Mary S. Willis

Health and related factors for Sudanese refugees in Nebraska.

Results of a health survey covering demographics, health risk/prevention factors, and barriers to health care among 263 refugees from Sudan, now living in Nebraska, are presented. Data are compared to Nebraskas general and minority populations. Sudanese refugees are generally young, highly mobile, uneducated, and live in poverty. Refugees are proportionally different from other Nebraskans, in terms of risk factors and rates of common U.S. conditions, but are unable to use preventive systems for maintaining high health status. Nearly 40% do not have health or dental insurance, 20% have never visited a dental or eye care professional, and 11% have never been to a doctor. Federal programs should standardize resettlement site screening so that mobile populations can begin the resettlement process healthy and prevent the spread of infectious disease. Good health at the outset will allow more time and resources for education, language, and employment acquisition, all of critical importance to the Sudanese refugee community.

Relationships between the diet and dentition of Asian leaf monkeys

Colobines have been generally described as primates that use the anterior teeth minimally, but the posterior teeth extensively, to process leaves and related food items. However, variation among leaf monkeys in both anterior and posterior dental morphology has been recognized for decades. In this study, we turn to Hylanders (Science 189 (1975) 1095-1098) analysis of anterior incisor row length and Kays (Adaptations for foraging in nonhuman primates, 1984) examination of relative molar crest length to test hypotheses proposed by them for Asian colobines. We present findings based on data from the largest Asian colobine sample measured to date. Our findings for incisor row length and molar cresting are not amenable to broad generalizations. In those instances when our morphological findings concur with those of Hylander (Science 189 (1975) 1095-1098) and Kay and Hylander (The ecology of arboreal folivores, 1978), the ecological evidence seldom supports the morphological predictions. The disassociation between diet and dental patterns may be a consequence of differential selection by fallback foods, anthropogenic disturbance or climatic shifts limiting preferred diets, or the use of food types as opposed to food mechanical properties for dietary categorization. We also found that in the case of both incisor row length and molar crest length, the patterns for males and females differed markedly. The reasons for these differences may in part be ascribed to the metabolic challenges faced by females and subsequent niche partitioning. We propose integrated analyses of the ingestive and digestive systems of our study taxa to clarify relationships among behavior, dental morphology, and diet in extant and extinct colobines.

Initiatory Mental Health Assessments for Dinka and Nuer Refugees from Sudan

Sudanese refugees resettled in the U.S. cited the replacement of lower front teeth removed through childhood ritual as critical to a healthy transition. Consequently, we designed a dental restoration program that included initiatory mental health assessments. This study presents the psychological baseline of participants prior to dental restoration and includes documentation of refugee-related trauma exposure. Dinka and Nuer adults were interviewed using the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25. Results demonstrated expected levels of trauma exposure, yet produced unexpectedly low aggregate scores for PTSD, depression, and anxiety. Such findings strongly suggest that aggregate scores must be considered within the context of the individual clinical presentation embedded within the refugees’ cultural schemas, cultural idioms of distress, and overall cultural meaning systems.

Dental Restorations for Dinka and Nuer Refugees: A Confluence of Culture and Healing

The Harvard Trauma Questionnaire, Hopkins Symptom Checklist-25, and the Self-reporting Questionnaire-24 were used to evaluate distress among 22 Dinka and Nuer refugees to the US before and after complete restoration of four to six lower front teeth that had been extracted during childhood in Sudan. Participants reported significant improvement in levels of distress following full restoration of missing teeth, including symptoms of PTSD. These results illustrate the value of incorporating community perspectives into the selection of health treatment options for newly arriving populations. But they also emphasize the unique situation faced by each refugee population as they embark on a wholly new cultural learning process.

Are you eating healthy? Nutrition discourse in Midwestern clinics for the underserved

OBJECTIVE To investigate nutrition information provided and exchanged between patients and health providers in Midwestern clinics for underserved populations. METHODS Forty-six clinic visits were observed to determine content and direction of nutrition information. In-depth data were collected with clinicians and clinic administrators regarding nutrition education provided to patients. RESULTS All patients were diagnosed with multiple obesity-related morbidities. Although women more often posed nutrition questions, few patients asked about dietary intake. Two-thirds of healthcare professionals initiated discussion about dietary intake; however, nutrition education was not provided regardless of clinicians profession. CONCLUSIONS Patients did not appear to link morbidity with diet. Providers did not share comprehensive nutrition knowledge during clinic visits. Dietitians, who specialize in nutrition education, rarely had access to patients. IMPLICATIONS Nutrition education during clinic visits is essential for reducing obesity rates. Nutrition students need clinic experience and could provide important patient education at low cost.