Health screenings administered during the domestic medical examination of refugees and other eligible immigrants in nine US states, 2014-2016: A cross-sectional analysis.

BACKGROUND: Refugees and other select visa holders are recommended to receive a domestic medical examination within 90 days after arrival to the United States. Limited data have been published on the coverage of screenings offered during this examination across multiple resettlement states, preventing evaluation of this voluntary program\u27s potential impact on postarrival refugee health. This analysis sought to calculate and compare screening proportions among refugees and other eligible populations to assess the domestic medical examination\u27s impact on screening coverage resulting from this examination. METHODS AND FINDINGS: We conducted a cross-sectional analysis to summarize and compare domestic medical examination data from January 2014 to December 2016 from persons receiving a domestic medical examination in seven states (California, Colorado, Minnesota, New York, Kentucky, Illinois, and Texas); one county (Marion County, Indiana); and one academic medical center in Philadelphia, Pennsylvania. We analyzed screening coverage by sex, age, nationality, and country of last residence of persons and compared the proportions of persons receiving recommended screenings by those characteristics. We received data on disease screenings for 105,541 individuals who received a domestic medical examination; 47% were female and 51.5% were between the ages of 18 and 44. The proportions of people undergoing screening tests for infectious diseases were high, including for tuberculosis (91.6% screened), hepatitis B (95.8% screened), and human immunodeficiency virus (HIV; 80.3% screened). Screening rates for other health conditions were lower, including mental health (36.8% screened). The main limitation of our analysis was reliance on data that were collected primarily for programmatic rather than surveillance purposes. CONCLUSIONS: In this analysis, we observed high rates of screening coverage for tuberculosis, hepatitis B, and HIV during the domestic medical examination and lower screening coverage for mental health. This analysis provided evidence that the domestic medical examination is an opportunity to ensure newly arrived refugees and other eligible populations receive recommended health screenings and are connected to the US healthcare system. We also identified knowledge gaps on how screenings are conducted for some conditions, notably mental health, identifying directions for future research

Health of Special Immigrant Visa holders from Iraq and Afghanistan after arrival into the United States using Domestic Medical Examination data, 2014-2016: A cross-sectional analysis.

BACKGROUND: Since 2008, the United States has issued between 2,000 and 19,000 Special Immigrant Visas (SIV) annually, with the majority issued to applicants from Iraq and Afghanistan. SIV holders (SIVH) are applicants who were employed by, or on behalf of, the US government or the US military. There is limited information about health conditions in SIV populations to help guide US clinicians caring for SIVH. Thus, we sought to describe health characteristics of recently arrived SIVH from Iraq and Afghanistan who were seen for domestic medical examinations. METHODS AND FINDINGS: This cross-sectional analysis included data from Iraqi and Afghan SIVH who received a domestic medical examination from January 2014 to December 2016. Data were gathered from state refugee health programs in seven states (California, Colorado, Illinois, Kentucky, Minnesota, New York, and Texas), one county, and one academic medical center and included 6,124 adults and 4,814 children. Data were collected for communicable diseases commonly screened for during the exam, including tuberculosis (TB), hepatitis B, hepatitis C, malaria, strongyloidiasis, schistosomiasis, other intestinal parasites, syphilis, gonorrhea, chlamydia, and human immunodeficiency virus, as well as elevated blood lead levels (EBLL). We investigated the frequency and proportion of diseases and whether there were any differences in selected disease prevalence in SIVH from Iraq compared to SIVH from Afghanistan. A majority of SIV adults were male (Iraqi 54.0%, Afghan 58.6%) and aged 18-44 (Iraqi 86.0%, Afghan 97.7%). More SIV children were male (Iraqi 56.2%, Afghan 52.2%) and aged 6-17 (Iraqi 50.2%, Afghan 40.7%). The average age of adults was 29.7 years, and the average age for children was 5.6 years. Among SIV adults, 14.4% were diagnosed with latent tuberculosis infection (LTBI), 63.5% were susceptible to hepatitis B virus (HBV) infection, and 31.0% had at least one intestinal parasite. Afghan adults were more likely to have LTBI (prevalence ratio [PR]: 2.0; 95% confidence interval [CI] 1.5-2.7) and to be infected with HBV (PR: 4.6; 95% CI 3.6-6.0) than Iraqi adults. Among SIV children, 26.7% were susceptible to HBV infection, 22.1% had at least one intestinal parasite, and 50.1% had EBLL (≥5 mcg/dL). Afghan children were more likely to have a pathogenic intestinal parasite (PR: 2.7; 95% CI 2.4-3.2) and EBLL (PR: 2.0; 95% CI 1.5-2.5) than Iraqi children. Limitations of the analysis included lack of uniform health screening data collection across all nine sites and possible misclassification by clinicians of Iraqi and Afghan SIVH as Iraqi and Afghan refugees, respectively. CONCLUSION: In this analysis, we observed that 14% of SIV adults had LTBI, 27% of SIVH had at least one intestinal parasite, and about half of SIV children had EBLL. Most adults were susceptible to HBV. In general, prevalence of infection was higher for most conditions among Afghan SIVH compared to Iraqi SIVH. The Centers for Disease Control and Prevention (CDC) Guidelines for the US Domestic Medical Examination for Newly Arriving Refugees can assist state public health departments and clinicians in the care of SIVH during the domestic medical examination. Future analyses can explore other aspects of health among resettled SIV populations, including noncommunicable diseases and vaccination coverage

