The Health Needs of Female Labor Migrants from Central Asia in Russia.

There has been an increasing number of women migrating for work from Central Asia to Russia in recent years, yet very little is known about their specific health needs. We conducted a scoping study to understand what is known about their health and to identify the gaps and research priorities among this population. We conducted a literature review and key informant interviews. Our findings were grouped around general health issues, access to and utilization of health care services, and sexual and reproductive health concerns. Through our review, we identified the following priority research areas: stress, acculturation and process of adaptation; cultural and gender norms influencing health; contraceptive use and sexual risk behaviors; prenatal care; patient-provider communication and trust; use of informal health services; and preventative health care.

Challenges of Combining Perspectives.

BACKGROUND: Asylum seekers have increased risk of suicide and suicidal behavior, with differences related to origin, gender, and age. There are barriers to communication in clinical encounters between asylum seekers and clinicians. There is insufficient knowledge about how communication in the clinical encounter affects the suicide risk in female asylum seekers. AIMS: To explore the documented communication between female asylum-seeking suicide attempters and clinicians and how it affects treatment. METHOD: The medical records of 18 asylum-seeking women who had attempted suicide were analyzed with content analysis. RESULTS: Communication between patients and clinicians was affected by: the unbearable realities of the women; difficulties for clinicians in decoding languages of distress, and understanding trauma and subjective meanings of suicide; challenges of combining patients' and clinicians' perspectives; and a sense of shared powerlessness. LIMITATIONS: The medical records did not give direct access to the patient's experience, only to the patient as documented by the clinician. CONCLUSION: The results suggest that clinicians working with asylum seekers who have attempted suicide need to develop an understanding of social and cultural factors and of trauma issues. A question for further study is how an enhanced integration of context and subjectivity in psychiatric practice would equip clinicians for the specific challenges encountered.

An imported case of cystic echinococcosis in the liver.

A 25-year-old Uzbek male presented with right upper abdominal pain for 20 days. On radiologic studies, a huge cystic mass was noticed in the right liver which was suspected as parasitic. The patient received right hepatic segmentectomy (segment 7), and the surgically resected mass was confirmed as cystic echinococcosis (CE), measuring 10.5 cm in its diameter. The inner surface of the cyst was bile-stained. The patient was discharged on the 8th hospital day, and was rechecked 6 months after the surgical intervention without any evidence of recurrence. The present report describes findings of an imported case of CE which represented ultrasound images of the 'ball of wool'.

Exploitation, vulnerability to tuberculosis and access to treatment among Uzbek labor migrants in Kazakhstan.

In recent years, Kazakhstan has become an important destination for primarily undocumented seasonal workers from Uzbekistan. In a context of high tuberculosis (TB) incidence, TB treatment is provided free for all residents in Kazakhstan, but migrants rarely access these services. This paper reports findings from a qualitative study conducted with migrants, TB patients and health care workers between July and September 2008 to understand the mechanisms that impede migrants' access to care. Findings describe three structural contexts--the employment, legal and health care contexts - which act in concert to render migrants vulnerable to exploitative work conditions and cause a series of barriers to health care. These conditions contribute to increased exposure to TB, heightened risk of reactivation due to weakened immunity, treatment-seeking delays, and increased severity of disease. Seasonal migration patterns also contribute to treatment interruption, which constitutes a risk for the creation of drug resistance. Using the theory of structural violence coupled with the concept of cumulative vulnerability, this paper analyzes how illegality interacts with exploitation and social marginalization to produce vulnerability to TB and restrict access to treatment.

An Imported Case of Cystic Echinococcosis in the Liver

A 25-year-old Uzbek male presented with right upper abdominal pain for 20 days. On radiologic studies, a huge cystic mass was noticed in the right liver which was suspected as parasitic. The patient received right hepatic segmentectomy (segment 7), and the surgically resected mass was confirmed as cystic echinococcosis (CE), measuring 10.5 cm in its diameter. The inner surface of the cyst was bile-stained. The patient was discharged on the 8th hospital day, and was rechecked 6 months after the surgical intervention without any evidence of recurrence. The present report describes findings of an imported case of CE which represented ultrasound images of the 'ball of wool'.

