A Qualitative Metasynthesis of Published Research Exploring the Pregnancy and Resettlement Experience Among Refugee Women

The number of refugees and asylum seekers throughout the world continues to increase, leading to increasing challenges in meeting healthcare needs of these individuals. Women’s antenatal health is of particular concern due to their vulnerability to sexual violence and the substantial proportion of refugees consisting of women and girls of or nearing reproductive age. The purpose of this qualitative metasynthesis was to integrate and interpret findings from previously published research reports in which authors explored aspects of pregnancy among resettled refugee women. Following a systematic search process, we used Dedoose qualitative data analysis software to manage the process of extracting and condensing data from primary sources. We developed themes including: comparing pregnancy care in resettlement with care at home; navigating unfamiliar language and cultural practices; making meaning through pregnancy and associated healthcare experiences. Our analysis revealed authors used thematic analysis regardless of research design, limiting the range of reported findings. Prior research focused on identifying challenges to pregnancy in resettlement; our findings expand this by considering how women navigate and make meaning from challenges. Service providers might encourage mentally healthy resettlement by guiding refugees to consider differences in an open-minded rather than judgmental attitude that respects old and new cultures

Developing Continuing Education for Ohio’s Local Boards of Health

Background: Public health functions at the county level and city level through the work of local health departments (LHDs). Local boards of health (LBoHs) work closely with LHDs as an administrative oversight body. In 2013, legislation was passed in the state of Ohio pertaining to the accreditation of LHDs, which included a provision requiring that Ohio’s LBoH members engage in 2 hours of continuing education (CE) per year. To assist LBoHs in fulfilling these requirements, a partnership was developed between the Ohio Association of Boards of Health (OABH) and the Kent State University College of Public Health (KSU-CPH) to deliver CE content. Methods: The process for developing the CE modules encompasses 3 steps: (1) needs assessment, (2) module development and delivery, and (3) evaluation. Feedback was solicited from Ohio’s LBoH members to determine topics of interest for CE modules. Taking this feedback, a curated set of 8 modules will be developed. Module content will be derived from graduate courses within KSU-CPH as well as from subject matter experts. The modules will be delivered online to LBoH members during their regularly scheduled meetings. Results: This program proposes to fulfill state requirements that LBoH members regularly engage in CE. Partner-ing with KSU-CPH allows for the use of academic content in these trainings. Conclusion: An adequately trained public health workforce is essential for a well-functioning public health system, which includes governing entities like LBoHs. There is limited understanding of how workforce development can be targeted specifically to LBoHs. This CE program contributes to current efforts to promote workforce development within the field of public health

On Being a Former Student Editor in the Midst of a Pandemic

https://kent-islandora.s3.us-east-2.amazonaws.com/node/10700/11458-thumbnail.jpgThe unfolding of the coronavirus pandemic is a pivotal moment, one that will shape us individually and collectively for years to come. Experiencing these events as an early career public health professional has brought to mind lessons I have learned about the value of public health evidence. Having reliable information in this time is critical, particularly as we are called to do our part in curbing the spread of the virus through social distancing. As a public health professional, I support my personal network of family and friends by sharing meaningful evidence. I share information to stay connected and highlight how public health works and what we know about this novel virus, and I offer a perspective on what the mitigation efforts we are living through mean for our health. Within my state, this includes watching a daily press conference hosted by the governor of Ohio, reading updates from my colleagues in epidemiology, and searching emerging research for information about the virus. Lessons in how to evaluate evidence were among the most important that I learned through my doctoral studies. Experience in how to do so was bolstered by my role as the first student editor of&nbsp;AJPH. By working with editor-in-chief Alfredo Morabia, MD, PhD, and the entire editorial team of the&nbsp;Journal, I learned the value of strong public health evidence and how to identify it. I developed these skills by working with associate editors as they made decisions about which articles to feature and about finding leading public health professionals to provide editorials. Through these activities, I strengthened my ability to think critically about evidence, observed firsthand how evidence is vetted, and participated directly in the important work of the&nbsp;Journal. I also acquired insight into how important the dissemination of research is. Sharing evidence and results with the broader community is an essential piece of the research process. Through my experience as student editor, I acquired a deep appreciation for this process that I now apply to my own work as a postdoctoral researcher. This has become particularly relevant in these times, as wide dissemination of evidence about coronavirus is informing the actions taken at all levels of the public health system. When I view these experiences in light of the current pandemic, it is clear that the work of public health is continual and that new evidence emerges about this novel coronavirus every day. It is essential to determine what is factual and accurate and to promote information that helps others take needed and appropriate action. News reports have applauded the efforts of Ohio’s Governor DeWine and health director Amy Acton, MD, MPH, for their work in implementing evidence-based social-distancing measures early, while working to educate the public on how to “flatten the curve.” Social-distancing measures have been in place in Ohio since early March, beginning with the closure of the 2020 Arnold Classic, a fitness expo in Columbus, Ohio, that brings together athletes from more than 80 countries and 60 000 spectators. With the closure of Ohio’s universities shortly thereafter, I found myself undertaking completely virtual work. No one has been left untouched by these widespread mitigation efforts, and while we all adjust to this “new normal,” it is important not to lose sight of the facts and evidence that inform these policies. Each day, I am reminded about the power of information and evidence, and I actively promote its importance. Public health professionals are working tirelessly across the globe to develop and share the necessary evidence that will help us, as a global society, emerge from this pandemic safely.</p

