Poetic resistance: Karen long-distance nationalism, rap music, and YouTube

This article investigates a concern among encamped elder Karen refugees (an ethnic minority from Myanmar) living along the Thai–Myanmar border that the youth are disconnected politically and culturally. I argue that Karen youth are creative, active participants, reimagining and revitalising Karen politics and culture in their image. I explore how displaced youths have found a voice in Karen rap and how they express this voice in the digitally mediated lived space of YouTube. I consider YouTube as a lived space where citizenship is reimagined and long-distance nationalism is articulated. Finally, I contend that YouTube is transforming Karen youths’ political experiences and mobility and that they are actively political – just not in the way the elders expect.

High levels of pathological jaundice in the first 24 hours and neonatal hyperbilirubinaemia in an epidemiological cohort study on the Thailand-Myanmar border

Population risks for neonatal hyperbilirubinaemia (NH) vary. Knowledge of local risks permits interventions that may reduce the proportion becoming severe. Between January 2015 and May 2016, in a resource-limited setting on the Thailand-Myanmar border, neonates from 28 weeks’ gestation were enrolled into a prospective birth cohort. Each neonate had total serum bilirubin measurements: scheduled (24, 48, 72 and 144 hours of life) and clinically indicated; and weekly follow up until 1 month of age. Risk factors for developing NH were evaluated using Cox proportional hazard mixed model. Of 1710 neonates, 22% (376) developed NH (83% preterm, 19% term). All neonates born <35 weeks, four in five born 35–37 weeks, and three in twenty born ≥38 weeks had NH, giving an overall incidence of 249 per 1000 livebirths [95%CI 225, 403]. Mortality from acute bilirubin encephalopathy was 10% (2/20) amongst the 5.3% (20/376) who reached the severe NH threshold. One-quarter (26.3%) of NH occurred within 24 hours. NH onset varied with gestational age: at a median [IQR] 24 hours [24, 30] for neonates born 37 weeks or prematurely vs 59 hours [48, 84] for neonates born ≥38 weeks. Risk factors for NH in the first week of life independent of gestational age were: neonatal G6PD deficiency, birth bruising, Sgaw Karen ethnicity, primigravidae, pre-eclampsia, and prolonged rupture of membranes. The genetic impact of G6PD deficiency on NH was partially interpreted by using the florescent spot test and further genotyping work is in progress. The risk of NH in Sgaw Karen refugees may be overlooked internationally as they are most likely regarded as Burmese in countries of resettlement. Given high levels of pathological jaundice in the first 24 hours and overall high NH burden, guidelines changes were implemented including preventive PT for all neonates <35 weeks and for those 35–37 weeks with risk factors.

The Americanization of Karen Refugee Youth: Exploring Attitudes Toward and Use of Methamphetamine

Drug use among refugee populations is a concerning trend in many urban American cities. For instance, Omaha, Nebraska is home to an estimated 7,000 refugees from Myanmar, with at least 75% of those being Karen refugees. The purpose of this paper is to explore methamphetamine use among Karen adolescents in Omaha and to examine whether Karen youth bring their drug use habits with them from refugee camps or if they learn about drugs from their American peers. Two focus groups of Karen youth and two focus groups of Karen parents were conducted to examine methamphetamine use among this population. Findings suggest, like most youth, the Karen children were reluctant to disclose their own use of drugs, but they did see the use of methamphetamine and other drugs in their schools. It appears drug use among the Karen youth is acquired during the “Americanization” of these children in Omaha schools.

“We Pray as a Family”: The Role of Religion for Resettled Karen Refugees

The role of religion for resettled refugees is particularly complex and illuminating. In the context of migration, the opportunity for increased positive outcomes has the potential to play a vital role in coping with the often tumultuous migration and resettlement experiences of refugees. We share qualitative findings from 14 Karen refugees for whom religious practices are inextricably tied to resilience through family closeness and community-building. Ethnographic methods were used to deeply understand participants’ resilience, and all described their faith and trust in God as an important part of their coping with traumatic experiences before and following resettlement in the United States. Findings are focused around descriptions of overcoming adversity, continuity in chaos, and connecting with their community and family.

