Depressive symptomatology among Namibian adolescent refugees

Symptoms of depression have been considered rare in sub-Saharan populations. Using a standard assessment measure of depressive symptomatology, the Beck Depression Inventory, the prevalence of symptoms of depression was obtained from a group (N = 56) of Namibian refugees residing in a sub-Saharan host country. Contrary to expectations, the rates of self-reported symptoms were quite frequent, with many symptoms reported as moderate or severe by a large proportion of these youths. Using a stress model to explore these data, it was demonstrated that social support ameliorated the effects of chronic stress, as represented by the length of time in exile. It is argued that adaptation, acculturation, and adolescent developmental demands result in self-reports of depressive symptoms. These demands, however, are lessened in intensity by a strong social support system that is especially helpful early in the exile period.     

Description of tobacco use and cessation among Bhutanese refugees participating in a tobacco cessation program

Objectives. To compare the tobacco use, exposure, and cessation differences between Bhutanese refugee and non-Hispanic Caucasian tobacco users in a US federally qualified health center tobacco cessation program.

Design. A retrospective cohort study reviewing data from 374 patients counseled on tobacco cessation was performed. Demographic information, tobacco use history, exposure to tobacco, and type of tobacco used characterized baseline assessments. The patient record was followed forward in time to evaluate tobacco cessation outcomes as the dependent variable. Data were analyzed using odds ratios and the Mann–Whitney U-test.

Results. Data analysis included 318 patients (211 non-Hispanic Caucasian patients and 107 Bhutanese refugee patients). Bhutanese refugees demonstrated a higher likelihood of smokeless tobacco product use than the non-Hispanic Caucasian population (67.3% vs 1%, OR?=?214.971, 95% CI 50.429, 916.383), and a greater odds of having household tobacco users (OR?=?2.533, 95% CI 1.532, 4.186). Likewise, the non-Hispanic Caucasian population exhibited larger odds of smoking cigarettes vs the Bhutanese population (97.2% vs 26.2%, OR?=?96.399, 95% CI 38.449, 241.687), had a higher odds of passive smoke exposure (OR?=?12.765, 95% CI 5.36, 30.393), and higher likelihood of a past quit attempt (OR?=?9.037, 95% CI 5.180, 15.765). Significant gender differences with regard to type of tobacco used were noted among Bhutanese refugees. Bhutanese refugees demonstrated significantly higher likelihood of tobacco cessation, compared with the non-Hispanic Caucasian population, at all length cutpoints, while showing no difference in number of follow-up visits or median time followed.

Conclusion. These culture-specific findings, showing unique tobacco use characteristics and increased cessation among the Bhutanese refugee population, provide novel information helpful to professionals identifying and treating these individuals for tobacco cessation. More research is needed to confirm our results and findings.     

Serum protein and immunoglobulin levels among nepalese living in southern Nepal

Objective  This study examined the levels of serum protein fractionation, immunoglobulin (Ig) and antistreptolysin O (ASO) of people (91 males and 84 females aged 10–68 years) living in the Terai region of southern Nepal, as there has previously been no information available about them. Methods  Blood samples were collected early in the morning after overnight fasting. Serum protein fractionation was carried out by cellulose-acetate electrophoresis. IgG, IgA, IgM and ASO were measured by immuno-turbidimetry with clinical kits. Results  The mean proportion of albumin (Alb) was rather low due to increased globulin (Glb). The Alb level of males was significantly higher than that of females, while the male γ-Glb level was significantly lower than that of females. The mean values of IgG, IgM and ASO for males were lower than those values for females, although the difference was significant only for the IgM value. The mean values of IgM for female age groups of 30–39 years or less were significantly higher than those for the corresponding male age groups. Age correlated positively with IgA, and negatively with ASO in both sexes. γ-Glb and IgG correlated significantly with TP, AlB, α₁-Glb and IgA in both sexes. ASO correlated with β-Glb and IgA in males, and with γ-Glb and IgG in females. Conclusions  The fact that the level of γ-Glb, a major component of serum globulin, was high suggested exposure to a highly bacterial and viral environment. These results point to the need to prevent infectious diseases as well as improve their nutritional status, especially for children and young adults.     

