Utilization of Standardized Mental Health Assessments in Anthropological Research: Possibilities and Pitfalls.

In the past decade anthropologists working the boundary of culture, medicine, and psychiatry have drawn from ethnographic and epidemiological methods to interdigitate data and provide more depth in understanding critical health problems. But rarely do these studies incorporate psychiatric inventories with ethnographic analysis. This article shows how triangulation of research methods strengthens scholars' ability (1) to draw conclusions from smaller data sets and facilitate comparisons of what suffering means across contexts; (2) to unpack the complexities of ethnographic and narrative data by way of interdigitating narratives with standardized evaluations of psychological distress; and (3) to enhance the translatability of narrative data to interventionists and to make anthropological research more accessible to policymakers. The crux of this argument is based on two discrete case studies, one community sample of Nicaraguan grandmothers in urban Nicaragua, and another clinic-based study of Mexican immigrant women in urban United States, which represent different populations, methodologies, and instruments. Yet, both authors critically examine narrative data and then use the Center for Epidemiologic Studies Depression Scale to further unpack meaning of psychological suffering by analyzing symptomatology. Such integrative methodologies illustrate how incorporating results from standardized mental health assessments can corroborate meaning-making in anthropology while advancing anthropological contributions to mental health treatment and policy.

Undeserving mothers? Shifting rationalities in the maternal healthcare of undocumented Nicaraguan migrants in Costa Rica.

The case of Nicaraguan migrants in Costa Rica is emblematic of the issues that immigration generates in host countries. Undocumented Nicaraguan women seeking maternal care constitute a key challenge to the universal coverage of Costa Rica's health system. Can the long-standing commitment to universality, solidarity and equality expressed in the legislation be translated into practice? Discourses of health professionals in Costa Rica reveal a contradiction between merit and prejudice in prenatal and delivery care. Here, I present qualitative research based on semi-structured interviews with physicians and nurses at a Costa Rican National Hospital. The data show that migrant women, rejected from primary care, do find help in emergency services, but not without difficulties, as they must engage in individual negotiations centred on their bodies. The discourses of health providers reflect an ambivalence between the perceived undeservingness of undocumented migrant women and the medical realisation that two lives are at risk. While the foetus often evokes compassion, the mother commonly provokes repression, as specific and shifting rationalities reflect new moral regimes that are applied to this population. Women are perceived as being 'illegal', 'immoral' and 'irrational', and the baby, although legally Costa Rican due to jus solis policy, embodies 'the other'. Ultimately, otherness frames perceptions of deservingness of maternal care for undocumented migrant women in Costa Rica.

Effect of recent historical events on migration and isonymic stratification among the Rama Amerindians from Nicaragua.

The Rama Amerindians from southern Nicaragua are one of few indigenous populations inhabiting the east coast and lowlands of southern Central America. Early-eighteenth-century ethnohistorical accounts depicted the Rama as a mobile hunter-gatherer and horticulturalist group dispersed in household units along southern Nicaraguan rivers. However, during the nineteenth and twentieth centuries, Rama settlement patterns changed to aggregated communities because of increased competition for local resources resulting from nonindigenous immigration. The objective of this study was to discern the degree of relatedness between and within subdivisions of seven of these communities based on patterns of surname variation and genealogical data. We applied surname analyses (n = 592) to evaluate inter- and intrapopulation variation, consanguinity and substructure estimates, and isolation by distance and used a genealogically based marital migration matrix obtained during fieldwork in 2007 and 2009 to better understand internal migration. Our evaluation indicates a pattern of geographic distribution linking kinships in major subpopulations to nearby family-based villages. Mantel tests provide a correlation (r = 0.4; p < 0.05) between distance matrices derived from surname and geography among Rama communities. Genealogical analysis reveals a pattern of kin networks within both peripheral and central populations, consistent with previous genetic investigations, where the Amerindian mitochondrial DNA haplogroup B2 is commonly found among peripheral communities and A2 is frequent in central subpopulations. Marital migration and genealogies provide additional information regarding the influx of non-Ramas to communities near populated villages. These results indicate that the disruption of the Rama's traditional way of life has had significant consequences on their population structure consistent with population fissions and aggregations since the eighteenth century.

"Pensando mucho" ("thinking too much"): embodied distress among grandmothers in Nicaraguan transnational families.