Gender earnings and poverty reduction: post-Communist Uzbekistan.

Women get less of the material resources, social status, power and opportunities for self-actualization than men do who share their social location ­ be it a location based on class, race, occupation, ethnicity, religion, education, nationality, or any intersection of these factors. The process of feminization of poverty in Central Asia and Uzbekistan is intimately connected to the cultural and institutional limitations that put a ceiling on women's involvement in economic activity. This article attempts to study and explore gender in the context of poverty reduction in Uzbekistan, the most populated state of Central Asia, to understand the ways and manner in which poverty and other forms of deprivation demand women's participation in variety of contexts. The study is primarily an empirical one and is based on an extensive sociological investigation in the field.

Addison's disease and severe encephalopathy in an infant with HIV infection.

AIM: To discuss the overlapping clinical spectrum of encephalopathy due to Addison's disease and HIV infection. PATIENT: We report a 2.5-year-old boy from Uzbekistan with recurrent episodes of encephalopathy and seizures, triggered by infection or vaccinations, in whom adrenal insufficiency and infection with HIV and HCV was diagnosed. Presumably, Addisonian crises prompted hypovolemic shock and blood transfusions, which were responsible for horizontal HIV infection. The combination of adrenal insufficiency and HIV infection eventually led to progressive severe encephalopathy. Despite highly active antiretroviral therapy (which led to substantial reduction of blood viral load), the neurological condition did not improve. DISCUSSION: The interactions of Addison's disease and HIV in the pathogenesis of encephalopathy are discussed.

The international classification of functioning, disability and health--children and youth (ICF-CY): testing its utility in classifying information from eco-cultural family interviews with ethnically diverse families with children with disabilities in Kyrgyzstan.

PURPOSE: The objective of this study was to test the utility of the International classification of functioning, disability and health--children and youth's (ICF-CY) Environmental Factors component by classifying family interview data from two ethnically and culturally diverse--Kyrgyz and Uzbek--families that have children with various types of disabilities in Kyrgyzstan, Central Asia. METHODS: The eco-cultural family interview (EFI) was used to interview four Kyrgyz and four Uzbek families. The obtained data were analysed by using manifest content analysis; identified units of meaning named as 'EFI items' and 'EFI concepts' were then linked to the ICF-CY's codes by application of ten linkage rules. RESULTS: The analysis of transcribed interviews identified 669 EFI items and 745 EFI concepts. The linking of EFI items to the ICF-CY showed: 92 EFI items and concepts were linked to nd (not definable); 104 items were linked to nc (not covered by the ICF-CY); 15 items were categorised as pf (personal factors); 21 items were linked to categories found in Activities and Participation; and 3 were linked to Body Functions components. The rest of EFI items and concepts were linked to categories of the Environmental Factors component. CONCLUSION: The codes included into Chapters 1, 2 and 5 of the ICF-CY environmental component can be easily assigned to the relevant EFI items. There is a necessity to add more codes in Chapters 3 and 4 of the Environmental Factors component, and the inclusion of a separate component of Personal Factors into the classification is suggested.

Alcohol dehydrogenase 1B and Aldehyde dehydrogenase 2 Polymorphisms in Uzbekistan.

The alcohol dehydrogenase 1B (ADH1B) -2 (47His) allele and the aldehyde dehydrogenase 2 (ALDH2) - 2 (487Lys) alleles are seen among some Asian peoples, but rare among other ethnic groups. This study examined the allele frequencies in the Uzbekistan Republic, which is located in Central Asia. Subjects were derived from a case-control study on peptic ulcer disease, which included 161 Uzbeks and 23 Russians. They were enrolled at the Republic Research Center of Emergency Medicine located in the capital, Tashkent City. Genotyping was performed for ADH1B Arg47His and ALDH2 Glu487Lys with a polymerase chain reaction using confronting two-pair primers. The frequency for the ADH1B- 2 allele was similar among cases and controls. The ALDH2 -2 allele was rare in both. Among 161 Uzbeks, the ADH1B -2 allele frequency was 0.286 (95% confidence interval, 0.237-0.338) and for the ALDH2 -2 allele was 0.016 (0.005-0.036), while among the 23 Russians the figures were 0.083 (0.024-0.208) and 0.000 (0.000-0.077), respectively. There were no significant differences in drinking habits among individuals with different genotypes, although the ALDH2 -2-2 genotype was not observed. The present study demonstrated that the ADH1B -2 allele frequency among Uzbeks was closer to that among Caucasians than East Asians, some Uzbeks also demonstrating the ALDH2 -2 allele.