Young lives disrupted: gender and well-being among adolescent Syrian refugees in Lebanon

Background

The conflict in Syria that began in 2011 has resulted in the exodus of over 5 million Syrian refugees to neighbouring countries, with more than one million refugees currently registered by UNHCR in Lebanon. While some are living in tented settlements, the majority are living in strained conditions in rented accommodation or collective shelters in the Bekaa Valley next to Syria. Adolescents are particularly vulnerable in any crisis. In 2013–4, the American University in Beirut in collaboration with the Women’s Refugee Commission, Johns Hopkins and Save the Children, sought to understand the specific experiences of very young adolescents, those 10–14 years of age, in this protracted crisis context.

Methods

The study was conducted in 2014 in Barelias and Qabelias – two urban areas located close to each other in the Beka’a valley that has a large concentration of Syrian refugees. Focus group discussions (FGDs), including community mapping and photo elicitation, were conducted with 10–12 and 13–14 year old Syrian refugee adolescents, in order to obtain information about their experiences and perspectives. FGDs were also implemented with 15–16 year old Syrian refugees and separately also with adult refugees, to consider their perspectives on the needs and risks of these adolescents.

Results

A total of 16 FGD (8 for each sex, with 6–9 participants in each) were conducted in Arabic across the two sites, with 59 female participants and 59 male participants. The experiences and risks faced by these adolescents were significantly impacted by economic strain and loss of educational opportunities during displacement, and only a minority of adolescents in the study reported attending school. Additionally, on-going protection risks for girls were felt to be higher due to the crisis and displacement. In Lebanon this has resulted in increased risks of child marriage and limitations in mobility for adolescent girls. Adolescents, themselves expressed tensions with their Lebanese counterparts and feared verbal attacks and beatings from school-aged Lebanese male youth.

Conclusions

Families and adolescents have been dramatically affected by the conflict in Syria, and the resulting forced displacement. The loss of educational opportunities is perhaps the most significant effect, with long-term devastating outcomes. Additionally, the futures of Syrian girls are deeply affected by new protection concerns, particularly as they are exposed to an unfamiliar and more liberal society in Lebanon. Child marriage and limitations in their mobility – particularly for girls - are presented by families as coping strategies to these risks. Programming is needed to ensure sustained education access for all adolescents, and to educate very young adolescents and their parents on managing their own health and well-being, given the multiple strains. More effort is needed to encourage positive interaction between adolescent Lebanese and adolescent Syrian refugees.

     

Infant mortality and childhood nutritional status among Afghan refugees in Pakistan

In 1984 and again in 1985, systematic surveys were undertaken to evaluate infant mortality and childhood nutritional status among the Afghan refugee population in Pakistan. The entire Afghan refugee population under the administration of the United Nations High Commissioner for Refugees was sampled. Infant mortality rates were estimated to be 156 per 1000 for 1984 and 119 per 1000 for 1985. A decline was also suggested in neonatal mortality rates from 61 per 1000 for 1984 to 46 per 1000 for 1985. For neither infant nor neonatal mortality was the difference statistically significant. Improvements were seen in the percentage of children who died before their fifth birthday (22.5% in 1984 and 18.8% in 1985), in the percentage of children who were malnourished (3.5% in 1984 and 2.3% in 1985), and an increase in the percentage of children above the WHO/NCHS/CDC weight-for-height reference median (26% in 1984 and 35% in 1985). Diarrhoea was the most frequently reported cause of death for both years and was a particularly important cause of death among one-year-old children. In 1985, measles was related to 24% of the deaths and neonatal tetanus to 9% of the deaths, an increase from 8% for measles and 6% for tetanus in 1984.     