In this paper, I describe an embodied form of emotional distress expressed by Nicaraguan grandmothers caring for children of migrant mothers, "pensando mucho" ("thinking too much"). I draw on ethnographic fieldwork and semi-structured exploratory interviews about pensando mucho conducted with grandmother heads-of-household to show the cultural significance of this complaint within the context of women's social roles as caregivers in transnational families. Adopting an interpretive and meaning-centered approach, I analyze the cultural significance of pensando mucho as expressed through women's narratives about the impacts of mother outmigration on their personal and family lives. I show how women use pensando mucho to express the moral ambivalence of economic remittances and the uncertainty surrounding migration, particularly given cultural values for "unity" and "solidarity" in Nicaraguan family life. I also discuss the relationship between pensando mucho and dolor de cerebro ("brainache") as a way of documenting the relationship between body/mind, emotional distress, and somatic suffering. The findings presented here suggest that further research on "thinking too much" is needed to assess whether this idiom is used by women of the grandmother generation in other cultural contexts to express embodied distress in relation to broader social transformations.

The unintended consequences of sex education: an ethnography of a development intervention in Latin America.

This paper is an ethnography of a four-year, multi-disciplinary adolescent sexual and reproductive health intervention in Bolivia, Nicaragua and Ecuador. An important goal of the intervention--and of the larger global field of adolescent sexual and reproductive health--is to create more open parent-to-teen communication. This paper analyzes the project's efforts to foster such communication and how social actors variously interpreted, responded to, and repurposed the intervention's language and practices. While the intervention emphasized the goal of 'open communication,' its participants more often used the term 'confianza' (trust). This norm was defined in ways that might--or might not--include revealing information about sexual activity. Questioning public health assumptions about parent-teen communication on sex, in and of itself, is key to healthy sexual behavior, the paper explores a pragmatics of communication on sex that includes silence, implied expectations, gendered conflicts, and temporally delayed knowledge.

Costa Rica's 'White legend': how racial narratives undermine its health care system.

A dominant cultural narrative within Costa Rica describes Costa Ricans not only as different from their Central American neighbours, but it also exalts them as better: specifically, as more white, peaceful, egalitarian and democratic. This notion of Costa Rican exceptionalism played a key role in the creation of their health care system, which is based on the four core principles of equity, universality, solidarity and obligation. While the political justification and design of the current health care system does, in part, realize this ideal, we argue that the narrative of Costa Rican exceptionalism prevents the full actualization of these principles by marginalizing and excluding disadvantaged groups, especially indigenous and black citizens and the substantial Nicaraguan minority. We offer three suggestions to mitigate the self-undermining effects of the dominant national narrative: 1) encouragement and development of counternarratives; 2) support of an emerging field of Costa Rican bioethics; and 3) decoupling health and national successes.

Nicaraguan Population Residing in Florida Attitude Toward Different Types of Organ Donation.

INTRODUCTION: The population of Nicaraguan immigrants is growing in North America; however, they have been little analyzed concerning their attitude toward donation and organ transplantation. OBJECTIVE: To analyze the attitude toward the different types of organ donation among the Nicaraguan population residing in Florida. METHODS: Study population. Nicaraguan population residing in Florida (USA). INCLUSION CRITERIA: Population sample over 15 years stratified by age and sex. Instrument valuation. Attitude questionnaires toward organ donation for transplantation "PCID-DTO-Ríos," "PCID-DVR-Ríos," and "PCID-XenoTx-Ríos." Setting for the study. Random selection of people to be surveyed according to stratification. The assistance of immigrant support associations in Florida was required to locate respondents. RESULTS: Sample composed of 89 participants. In the attitude toward donation of one's own organs after death, 22% (n = 20) were in favor, 41% (n = 36) were against, and 37% (n = 33) were undecided. Regarding the donation of living related organs, 76% were in favor (n = 68), 10% were against (n = 9), and 14% were undecided (n = 12). Finally, regarding attitudes toward the acceptance of organ xenotransplantation, if the results were similar to those obtained with human organs, they were not in favor, with 72% (n = 64) against and 28% (n = 25) doubtful. CONCLUSIONS: The attitude of the Nicaraguan population residing in Florida toward different types of organ donation is unfavorable.

Head injury and neuropsychiatric sequelae in asylum seekers.

