/southeastern Siberia region

A commonly held theory is that the first wave of migrants into the New World was derivative from the ethnic groups then inhibiting eastern Siberia. However, these ethnic groups lack a mtDNA haplogroup (B) that is well represented in Amerindian tribes. Also, the time depth of the other three mtDNA haplogroups found in Amerindians (A, C, and D) appears to be greater in the Amerindians than in the eastern Siberian ethnic groups. In this communication we demonstrate that the human T-cell lymphotrophic virus type II, present in 11 of the 38 Amerindian tribes thus far examined, is not present in any of the 10 ethnic groups of eastern Siberia that we have studied. However, the virus has just been reported in the indigenous population of Mongolia, and mtDNA haplogroup B is also represented in this region. On the basis of these facts, we propose that the ancestors of the first migrants to the New World were not derived from north and central Siberia but from populations to the south, inhabiting the regions of Mongolia, Manchuria, and/or the extreme southeastern tip of Siberia.

Further psychometric evaluation of the Spanish language health-promoting lifestyle profile

The reliability and validity of the Spanish language version of the Health-Promoting Lifestyle Profile (Spanish-HPLP) was evaluated for a predominantly Central American sample. A convenience sample (N = 106) completed the demographic sheet and Spanish-HPLP. Alpha coefficients were 0.94 for the total scale and ranged from 0.64 to 0.89 for the subscales. Significant Pearson correlations were found between Spanish-HPLP scores and the variables of age, education, income, length of residence in the United States, and perceived health status. Significant differences based on sex and marital status were noted. The Spanish-HPLP was found to be reliable for this sample. Although content and construct validity were supported, the instrument is in need of further convergent, or criterion-related validation.

Cultural issues in serving minority populations: emphasis on Mexican Americans and African Americans

Patients' cultural beliefs may affect acceptance of health care, compliance, and treatment outcomes. This article discusses cultural views of health and illness, folk beliefs and customs, cultural barriers to care, and alternative health-care systems, with particular emphasis on Mexican Americans and African Americans, including curanderismo, rootwork, and voodoo. Physicians who wish to provide appropriate and acceptable care in a cross-cultural setting should integrate these beliefs with conventional medicine.

Predictors of function among older Hispanic immigrants: a five-year follow-up

In a 5-year follow-up of 76 participants in a community study of older Hispanic immigrants, there were minimal functional declines in social resources and activities of daily living and minimal increases in economic, physical, and mental health function. Age and education were significantly correlated with most of the functional ratings but years of residence in the United States were related only to economic resources. In general, functional ratings from the original study were the strongest predictors of follow-up ratings.

New lines of inquiry on the illness of susto

The folk-illness of susto has long captured the interest of anthropologists. A review of the literature reveals a multitude of competing ideas as to its biological basis, its epidemiological patterning, and why it persists as it does. The present essay offers not only a summation of much of the research done on fright-sickness to date, but also suggests a number of new lines of inquiry that, when completed, will advance our understanding of this widely spread, yet still to be fully understood, ethnomedical disease category.

Fallen fontanelle: culture-bound or cross-cultural?

Rather than bound to one culture, fallen fontanelle has been labeled as an illness or recognized as a symptom through time and space. The condition may be called siriasus, sitibundum, fontanellae collapsus, el apostema cálido del cerebro, Blatfallen, Blattschiessen, entzündung des Gehirns und der Gehirnhäute der Kleinen Kinder, coup de soleil, sorte de maladie causée par l'inflammation des membranes du cerveau, head-mould-shot, mollera caída, desmollerado, gual, split skull, sutt, nhova, kubabula, chipande, phogwana and dehydration. Defining features of this condition as well as prevention and treatment have corresponded to the specific cultural setting and ethnographic present. Fallen fontanelle (or fontanel) is "a culturally interpreted symptom rather than culture-bound" (Low 1985). The methodological perspective is an ethnohistorical recounting of change in the meaning of this symptom.

Empacho in four Latino groups: a study of intra- and inter-cultural variation in beliefs

It is usually impossible to know if reported differences between cultures are due to cultural differences or due to a difference in the methods used to study the cultures. This paper describes a collaborative, multisite study using a shared methodology to study intra- and inter-cultural variation in beliefs. A series of standard interview schedules were used to study Latin American beliefs about empacho in Guatemala, Mexico, and in the United States (Mexican-Americans and Puerto Ricans). Results showed consistency in beliefs about empacho both within and between the four samples.