Neanderthals in central Asia and Siberia.

Morphological traits typical of Neanderthals began to appear in European hominids at least 400,000 years ago and about 150,000 years ago in western Asia. After their initial appearance, such traits increased in frequency and the extent to which they are expressed until they disappeared shortly after 30,000 years ago. However, because most fossil hominid remains are fragmentary, it can be difficult or impossible to determine unambiguously whether a fossil is of Neanderthal origin. This limits the ability to determine when and where Neanderthals lived. To determine how far to the east Neanderthals ranged, we determined mitochondrial DNA (mtDNA) sequences from hominid remains found in Uzbekistan and in the Altai region of southern Siberia. Here we show that the DNA sequences from these fossils fall within the European Neanderthal mtDNA variation. Thus, the geographic range of Neanderthals is likely to have extended at least 2,000 km further to the east than commonly assumed.

Oculopharyngeal MD among Bukhara Jews is due to a founder (GCG)9 mutation in the PABP2 gene.

OBJECTIVE: To determine whether all cases of oculopharyngeal muscular dystrophy (OPMD) among Bukhara Jews share the same founder mutation. BACKGROUND: Autosomal dominant OPMD is caused by a (GCG)8-13 repeat expansion in the polyadenylation binding protein 2 (PABP2) gene. The disease has a worldwide distribution but is particularly prevalent in Bukhara Jews and in French Canadians, in whom it was introduced by three sisters in 1648. METHODS: We established the size of the PABP2 mutation in 23 Bukhara Jewish patients belonging to eight unrelated families. In all families, we constructed haplotypes for the carrying chromosomes composed of the alleles for eight chromosome 14q polymorphic markers. RESULTS: All patients share a (GCG)9 PABP2 mutation and a four-marker haplotype. Furthermore, a shared intron single nucleotide polymorphism (SNP) in the PABP2 gene 2.6Kb from the mutation was not observed in 22 families with (GCG)9 mutations from nine different countries. The smaller size of the chromosomal region in linkage disequilibrium around the mutation in Bukhara Jews, as compared with French Canadians, suggests a founder effect that occurred more than 350 years ago. Based on the Luria-Delbrück corrected "genetic clock," we estimate that the mutation appeared or was introduced once in the Bukhara Jewish population between AD 872 and 1512 (mean, AD 1243). CONCLUSION: OPMD among Bukhara Jews is the result of a shared, historically distinct, PABP2 (GCG)9 mutation that likely arose or was introduced in this population at the time they first settled in Bukhara and Samarkand during the 13th or 14th centuries.

Very high prevalence of hepatitis B and C in Bukharian Jewish immigrants to Israel.