Pantothenic acid status of free living adolescent and young adults

The objective of the current study was to compare estimated dietary pantothenic acid of adolescent and adult humans on self-selected diets with urinary excretion and blood levels of pantothenic acid in order to gain insights on apparent pantothenic acid nutritional status of these individuals. In Study I, 11 adolescent boys and girls ranging in age from 10–16 years participated. Subjects were interviewed on past dietary practices. During the 4-day test period, subjects kept daily records of food intakes and made complete collections of urine. Fasting blood samples were drawn at the end of the study. Study II was similar to Study I except that 23 adult subjects participated. Pantothenic acid contents of urine and blood serum from both studies were determined microbiologically using Lactobacillusplantarum. Intakes of pantothenic acid were calculated from dietary diaries and from the check forms. For adolescent subjects, a strong, statistically significant correlation between pantothenic acid intake and blood serum pantothenic acid was found. However, no statistically significant positive correlation was found between pantothenic acid intake and either pantothenic acid excretion expressed in terms of mg/day or mg/g creatinine. In the latter case, the correlation was directionally negative. For adults, a strong, statistically significant positive correlation was found between pantothenic acid intake and urinary pantothenic acid excretion. However, the relationship between pantothenic acid intake and blood serum pantothenic acid was not statistically significant.     

Acceptability of health status questionnaire screening and vaccination among Kosovar refugees

During 1999, following the war in Kosovo, thousands of Kosovar refugees were received by different countries. The public health reception protocols for these refugees varied widely between and within reception countries. We surveyed a group of Kosovar refugees received in Bolton to assess the acceptability of vaccination and health status questionnaire screening. We also examined the refugees' opinions about the confidentiality of their medical history and their willingness to take part in research. Fifteen out of 29 people responded. Most respondents were happy with the interventions.     

Food consumption and serum nutritional status of people living in the Kathmandu valley in Nepal

Objective The food consumption and serum nutritional status of people living in the Kathmandu valley, Nepal, were examined to obtain actual data for comparison with our previous findings. Methods A dietary survey of 45 males and 60 females was carried out in March 1997 by the 24-hr dietary recall method and nutrient intake was calculated from food tables of India and Japan. Fasting venous blood samples were obtained and serum biochemical parameters were measured using clinical kits. Results The mean body mass index values was at about the same level in both sexes, although the mean percentage body fat of females was higher than that of males, and vice versa for packed red cell volume. The main foods consumed by both sexes, were rice, potatoes, meats, milk & dairy products and vegetables, with a difference in the amounts consumed. Females did not drink alcoholic beverages. The mean daily intakes of energy, protein, lipids, iron and vitamin B group for the males were higher than those for the females, while those of vitamins A and C for the males were lower than those for the females. The mean values of serum biochemical parameters for both sexes were generally at the normal levels, but those of ALT and TG were at the higher end of the normal range. Differences of correlation between food groups and between serum parameters were observed depending on the sex, however, no clear relationship between food and nutrient intake and serum biochemical parameters were observed. Conclusions The present food intake study revealed that the amounts of food consumption for both sexes, especially for the females, were mostly insufficient although the serum parameters were at the normal levels. The energy intake of both sexes was lower than that of estimated requirements and those in Terai region. The relatively high serum TG level of the subjects may be due to the consumption of large amounts of cereals containing much carbohydrate. Our findings suggested a marked influence on food consumption by food price and income in spite of the easier food availability in the city, and also lack of knowledge about nutrients and health, thus there is need for improvement of the nutritional status of this group of people.     

Sexual and reproductive health needs and risks of very young adolescent refugees and migrants from Myanmar living in Thailand

Background

The very young adolescent (VYA) population age 10–14 years is often neglected in the field of sexual and reproductive health (SRH) research due to the combined sensitivity of the topic and the young age group, resulting in little data about the SRH needs and concerns of VYA. In 2013, the Women’s Refugee Commission (WRC), Johns Hopkins University (JHU), Adolescent and Reproductive Health Network (ARHN) and Karen Youth Organization (KYO) implemented qualitative participatory research to explore the SRH needs and risks of VYA. The study was conducted in Mae Sot town and Mae La refugee camp, both in Thailand, with migrant populations and refugees, respectively.

