Psychosocial problems in traumatized refugee families: overview of risks and some recommendations for support services.

This article is an abridged version of a report by an advisory council to the German government on the psychosocial problems facing refugee families from war zones who have settled in Germany. It omits the detailed information contained in the report about matters that are specific to the German health system and asylum laws, and includes just those insights and strategies that may be applicable to assisting refugees in other host countries as well. The focus is on understanding the developmental risks faced by refugee children when they or family members are suffering from trauma-related psychological disorders, and on identifying measures that can be taken to address these risks. The following recommendations are made: recognizing the high level of psychosocial problems present in these families, providing family-friendly living accommodations, teaching positive parenting skills, initiating culture-sensitive interventions, establishing training programs to support those who work with refugees, expanding the availability of trained interpreters, facilitating access to education and health care, and identifying intervention requirements through screening and other measures.

Culture and early infancy among central African foragers and farmers.

Everyday infant experiences among the Aka hunter-gatherers and the neighboring Ngandu farmers were observed and compared. Twenty Aka and 21 Ngandu 3- to 4-month-olds and 20 Aka and 20 Ngandu 9- to 10-month-olds were observed for 3 hr on each of 4 days so that all 12 daylight hr were covered. The Aka infants were more likely to be held, fed, and asleep or drowsy, whereas Ngandu infants were more likely to be alone and to fuss or cry, smile, vocalize, or play. The amount of crying, soothing, feeding, and sleeping declined over time in both groups. Distal social interaction increased over time among the Ngandu but not among the Aka. Despite striking cultural differences on many variables, however, functional context systematically affected the relative prominence of the infants' behavior in both cultural groups.

Contexts as moderators of observed interactions: a study of Costa Rican mothers and infants from differing socioeconomic backgrounds.

20 first-born infants from low socioeconomic status (SES) families and 20 first-born infants from middle SES families in Costa Rica were observed for 12 hours when they were 14 weeks old. The goals of this study were the following: 1) to study the impact of length of observation and context on the authors measures of interactional engagement; 2) to compare the interactional experiences of the infants in the two groups in various functional (e.g. feeding, object play) and social (e.g. with mother, with mother and others) contexts. Attuned and disharmonious interactions, as well as the frequency of positive affect, soothing, and vocalization, varied considerably across the functional contexts. In addition, disharmonious interactions increased and interactional engagement decreased when mothers and infants were joined by others. Highly unstable measures of individual differences were obtained when observations were limited to 45-minute blocks, but stability increased considerably as the duration of the observations expanded. The groups did not differ with respect to amounts of time spent in various functional and social contexts, in attuned or disharmonious states, or in high levels of interactional engagement. Within some of the functional contexts, however, significant group differences in levels of attuned interactions, infant vocalization, and maternal response vocalization were found. Overall, functional and social contexts clearly moderated interactional experiences. SES effects on verbal and other interactional measures were limited to some contexts and may thus represent the infants' overall experiences quite poorly. Consequently, comparisons based on a single context may be inadequate for studies of subjects from differing socioeconomic backgrounds.

Quality of life of liver transplant recipients. A pilot study.

In a cross-sectional survey of the quality of life of 45 liver transplant recipients, physical and psychological status, physical complaints, capability to participate in daily life, social support, and global quality of life were assessed. The average time of follow-up was 9 months after transplantation. Nine patients had moderate liver damage, 12 suffered from drug side effects, and 10 had extrahepatic diseases. Physical complaints, especially rheumatism, exhaustion, and gastric complaints, were higher than in the general population. Most patients were able to participate in daily life (do housework, take part in family life, etc.). Apart from the complex "health" (use of body), they did not differ in this respect from healthy individuals. Eighty percent of the patients reported having very good social support. The psychological status was generally good, with only 5% complaining of anxiety and nervousness. Sixty percent regarded their quality of life to be very high, 31% reported medium quality of life, and 9% felt very bad. No relationship was found between low quality of life and transplant malfunction; patients with extrahepatic diseases had the lowest quality of life. Among all subgroups, the individuals who were actively working again felt best. Psychological qualities necessary for coping with daily life (self-assurance, self-realization, satisfaction, and happiness) correlated most with the global quality of life (r = 0.80), whereas no relationship was found between quality of life and complaints in total (r = -0.32). This survey shows that during the first year after transplantation, transplant recipients report a high quality of life in important areas of living, despite many physical complaints, and even display an almost euphoric mood.