Social Workers’ Perceptions of Working with People who have HIV/AIDS

This article presents the results of a cross-sectional online survey sent to a national sample of licensed social workers to examine their attitudes toward individuals living with HIV/AIDS. The survey included the AIDS Attitude Scale (Froman, Owen & Daisy, 1992), the HIV Knowledge Questionnaire-18 (Carey & Schroder, 2002), and the Modern Homonegativity Scale (Morrison & Morrison, 2002). Factors related to education, training, and other personal characteristics are explored. In this sample, 45% of the social workers indicated that more education and training would be beneficial to them in their current position, and greater HIV knowledge was associated with more positive attitudes toward people living with HIV/AIDS. Additionally, 57% of those surveyed indicated knowing someone personally who has HIV/AIDS, and demonstrated overall higher scores on empathy, and lower scores on avoidance. Those social workers who had higher avoidance of people living with HIV/AIDS were also found to be higher in homonegativity. The findings of this study add to the body of knowledge regarding social work attitudes, and provide further insight into an area with little existing data. The authors propose further research to identify causes of attitudes, potential gender and cultural differences, and the impact of the National Association of Social Workers Code of Ethics on social workers’ attitudes

Health of Asylees Compared to Refugees in the United States Using Domestic Medical Examination Data, 2014-2016: A Cross-Sectional Analysis.

Background: Between 2008 and 2018, persons granted asylum (asylees) increased by 168% in the United States. Asylees are eligible for many of the same domestic benefits as refugees under the US Refugee Admissions Program (USRAP), including health-related benefits such as the domestic medical examination. However, little is known about the health of asylees to guide clinical practice. Methods: We conducted a retrospective cross-sectional analysis of domestic medical examination data from 9 US sites from 2014 to 2016. We describe and compare demographics and prevalence of several infectious diseases such as latent tuberculosis infection (LTBI), hepatitis B and C virus (HBV, HCV), and select sexually transmitted infections and parasites by refugee or asylee visa status. Results: The leading nationalities for all asylees were China (24%) and Iraq (10%), while the leading nationalities for refugees were Burma (24%) and Iraq (19 %). Approximately 15% of asylees were diagnosed with LTBI, and 52% of asylee adults were susceptible to HBV infection. Prevalence of LTBI (prevalence ratio [PR] = 0.8), hepatitis B (0.7), hepatitis C (0.5), and Strongyloides (0.5) infections were significantly lower among asylees than refugees. Prevalence of other reported conditions did not differ by visa status. Conclusions: Compared to refugees, asylees included in our dataset were less likely to be infected with some infectious diseases but had similar prevalence of other reported conditions. The Centers for Disease Control and Prevention\u27s Guidance for the US Domestic Medical Examination for Newly Arrived Refugees can also assist clinicians in the care of asylees during the routine domestic medical examination

Blood Lead Levels Among Afghan Children in the United States, 2014-2016

Lead poisoning disproportionately affects children and can result in permanent neurologic damage.1 Although blood lead levels (BLLs) declined among children in the United States over the past several decades, children resettling to the United States from other countries emerged as a population at risk for BLLs that are higher than the United States blood lead reference value of $5 mg/dL at the time of this analysis.2 Among children screened for lead shortly after resettlement, children from Afghanistan have a higher prevalence of BLLs$5 mg/dL compared with children from other countries,3,4 but timely sources of data available for analysis are limited. In 2021, the United States troop withdrawal from Afghanistan prompted the rapid evacuation and resettlement of more than 76 000 Afghans to the United States.5 We analyzed existing data from domestic medical examinations (DMEs) conducted from 2014 to 2016 for refugees and eligible populations #90 days after arrival in multiple states. We described and compared the prevalence of BLL $5 mg/dL among Afghan and non-Afghan refugee children screened and evaluated select characteristics associated with BLL$5 mg/dL among Afghan children

