Speaking up for the
silent
Urgent attention to the mental health
needs of refugee children is required
and particularly to those who travel
unaccompanied. (Arch Dis Child
2002;87:366–70)

There are currently over 50 million
refugees in the world. Over half of that
number are children and, as they
represent a silent group, they and their
needs are easily overlooked. The authors
highlight three key stages where psy-
chological trauma is likely to occur to
refugee children: (1) while in their
country of origin; (2) during their
attempted journey to a safe country,
and (3) while trying to settle in that
country. There is a high prevalence of
emotional and behavioural disorders,
with post-traumatic stress disorders,
anxiety with sleep disorders, and
depression representing the most com-
mon diagnostic classifications. Factors
that enable high risk refugee children to
be more psychologically resilient include
having a supportive family environ-
ment, access to a reliable and stable
external person or organisation, or
positive personality characteristics.

Unaccompanied children are a parti-
cularly vulnerable group and are more
likely to be neglected, exploited, and
abused. Few unaccompanied children
are granted asylum, although the major-
ity arriving in the UK are given tempor-
ary, discretionary leave to remain in the
UK until they are 18.

Noting that UK immigration law does
not seem to always take the best
interests of refugee children into
account, the authors conclude that
‘‘attention to the mental health needs
of this vulnerable group by government
and other policy makers is urgently
required’’.

Recall bias and MMR
In 1998 a paper hypothesising a causal
association between the measles,
mumps, and rubella (MMR) vaccine

and autism was seized upon by the
British press and given the full tabloid
treatment. The resulting furore created a
great deal of negative publicity for the
vaccine and prompted pronounced
uncertainty in parents. The media
ignored several subsequent studies that
did not demonstrate a link.

It now appears that a further effect of
that publicity has been to initiate recall
bias in parents of autistic children who
received the MMR vaccine. (Arch Dis
Child 2002;87:493–4)

Researchers compared the results of
two studies performed before and after
the putative autism-MMR association
that contained, as elements, recalled
measurements of onset of parental
concern. They found that parents of
children with regressive symptoms who
were diagnosed after the publicity
tended to recall the onset as shortly
after MMR more often than parents of
similar children who were diagnosed
before the publicity. The authors con-
clude that this paper raises the possibi-
lity that such a bias could affect future
studies, and suggest that the capacity
for bias should be examined in studies
reliant on clinical histories obtained
after a publicised hypothesis.

Negativity follows
inactivity
A recent study suggests the benefits of
persistent exercise could be much
broader then previously realised. (Br J
Sports Med 2002;36:360–4). The study,
conducted with a series of three ques-
tionnaires concerning leisure time phy-
sical activity sent to sets of twins in their
late teens, investigates both the link
between frequency of exercise and level
of health and the associations of exer-
cise with smoking, drinking, social
relationships, and school grades as well.

Dealing mainly with the two extremes
present in adolescents, the study
observed persistently active (those who
exercised four to five times a week) and
inactive (those who exercised one to two
times a month) teenagers. Examining
the characteristics of each category, the
persistent exercisers were, in general,
non-smokers, regular breakfast eaters,
and had better grades at school,
whereas the persistently inactive were

often smokers with poor perceived
health, poorer school grades, and their
parents were often of a lower social class.
A moderate to high level of exercise
therefore seems to promote improved
health and an improved lifestyle.

Consequently, the authors conclude,
health promotion in adolescence must
address the health and wellbeing of
adolescents as a whole, as promoting
physical activity among teenagers could
help lead them toward a more positive
lifestyle overall.

KATRINA WARDROPE

11th September
triggered hate crime
rise
There was a marked increase in hate
related violent crime against people
from or perceived to be from the
Middle East in the month after the
terrorist attacks in New York City and
Washington DC on September 11 2001.
(Injury Prevention 2003;9:187–9)

Researchers used the LexisNexis data-
base, which provides access to over
30 000 news sources, to collate media
reports on violent assaults of Middle
Easterners in the USA in the period
between 1 September and 11 October
2001. Of 100 incidents of violent crime
meeting the case definition (which
included homicides, physical assaults,
threats with a weapon, or attacks on
people in buildings such as drive by
shootings, explosions, or arson), only
one occurred before 9/11. More than
three quarters occurred within the 10
days immediately after the disaster.

The researchers recommend that tol-
erance promoting interventions must be
implemented as quickly as possible by
public health and criminal justice offi-
cials to be effective in pre-empting such
hate crimes. In addition, as many of the
crimes were perpetrated in businesses
owned or operated by minorities, such
as convenience stores and gas stations,
an increased police presence at these
locations would also be an important
step in the prevention of similar crimes
after such an event.

KATRINA WARDROPE

All articles written by Michael Muir
unless otherwise attributed.
BMJ Journals; mmuir@bmjgroup.com

www.jech.com

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