In Israel, the reported prevalence of hepatitis-C virus (HCV) infection among blood donors is 0.44%. As we found a high prevalence of chronic hepatitis-B virus (HBV) and HCV infection in Jewish immigrants from Uzbekistan and Tajikistan (Bukharian Jews) among our general patient population, we determined the prevalence of HBV and HCV infection among "healthy" Bukharian Jewish immigrants by screening for HBV and HCV markers and risk factors in a population of Bukharian Jews in north Jerusalem. A total of 27 (26.5%) of 102 patients were anti-HCV positive (by ELISA and confirmation tests). The HCV positive patients were older and had a higher rate of liver enzyme abnormalities than were the HCV-negative patients (56.5 +/- 2.3 versus 47.6 +/- 1.8, p = 0.003; and 14 of 27 versus 7 of 75, p < 0.01, respectively). HCV-positive patients with liver enzyme abnormalities were younger than HCV-positive patients without liver enzyme abnormalities (52.5 +/- 3.0 versus 62.8 +/- 2.8, p = 0.02). Sixteen patients (15.7%) were hepatitis-B surface antigen (HBsAg) carriers, and only two of these HBsAg carriers had liver enzyme abnormalities. None of the HCV-positive patients were HBsAg carriers (0 of 27 among HCV-positive patients versus 16 of 75 among HCV-negative patients, p = 0.0055). Past infection with HBV was found in 67 examinees (66%) (45 of 75 HCV-negative patients and 22 of 27 HCV-positive patients, p = 0.058). However, similar proportions of patients from both groups had past and present exposure to HBV [61 (81.3%) of 75 among HCV-negative patients versus 22 (81.5%) of 27 among HCV-positive patients]. Only 14 patients (13.7%) had no exposure to either HCV or HBV. Possible risk factors were use of nondisposable needles during mass vaccination in the U.S.S.R. or possible intrafamilial spread. The study concluded that immigrant Jews from former Asiatic U.S.S.R. republics have the highest rate of HCV positivity ever reported, and many of them have past and present HBV infection. Measures to prevent intrafamilial transmission of both viruses should be instituted.

Esophageal smooth muscle dysfunction in oculopharyngeal muscular dystrophy.

Oculopharyngeal muscular dystrophy (OPMD) is a rare genetic disorder with late-onset progressive myopathy affecting mainly head and neck striated muscles. It is more common in certain ethnic communities. Dysphagia was usually attributed to the malfunction of striated pharyngeal muscles. We studied a group of Bukharan immigrants affected by this disorder (N = 13). Esophageal studies, including endoscopy, manometry, and scintigraphic emptying were performed. Very low pharyngeal pressures were measured. Upper esophageal pressures (UEP) were in the normal range in eight patients, and above normal in three patients. Four also had low lower esophageal sphincter pressure. Esophageal body peristaltic activity was grossly impaired in all patients: mainly nonpropulsive, simultaneous, retrograde, and failed activity was recorded. Marked retention of isotopic material was demonstrated in all patients studied, usually in the middle and lower parts of the body, ranging from 17 to 100% retention. The dysphagia in OPMD is due not only to dysfunction of pharyngeal and upper esophageal striated muscle, but also has a significant smooth muscle component.

Intranuclear inclusions in oculopharyngeal muscular dystrophy among Bukhara Jews.

We studied, by electron microscopy, muscle biopsies from seven patients with autosomal dominant oculopharyngeal muscular dystrophy (OPMD) belonging to the recently described Bukhara-Jewish cluster. Typical tubulofilamentous intranuclear inclusions (INI) of 8.5 nm outer diameter were present in all cases. The INI were observed in 4.5 +/- 1.8% of the nuclei in five patients. In the other two, they occurred in 9.5 +/- 0.5% of the nuclei and often occupied a larger nuclear area. These two patients, offspring of intermarriage between affected cousins, had an unusually severe form of OPMD beginning in their early 30s, suggesting homozygote state. Our results confirm that INI are pathognomonic for OPMD and suggest that their frequency may be quantitatively related to the number of abnormal DNA copies.

[Oculopharyngeal muscular dystrophy with dysphagia in a Jewess from Uzbekistan].

An 82-year-old Jewish woman from Tashkent, Uzbekistan was hospitalized because of dysphagia and weight loss. Physical examination revealed bilateral ptosis. The diagnosis of the rare inherited disease oculopharyngeal muscular dystrophy was confirmed by electron microscopy of biopsied muscle. It has recently been found that the prevalence of the disease among Jews from Uzbekistan is very high. It should therefore be considered when such patients present with dysphagia, so invasive imaging procedures can be avoided.

[A case of self-circumcision].