OBJECTIVE: Asylum seekers experience a high burden of physical and psychological trauma, yet there is a scarcity of literature regarding the epidemiology and sequelae of head injury (HI) in asylum seekers. We examined HI prevalence and association with neuropsychiatric comorbidities in asylum seekers. METHODS: A retrospective cross-sectional study was performed through review of 139 medical affidavits from an affidavit database. Affidavits written from 2010 to 2018 were included. Demographic and case-related data were collected and classified based on the presence of HI. For neuropsychiatric sequelae, the primary study outcome was headache and the secondary outcomes were depression, posttraumatic stress disorder, and anxiety. Multivariable logistic regression was performed to examine the association between HI and neuropsychiatric sequelae, adjusted for demographic and clinical characteristics. RESULTS: A total of 139 medical affidavits of asylum seekers were included. The mean age was 27.4 ± 12.1 years, 56.8% were female, and 38.8% were <19 years. Almost half (42.5%) explicitly self-reported history of HI. Compared to clients who did not report HI, clients with HI were older and more likely to report a history of headache, physical abuse, physical trauma, concussion, and loss of consciousness. After adjustment for demographic and clinical characteristics, clients with HI had greater odds for neuropsychological sequelae such as headache (odds ratio [OR] 4.2, 95% confidence interval [CI] 2.0-8.7) and depression (OR 2.5, 95% CI 1.1-5.7). CONCLUSIONS: We observed a high prevalence of HI in asylum seekers. Comprehensive screening for HI and neuropsychiatric comorbidities is encouraged when evaluating asylum seekers.

Local Biologies, Leaky Things, and the Chemical Infrastructure of Global Health.

This article examines how two chemical substances are woven into the infrastructure of global health as well as into the social lives of health workers in urban Nicaragua. One chemical is temephos, an organophosphate used to control mosquitoes. The other is chlorine-based products, which are used to disinfect surfaces and water. While global health projects tend to treat these substances as stable objects, there are three ways in which they might be understood as leaky things, implicated in fluid social interactions. First, global health chemicals are tracked through rigid accounting, but because of numerical leakages, they become vehicles for fashioning new forms of concern. Second, chemicals leak structurally: They can be dissolved and reproduced at a molecular level, although that dissolution is never absolute, and that reproduction is not everywhere the same. Third, chemicals leak in a sensory fashion. Sensory interactions with chemicals produce an entanglement of knowledge about bodies and environments.

Cross-cultural beliefs, ceremonies, and rituals surrounding death of a loved one.

The purpose of this qualitative study was to describe practices surrounding death of a loved one by European, Asian, Caribbean, Central American, and South American families living in the United States. A focus group with 14 masters nursing students from a wide variety of cultural and religious backgrounds was conducted to gain a better understanding of the beliefs, ceremonies, and rituals surrounding death. Many commonalties were found across cultures and religions. A pervasive theme was that beliefs about the soul of the deceased lead families to perform rituals and ceremonies that foster passage to God, the "light," or another life. The stronger their beliefs, the more dedicated the family is in completing the rituals and ceremonies in the way dictated by their religion or culture. Participants had difficulty separating the influence of culture and religion on these practices.

Perceived social status, language and identified dental home among Hispanics in Florida.

BACKGROUND: The authors conducted a study to examine the extent to which perceived social status in communities and in U.S. society in general and primary language are associated with having a dental home among four Hispanic groups. METHODS: The authors used random-digit-dialing technology to select a probability sample of Hispanic adults in Miami-Dade County, Fla., for a telephone-based survey. Trained interviewers administered the pretested survey instrument in Spanish or English. The authors used bivariate contingency tables and multiple logistic regression modeling to analyze the data. RESULTS: Eight hundred ten adults participated, and their nationality groups were as follows: Cuba (n = 450), Nicaragua (n = 139), Colombia (n = 132) and Puerto Rico (n = 89). After controlling for nationality group, the authors found that respondents who perceived themselves to be at a higher social status in the United States than in their own community were significantly more likely to have a dental home; those who reported having a higher community status were significantly less likely to have a dental home compared with respondents who perceived their national and community social status to be equal. Respondents who primarily spoke a language other than English at home were less likely than those who primarily spoke English to have a dental home. Female respondents were more likely than male respondents to have a dental home. Respondents with dental insurance were more likely to have a dental home than were those without dental insurance. CONCLUSIONS: Perceived social status and acculturation may influence whether Hispanics have a dental home. However, because of the sample design, the findings may not be generalizable to all Hispanic populations in Florida or the United States. CLINICAL IMPLICATIONS: Reducing disparities in oral health status and in use of dental services among Hispanics relative to non-Hispanic whites may require attention to cultural factors such as language, community structure and immigrants' degree of acculturation.

American trypanosomiasis (Chagas' disease) in Central American immigrants.

