Immigration Policy Changes and the Mental Health of Mexican-American Immigrants.

In recent years, significant policy changes focused on immigrants migrating through the southern United States border have been implemented. To determine if there was an association between time since immigration and increases in negative mental health symptomology, 249 Mexican-American immigrants ages 18-65 were field recruited to participate in a survey exploring their physical and mental health. Results indicate that inconsistent with the Hispanic Health Paradox, the psychological health of immigrants arriving since 2015 was significantly worse than that of more established immigrants. New arrivals had a .38 increased risk of experiencing clinically significant depression and a .47 increased risk of experiencing global psychological distress. Time since immigration was not significantly related to past 30-day alcohol use. Implications for future research and clinical practice with immigrants are explored, and suggestions on how better identify and assist Mexican-American immigrants with mental health concerns are offered.

Aetiology of genital ulcer disease in patients attending an STD clinic in Kingston, Jamaica

The purpose of this study was to determine the aetiology of genital ulcers (GUD) in STD clinic attenders, using state-of-the-art diagnostic tests, and to compare this with clinical diagnosis. Patients attending an STD clinic in Kingston, Jamaica for a new STD complaints were screened for GUD and clinically diagnosed. Swabs of ulcers were taken and tested for T. pallidum (TP), herpes simplex virus (HSV), and H. ducreyi (HD), using polymerase chain reaction (PCR). Sera were tested for syphilis and HIV infection. Of 4873 patients screened, 304 (6.2 percent) had GUD. In patients with ulcers, 158 (52 percent) were HSV (+), 73 (24 percent) were HD (+), and 31 (10 percent) were TP (+). Dual infections were identified in 20 (7 percent) ulcers. Clinically, herpes was diagnosed in 85/158 (54 percent) of HSV (+) ulcers, chancroid in 54/72 (75 percent) of HD (+) ulcers, and syphilis in 21/31 (68 percent) of TP (+) ulcers. Over three-quarters of GUD in Kingston had defined aetiology for herpes, chancroid or syphilis using PCR, with herpes being the commonest. Uniformly, clinical diagnosis performed poorly and Jamaican algorithms for the management of GUD will need to take into account the findings of this study, and should include counselling for herpes.(AU)

Genital ulcer audit, Jamaica: patient profile - abstract

Between March and August 1996, 4873 patients (2,181 men and 2,682 women) attending the Comprehensive Health Centre, Kingston, for a new STD complaint were screened for genital ulcer disease (GUD). Prevalence of GUD was 7.3 percent (356/4,873; men 13.4 percent women 2.4 percent). This represented a two-fold decrease in six years. 304 (men 252, women 52) ulcer patients were questioned for demographic and behavioural factors related to STD, clinically assessed for GUD, and tested for HIV infection, syphilis and other GUDs. The employment rate among GUD patients was 77 percent (M 83 percent, F50 percent), 79 percent were single or had a steady visiting partner and 55 percent had completed secondary education. Condoms were reportedly used more than half of the time by 34 percent. Of 280 patients, 17 percent reported no contacts, 53 percent one, and 47 percent two or more in the past month. Of 274 subjects who admitted having sex in the previous three months, 55 percent were with steady partners, 43 percent with casual partners, 27 percent with new partners and 13 percent with prostitutes. A history of bruising was obtained from 50 percent of patients. It was significantly associated with the presence of more than 1 ulcer ( p=0.005), but not with clinical assessment of herpes. 24 percent of patients continued to have sex despite their ulcers and despite the fact that 58 percent of the ulcers were painful. One-third of patients had one ulcer, the rest, two or more. Prevalence of HIV-1 infection was 22 percent (M23 percent, F 19 percent), three times the rate in the general STD population. HIV infection was significantly higher (p<0.002) in patients clinically assessed as having granuloma inguinale, and in those with reactive tests for syphilis (p<0.002). Prevalence of syphilis serology [TRUST + MHA - TP(+)] was 24 percent (M 22 percent, F 33 percent). GUDs continue to be important in the transmission of HIV infection. Creative clinical and community approaches are required for its effective control. (AU)