Methods

A total of 22 focus group discussions (FGD) were conducted with 176 participants. FGD were implemented with girls and boys aged 10–16, and adults in both settings. The FGD with 10–14 year olds included community mapping and photo elicitation interviews. These activities gathered information about their own perspectives, experiences and values regarding SRH, as well as SRH risks. The FGD with 15–16 year olds and adults focused on their perspectives regarding the SRH needs and risks of VYA.

Results

Fourteen (64%) of FGD were conducted in Mae Sot town, and 8 (36%) were conducted in Mae La refugee camp.Schools, youth centers and religious institutions were identified as key locations for obtaining SRH information. Schools are most promising, but access to schools is unequal between boys and girls. Parents can provide support and education to adolescents if they are supported to do so and if trust and comfort can be built between adolescents and parents around SRH.

Conclusions

To a large degree, the same themes emerged from both locations, in terms of the awareness of body changes and puberty, the centrality of peer influences, and the value of education. These findings call for rigorous study of youth-directed programs and policies that meaningfully involve key influential adults identified by vulnerable young adolescents and utilize the specific places young adolescents, themselves, voice as being critical settings for obtaining information on SRH issues.

     

Aspects of parenting and family functioning associated with obesity in adolescent refugees and migrants from African backgrounds living in Australia

Objective: To investigate the relationship between parenting style and family functioning, and BMI, among adolescent migrants and refugees from African countries. Method : A total of 104 parents and their adolescent offspring completed questionnaires assessing the variables of interest, and anthropometric data were collected from them. Results: Parents reported higher maternal involvement, lower levels of paternal involvement, higher levels of positive parenting, greater use of ‘other’ (non‐corporal) discipline styles, greater satisfaction and better communication than did their offspring. Parents also reported greater family cohesion and flexibility than adolescents, and saw their families as more enmeshed and more rigid. Parenting style and family functioning were not strong predictors of BMI according to either report. For adolescents, inconsistent discipline and lack of parental supervision accounted for significant variance in BMI. Conclusions: Inconsistent discipline and lack of parental supervision may be related to adolescent BMI. Further studies with larger samples are required to confirm these relationships with the view to informing obesity prevention programs for this target population. Implications: Prevention or intervention programs aimed at reducing the prevalence of overweight and obesity need to consider parenting style in their design.     

Malnutrition and micronutrient deficiencies among Bhutanese refugee children--Nepal, 2007

Acute and chronic malnutrition and micronutrient deficiencies have been found in refugee camp populations. In southeastern Nepal, despite consistent access by refugees to general rations, certain micronutrient deficiencies have posed a substantial health burden to the approximately 100,000 Bhutanese residing in seven refugee camps. Limited food diversity, frequent illness, and poor feeding practices have been cited as underlying causes of poor nutritional status in this population. Annual surveys to assess levels of acute malnutrition (i.e., wasting) and chronic malnutrition (i.e., stunting) have been conducted in these camps by the Association of Medical Doctors of Asia (AMDA) and United Nations High Commissioner for Refugees (UNHCR); however, the capacity to reliably evaluate micronutrient deficiencies has not existed locally in the camps. In January 2007, AMDA and CDC, at the request of UNHCR and the World Food Programme (WFP), conducted a nutritional survey of children aged 6-59 months, assessing 1) the prevalence of acute malnutrition, chronic malnutrition, underweight, anemia, and angular stomatitis (i.e., riboflavin deficiency); 2) the cumulative incidence of diarrhea and acute respiratory illness (ARI); and 3) the feeding practices of the children's mothers. This report describes the results of that survey, which indicated that, although acute malnutrition was found in only 4.2% of the children, chronic malnutrition was found in 26.9% and anemia in 43.3%. These findings underscore the importance of monitoring both malnutrition and micronutrient deficiencies and addressing the underlying causes of nutritional deficits.     

