Culturally Adapted Cognitive Behavioral Therapy Plus Problem Management (CA-CBT+) With Afghan Refugees: A Randomized Controlled Pilot Study.

Culturally adapted cognitive behavioral therapy (CA-CBT) is a well-evaluated, transdiagnostic group intervention for refugees that uses psychoeducation, meditation, and stretching exercises. In the current study, we added problem-solving training to CA-CBT and evaluated this treatment (i.e., CA-CBT+) in a randomized controlled pilot trial with a sample of Farsi-speaking refugees. Participants (N = 24) were male refugees diagnosed with DSM-5 PTSD, major depressive disorder, and anxiety disorders who were randomly assigned to either a treatment or waitlist control (WLC) condition. Treatment components were adapted both to the specific cultural background and the current social problems of asylum seekers. Assessments were performed pretreatment, 12-weeks posttreatment, and 1-year follow-up. The primary treatment outcome was the General Health Questionnaire (GHQ-28); secondary outcome measures included the Posttraumatic Stress Disorder Checklist, Patient Health Questionnaire, Somatic Symptom Scale, World Health Organization Quality of Life, and Emotion Regulation Scale. Eleven of 12 participants were randomized to CA-CBT+ completed treatment. Based on intent-to-treat data, large between-group effect sizes were seen at posttreatment in the GHQ-28, d = 3.0, and for most secondary outcome measures. Improvements for individuals in the treatment group decreased at 1-year follow-up, but effect sizes demonstrated continued large improvements on all measures as compared to pretreatment levels. In summary, CA-CBT+ led to large improvements in general psychopathological distress and quality of life, which were maintained in the long term. In addition, the dropout rate was very low, with delivery in group format. Thus, problem-solving training appears to be a promising addition to CA-CBT.

Knowledge, attitudes and practices of South Asian immigrants in developed countries regarding oral cancer: an integrative review.

BACKGROUND: Oral cancer is a growing problem worldwide, with high incidence rates in South Asian countries. With increasing numbers of South Asian immigrants in developed countries, a possible rise in oral cancer cases is expected given the high prevalence in their source countries and the continued oral cancer risk behaviours of immigrants. The aim of this review is to synthesise existing evidence regarding knowledge, attitudes and practices of South Asian immigrants in developed countries regarding oral cancer. METHODS: Five electronic databases were systematically searched to identify original, English language articles focussing on oral cancer risk knowledge, attitudes and practices of South Asian immigrants in developed countries. All studies that met the following inclusion criteria were included: conducted among South Asian immigrants in developed countries; explored at least one study outcome (knowledge or attitudes or practices); used either qualitative, quantitative or mixed methods. No restrictions were placed on the publication date, quality and setting of the study. RESULTS: A total of 16 studies involving 4772 participants were reviewed. These studies were mainly conducted in the USA, UK, Italy and New Zealand between 1994 and 2018. Findings were categorised into themes of oral cancer knowledge, attitudes and practices. General lack of oral cancer risk knowledge (43-76%) among participants was reported. More than 50% people were found engaging in one or more oral cancer risk practices like smoking, betel quid/pan/gutka chewing. Some of the participants perceived betel quid/pan/gutka chewing habit good for their health (12-43.6%). CONCLUSION: This review has shown that oral cancer risk practices are prevalent among South Asian immigrants who possess limited knowledge and unfavourable attitude in this area. Culturally appropriate targeted interventions and strategies are needed to raise oral cancer awareness among South Asian communities in developed countries.

Consider Autotransfusion in the Field.

Massive hemothorax is a life-threatening condition that can present as hemorrhagic shock, cardiogenic shock, or elements of both. It is described by the American College of Surgeons, in the 9th Edition of Advanced Trauma Life Support, as a rapid accumulation of more than 1,500 mL of blood or one-third or more of the patient's blood volume. The use of autotransfusion systems has been implemented for the treatment of hemothorax in hospital settings. The implementation of autotransfusion has been documented in situations where an extended period can elapse before definitive treatment can occur. This article is the first described case where an autotransfusion system has been implemented in a prehospital setting, at a Role 1 medical facility, for massive hemothorax in Afghanistan.

Immigrant Afghan women's emotional well-being after birth and use of health services in Melbourne, Australia.