A survey was conducted to determine the prevalence of infection with Trypanosoma cruzi, the protozoan etiologic agent of American trypanosomiasis (Chagas' disease), among Nicaraguan and Salvadoran immigrants living in the Washington, D.C., area. The serum samples of study subjects were tested for reactivity with T. cruzi antigens in an enzyme-linked immunosorbent assay, and also tested for antibody specific for the 72 and 90 kilodalton (kDa) surface glycoproteins of the parasite in an immunoprecipitation and electrophoresis procedure. Xenodiagnosis using reduviid bugs to detect parasites, and clinical evaluations for cardiac and gastrointestinal disease were performed in patients in whom results of both serologic tests were positive. Of 205 subjects studied, 4.9 percent were infected with T. cruzi, and parasites were isolated from 50 percent of those in whom xenodiagnosis was attempted. No significant cardiac or gastrointestinal abnormalities were detected in the six infected patients who were evaluated clinically. These findings suggest that a sizable proportion of persons in this immigrant group are infected with this organism. Thus, routine serologic testing for antibody to T. cruzi may be warranted in immigrants from these countries, especially in view of the potentially serious consequences of infection with this parasite, and also because of the risk of transmission of T. cruzi by blood transfusion.

Mortality trends among refugees in Honduras, 1984-1987.

Mortality data collected from 1984 to 1987 through a routine standardized health information system in the five main refugee populations of Honduras were reviewed. The direct standardized mean annual death rate for all refugees was 5.5 per 1000 population (Honduras population as reference; Honduras mortality rate: 10.1 per 1000). Mortality decreased or remained stable among Salvadoran refugees from 1984 to 1987, but increased among Nicaraguan refugees after 1985. The highest neonatal (56.1 per 1000 livebirths), infant (126.1 per 1000 livebirths) and under-five-year-olds (35.7 per 1000 child less than five years of age) mortality rates were observed in the two Nicaraguan camps. These two camps had the highest rate of newly arriving refugees. Deaths in infants and under-five-year-olds accounted for 42 and 54.1% of all deaths respectively. Of all deaths under five years of age, respiratory infections, diarrhoeal diseases and measles accounted for 21.4%, 22.1% and 4.7%, respectively. Mortality rates, particularly among under-five-year-olds and infants increased when the rate of newly arriving refugees was higher. The importance of adapted health surveillance in refugee settlements is discussed.

Ethnomedical interactions: health and identity on Nicaragua's Atlantic coast.

This paper describes contemporary and historical interactions of medical belief and practice among the six ethnic groups of Nicaragua's Atlantic Coast--Mestizo, Creole, Miskitu, Sumu, Garifuna and Rama. The expansion of preventive medicine and primary care under the Sandanista-led government during the 1980s is presented, along with brief descriptions of counter-revolutionary attacks on the health care system. Traditional uses of medicinal plants and various forms of spiritual healing are then juxtaposed with the sporadic introduction of European and North American biomedicine throughout history. Next, the results of a health care survey carried out in 1990 are used to: (1) demonstrate the widespread use of the official health care system; and (2) show that traditional practices--use of herbal medicine, visits to spiritual healers, and home birth--are more prevalent among specific ethnic and socioeconomic strata of Nicaraguan Atlantic Coast society. Finally, I use these descriptions and survey results to argue for an understanding of health care behavior based on personal identity. I argue that a number of identities--ethnic, historical, political, socioeconomic and spatial (village, city, region or nation)--both situate and influence health care behavior, and thus mediate between the psychological and spiritual realms of illness and healing. Each individual chooses, variably and often subconsciously, to identify with any of a number these 'imagined communities' as he or she makes health care choices. These identity-influenced decisions are then manifested as specific health-related behaviors, forming the real-world data on which this argument is premised.

Risk factors for suicidal behavior among Hispanic, African-American, and non-Hispanic white boys in early adolescence.

Using survey data from a longitudinal study of adolescents (n = 6760) in Miami, Florida, we assessed prevalence and risk factors for suicide ideation and attempts among a sample of Cuban-American, Nicaraguan, other Hispanic, African-American, and non-Hispanic white 6th- and 7th-grade boys. The results indicated that African-American boys had the highest level of suicide ideation (19.2%) during the past 6 months and that Nicaraguans and other Hispanics had the highest levels of lifetime suicide attempts (7.8%). The risk factor analyses indicated a differential distribution of risk factors by ethnic-racial subsamples, with blacks scoring higher than the other subsamples. Cumulative risk factors were related to increased suicidal ideation and attempts in all subsamples. However, the highest percentage of attempts among boys with eight or more risk factors was among other Hispanics (56.9%), and the lowest percentage was among non-Hispanic white boys (21.7%). An odds ratio analysis predicting attempts indicated that depressive symptoms, low self-esteem, and teacher and parent derogation were relatively higher for African-American and Hispanic subsamples, and deviancy-delinquency was relatively higher for non-Hispanic whites. High acculturation was associated with higher levels of suicide attempts in the three Hispanic subsamples (P < .05).