Nutritional status of people living in Dzong village, in the northern mountainous area of Nepal

A nutritional survey was carried out among residents (39 males and 46 females) of Dzong village in the northern area of the Gandaki region of Nepal. The results were compared with our previous findings. The mean body mass index value was under 21 for both sexes, but the mean percentage of body fat of females (17-19 years old, 25.8 +/- 9.4%; 20-29 years old, 31.0 +/- 8.4%) was higher than that of males (17-19 years old, 12.0 +/- 1.0%; 50-59 years old, 24.4 +/- 7.6%). Most serum nutritional markers for both sexes were generally at normal levels although the iron levels were lower and packed red cell volume levels were higher than normal. As determined by results of the 24-hr dietary recall survey, the main food groups consumed by both sexes were cereals, potatoes, pulses, meats and vegetables. The mean daily intake of nutrients was similar for both sexes, with a few exceptions. The relatively high serum TG levels of the subjects may have been due to the high consumption of carbohydrate-laden cereals. The amounts of food consumed were not adequate, resulting in a latent and chronic deficiency of nutrients, especially calcium and iron. These results suggest that improvements in the nutritional status of this group of people are necessary.     

Resilience of refugees displaced in the developing world: a qualitative analysis of strengths and struggles of urban refugees in Nepal

Background

Mental health and psychosocial wellbeing are key concerns in displaced populations. Despite urban refugees constituting more than half of the world's refugees, minimal attention has been paid to their psychosocial wellbeing. The purpose of this study was to assess coping behaviour and aspects of resilience amongst refugees in Kathmandu, Nepal.

Methods

This study examined the experiences of 16 Pakistani and 8 Somali urban refugees in Kathmandu, Nepal through in-depth individual interviews, focus groups, and Photovoice methodology. Such qualitative approaches enabled us to broadly discuss themes such as personal experiences of being a refugee in Kathmandu, perceived causes of psychosocial distress, and strategies and resources for coping. Thematic network analysis was used in this study to systematically interpret and code the data.

Results

Our findings highlight that urban refugees' active coping efforts, notwithstanding significant adversity and resulting distress, are most frequently through primary relationships. Informed by Axel Honneth's theory on the struggle for recognition, findings suggest that coping is a function beyond the individual and involves the ability to negotiate recognition. This negotiation involves not only primary relationships, but also the legal order and other social networks such as family and friends. Honneth's work was used because of its emphasis on the importance of legal recognition and larger structural factors in facilitating daily coping.

Conclusions

Understanding how urban refugees cope by negotiating access to various forms of recognition in the absence of legal-recognition will enable organisations working with them to leverage such strengths and develop relevant programmes. In particular, building on these existing resources will lead to culturally compelling and sustainable care for these populations.     

Epidemiology of anemia among 4- to 17-month-old children living in south central Nepal

OBJECTIVE: To describe the distribution of hemoglobin and prevalence of anemia in Nepali children living in the Terai region by potential risk factors for deficiency. DESIGN: This was a cross-sectional, community-based study of baseline characteristics of children enrolled in a randomized, placebo-controlled clinical trial between January and March 2002. Participants were weighed and measured and had their blood drawn. Their mothers contributed demographic, morbidity, and feeding data. SUBJECTS: There were 569 4- to 17-month-old children. Statistical models were based on 490 children. RESULTS: Anemia was prevalent: 58% of the children had a hemoglobin <105 g/l. Iron-deficiency anemia (anemia with erythrocyte protoporphyrin (EP) > or =90 micromol/mol heme) was present in 43% of the children. Severe anemia was rare: less than 2% of the children had a hemoglobin <70 g/l. The mean (s.d.) hemoglobin concentration was 101 (12.5) g/l. Stunting and wasting were prevalent: 30.8% were stunted (length-for-age Z-score <-2) and 18.1% were wasted (weight-for-length Z-score <-2). Bivariate analyses revealed that age, caste, socioeconomic status, dietary diversity, stunting, and underweight were associated with hemoglobin concentration and/or anemia. In multivariate models with and without EP, age and caste were found to be strong predictors of both hemoglobin concentration and anemia. CONCLUSIONS: Anemia and iron deficiency increased strongly with age and low-caste status among the study children. The data reveal the importance of targeting interventions to children in the first year of life before they become anemic and iron deficient.     