OBJECTIVE: to investigate immigrant Afghan women's emotional well-being and experiences of postnatal depression after childbirth and their use of health services. DESIGN: telephone interviews were conducted at four months after birth, using a semi-structured questionnaire; and a further in-depth face-to-face interview with a small number of women approximately one year after the birth. Women's emotional health was assessed at four months using the Edinburgh Postnatal Depression Scale (EPDS), as well as women's own descriptions of their emotional well-being since the birth. SETTING: women were recruited from four hospital antenatal clinics or postnatal wards in Melbourne, Australia, between October 2006 and May 2007. PARTICIPANTS: Immigrant women who were born in Afghanistan, spoke Dari/Persian or English, and had given birth to a live and healthy baby. FINDINGS: Thirty nine women were interviewed at four months after birth; 41% reported feeling depressed or very unhappy since the birth and 31% scored as probably depressed on the EPDS. Ten women participated in further in-depth face-to-face interviews. Isolation, lack of support and being overwhelmed by life events were the most frequently reported contributing factors to women's emotional distress, and for many being a migrant appeared to intensify their experiences. The themes that emerged from both the telephone and face-to-face interviews revealed that some women were reluctant to discuss their emotional difficulties with health professionals and did not expect that health professionals could necessarily provide assistance. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: in this study a significant proportion of immigrant Afghan women experienced emotional distress after childbirth. Women's experiences of emotional distress and help-seeking were at times affected by their status as immigrants and their perceptions of possible causes and treatment for their emotional health problems. Understanding the effects of migration on women's lives and paying careful attention to individual needs and preferences are critically important in providing care for immigrant Afghan women.

How do Australian maternity and early childhood health services identify and respond to the settlement experience and social context of refugee background families?

BACKGROUND: Refugees have poor mental, social and physical health related to experiences of trauma and stresses associated with settlement, however little is known about how refugee families experience maternity and early childhood services. The aim of this study was to explore the responsiveness of health services to the social and mental health of Afghan women and men at the time of having a baby. METHOD: Participatory methods including community engagement and consultation with the Afghan community and service providers in Melbourne, Australia. Bicultural researchers conducted interviews with Afghan women and men who had recently had a baby. Interviews and focus groups were also conducted with health professionals working in the region. RESULTS: Thirty interviews were conducted with Afghan women and men who had recently had a baby. Thirty-four health professionals participated in an interview or focus group.Afghan women and men reported significant social hardship during the period before and after having a baby in Australia, but were rarely asked about their social health by maternity and early childhood services.Most health professionals recognised that knowledge and understanding of their client's migration history and social circumstances was relevant to the provision of high quality care. However, inquiring about refugee background, and responding to non-clinical needs of refugee families was challenging for many health professionals. Factors that made it more difficult for health professionals to engage with Afghan families in pregnancy included limited understanding of the context of migration, dependency of many Afghan women on their husband for interpreting, short appointments, and the high likelihood of seeing different health professionals at each antenatal visit. Community-based maternal and child health nurses had more scope to work with interpreters, and build relationships with families, providing a stronger foundation for identifying and responding to complex social circumstances. CONCLUSION: There are significant challenges in providing comprehensive, high quality primary health care for Afghan families accessing Australian maternity and early childhood services. The limited capacity of public maternity services to identify families of refugee background and provide tailored service responses are contributing to inequitable maternal and child health outcomes for families of refugee background.

Christchurch earthquakes: how did former refugees cope?

AIM: This study investigated how former refugees now living in Christchurch (Canterbury Province, New Zealand) communities coped after the 4 September 2010 and subsequent earthquakes. METHOD: A systematic sample of one in three former refugees from five ethnic groupings (Afghanistan, Kurdistan, Ethiopia, Somalia and Bhutan) was selected from a list of 317 refugees provided by the Canterbury Refugee Council and invited to participate in the study. Seventy-two out of 105 potential participants completed a 26 item questionnaire regarding the impact of the quakes, their concerns and anxieties, coping strategies and social supports. The methodology was complicated by ongoing aftershocks, particularly that of 22 February 2011. RESULTS: Three-quarters of participants reported that they had coped well, spirituality and religious practice being an important support for many, despite less then 20% receiving support from mainstream agencies. Most participants (72%) had not experienced a traumatic event or natural disaster before. Older participants and married couples with children were more likely to worry about the earthquakes and their impact than single individuals. There was a significant difference in the level of anxiety between males and females. Those who completed the questionnaire after the 22 February 2011 quake were more worried overall than those interviewed before this. CONCLUSION: Overall, the former refugees reported they had coped well despite most of them not experiencing an earthquake before and few receiving support from statutory relief agencies. More engagement from local services is needed in order to build trust and cooperation between the refugee and local communities.

Poppies for medicine in Afghanistan: lessons from India and Turkey.

This study examines India and Turkey as case studies relevant to the Senlis Council's 'poppies for medicine' proposal. The proposal is that Afghan farmers are licensed to produce opium for medical and scientific purposes. Here it is posited that the Senlis proposal neglects at least three key lessons from the Turkish and Indian experiences. First, not enough weight has been given to diversion from licit markets, as experienced in India. Second, both India and Turkey had significantly more efficient state institutions with authority over the licensed growing areas. Third, the proposal appears to overlook the fact that Turkey's successful transition was largely due to the use of the poppy straw method of opium production. It is concluded that, while innovative and creative policy proposals such as that of the Senlis proposal are required if Afghanistan is to move beyond its present problems, 'poppies for medicine' does not withstand evidence-based scrutiny.

