Trauma Stabilisation as a Sole Treatment Intervention for Post-Traumatic Stress Disorder in Southeast Asia.

Southeast Asia contains high numbers of traumatised populations arising from either natural disasters or interpersonal violence. Consequently, the need for empirically based trauma treatments, compromised by insufficiency in appropriately trained clinicians and mental health workers, makes the situation more challenging in addressing traumatic sequelae in local populations. In response, the humanitarian/ trauma capacity building organisation, Trauma Aid Germany, trained 37 therapists in psycho-traumatology, based on EMDR Therapy, which included trauma stabilisation techniques. This research analyses the impact of Trauma Stabilisation as a sole treatment intervention for Post-Traumatic Stress Disorder (PTSD) in adults. Each client was screened for PTSD utilising the Harvard Trauma Questionnaire - pre- and post-treatment. Analysis of the data considered only those interventions focussed on trauma stabilisation, including psychoeducation. Participants receiving trauma confrontation interventions were excluded from the data. Trauma stabilisation - as a sole treatment intervention, was highly effective in alleviating PTSD diagnoses. Results demonstrate PTSD symptoms were reduced in both clinical and sub-clinical trauma groups. The data set suggests trauma stabilisation, as a sole treatment intervention, was safe, effective, efficient and sufficient treatment intervention for PTSD. Furthermore, trauma stabilisation interventions have the advantage of being safe, flexible, and adaptable to the cultural and spiritual context in which they were are applied. The research findings also have implications regarding teaching and learning and the potential utilisation of paraprofessionals, and other allied health professionals in addressing the global burden of psychological trauma.

Violence Against Women in Cambodia: Towards a Culturally Responsive Theory of Change.

Almost one in four women in Cambodia is a victim of physical, emotional or sexual violence. This article brings together two seldom connected fields: Theory of Change (ToC) and cultural responsiveness in international development. It applies these approaches to a priority in global health, which is to prevent violence against women (VAW) and, drawing on my research on the epigenesis of VAW in Cambodia, develops an argument on the need for interventions to work with tradition and culture rather than only highlight it in problematic terms. The research draws on an ethnographic study carried out in Cambodia with 102 perpetrators and survivors of emotional, physical and sexual VAW and 228 key informants from the Buddhist and healing sectors. The eight 'cultural attractors' identified in the author's prior research highlight the cultural barriers to acceptance of the current Theory of Change. ToC for VAW prevention in Cambodia seems to assume that local culture promotes VAW and that men and women must be educated to eradicate the traditional gender norms. There is a need for interventions to work with tradition and culture rather than only highlight it in problematic terms. The cultural epigenesis of VAW in Cambodia is an insight which can be used to build culturally responsive interventions and strengthen the primary prevention of VAW.

Lead poisoning of a child associated with use of a Cambodian Amulet --- New York City, 2009.

Lead poisoning in children is a preventable public health problem that can adversely affect the developing nervous system and result in learning and behavior problems. The most common source of exposure for lead-poisoned children aged <6 years in the United States is lead-based paint. However, nonpaint sources have been identified increasingly as the cause of lead poisoning, particularly in immigrant communities. This report describes a case of lead poisoning in a child aged 1 year that was investigated by the New York City Department of Health and Mental Hygiene's (NYC DOHMH) Lead Poisoning Prevention Program in 2009. The likely source of exposure was an amulet made in Cambodia with leaded beads that was worn by the child. Health-care providers and public health workers should consider traditional customs when seeking sources of lead exposure in Southeast Asian populations. Health-care providers should ask parents about their use of amulets, especially those in Southeast Asian families and those with children found to have elevated blood lead levels (BLLs). Educational efforts are needed to inform Southeast Asian immigrants that amulets can be a source of lead poisoning.

Self-Medication and the Pharmaceutical System in Cambodia.

Based on an ethnographic study of the Cambodian pharmaceutical system conducted in an urban and a rural setting between January 2015 and June 2016, we report on the complex dynamics surrounding the issue of self-medication in that country. We describe the history of the circulation of pharmaceuticals in Cambodia, and we discuss the contemporary relationship individuals have with these medicines and with those who distribute them. We illustrate the specific dynamics of the pharmaceuticalization of Cambodian society, where private drug vendors are playing a key role.