Tuberculosis among Tibetan refugees in India

Tuberculosis (TB) is a major public health problem among Tibetan refugees in India. To determine the incidence of and risk factors for TB among Tibetan refugees in India, data on TB were included in the demographic and health surveillance project carried out by the Tibetan government-in-exile in Dharamsala from 1994 to 1996. Risk factor and morbidity data were determined by baseline and monthly follow-up home visits, and reported TB was confirmed by clinic records. The surveillance covered approximately 90% of the refugees in civilian settlements and approximately 70% of the monks in monasteries. In the settlement population, TB incidence was extraordinarily high in the settlement population, 10.9/ 1,000 in 1994. but decreased to 7.7/1,000 in 1996. Incidence rates varied between regions, age groups, and occupational groups, being highest in the Doon Valley (14.8/1,000). in sweater sellers (16.7/1,000), and in the unemployed (23/1,000). Among monastery monks, incidence rates were even higher than in the settlements, averaging 17.2/1,000 over the 3-year period. The proportion of patients without sputum results and variation in the proportion of smear positive cases indicated inadequate use and poor quality of laboratory services. India's Revised National Tuberculosis Control Program, based on WHO-recommendations, has been highly successful in pilot districts and is being extended to the whole country. This program should be adopted promptly by the health care system serving Tibetan refugees and vigorously implemented among the refugee population.     

Socio-cultural factors influencing adolescent pregnancy in rural Nepal

Early child bearing is a widely observed phenomenon in Nepal. However, little information is available in regard to its contributing factors. This retrospective exploratory study was carried out to determine factors contributing to adolescent pregnancy in rural Nepal. Cluster sampling technique was used to select the study settings. The findings on variable contributing to pregnancy from the sample of 575 mothers, who had their first pregnancy at an age below 19 years, were compared with the findings from an equal number of mothers who had their first pregnancy at the age of 20 years or above. The adolescent mothers were married at a comparatively younger age with a mean age of 15.9 years. Parents or elders, with/without the girl's consent, decided the majority of adolescent marriages. The age at marriage exposed women to early pregnancy regardless of who decided the marriage. Comparatively, most adolescent mothers were from a low social class, engaged in agricultural work, and they had low literacy rate. Majorities of the mothers from both groups had no prior knowledge about conception until they conceived. Peers were the main source of information regarding conception. Although the majority of the respondents knew at least one method of contraception, less than 1% had used it before their first pregnancy. To conclude, early pregnancy had put the adolescent mothers at the risk of unwanted pregnancy and obstetric complications. Women empowerment through compulsory girls' education would be the most effective strategy to prepare them for late marriage, planned and delayed pregnancy, and better motherhood.     