Representative drug susceptibility patterns for guiding design of re-treatment regimens for multidrug-resistant tuberculosis in Iran.

BACKGROUND AND OBJECTIVE: The prevalence of multidrug-resistant tuberculosis (MDR-TB) has increased substantially in the past 20 years, however, there are no data specific to Iran. This study investigated patients suspected to have MDR-TB, attending the TB referral hospital in Iran. METHODS: All patients suspected of having MDR-TB on hospital admission in the period 2003-2005 were included in this study. Sputum from all patients was tested for smear and culture, and drug sensitivity testing was performed using the proportion method. Patients were categorized into three groups based on their history of medical treatment. Group I consisted of patients with CAT I regimen failure; Group II consisted of patients with a history of CAT II regimen failure and Group III comprised patients with a history of more than two courses of irregular CAT I anti-TB regimen. RESULTS: There were 105 patients recruited; 32 in Group I, 53 in Group II and 20 in Group III. There were no significant differences between the three groups in their resistance to first-line anti-TB drugs. Fifty-five patients were diagnosed with MDR-TB. The prevalence of MDR-TB was 56% (18 cases) in group I, 49% (26 cases) in group II and 55% (11 cases) in group III. No significant difference in the pattern of drug resistance was observed between the three groups. CONCLUSION: The prevalence of MDR-TB was high in this study. The lack of response of MDR-TB patients to CAT II treatment indicates that antibiotic sensitivity testing is essential in patients with CAT I treatment failure.

Afghan refugees and their general practitioners in The Netherlands: to trust or not to trust?

In-depth interviews with Afghan refugees living in The Netherlands about their experience of healthcare, have led to a series of narratives. This article focuses on the relationship between the refugee-patients and their general practitioners (GPs) from the participants' point of view. It was possible to distinguish four different types of narrative, by analysing the individual interviews into critical episodes. Building trust was identified as the crucial issue. A number of possible explanations are given for the differences found. Links are made to participant expectations in respect of health and healthcare and to their personal and social resources. The GP has a key role in the Dutch healthcare system, but is a novel phenomenon for refugees arriving from Afghanistan. The development of a relationship of trust is sometimes compromised by negative personal experience and also by stories relating such experiences circulating in the Afghan community. The elements that constituted positive and negative episodes and led to the development or undermining of trust were identified in the narratives. Negative experience tended to be interpreted as a sign of prejudice on the part of the healthcare professional. The findings of this study are discussed in the wider context of research into patient priorities in general practice.

Providing emergency mental health care to asylum seekers at a time when claims for permanent protection have been rejected.

In total, 90% of 'boat people' who make it to Australia's migration zone are assessed as legitimate refugees and given Temporary Protection Visas (TPV) allowing them to stay in Australia for 3 years in the first instance. With an increasing number of individuals and families on TPV having their claims for a Permanent Protection Visa (PPV) rejected, this paper argues using the National Mental Health Plan 2003-2008 as a guide, for interventions that are culturally and linguistically appropriate, thus, aiming to minimize risk from exposure to extreme mental stressors in the event of an application for a PPV being rejected. Continuity and integration of mental health care involving key stakeholders is best achieved by bridging discrete elements through preparing for visa appeals and reviews, news from home and ongoing psychosocial stressors--in the context of different episodes, interventions by different providers, and changes in mental distress. To help strengthen continuity and integration of mental health supports for TPV holders, well resourced care must be experienced as connected and coherent.

Trained traditional birth attendants as educators of refugee mothers.

Following training courses for traditional birth attendants among refugee Afghan women in Pakistan, a survey was conducted to test the knowledge and practices of the participants and of mothers whose babies had been delivered by them, using untrained birth attendants as the basis for comparison. Marked improvements in knowledge and skills were demonstrated, and recommendations made by the trained birth attendants about breast-feeding, maternal nutrition, immunization and hygiene were generally followed by mothers before and after delivery. Furthermore, far fewer complications and deaths were associated with deliveries performed by trained birth attendants than with those conducted by their untrained colleagues. The training of traditional birth attendants was clearly an effective way to educate women about hygiene and health.

Health issues of Afghan refugees in California.

Since the 1979 Soviet invasion of Afghanistan, more than 6 million Afghan refugees have become the world's largest refugee population. Although refugees in Pakistan and Iran are now beginning to repatriate, continuing political turmoil in Afghanistan and children's acculturation and educational opportunities will keep many Afghans in the United States permanently. Although there are no accurate statistics, local resettlement agencies and Afghan community leaders estimate that there are 10,000 to 35,000 Afghans in northern California. They suffer from a variety of problems common to refugees: language, economic and occupational problems, and substantial challenges in psychological, family, social, and cultural adjustment to the United States. Although many Afghans are doing well, many others have depression, psychosomatic symptoms, and posttraumatic stress disorder.