Primary Care Providers' Perceptions of Young Cambodian American Female Patients.

There are significant health disparities among Southeast Asian Americans. As an initial step toward understanding the psychosocial factors associated with these disparities, the present study examined primary care providers' perspectives of health status, healthcare utilization, health-related behaviors, and stressors among one subset of Southeast Asian Americans-Cambodian American women between the ages of 18 and 24 years. Interviews with five primary care providers indicated that cultural, historical, psychological and social issues were associated with health outcomes and health behaviors. Results also pointed to clinical considerations and research directions that would improve treatment and understanding of health problems among young Cambodian American women.

Colorectal Cancer Screening among Chinese, Cambodian, and Vietnamese Immigrants in Chicago.

Asian Americans are now the most rapidly growing minority group in the USA. Over 60 % of Asian Americans in the USA are immigrants. Cancer has been the leading cause of death among Asian Americans since 1980. Understanding the barriers to screening is essential to reduce the unnecessary burden of cancer. Little is known about colorectal cancer screening behavior among foreign-born Asian Americans and how socio-demographic factors may influence the behavior. Even less is known about disaggregated Asian subgroups. Using data from the Chicago Asian Community Survey, a local health assessment survey of three Asian subgroups in Chicago, Chinese, Cambodian, and Vietnamese, this study found that the colorectal cancer screening rate were much lower among foreign-born Asian Americans in Chicago (30 %) than the national rate for the general population (59 %). Furthermore, we studied disaggregated data to determine colorectal cancer screening differences between communities. Findings from this study provide a critical evidence base to inform future research and intervention designs.

Assessing symptom change in Southeast Asian refugee survivors of mass violence and torture.

The authors evaluated changes in symptoms and levels of perceived distress of 21 Cambodian, 13 Hmong/Laotian, and 18 Vietnamese patients before and after a 6-month treatment period. Most of the patients improved significantly. Cambodians had the greatest and Hmong/Laotians had the least reductions in depressive symptoms. Although psychological symptoms improved, many somatic symptoms worsened. The authors conclude that refugee survivors of multiple traumata and torture can be aided by psychiatric care. They recommend investigations with larger samples and suitable control groups to further clarify the relative contributions of trauma, diagnosis, and acculturation stress to treatment outcome.

Intentional isoniazid overdosage in young Southeast Asian refugee women.

During a two-year period, from January 1984 through December 1985, six cases of intentional overdosage with isoniazid were reported in young Southeast Asian refugee women. The patients were aged 14 to 23 years, had all immigrated within one year and were receiving isoniazid preventive therapy for tuberculosis infection without disease. Clinically, all patients experienced generalized seizures, and three sustained moderate metabolic acidosis. All recovered uneventfully. Psychiatric evaluations revealed that two patients had major depression; two, adjustment disorders with depressed mood; and two, no psychiatric illness. The latter two patients and two others ingested an excessive amount of isoniazid immediately following an argument with a family member. Because tuberculosis infection is prevalent in refugees immigrating from Southeast Asia, isoniazid, given for six months to one year as preventive therapy, is one of the most frequently prescribed drugs during the early resettlement period. There may be an increased risk of intentional isoniazid overdosage during preventive therapy of young refugee women.

Understanding the dynamics of illness and help-seeking: event-structure analysis and a Cambodian-American narrative of "spirit invasion".

Event structure analysis (ESA) and its computer analog, ETHNO, represent a class of relatively new methodological approaches that make it possible to capture the complexity of help-seeking interactions. Using narrative data from a study of Cambodian-American help-seeking interactions within a circumscribed illness episode, this paper demonstrates the feasibility of using ESA/ETHNO to illuminate how event sequence, operant illness beliefs, structural conditions, and human agency interpenetrate and shape the occurrence and timing of pivotal actions and the denouement of a help-seeking episode.