A 29-year-old bachelor had immigrated from Uzbekistan to Israel 2 years before to improve his economic situation. He began drinking at the age of 20, and increased to 1-1.5 bottles of vodka a day. He was unable to keep a job more than a few months. When called up for limited military service, he thought that the army might be a solution for his employment problem. However, he felt that he would not be able to integrate into the army, and later into Israeli society, unless he was circumcised. The Ministry of Religion deferred his request for a religious circumcision because they did not consider him Jewish. Since he could not afford to pay for the operation, he read up on the procedure, drank a bottle of vodka as premedication, and tried to circumcise himself with a razor blade. Since he was unable to control bleeding, he applied to the hospital emergency room half an hour later, where the circumcision was completed and sutured. The psychiatric diagnosis was an unspecified personality disorder with psychopathic but not psychotic features.

Clinical features of oculopharyngeal muscular dystrophy among Bukhara Jews.

Oculopharyngeal muscular dystrophy (OPMD), a late onset autosomal dominant myopathy, is common among the French-Canadians and the Jews from Bukhara (Uzbekistan); most clinical histologic and genetic data published until now, as well as the recently suggested diagnostic criteria, are based on studies among the former. We studied 79 patients with OPMD belonging to the newly described Jewish-Bukhara cluster. The disease began between the ages of 21 and 78 yr (median 53 yr). In 11 patients (15%) it began before the age of 40. Ptosis was the first symptom in 59 patients and dysphagia in the remaining 20. Eight patients (10%) were monosymptomatic (ptosis) after more than 7 yr from the start of the disease; however, other family members had additional signs/symptoms. The patients belong to 29 families; in 26 age-dependent autosomal dominant inheritance could be documented. Among them there is certain evidence for genetic anticipation. This clinical study is the largest published concerning patients other than French-Canadians.

The autosomal dominant polycystic kidney disease gene in a Jewish family from Uzbekistan is PKD1.

A large Jewish family from Tashkent (Uzbekistan) was studied for linkage of autosomal dominant polycystic kidney disease (ADPKD) to molecular markers on the short arm of chromosome 16. A restriction fragment length polymorphism (RFLP) analysis was performed on 28 family members, including 9 ADPKD diagnosed patients in 3 consecutive generations. A specific haplotype was found to segregate with the disease in eight of the nine affected individuals. The peak lod scores for linkage between the disease phenotype and the five informative flanking markers were: 3'HVR 1.70 at theta = 0.08; GGG1 1.18 at theta = 0.001; CMM65 1.50 at theta = 0.001; 26-6 0.86 at theta = 0.001 and 218EP6 1.39 at theta = 0.001. A particular haplotype of these markers segregated with the disease phenotype. The peak lod score of this haplotype was 3.046. Homogeneity test, comparing this family to 40 PKD European families, showed that the conditional probability that it belongs to the same group is 1.000. Taken together, these findings show that the defective gene in this Jewish family from Uzbekistan is PKD1. To our knowledge, this is the first ADPKD family in Israel in whom linkage studies were performed and one of the few originating from populations outside the Western world.

[Morphometric characteristics of coronary atherosclerosis in different ethnic groups of Andizhan population]. / Morfometricheskaia kharakteristika ateroskleroza koronarnykh arterii v razlichnykh étnicheskikh gruppakh naseleniia Andizhana.

A gross morphometric study of coronary atherosclerosis was performed in 554 native males aged 20-59 years and 142 migrant males of the same age from Andizhan according to the WHO Expert Programme (Bull, WHO, 1976, vol. 53, p. 485). The migrants over 40 years displayed a greater extent of atherosclerosis (except lipid streaks) than did the natives; but there were small differences between the comparable groups of young persons under 40 years. A histometric study of the coronary arteries was made in 81 apparently healthy males indicated that fine-dropped (mainly intracellular) lipid deposits were more common in the natives, mixed (fine- and coarse-dropped) and coarse-dropped lipid deposits occurring with cell breakdown were seen in the migrants. The thickness of atherosclerotic lesions in the coronary arteries was greater in the migrants. Varying degrees of coronary intimal hyperplasia were found in individuals from the comparable ethnic groups. The hyperplasia was more profound in the migrants. There was a direct relationship between its degree and the development of atherosclerotic lesions.