Health of War-Affected Karen Adults 5 Years Post-Resettlement

Background: An estimated 140 000 refugees from Burma have resettled to the USA since 2009, comprising 21% of total resettlement in the USA over the last decade. Our objective was to describe patterns of longitudinal health outcomes in a cohort of Karen refugees resettled in the USA for 5 years, and to translate these findings to a primary healthcare context. Methods: The study was a retrospective cohort study focused on the analysis of the first 5 years of electronic health records of a sample of 143 Karen refugees who were initially resettled between May 2011 and May 2013. Results: Through descriptive, inferential and survival statistics, we described patterns of retention in primary care, biometric trends, condition prevalence and survival probabilities. Highest prevalence health conditions documented at any point in the 5-year period included diagnoses or symptoms associated with pain (52%); gastrointestinal disturbance (41%); metabolic disorder (41%); infectious process (34%); mental health condition (31%) and central nervous system disorder (24%). Conclusions: This study is the first retrospective longitudinal analysis of patterns of health in Karen refugees originating from Burma and resettled to the USA. Findings identified in the 5-year, the post-resettlement period provided important clinical insights into the health trajectories of war-affected populations. Burden of illness was high although results did not demonstrate the extent of trauma-associated physical health conditions reported in the literature. Indicators such as significant increases in body mass index (BMI), the overall prevalence of dyslipidaemia and others suggested that the cohort may be exhibiting an early trajectory towards the development of these conditions. Authors summarize potential protective factors experienced by the cohort that promoted aspects of health frequently challenged in forced migration

Effect of approach side during anterior cervical discectomy and fusion on the incidence of recurrent laryngeal nerve injury

N designing this study, we were motivated by the diversity of opinions among neurosurgeons, otolaryngologists, and speech pathologists at our institution regarding the effect of approach side on the incidence of RLN injury after ACS surgery. As indicated later in this section, a thorough review of the available literature did not resolve the issue. In 2003 Ghanayem 9 summarized the situation this way: "The question as to whether the right recurrent laryngeal nerve is at greater injury (risk) than the left remains unanswered." At our institution, a relatively large number of ACDF procedures are performed from both the right and the left sides, affording us an opportunity to perform a retrospective study of this issue. We report the results of this study. Numerous authors have documented the incidence of RLN injury after ACS surgery. 3 Studies favoring either a right-or a left-sided approach are found in the literature. 2,3 These two retrospective studies found that side of approach had no influence on the incidence of RLN injury. However, we believe that the results of these studies were confounded by a relatively small sample size 2 and nonhomogeneity of the Effect of approach side during anterior cervical discectomy and fusion on the incidence of recurrent laryngeal nerve injury CRAIG KILBURG, HUMBERT G. SULLIVAN, M.D., AND MICHELLE A. MATHIASON, M.S. Department of Neurosurgery, Gundersen Lutheran Medical Center, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin Object. This retrospective study was designed to determine whether side of approach during instrumented, one-or two-level primary anterior cervical discectomy and fusion (ACDF) affects the incidence of recurrent laryngeal nerve (RLN) injury diagnosed by observation of the vocal cords (OVC). Methods. Records of all patients who underwent one-or two-level instrumented primary ACDF (418 patients) between January 1995 and February 2004 were reviewed. Data collected from these charts included surgeon, patient demographics, preoperative diagnosis, side of exposure, number of vertebral levels fused, and presence of RLN injury diagnosed by OVC after referral for persistent dysphonia. Time from surgery to OVC for patients with right-sided exposures was not statistically different from that for patients with left-sided exposures. Of 418 patients, 278 (66.5%) had right-sided exposures and 140 (33.5%) had left-sided exposures. Eight RLN injuries (1.9%) were noted-five in patients with right-sided exposures (1.8%) and three in patients with left-sided exposures (2.1%). The difference between right-and left-sided injury rates was shown to be nonsignificant using Fisher exact tests. Conclusions. Results indicate that, given the study's sample size, side of approach during instrumented, one-or twolevel primary ACDF has no significant effect on RLN injury incidence in patients with persistent dysphonia referred for OVC. The definitive answer regarding the true incidence of RLN injury relative to approach side awaits a prospective study with preoperative, immediate postoperative, and periodic OVC in a large, homogeneous population with sufficient numbers of patients with right-and left-sided approaches. KEY WORDS • anterior cervical discectomy and fusion • surgical complication • recurrent laryngeal nerve injury 273 Abbreviations used in this paper: ACDF = anterior cervical discectomy and fusion; ACS = anterior cervical spine; OVC = observation of the vocal cords; RLN = recurrent laryngeal nerve; VFMI = vocal fold motion impairment

Peer Group and Text Message–Based Weight-Loss and Management Intervention for African American Women

About 80% of African American (AA) women are overweight or obese. Accessible and effective weight management programs targeting weight loss, weight maintenance and the prevention of weight regain are needed to improve health of AA women. A feasibility study was conducted to examine the feasibility, acceptability, and potential efficacy of a 16-week intervention protocol for weight loss and management that combined daily text messages and biweekly peer group sessions. Modest but statistically significant reductions were detected in weight and body mass index from baseline to 16 weeks. At baseline, 36% of participants were in action and maintenance stages in measures of the stages of change for weight loss and management; this percent increased to 82% at 16 weeks. Findings of this feasibility study provide preliminary evidence of an educational intervention that could motivate women and lead to successful behavior change, and successful weight loss and management for AA women

Associations Between Gender, Torture, and Health: A 5-Year Retrospective Cohort Analysis

Our purpose was to identify longitudinal associations between torture exposure, physical and mental health outcomes, and gender in a cohort of 143 war-affected Karen adults five years post resettlement. Results showed that participants who self-reported primary torture experiences had higher rates of certain mental and physical health diagnoses. We observed gender differences in health over time in the cohort. Findings have implications for how primary care and public health providers implement war trauma screening tools and timelines, targeted healthcare services, and community resources to promote health and prevent disease in populations that have trauma from torture or war

Data from: A strengths-based data capture model: mining data-driven and person-centered health assets

With healthcare policy directives advancing value-based care, risk assessments and management have permeated healthcare discourse. The conventional problem-based infrastructure defines what data are employed to build this discourse and how it unfolds. Such a healthcare model tends to bias data for risk assessment and risk management toward problems and does not capture data about health assets or strengths. The purpose of this paper is to explore and illustrate the incorporation of a Strengths-based Data Capture Model into risk assessment and management by harnessing data-driven and person-centered health assets using the Omaha System. This Strengths-based Data Capture Model encourages and enables use of whole-person data including strengths at the individual level and, in aggregate, at the population level. When aggregated, such data may be used for the development of strengths-based population health metrics that will promote evaluation of data-driven and person-centered care, outcomes and value

Physical Correlates of Torture Exposure in Karen Refugees

We explored associations between torture history and physical health symptoms of 111 Karen refugees newly arrived to the United States. We conducted a retrospective cross-sectional analysis of electronic health data collected at the initial refugee health-screening exam. Unique to this analysis was the exploration of relationships between torture exposure, war trauma, and presenting physical and psychological health issues. We identified no unique effects of torture on physical health above and beyond trauma exposure. Overall, in our sample we found a high prevalence of underlying infectious conditions, pain, and hypercholesterolemia, regardless of torture exposure. We discuss effects of war trauma and torture experiences on physical exam findings and implications for future research