Health of Cambodian refugees.

Cambodian refugees have been entering the United States since 1975, with the largest numbers arriving in the early 1980s. While many adjusted satisfactorily to their new environment, many continue having severe difficulty with the resettlement. Studies show that Cambodians are suffering more physical and mental distress than Vietnamese, Hmong, and Laotians. They are experiencing more financial and social distress, as well. This paper describes a small neighborhood home visiting program established 13 years ago to provide follow-up care for Cambodian refugees seen in a University Medical Center and later serving as a community experience for fourth-year medical students. These close contacts with the Cambodian community indicate that for many, especially those who are aging, both health and adjustment appear to be deteriorating. Chronic illnesses and prolonged severe depression are taking the place of the infectious diseases and the personal health problems, like dental disease, that they brought with them when they resettled in America.

Multilevel healing pursuits of Cambodian refugees.

The difficult adjustment of Cambodian refugees to life in the United States is no more evident than in their use of the biomedical health care system. When forced by circumstances to seek Western medical care, they often perceive the cause of their symptoms to be untreatable by this technological modality of healing. This attitude is understandable because the lengthy and destructive civil war they survived also extinguished their medical system. Many of the refugees had no contact with Western-style health care until they reached the camps in Thailand. As a result, the Cambodians have had to develop ways to integrate centuries-old indigenous and self-care practices, that they know well, with the modern health care services and technologies, that are new to them. In San Diego they have sought what is for them a new kind of provider, Vietnamese physicians who practice medicine that is culturally appropriate and convenient. Although these multiple systems satisfy them in many ways, a significant number of Cambodians are still not getting well. The constant pursuit of healing is time-intensive and expensive, and ignores the emotional effects of refugee status on physical health.

Providing health care to refugees.

Migration into the United States is currently a hotly debated and highly charged issue. For political reasons changes in U.S. immigration policy are certain to occur in the near future. While America is called a country of immigrants it is much less a country of refugees. The distinction between the two groups is not always clearly understood by clinicians yet is of great importance for both health screening and follow-up care. If all migration into the country were stopped today, health care professionals would still be treating health conditions and observing cultural practices that are unique to those already admitted.

Positive PPD and chemoprophylaxis for tuberculosis infection.

The appearance of an indurated area of 5 mm or more 48 to 72 hours after administration of purified protein derivative (PPD) is considered a positive reaction in persons who have recently had close contact with an individual with active tuberculosis, in persons with radiographic findings consistent with a past history of tuberculosis or in persons with known or suspected human immunodeficiency virus infection. Ten or more millimeters of induration is considered a positive reaction in persons at increased risk of tuberculosis. Induration of 15 mm or more is considered a positive result in all other persons. Candidates for a six-month course of isoniazid include persons under age 35 who are recent converters and have induration of 10 mm or more and persons over age 35 with 15 mm or more of induration. Patients with HIV infection and those with radiographic evidence of previous tuberculosis should receive 12 months of therapy. A regimen of pyrazinamide and either ethambutol, ofloxacin or ciprofloxacin is recommended for contacts of patients with multidrug-resistant tuberculosis.

Acculturation as a risk factor for chronic disease among Cambodian refugees in the United States.

Although the concept of acculturation originated within anthropology, in recent years it has assumed a prominent role within epidemiology as a risk factor for chronic disease. However, these studies often consider acculturation in structural terms, reflected in differences between groups assumed to lie along the same continuum, all moving in the same direction toward greater acculturation to the values and behaviors of the dominant society. This paper addresses how acculturation should be conceptualized when examining it as a potential risk factor for chronic disease and how it should be measured so that it becomes both theoretically and clinically meaningful. Four case studies of Cambodian refugees of San Diego, California are used to illustrate the following: (1) the importance of integrating an acculturation-as-process perspective with an acculturation-as-structure perspective; (2) viewing acculturation as both individual and group experience of conflict and negotiation between two systems of behavior and belief; (3) measuring it longitudinally and as narrative; and (4) understanding that rather than being an inherent health risk, it may also promote health by creating access to certain forms of health care unavailable in the country of origin and by contributing to the abandonment of risky health-related behaviors and the adoption of behaviors that promote good health.

'Betelmania'. Betel quid chewing by Cambodian women in the United States and its potential health effects.

Although an estimated 10% to 25% of the world's population chews betel quid, this practice is virtually unknown in the United States. Health care professionals coming into contact with immigrants and refugees from India, New Guinea, and Southeast Asia will increasingly notice this habit. Possible hazards associated with the chewing of the various ingredients of the quid include oral cancer and an addictive potential as strong as for cigarettes. We surveyed a group of Cambodian refugee women who are addicted to betel nut and its associated components. Participant-directed interviews uncovered some of the cultural meanings surrounding the ritual of preparing and using the betel quid and the role of culture in the beliefs and behaviors related to chemical addiction.

The structure, content, and quality of family nurse practice.

Relatively little data has been collected documenting the scope of family nurse practitioner (FNP) clinical practice, and virtually no research definitively describes the quality of that practice. Physicians have led the way in quantitative collection of practice content information. The resulting analyses have determined not only the most common diagnoses in primary care but also the content of teaching and research in family practice. Nurse clinicians, educators, and researchers have assumed this content to be pertinent to FNP practice as well. This article describes the major studies of family physician practice and the few studies of nurse practitioner/FNP practice, and advocates intensified review of FNP clinical content as an empirical basis for practice, education, and research.

The curriculum blueprint: an application to nurse practitioner education.

A psychometric model for the construction of examinations (the test construction process) is adapted as a conceptual framework for curriculum design. The outcome of the process, the curriculum blueprint, is proposed as particularly advantageous for nurse practitioner education, which is somewhat unique among nursing specialties in its need to accommodate the competing demands of several regulatory or educational approval bodies that influence the content of its curriculum. The curriculum blueprint provides a visual dimension and therefore is useful as a communication tool. An excerpted example of a curriculum blueprint is offered.

Positive tuberculin skin tests and isoniazid chemoprophylaxis.

The American Thoracic Society recommends that specific individuals who are classified as tuberculosis infected receive a year-long course of INH chemoprophylaxis. They further recommend that patients receiving medication be evaluated on a monthly basis to assess the individual for side effects related to the medication. The most prevalent side effects are hypersensitivity, GI distress, hepatitis and neurotoxicity. Subjective data relating to these side effects need to be elicited at every visit and a pertinent physical examination done. Careful monthly monitoring is required to evaluate the patient for the most prevalent and significant side effects of the medication. Nurses must be aware of the significance of this preventive measure, the adverse reactions which may occur with the drug therapy and the health teaching which contributes to patient compliance.