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome

Influence of polypharmacy on 30-day readmission rates among Medicare recipients

Background: As chronic diseases become increasingly treatable, the American population continues to experience longer lifespans. These longer lifespans place further burden on federally funded healthcare programs, including Medicare. Established by the Affordable Care Act, the Hospital Readmissions Reduction Program (HRRP) was created to address hospitals with excessive readmissions. The 30-day All-Cause Hospital Readmission measure objectively evaluates the level of care and identifies areas in need of improvement within hospitals. The goal of the measure is to provide better quality care to patients and reduce 30-day readmissions. In this study, we aimed to investigate the influence of polypharmacy on 30-day readmissions among Medicare patients. Methods: Gateway Health Medicare members with at least one inpatient hospital discharge during 2016 was the target population for this investigation. To be included in the study, members were required to have been continuously enrolled in a Gateway Health Medicare plan for at least one year prior to their first admission, and for at least thirty days after being discharged. 9,414 Gateway Health Medicare members, including both disabled and aged beneficiaries, met the study eligibility requirements. Multivariate logistic regression analysis was used to determine the relationship between polypharmacy (concurrent use of 5 or more medication) and 30-day readmission, adjusting for age, race/ethnicity, gender, Significant Persistent Mental Illness (SPMI) flag, and the location the member was discharged to after the inpatient hospital admission. Results: Polypharmacy use (OR 2.0, 95% CI 1.7 – 2.2), discharge to Home Healthcare (HHC) (OR: 1.4, 95% CI: 1.2, 1.6), discharge to Skilled Nursing Facility (SNF) (OR: 1.9, 95% CI: 1.7, 2.2), and a SPMI flag (OR: 1.9, 95% CI: 1.5, 2.4) were associated with a higher risk of 30-day readmission. Conclusion: The results of this study indicate several characteristics which, in addition to polypharmacy, increase an individual’s risk of 30-day readmission. Polypharmacy individuals often have complex medical conditions and comorbidities which pose unique challenges to recovery. Addressing individuals’ medication burden prior to discharge, improving HHC, and expanding mental health services could lead to a reduction in 30-day readmissions in this vulnerable population. By focusing on a non-traditional barrier to care, hospitals can provide better care for their patients and improve public health in the surrounding communities

PERSPECTIVES ON SOCIAL WORK VOLUME 11 (FALL 2015)

This is the full-text volume of Perspectives on Social Work, vol. 11 (Fall 2015)

Phage therapy in a lung transplant recipient with cystic fibrosis infected with multidrug-resistant Burkholderia multivorans

BackgroundThere is increased interest in bacteriophage (phage) therapy to treat infections caused by antibiotic-resistant bacteria. A lung transplant recipient with cystic fibrosis and Burkholderia multivorans infection was treated with inhaled phage therapy for 7 days before she died.MethodsPhages were given via nebulization through the mechanical ventilation circuit. Remnant respiratory specimens and serum were collected. We quantified phage and bacterial deoxyribonucleic acid (DNA) using quantitative polymerase chain reaction, and tested phage neutralization in the presence of patient serum. We performed whole genome sequencing and antibiotic and phage susceptibility testing on 15 B. multivorans isolates. Finally, we extracted lipopolysaccharide (LPS) from two isolates and visualized their LPS using gel electrophoresis.ResultsPhage therapy was temporally followed by a temporary improvement in leukocytosis and hemodynamics, followed by worsening leukocytosis on day 5, deterioration on day 7, and death on day 8. We detected phage DNA in respiratory samples after 6 days of nebulized phage therapy. Bacterial DNA in respiratory samples decreased over time, and no serum neutralization was detected. Isolates collected between 2001 and 2020 were closely related but differed in their antibiotic and phage susceptibility profiles. Early isolates were not susceptible to the phage used for therapy, while later isolates, including two isolates collected during phage therapy, were susceptible. Susceptibility to the phage used for therapy was correlated with differences in O-antigen profiles of an early versus a late isolate.ConclusionsThis case of clinical failure of nebulized phage therapy highlights the limitations, unknowns, and challenges of phage therapy for resistant infections.A critically ill lung transplant recipient with CF and B. multivorans sepsis was treated with phage therapy for 7 days before they died. We investigated phage and antibiotic susceptibility of serial B. multivorans isolates collected from the patient as well as phage pharmacokinetics and immune responses.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/176290/1/tid14041_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/176290/2/tid14041-sup-0002-figureS1-S2.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/176290/3/tid14041.pd