Factors Associated with the Presence of Strong Social Supports in Bhutanese Refugee Women During Pregnancy

Social support may mitigate stress related to the refugee experience, including during resettlement. For refugee women, social support can play an important role during pregnancy. In-depth interviews were conducted within a sample of 45 Bhutanese refugee women. Perceived social support was measured using the Norbeck Social Support Questionnaire. Averaged social support scores are reported to account for personal network size. Participants were identified as “low support” and “high support” based on their reported score. The mean social support score reported was 18.9. Participants experiencing a secondary resettlement within the U.S. were 4.52 (95% CI 1.19–17.15) times as likely to report a “high support” network compared to participants who resettled directly from Nepal. Personal social networks are an important source of support for resettled refugee women during pregnancy in the U.S.. Refugee women who experience secondary resettlement may perceive stronger support from their personal connections

Tumor-conditional anti-CTLA4 uncouples antitumor efficacy from immunotherapy-related toxicity

While immune checkpoint blockade leads to potent antitumor efficacy, it also leads to immune-related adverse events in cancer patients. These toxicities stem from systemic immune activation resulting in inflammation of multiple organs, including the gastrointestinal tract, lung, and endocrine organs. We developed a dual variable domain immunoglobulin of anti-CTLA4 antibody (anti-CTLA4 DVD, where CTLA4 is defined as cytotoxic T lymphocyte-associated antigen-4) possessing an outer tumor-specific antigen-binding site engineered to shield the inner anti-CTLA4-binding domain. Upon reaching the tumor, the outer domain was cleaved by membrane type-serine protease 1 (MT-SP1) present in the tumor microenvironment, leading to enhanced localization of CTLA4 blockade. Anti-CTLA4 DVD markedly reduced multiorgan immune toxicity by preserving tissue-resident Tregs in Rag 1-/- mice that received naive donor CD4+ T cells from WT C57BL/6j mice. Moreover, anti-CTLA4 DVD induced potent antitumor effects by decreasing tumor-infiltrating Tregs and increasing the infiltration of antigen-specific CD8+ T lymphocytes in TRAMP-C2-bearing C57BL/6j mice. Treg depletion was mediated through the antibody-dependent cellular cytotoxicity (ADCC) mechanism, as anti-CTLA4 without the FcγR-binding portion (anti-CTLA4 DANA) spared Tregs, preventing treatment-induced toxicities. In summary, our results demonstrate an approach to anti-CTLA4 blockade that depletes tumor-infiltrating, but not tissue-resident, Tregs, preserving antitumor effects while minimizing toxicity. Thus, our tumor-conditional anti-CTLA4 DVD provides an avenue for uncoupling antitumor efficacy from immunotherapy-induced toxicities