Determinants and consequences of child culture brokering in families from the former Soviet Union.

Child culture brokering occurs when immigrant children help their families navigate the new culture and language. The present study develops a model of the child culture broker role that situates it within the family and community economic and acculturative contexts of 328 families from the former Soviet Union. Path analysis was utilized to explore the relationships of community and family economic and cultural contexts with child culture brokering, child emotional distress, and family disagreements. All children reported some culture brokering for their parents. Less English proficient parents with lower status jobs, and living in areas with more Russian speaking families tended to utilize their children as brokers more often. Further, community economic conditions also predicted brokering indirectly, mediated by parent job social status. Brokering was related to child emotional distress and family disagreements. Further, culture brokering was a mediator of the impact of parent job social status on both child emotional distress and family disagreements. These results add to our understanding of the culture broker role and emphasize the utility of approaching research on it from an ecological perspective.

Issues in renal nutrition for persons from the former Soviet Union.

Dietary practices differ greatly among individuals by race and ethnicity. The importance of these differences is accentuated in patients with end-stage renal disease, a population for whom dietary restrictions are often prescribed. In addition to the known variation in dietary practices among US-born whites and African-Americans, persons of other ethnicities often present new and unique challenges to the dialysis-nutrition care team. The UCSF-Mt. Zion Dialysis Unit (San Francisco, CA) is a university-affiliated dialysis unit that serves an ethnically diverse population in San Francisco's Western Addition neighborhood. Ten percent to 15% of patients are recent immigrants from the former Soviet Union. This report highlights the dietary practices of this immigrant community and the need for ethnicity-specific renal nutrition recommendations in modern dialysis practice.

Violent mortality patterns in immigrants in Israel (1990-95).

Since 1989, a large number of immigrants, mostly from the former Soviet Union, have arrived in Israel, increasing the local population (c. 5 million) by 700,000. The morbidity and mortality of this immigrant population have been the concern of many investigations. In the present study we examine the mortality pattern of a sample of 1,000 immigrants, whose deaths occurred during the years 1990-95 and were examined at the L. Greenberg (National) Institute of Forensic Medicine. The sample was divided into two subgroups, natural and unnatural, according to manner of death. Seventy-five per cent of the victims in the violent death subgroup were males with a mean age of 44.6 (SD 17.3) years, while the females of the same category were 52.7 years old on average (SD 19.9). The age distribution of the whole sample showed peaks in the 25-34-year-old group for males and the 35-44-year-old group for females. The most frequent causes of death were accident (44.1%), suicide (12.6%) and homicide (7%). In 5% of cases the cause of death could not be determined. The pattern of mortality from violent causes in the immigrant population differed from that of the country of origin in all parameters. The incidence of unnatural death in immigrants resembled the local pattern in Israel, and was significantly lower than that of their homeland.

Coping with the stress of immigration among new immigrants to Israel from Commonwealth of Independent States (CIS) who were exposed to Chernobyl: the effect of age.

This study examined the differential effect of age on coping and psychological measures among immigrants from Commonwealth of Independent States (CIS) to Israel. Some of these immigrants originated in the Republics adjacent to the Chernobyl Power Plant, site of the 1986 accident. The sample consisted of 708 immigrants who were interviewed between the years 1993-1995 with an average age of 47.5 (sd 11.8). This sample was reinterviewed approximately a year and three months later (n = 520). The sample included two exposure groups--high exposed and low exposed based on the estimated levels of ground cesium contamination from the IAEA maps and a comparison group matched by age, gender, and year of immigration. Those over the age of sixty-five were disadvantaged, compared to those aged fifty to sixty-four, and younger, when it came to the tasks of immigrant absorption; learning the language, working and acquiring an income, and establishing alternative social networks which could offer support in times of illness. The psychological variables showed that over time, somatization, depression, and post-traumatic stress disorder (PTSD) symptoms related to Chernobyl improved, however at a much slower pace for older immigrants (aged 55 and over) compared to younger ones.

IS6110 fingerprinting of drug-resistant Mycobacterium tuberculosis strains isolated in Germany during 1995.

The epidemiological relatedness of drug-resistant Mycobacterium tuberculosis strains isolated in Germany in 1995 was evaluated by the standardized IS6110 fingerprinting method. Altogether, 196 M. tuberculosis isolates from 167 patients were analyzed. A large degree of IS6110 polymorphism was found, ranging from 1 to 20 copies. Multiple isolates from one patient generally remained stable over a period of up to 1 year. However, one strain showed an additional fragment 7 months after the first isolate was obtained. Isolates from 55 patients (33%) showed identical fingerprint patterns or fingerprint patterns that differed only in one band, and thus they were clustered in 22 fingerprint groups. Specific transmission links could be established between members of four groups, e.g., transmission by family contacts. In one case, transmission of a multidrug-resistant strain to a patient initially infected with a drug-susceptible strain could be shown. Besides these fingerprint groups, 30 of the 167 isolates (approximately 18%) could be grouped in two fingerprint clusters with a similarity of at least 78%. Approximately 60% of the patients of these two clusters were known to be immigrants from the former Soviet Union, and one patient is still living in Belarus. In conclusion, our results indicate that (i) transmission of drug-resistant strains contributes substantially to the emergence of drug-resistant tuberculosis in Germany and (ii) drug-resistant M. tuberculosis strains were presumably carried over from the former Soviet Union to Germany by immigrants.