Sexual abuse during childhood and adolescence among Nicaraguan men and women: a population-based anonymous survey.

AIMS: The objective was to describe experiences of sexual abuse occurring before 19 years of age among men and women in León, Nicaragua and to explore the possible association to later sexual risk behavior. METHOD: A sub-sample of literate urban men and women 25-44 years of age was selected from a representative sample of households in León. After an invitation to a public health event, 154 men (53% of the invited) and 213 women (66% of those invited) participated in giving written answers to an anonymous questionnaire. RESULTS: Twenty percent of men and 26% of women reported that they had experienced sexual abuse. Women had been victims of attempted or completed rape twice as often as men, 15% as compared to 7%. Thirty-three percent of the abuse towards boys and 66% of the abuse towards girls was committed by family members. Women who had experienced attempted or completed rape were more likely to later have had a higher number of sexual partners compared to non-abused or moderately abused women. CONCLUSIONS: Sexual abuse of children and adolescents of both sexes is common in Nicaragua. The results underscore the urgent need to address this serious problem more openly, and to make more resources available for the prevention of sexual abuse and for support to victims.

Infectious diseases in a Nicaraguan refugee camp in Costa Rica.

Some Nicaraguans living in Costa Rica are in refugee camps. The types and rates of infectious diseases in the Pueblo Nuevo refugee camp were measured by examining medical records for 1985 and performing stool and blood testing. The incidence of infections was 320 episodes per 1000 persons per year. Respiratory infections represented 63% of all illnesses and pulmonary tuberculosis was high. Malaria was not found in blood samples and no childhood illnesses preventable by immunizations were recorded in the records. Intestinal parasites were found in 56% of the persons examined, considerably higher than the 15% prevalence noted in surveys of Costa Rica as a whole. Trichuris trichiura was found in 40% of the positive stool samples. The deficient hygienic conditions and overcrowding in the camp are responsible for the high rates of infections and the continued presence of infections many of which probably were acquired in Nicaragua. Improvement of hygienic conditions can be accomplished by involving the refugees in education, cleaning and identifying problem areas. Adequate sanitation and improved water supply, and reducing overcrowding are also recommended.

[Diagnostic image (174). A Nicaraguan man with an epileptic seizure. Neurocysticercosis]. / Diagnose in beeld (174). Een Nicaraguaanse man met een epileptische aanval. Neurocysticercose.

A 56-year-old Nicaraguan man was referred because of a generalised seizure. CT revealed neurocysticercosis.

Nicaraguan population data on LDLR, GYPA, D7S8, HBGG, GC and HLA-DQA1 loci.

Nicaraguans have become the most numerous and fastest increasing minority in Costa Rica: at present they represent around 6% of the total population of the country. We have analyzed the allele and genotype frequencies of six PCR-based genetic markers (LDLR, GYPA, HBGG, D7S8, GC, and HLA-DQA1) in 100 unrelated Nicaraguans living in Costa Rica. All loci studied were in Hardy-Weinberg equilibrium. Some statistical parameters of forensic interest were also calculated (h, PD and CE). Allele frequencies of the markers HLA-DQA1 and GYPA were found to be significantly different between the populations of Nicaragua and Costa Rica. Nevertheless, genetic distances showed that Nicaragua is close to other Hispanic-admixed populations like those from Argentina, Chile, Colombia, Costa Rica, and USA Hispanics. The loci set was assessed to be useful for paternity testing and individual identification in the Nicaraguan population residing in Costa Rica.

Nicaraguan migration and the prevalence of adolescent childbearing in Costa Rica.

This study describes the dynamics of adolescent childbearing of Nicaraguan-born and Costa Rican-born adolescents in Costa Rica and examines the association between socio-demographic factors and adolescent childbearing in the country. We studied Nicaraguan-born and Costa Rican adolescents using the data of the 2000 Census. Multivariate logistic regression was used to analyze the association between country of origin and adolescent childbearing, while controlling for socio-demographic factors (age, education, union, urbanization and poverty). 26% of Nicaraguan-born migrants and 9.5% of Costa Ricans had given birth during adolescence. The migrants' increased odds of pregnancy decreased from 3.34 (CI 3.21, 3.48) to 1.88 (CI 1.79, 1.97) when controlling for socio-demographic factors. Age, low educational attainment, urban residence, poverty and union were all significant predictors of adolescent pregnancy. Nicaraguan-born status is associated with adolescent childbearing in Costa Rica. Further research is needed to understand what factors, other than socio-demographic indicators, contribute to the differing prevalence of adolescent childbearing in Costa Rica.