Intensive psychotherapy and case management for Karen refugees with Major Depression in primary care: a pragmatic randomized control trial

Background: Despite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. We studied the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in St Paul, Minnesota) with depression. Methods: A pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to one year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU). Eligibility criteria included Major Depression diagnosis determined by structured diagnostic clinical interview, Karen refugee, ages 18-65. IPCM (n=112) received a year of psychotherapy and case management coordinated onsite between the case manager, psychotherapist, and primary care providers; CAU (n=102) received care-as-usual from their primary care clinic, including behavioral health referrals and/or brief onsite interventions. Blinded assessors collected outcomes of mean changes in depression and anxiety symptoms (measured by Hopkins Symptom Checklist-25), PTSD symptoms (Posttraumatic Diagnostic Scale), pain (internally developed 5-item Pain Scale), and social functioning (internally developed 37-item instrument standardized on refugees) at baseline, 3, 6 and 12 months. After propensity score matching, data were analyzed with the intention-to-treat principle using repeated measures ANOVA with partial eta-squared estimates of effect size. Results: Of 214 participants, 193 completed a baseline and follow up assessment (90.2%). IPCM patients showed significant improvements in depression, PTSD, anxiety, and pain symptoms and in social functioning at all time points, with magnitude of improvement increasing over time. CAU patients did not show significant improvements. The largest mean differences observed between groups were in depression (difference, 5.5, 95% CI, 3.9 to 7.1, P <.001) and basic needs/safety (difference, 5.4, 95% CI, 3.8 to 7.0, P <.001). Conclusions: Adult Karen refugees with depression benefited from intensive psychotherapy and case management coordinated and delivered under usual conditions in primary care. Intervention effects strengthened at each interval, suggesting robust recovery is possible.

Intensive psychotherapy and case management for Karen refugees with Major Depression in primary care: a pragmatic randomized control trial

Background: Despite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. We studied the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in St Paul, Minnesota) with depression. Methods: A pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to one year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU). Eligibility criteria included Major Depression diagnosis determined by structured diagnostic clinical interview, Karen refugee, ages 18-65. IPCM (n=112) received a year of psychotherapy and case management coordinated onsite between the case manager, psychotherapist, and primary care providers; CAU (n=102) received care-as-usual from their primary care clinic, including behavioral health referrals and/or brief onsite interventions. Blinded assessors collected outcomes of mean changes in depression and anxiety symptoms (measured by Hopkins Symptom Checklist-25), PTSD symptoms (Posttraumatic Diagnostic Scale), pain (internally developed 5-item Pain Scale), and social functioning (internally developed 37-item instrument standardized on refugees) at baseline, 3, 6 and 12 months. After propensity score matching, data were analyzed with the intention-to-treat principle using repeated measures ANOVA with partial eta-squared estimates of effect size. Results: Of 214 participants, 193 completed a baseline and follow up assessment (90.2%). IPCM patients showed significant improvements in depression, PTSD, anxiety, and pain symptoms and in social functioning at all time points, with magnitude of improvement increasing over time. CAU patients did not show significant improvements. The largest mean differences observed between groups were in depression (difference, 5.5, 95% CI, 3.9 to 7.1, P <.001) and basic needs/safety (difference, 5.4, 95% CI, 3.8 to 7.0, P <.001). Conclusions: Adult Karen refugees with depression benefited from intensive psychotherapy and case management coordinated and delivered under usual conditions in primary care. Intervention effects strengthened at each interval, suggesting robust recovery is possible.

Intensive psychotherapy and case management for Karen refugees with Major Depression in primary care: a pragmatic randomized control trial

Background: Despite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. Our aim was to study the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in the study location) with depression. Methods: A pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to one year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU). Eligibility criteria included Major Depression diagnosis, Karen refugee, ages 18-65. IPCM (n=112) received a year of psychotherapy and case management coordinated onsite between the case manager, psychotherapist, and primary care providers; CAU (n=102) received care-as-usual from their primary care clinic, including behavioral health referrals and/or brief onsite interventions. Blinded assessors collected outcomes of mean changes in depression, anxiety, PTSD, pain, and social functioning at baseline, 3, 6 and 12 months. Measures included HSCL-25 (depression and anxiety), PDS (PTSD), pain (range of 0-4), and social functioning scales (range of 0-4). Data were analyzed with the intention-to-treat principle. Results: Among 214 randomized participants, 193 completed a baseline and follow up assessment (90.2%). IPCM patients showed significant improvements in depression, PTSD, anxiety, and pain symptoms and in social functioning at 3, 6, and 12 months, with magnitude of improvement increasing over time. CAU patients did not show significant improvements. The largest mean differences observed between groups were in depression (difference, 5.5, 95% CI, 3.9 to 7.1, P<.001) and basic needs/safety (difference, 5.4, 95% CI, 3.8 to 7.0, P<.001). Conclusions: Adult Karen refugees with depression benefited from intensive psychotherapy and case management coordinated and delivered under usual conditions in primary care. Intervention effects strengthened at each interval, suggesting robust recovery is possible. Trial registration: clinicaltrials.gov Identifier: NCT03788408. Registered 20 Dec 2018. Retrospectively registered. Keywords: Refugees, Depression, Primary care, PTSD, Basic needs, Case management