Unmet Needs of Unaccompanied Minors from Central America: Perceptions of Professionals from Multiple Sectors

Background: In recent years, there has been a significant influx of Central American youth who cross the U.S.-Mexico border without a parent or legal guardian. While federal procedures are established to oversee the treatment and placement of unaccompanied minors, less is known about the needs of unaccompanied minors and available services afterthey are placed in appropriate custody. Methods: Purposive and strategic sampling of professionals from medical, social work, education and legal fields was conducted. Fourteen informants were recruited across the U.S. for confidential semi-structured interviews, which were audio recorded and transcribed in 2016 to 2017. Standard anthropological methods were employed, including immersion and crystallization techniques that incorporated within-case and across-case analytic strategies. Results: Recruited informants had previous or current direct experience working with immigrant minors for three or more years in addition to extensive public health experience. Unaccompanied minors were described as predominantly adolescent boys, ranging from 2 to 18 years old. Children faced unmet mental, medical and psychosocial needs that are interconnected and largely unmet due to children’s legal status and ineligibility to access services in most jurisdictions. The most pressing challenge affecting the health of youth was their immigration status. Across sectors,informants revealed an imbalance between the growing demand for services, including legal counsel, and the limited supply of professionals and well-funded services to meet children’s complex needs. Informants emphasized the value of trauma-informed practice, Spanish language proficiency, child-informed practice and intercultural awareness and humility towards their clients as key features of equipped professionals working with this vulnerable population. Regardless of sector, professionals emphasized the importance of culturally-informed care to immigrant youth. Building these skills is associated with greater confidence to provide services to unaccompanied minors, many of whom have experienced as significant burden of childhood trauma. Conclusions: The health needs of unaccompanied minors are complex and span across medical, social work, education, and legal fields. Interdisciplinary collaboration is needed to address the challenges faced by unaccompanied minors in their efforts to integrate themselves into their new communities and promote their resilience. Promising initiatives include co-location of inter-sector services for increased access and efficiency of services and development of professional trainings and resources for professionals in sectors that serve this population

The Relationship between Parental Educational Attainment and Perceived Racial Discrimination among African-American Female Adolescents

Background: Perceived racial discrimination acts as a considerable stressor for African- Americans and is associated with adverse health outcomes among adults and adolescents. The relationship between perceived discrimination and socioeconomic dimensions has been studied among adult African-American populations to assess the role of social patterning in reports of discrimination. However, less is known about the relationship between parental educational attainment and adolescents’ perceived discrimination. Methods: We explored the relationship between parental educational attainment and adolescents’ reports of racial discrimination using written surveys from 135 African-American female adolescents seeking family planning services at an urban hospital-based adolescent clinic in Pennsylvania. Dimensions of perceived discrimination that were captured in this study included personal experiences, vicarious racial discrimination, and perceived discrimination against African-Americans as a group. Parental educational attainment was categorized as “some or completed high school/GED” and “some or completed college.” To account for missing parental education data, a sensitivity analysis was performed in which missing data were recoded into parental education categories and used in chi-square cross tabulations. Results: Most of the sample (mean age = 17.04; SD = 1.33) had completed high school or were currently enrolled in school, and were living in single-parent homes. Close to half (41.5%) of respondents did not know their father’s educational attainment, and 17.8% did not know their mother’s educational attainment. To account for missing education data, a sensitivity analysis was performed, which revealed no significant association between parental educational attainment and adolescents’ perceived discrimination. However, although the respondents in our study do not appear to experience frequent discrimination, 85.9% reported at least one dimension of discrimination measured in this study. Conclusions: The large percentage of African-American female adolescents who reported at least one dimension of discrimination implies an added burden and vulnerability to social stressors in their life

Estudio químico-cuántico de los defectos producidos por las vacancias de oxígeno en los cristales de Titanato de plomo PbTiO3

Estudio químico-cuántico de los defectos producidos por las vacancias de oxígeno en los cristales de Titanato de plomo PbTiO

Estudio químico-cuántico de los defectos producidos por las vacancias de oxígeno en los cristales de Titanato de plomo PbTiO3

Estudio químico-cuántico de los defectos producidos por las vacancias de oxígeno en los cristales de Titanato de plomo PbTiO