Dental knowledge, attitudes, and behaviors of Indochinese and Australian-born adolescents.

Since 1975 more than 100,000 Indochinese refugees have settled in Australia. This study compared the dental health knowledge, attitudes, and behaviors of 131 Indochinese and 107 Australian-born adolescents from a state high school in Melbourne, Victoria. The Australian-born subjects demonstrated the highest level of dental knowledge, and the Kampuchean/Laotian subjects the least. Of the three birthplace groups (Australia, Vietnam, Kampuchea/Laos), the Kampuchean/Laotian group were more likely to believe that their dental health was controlled by external forces. The Kampuchean/Laotian group presented the highest proportion of subjects believing they needed dental treatment. In contrast, however, the Kampucheans and Laotians had the lowest perceived value of preventive dental visits with the Australian-born adolescents presenting the highest proportion. The dental health behaviors of the Kampucheans and Laotians were generally the least favorable and those of the Australian-born subjects the most favorable, although all groups were well short of the conventional ideal. One-third of the Kampuchean and Laotian subjects said they had never been to the dentist before. Few Indochinese subjects claimed to be regular visitors to the dentist. Analysis of data using the framework of the Health Belief Model provided little explanatory power in predicting preventive behaviors. A greater understanding of cultural variations between ethnic groups and targeted dental health education programs would appear to be beneficial strategies for improving oral health of high risk adolescents.

Family trauma and its association with emotional and behavioral problems and social adjustment in adolescent Cambodian refugees.

OBJECTIVE: The main aim of this study was to investigate the effect of war-related trauma on the subsequent social adjustment and functioning of young Cambodian refugees. METHOD: This longitudinal study of 67 young Cambodian refugees in Montreal interviewed in the first year of high school and then 2 years later examines a family's exposure to war related premigration trauma and its association with an adolescent's emotional and behavioral problems and social adjustment. Emotional and behavioral problems were assessed using the Youth Self-Report and an inventory of risk behavior. Social adjustment was assessed in terms of academic achievement, peer relations, and feeling of competence. RESULTS: The trauma a family suffered before leaving their homeland and prior to the teenager's birth seems to play a protective role at various times in adolescence with regard to externalized symptoms, risk behavior, and school failure in boys, and foster positive social adjustment in girls. CONCLUSIONS: These reactions may be understood as overcompensation by the children of the survivors of a massacre, to whom the implicit duty to succeed has been passed on. They suggest that a broader range of posttraumatic responses to war situations should be investigated and that trauma's dual nature as both burden and source of strength should be examined more closely.

Childbearing beliefs among Cambodian refugee women.

PIP: The reproductive beliefs and practices of 12 Cambodian women who had begun childbearing in Southeast Asia and were currently residents of Canada's Cambodian community of refugees were assessed through in-depth ethnographic interviews. The researcher, a public health nurse in a clinic that served a predominantly refugee population, conducted the interviews through female bilingual translators and obtained endorsement from the Cambodian Association. Respondents averaged 35 years of age, were married, and had been in Canada for 8 months-4 years following an average stay in a refugee camp of 6 years. They had experienced an average of 4 pregnancies. None of the women were knowledgeable about the timing of ovulation, and only 1 was aware of the conception process. Predominant was a belief that women needed to be "cool" to become pregnant, and that this state could be achieved through herbal medicines. Herbal remedies were also used to induce the menstrual period. Informants could not describe the process of fetal development, but recognized the importance of the maternal diet. "Cold" foods such as coconut were believed to enhance the chance of a health infant, while "hot" foods such as red peppers were avoided. A short, easy labor was sought through coconut milk and flower-based medicines as well as practices such as working hard and fast, not walking on tiptoe, and finishing eating before others. The women attended prenatal care appointments in Canada to please authorities, but showed little understanding of their purpose. 8 women had received a tubal ligation after their arrival in Canada and appeared to have been given little information about this procedure and alternatives to it. Overall, these findings indicate that Cambodian refugees in Canada maintain their cultural beliefs about childbearing, yet the Western system of medicine is failing to address these attitudes.^ieng

[Fascioliasis of the common bile duct: endoscopic ultrasonographic diagnosis and endoscopic sphincterotomy]. / Distomatose de la voie biliaire principale: diagnostic écho- endoscopique et traitement par sphinctérotomie endoscopique.