Nutritional status, growth and sleep habits among Senegalese adolescent girls

OBJECTIVE: To study the relation between sleep habits, nutritional status, growth and maturation in a group of African adolescent girls. The main hypothesis to be tested was that sleep length could be an effective way to spare energy, and thus malnourished girls sleep longer than normal girls. DESIGN: Three repeated yearly surveys (1997-1999) on a subsample of girls drawn from a larger study cohort on growth at adolescence. SETTING: The Niakhar district in the central part of Senegal. SUBJECT: In total, 40 girls were initially drawn. Missing girls were replaced at each round by girls having the same characteristics and belonging to the same cohort. INTERVENTION: At each round, data on pubertal development (breast stages and occurrence of menarche), growth and nutritional status were collected. Adolescents wore an accelerometer for three or four consecutive nights and days at each round. RESULTS: At the beginning of the survey, girls were 13.3+/-0.5 y old. They were under international reference values in weight and height. Their mean sleep duration was 8.5+/-0.9 h. Their puberty status did not influence their sleep habits; however, they slept more in March than in June, which was related to the seasonal change in daylight. There was a significant relation between body mass index and sleep habits: thinner girls slept a longer time and more quietly than the more corpulent girls. CONCLUSION: The nutritional status of these girls influenced their sleep habits: this may have been either a direct causal relation or a consequence of a protective attitude on the part of the mothers towards the frailer girls.     

Health and functional status among elderly individuals living in nursing homes in Madrid

OBJECTIVES: Epidemiologic studies on probabilistic samples of the institutionalized elderly in Spain are very scarce. The aim of this study was to describe the health and functional status of a population of older people living in nursing homes. SUBJECTS AND METHOD: A cross-sectional epidemiologic study was carried out. A sample of 800 subjects living in 19 public and 26 private nursing homes in Madrid was obtained through a stratified cluster method. Residents, main caregivers, doctors and nurses were interviewed. Cognitive status, perceived health, depression, pain, functional capacity, chronic illnesses, pressure ulcers, urinary and fecal incontinence, drug consumption and hospitalizations were assessed. RESULTS: Seventy-five percent of the sample were women. The mean age was 83.4 (standard deviation, 7.3) years. Forty-four percent had some degree of cognitive impairment. Forty-six percent were independent or mildly dependent in basic activities of daily living. Fifty-five percent reported very good or good perceived health. Thirty percent had depressive symptoms. Thirty-one percent had experienced daily pain in the previous 7 days. Three percent had pressure ulcers. The most prevalent illnesses were hypertension (45%), osteoarthritis (34%), dementia (33%) and anxiety (27%). The prevalence of Alzheimer's disease was 14%. Fifty-three percent had urinary incontinence and 26% had fecal incontinence. Twenty-six percent had been transferred to an emergency unit in the previous year. CONCLUSIONS: The estimates of the main variables, such as cognitive impairment and functional status, were in general more favorable than those in other populations of nursing home residents in Europe and North America. This is partly explained by the greater proportion of persons with a low need for care in the nursing homes in Madrid.     

独居老年人生活及精神健康状况调查

目的分析山东省济南市独居老年人生活现状及精神健康状况。方法采用调查问卷收集160名独居老人和911名非独居老人的生活现状及精神健康状况等,应用2χ检验和秩和检验进行统计分析。结果独居老人中女性99人,占61.88%,男性61人,占38.12%,平均年龄为74.45岁,文化程度小学及以下105人,占65.62%;城乡独居老人的平均月收入分别为1 816.40和274.46元,非独居老人分别为1 911.37和372.59元;城乡独居老人中从不与亲戚、朋友交往的比例分别为20.93%和25.68%;从不参加体育活动的比例为60.47%和94.59%;独居老年人的精神健康得分为45.21分,低于非独居老年人的46.81分。结论与非独居老人相比较,独居老年人尤其是农村独居老人的生活状况较差,精神健康水平较低,需进一步改善。     

Domestic violence among Iraqi refugees in Syria

A domestic violence questionnaire was administered to 701 adult females in a sample of 813 Iraqi households in Syria; unmarried women and women whose husbands were away were excluded, yielding a final sample of 486. Lifetime physical, verbal, or emotional abuse was reported by 30%, and approximately 20% experienced abuse within the past year. Non-Damascus residence, children <18 years in the household, no financial challenges upon arrival, and borrowing money in Syria were associated with increased risk of domestic violence within the past year. Support services are inadequate and should be expanded; and longer-term prevention measures also should be implemented.