Adverse effects of the antimalaria drug, mefloquine: due to primary liver damage with secondary thyroid involvement?

BACKGROUND: Mefloquine is a clinically important antimalaria drug, which is often not well tolerated. We critically reviewed 516 published case reports of mefloquine adverse effects, to clarify the phenomenology of the harms associated with mefloquine, and to make recommendations for safer prescribing. PRESENTATION: We postulate that many of the adverse effects of mefloquine are a post-hepatic syndrome caused by primary liver damage. In some users we believe that symptomatic thyroid disturbance occurs, either independently or as a secondary consequence of the hepatocellular injury. The mefloquine syndrome presents in a variety of ways including headache, gastrointestinal disturbances, nervousness, fatigue, disorders of sleep, mood, memory and concentration, and occasionally frank psychosis. Previous liver or thyroid disease, and concurrent insults to the liver (such as from alcohol, dehydration, an oral contraceptive pill, recreational drugs, and other liver-damaging drugs) may be related to the development of severe or prolonged adverse reactions to mefloquine. IMPLICATIONS: We believe that people with active liver or thyroid disease should not take mefloquine, whereas those with fully resolved neuropsychiatric illness may do so safely. Mefloquine users should avoid alcohol, recreational drugs, hormonal contraception and co-medications known to cause liver damage or thyroid damage. With these caveats, we believe that mefloquine may be safely prescribed in pregnancy, and also to occupational groups who carry out safety-critical tasks. TESTING: Mefloquine's adverse effects need to be investigated through a multicentre cohort study, with small controlled studies testing specific elements of the hypothesis

From brain drain and brain gain to brain circulation: conceptualizing re-expatriation intentions of Vietnamese returnees

Much of the extant literature in the field of brain circulation has tended to focus on talented individuals leaving their home countries (brain drain) or talented graduate/professionals returning to their home countries (reverse brain drain). As part of its economic strategy to transform its economy, Vietnam has adopted measures aimed at tackling skill shortages and reversing the so-called “brain drain” by attracting back overseas Vietnamese graduates/professionals. This reversal, however, may be temporary as Vietnamese returnees may go abroad again (in other words, re-expatriate), if for example, they are unhappy and do not adjust well to their home country. This paper reviews research on the reasons behind why Vietnamese returnees who have studied and/or worked abroad in advanced/developed economies, and have returned to Vietnam, may decide to re-expatriate on their own initiative. We find that intentions to re-expatriate are affected by different pull and push factors associated with the home and host countries. Vietnamese returnees are pulled abroad by host country attraction (e.g. higher salaries and better job opportunities), and pushed away from their home country by home country dissatisfaction (e.g. dissatisfaction with the working environment in Vietnam). Further, negative re-entry experiences (e.g. reverse culture shock and poor cross-cultural readjustment) may prompt Vietnamese returnees to consider re-expatriating. This chapter adds to the limited number of studies on brain circulation and re-expatriation of returnees in emerging economies. It contributes to theory by developing a conceptual framework of factors affecting the re-expatriation intentions of returnees in the context of an emerging economy, notably Vietnam. It also offers a number of implications for the Vietnamese government and managers with respect to retaining Vietnamese returnees

When You have Lived in a Different Culture, Does Returning ‘Home’ not Feel like Home? Predictors of Psychological Readjustment to the Heritage Culture

Many repatriates find it challenging to readjust to their heritage culture after spending a significant period of time abroad. Research on predictors of readjustment, however, remains limited. The present study in particular investigated the identification of third culture individuals (TCIs) – that is, individuals who spent their formative years outside of their heritage culture - with an abstract, third culture. Our findings demonstrated that TCIs’ identification with the third culture was empirically distinct from that of the heritage and host cultures. The present study further examined whether several variables – sojourner type (TCI vs. non-TCI), perceived conflict between heritage and host culture, perceived cultural distance, and cultural identification with heritage and other cultures – predicted psychological readjustment (stress, anxiety, depression and overall psychological readjustment). The results showed that strong heritage culture identification was associated with better psychological readjustment, whereas cultural conflict was generally associated with poorer readjustment. Furthermore, sojourner type significantly moderated the latter association, such that cultural conflict predicted the stress aspect of psychological readjustment for non-TCIs, but not for TCIs. As the present investigation is the first study to empirically establish identification with a ‘third culture’ we discuss implications for the literature on third culture individuals and psychological adjustment upon re-entry

Revisiting repatriation concerns: organizational support versus career and contextual influences

This paper reviews and integrates two perspectives on repatriate retention: a traditional one, which suggests that the main determinant of repatriate retention is the availability of repatriation support programs; and an emerging one, which focuses on individual career activism in a changing employment context. Results of a study of 133 expatriates from 14 MNCs indicate that both views contribute to our understanding of repatriate retention. Building on the results of our study, we put forward a framework to guide future research. Journal of International Business Studies (2007) 38, 404–429. doi:10.1057/palgrave.jibs.8400273