Fatty Liver and the Coronavirus Disease 2019 Pandemic: Health Behaviors, Social Factors, and Telemedicine Satisfaction in Vulnerable Populations

The coronavirus disease 2019 (COVID-19) pandemic has impacted health-related behaviors that influence fatty liver disease (FLD) management. We evaluated the impact of the pandemic on FLD management and satisfaction with care delivery in this population. In the San Francisco safety-net hepatology clinics, we evaluated health-related behaviors and factors associated with self-reported weight gain during the COVID-19 pandemic as well as satisfaction with telemedicine in adults with FLD by using multivariable modeling. From June 1, 2020, to May 5, 2021, 111 participants were enrolled. Median age was 52 years, 30% were men, 63% were Hispanic, 21% were Asian/Pacific Islander, and 9% were White. Eating habits were unchanged or healthier for 80%, physical activity decreased in 51%, 34% reported weight gain, and 5% reported increased alcohol intake. Forty-five percent had severe depressive symptoms, 38% in those without diagnosed depression and 60% of individuals with heavy alcohol use. On multivariable analysis, decreased physical activity (odds ratio [OR], 4.8) and heavy alcohol use (OR, 3.4) were associated with weight gain (all P < 0.05). Among those with telemedicine visits (n = 66), 62% reported being very satisfied. Hispanic ethnicity was associated with a 0.8-unit decrease in the telemedicine satisfaction score (P = 0.048) when adjusting for sex, age, and pandemic duration. Conclusion: During the pandemic, decreased physical activity and heavy alcohol use were most influential on self-reported weight gain in FLD. Maintenance of healthy eating and increased physical activity, alcohol cessation counseling, and mental health services are critical in preventing poor FLD-associated outcomes during the pandemic recovery. Dissatisfaction with telemedicine should be explored further to ensure equitable care, especially among the vulnerable Hispanic population

Cross‐sectional study on stigma and motivation to adhere to lifestyle modification among vulnerable populations with fatty liver disease

ObjectivesAdherence to lifestyle modification (diet, exercise, and alcohol cessation) for fatty liver disease (FLD) management remains challenging. The study examined stigma, barriers, and factors associated with motivation to adhere to lifestyle modification in a diverse and vulnerable population with FLD.MethodsFrom 2/19/2020 to 2/28/2022, 249 FLD patients within San Francisco safety-net hepatology clinics were surveyed along with clinical data taken from medical records. Multivariable modeling assessed factors associated with motivation to adhere to lifestyle modification in a cross-sectional study.ResultsMedian age was 53 years, 59% female, 59% Hispanic, 25% Asian/Pacific Islander, 9% White, and 2% Black, 79% were non-English speakers, 64% had ≤ high school education, and 82% reported <$30,000 annual income. Common comorbidities included hyperlipidemia (47%), hypertension (42%), diabetes (39%), and heavy alcohol use (22%). Majority (78%) reported experiencing stigma, 41% reported extreme motivation, and 58% reported ≥ two barriers. When controlling for age, sex, Hispanic ethnicity, alcohol consumption, BMI, >high school (coef 1.41, 95% CI 0.34-2.48), stigma (coef 0.34, 95% CI 0.07-0.62), and depression (coef -1.52, 95% CI -2.79 to -0.26) were associated with motivation.ConclusionsStigma is commonly reported among FLD patients. Interventions to enhance patient education and mental health support are critical to FLD management, especially in vulnerable populations

Black Adolescent Females’ Perceptions of Racial Discrimination When Accessing Reproductive and General Health Care

Adolescents, like adults, frequently experience discrimination, which can be particularly salient in the context of reproductive health care. We examined urban Black adolescent females’ perceived experiences of racial discrimination during reproductive health care encounters. Structured face-to-face interviews were conducted with female African American patients, from age 13 through 20, who obtained reproductive health care services at a single site. Twenty-four participants were enrolled. All were in or graduated from high school, with a mean age of 16.8 years. These young Black women reported infrequent race-based discrimination in the health care setting; however, many reported commonly experiencing discrimination in other places. An awareness of the discrimination that minority young women experience in non–health care settings can help providers demonstrate cultural humility when addressing such concerns with their patients. With this information, providers can provide anticipatory guidance and the tools necessary to navigate complex social systems