Two cases of biliary fasciolasis are reported. The patients presented with biliary pain and/or acute pancreatitis. Pre-operative ultrasound endoscopy showed main bile duct dilation and linear elongated echogenic structures in the common bile duct lumen. Endoscopic retrograde cholangiography and endoscopic sphincterotomy were performed. Parasites were endoscopically removed resulting in disappearance of symptoms and biological abnormalities. Serological tests and pathological examination confirmed the presence of Fasciola hepatica. During follow-up, stool examination failed to show any Fasciola hepatica eggs, and in one case, serology became negative. This report emphasizes the value of ultrasound endoscopy in the diagnosis of unsuspected biliary fasciolasis. This report also confirms the therapeutic role of endoscopic sphincterotomy in patients with obstructive biliary fasciolasis.

Health promotion in a Cambodian refugee camp: a CHILD-to-child approach.

This paper describes a School Health Program established in Khao I Dang, a refugee camp of 80,000 Cambodians in Thailand. Originally designed to provide health screening and immunization, the program was expanded to include health promotion. The author conceptualizes the health promotion activities based on the underlying principles in the manual CHILD-to-child. Three specific projects using CHILD-to-child techniques are described. The article concludes with a discussion of the applicability of these techniques to refugee settings in general and to American schools.

Southeast Asian refugee women and depression: a nursing intervention.

Globally, conflicts continue to result in large numbers of refugees and displaced persons, the majority are women. At present, there is scant literature on the mental health status of refugee women following resettlement in countries that grant asylum. We do know that adaptation following migration is a complex cultural, psychological and social process. Some studies have suggested a high prevalence of depression symptoms related to premigration and post-migration experiences. The purpose of this paper will be to describe the mental health status of Southeast Asian (S.E.A.) refugee women in the United States, before home visit interventions by school nurses and bilingual teachers, and at 10, 20 and 33 weeks following the intervention. A comparison group of S.E.A. refugee women, who did not receive the intervention, were evaluated for mental health status on two occasions ten weeks apart. The identified needs and problems identified by the women, the interventions implemented by the school nurses and the success of the interventions will also be discussed. The underlying problem for the majority of women was poverty and social isolation. The study demonstrates that indeed, refugee women in the U.S., are experiencing needs and problems related to basic survival issues in multiple areas of their lives. The findings suggest that home visit interventions by nurses may be a valuable means of reducing depression in S.E.A. refugee women.

Developing community health nursing skills collaboration in a culturally diverse population.

The graduate curriculum in Community Health Nursing at the University of South Alabama was revised to prepare nurses to function as a community health specialist. The revised curriculum model includes two semesters that focus on a specific population or high risk group of patients or clients. Emphasis is placed on the skills that community health nurses must have in order to assess communities, identify community needs, plan and implement interventions at the population aggregate or community level. During the first semester, or the practicum course, a community needs assessment is performed. In the internship course, the planned intervention is implemented and evaluated. The purpose of the paper is to describe the process of identifying and accessing a Cambodian population aggregate in a rural setting. The collaboration among faculty, student, preceptor, official agency, as well as lay leaders in the Cambodian community is described.

The tyranny of taste: the case of organic rice in Cambodia.

Fair-trade and organic products are often sold at price premiums justified by smaller production volumes that are associated with greater social and environmental responsibility. The consumption of these products confers on the consumer a greater sense of morality ­ and usually a claim to better taste. This paper tells the story of attempts to promote organic/fair-trade rice production by de facto organic Cambodian farmers for export to North American and European markets in order to assist poor farmers to trade their way out of poverty. It demonstrates that instead of promoting sustainable agriculture and fair trade between developed and developing markets, organic/fair-trade projects may impose First World consumer ideals and tastes that are out of step with the larger realities of agrarian transition in Cambodia and the wider region of developing Southeast Asia.