[Short course for primary physicians care].

This department of family medicine has been challenged with helping a group of Russian immigrant physicians find places in primary care clinics, quickly and at minimal expense. A 3-month course was set up based on the Family Practice Residency Syllabus and the SFATAM approach, led by teachers and tutors from our department. 30 newly immigrated Russian physicians participated. The course included: lectures and exercises in treatment and communication with patients with a variety of common medical problems in the primary care setting; improvement of fluency in Hebrew relevant to the work setting; and information on the function of primary care and professional clinics. Before-and-after questionnaires evaluating optimal use of a 10- minute meeting with a client presenting with headache were administered. The data showed that the physicians had learned to use more psychosocial diagnostic question and more psychosocial interventions. There was a cleared trend toward greater awareness of the patient's environment, his family, social connections and work. There was no change in biomedical inquiry and interventions but a clear trend to a decrease in recommendations for tests and in referrals. The authors recommend the following didactic tools: adopting a biopsychosocial attitude, active participation of students in the learning situation, working in small groups, use of simulations and video clips, and acquiring basic communication experience.

[Use of medication for hypertension and coronary heart disease by Russian immigrants].

397 recent immigrants (olim) were under medical treatment at a primary care clinic during their first year (1990-1991) after immigration to Israel (aliya) from 14 republics of the Commonwealth of Independent States (CIS, formerly the Soviet Union). While in the CIS 3/4 had used medication for hypertension intermittently for only 2-4 weeks, whenever blood pressure was elevated. More than 3/4 took prophylactic drugs for coronary heart disease only when chest pain appeared and for only approximately 4 weeks, in contrast with continuous, prolonged treatment used in Israel and western countries. Immigrants brought with them stocks of drugs and continued to take them intermittently as they had in the CIS. This form of treatment is described in the official pharmacology book. Only after intervention of the family physician did the immigrants begin to take their drugs for hypertension and coronary heart disease continuously.

Past and present contraceptive behavior of new Soviet immigrant women in Israel.

This exploratory research investigated past and current use of contraceptives among a purposive sample of 117 new immigrant women from the Commonwealth of Independent States (former Soviet Union). The findings confirm the widespread use of induced abortion (IA) as a method of birth control before immigration. Fifty-eight percent of the sample had had at least one IA, and the average was 2.7 IA. The most commonly used types of contraception before immigration were the pill, safe days, withdrawal, and the IUD. Currently used types of contraception were the IUD, safe days, withdrawal, and condoms; however only 45% of the sample were currently using any type of contraception. Of particular interest were the relatively high reported use of the pill before immigration and low current use, and the former low level of condom use and its increase in popularity in Israel. Despite the availability of more effective methods of birth control, safe days and withdrawal remain commonly used. The high cost of the pill was mentioned as a deterrent to its current use. Despite the high prior level of IA, the majority of women in this sample (84%) preferred today to use other birth control methods, and would like the opportunity to receive professional advice. These findings support the need for educational efforts directed toward new immigrant women from CIS.

PIP: In early 1992 in Israel, 117 recent Jewish immigrant women from Belarus, Russia, and the Ukraine completed a questionnaire designed to examine their past and current contraceptive behavior. The mean number of months in Israel was 2.7 months. The mean number of children among the 90 women with children was 1.74 (range 1-5). 58.1% of all 117 women had had at least one induced abortion. The mean number of induced abortions per woman was 2.7 (range 1-12). More than 40% of women who had had at least one induced abortion had at least 3 induced abortions. 104 women were or had been married, or had a steady partner. The most frequently used family planning methods in the past were oral contraceptives (OCs) (33.7%), safe days (24%), withdrawal (15.3%), and IUD (15.3%). Only 4% used condoms in the past. Current family planning methods used included IUD (23%), safe days (23%), withdrawal (18.3%), and condoms (13.5%). Only 2.9% currently used OCs. The mean number of methods currently used was 1.8. Reasons for not using contraception before immigration were: not safe (18%), reduced sexual pleasure (11%), not available (9%), no steady sexual partner (7%), and desire to conceive (5%). After immigration, reasons for not using contraception were too expensive (11%) (especially OCs) and not safe (9%). 84% preferred to use contraception rather than undergo an induced abortion. 62% wanted professional advise on contraception. These findings illustrate the need to provide new immigrant women from the Commonwealth of Independent States with accurate information about the health effects of various family planning methods.