[Depression and self concept of patients with acute viral hepatitis]. / Depressivität und Selbstwertgefühl bei Patienten mit akuter Virushepatitis.

As part of a complex multimodal study of the biological, psychological and social situation of patients with acute viral hepatitis, the specific hypothesis that patients with this disease appear to be especially depressive is examined. Two instruments were used to assess variables of depression: the Giessen-Test, a standardized personality questionnaire (Beckmann, Brähler, Richter, 1983) and the idiographic role-repertorygrid (Kelly 1955). Seeing that self-esteem and basic affective state of the hepatitis patients as a whole differed significantly from that of patients with depression, it does not seem justifiable to speak of "the depressive" hepatitis patient. On the contrary, differential investigation discriminates three subgroups of patients with depressed, "normal" and hypomanic mood states. Since the measures of depression used here are quite stable and thus rather "trait" than "state" variables and further, some patients even appear to be hypomanic, the observed depression is not, as discussed in the literature, regarded to be "psychoreactive".

Character of initial symptomatology and further course of acute viral hepatitis.

Guided by the assumption that the initial symptomatology of patients with acute viral hepatitis may allow to predict the further course of the disease, bodily complaints, mood and laboratory findings of 50 patients were assessed. For single parameters such as liver complaints, transaminases or anxious depression, no differences were found between patients with rapid, medium and slow recovery. As far as the pattern of symptoms were concerned, however, the three groups differed from each other. This finding implies the use of different illness coping strategies in the various groups.

[Human hepatitis experiments in the 2d World War]. / Hepatitis-Humanexperimente im zweiten Weltkrieg.

During the Second World War a hepatitis epidemic spread across wide areas of Europe, leaving no doubt about the previously questioned infectious nature of the disease. The losses to the German forces due to hepatitis, presented a challenge to several German scientists to identify the infective agent via animal trials and experiments with humans. Kurt Gutzeit, the "Beratende Internist beim Heeres-Sanitäts-Inspekteur" was in charge of the hepatitis research in the army. Under his guidance, two co-workers conducted experiments on non-voluntary subjects: in 1941, Hans Voegt infected psychiatric patients from the mental hospital in Breslau, and in 1944, Arnold Dohmen carried out experiments on jewish children in the Sachsenhausen concentration camp. In the Nürnberg trials, Gutzeit had denied his and Dohmen's responsibility. Further investigation into the hepatitis research which was carried out by German scientists during the Second World War, especially Gutzeit's group, is regarded necessary.

[The symptom picture in patients with acute viral hepatitis. A systematic study using the Giessen Symptom Questionnaire]. / Das Beschwerdebild bei Patienten mit akuter Virushepatitis. Eine systematische Untersuchung mit dem Giessener Beschwerdebogen.

As part of a study on the relationship between psychosocial factors and the course of acute viral hepatitis A, B and NANB, bodily complaints of 41 patients were examined and two major complaint factors evolved. One complex of specific liver complaints, consisting of fatigue and an excessive need for sleep, gastrointestinal and skin symptoms, correlated with the degree of liver damage and can most readily be regarded as organdependent. A smaller group of general complaints did not correlate with liver damage. It seems to represent a complex symptomatology, which is probably partly psychologically determined. Patients with hepatitis B suffer the severest liver damage and present the most specific complaints. Patients with hepatitis NANB show the mildest symptomatology and patients with hepatitis A hold a medium position. The hepatitis types do not differ in respect to their general complaints. While sex-related differences in the level of complaints are still visible during the prodromal phase, sex and age-related differences disappear during the acute phase. Further morbidity also does not influence symptomatology at this stage. At discharge, however, sex-related differences and the effects of further morbidity on the remaining complaints reaper.