An Overview of the Health Profile of Syrian Refugees Arriving in Kentucky from 2012-2017

Background: The civil unrest in Syria has led to millions of displaced Syrians. The United States has relocated over 15,000 Syrian refugees, mostly arriving since 2015. Little is known about the health of Syrian refugees entering the United States. Methods: Syrian refugees in Kentucky who had a medical screening and documented RHA from October 2012 to September 2017 were included in the study. The information is collected and stored in the Arriving Refugee Informatics Surveillance and Epidemiology (ARIVE) database. This study is a retrospective review of the ARIVE database to describe the general health of the Syrian refugees arriving to Kentucky which can be generalized to those arriving to other states. Results: A total of 521 Syrian refugees had a complete RHA from October 2012 to September 2017. The top diagnosed conditions in Syrian refugee adults included dental conditions, elevated BMI, hematuria, vision changes and anemia. The top diagnosed conditions in Syrian refugee children included low BMI, dental conditions, hematuria, vision changes and anemia. Adult Syrian males had significantly higher cardiovascular risk factors compared to adult females. Conclusions: Syrian refugees often have chronic conditions that require long term management, aggressive risk stratification and preventative health measures. Effective primary and preventative care is therefore essential to limit the long-term tertiary complications as they integrate into the local communit

Intestinal Parasite Burden and Pre-Departure Treatment Compliance in Kentucky Refugee Children: A Descriptive Study

Objective: Children are 1/2 of the world’s refugees and often have intestinal parasites. This study seeks to determine the intestinal burden and pre-departure treatment of Kentucky pediatric refugees. Methods: This is a chart review of Kentucky pediatric refugee health screening data from 2012-2017. Stool culture results from children arriving through refugee camps were compared to non-camp children. They were placed into 3 regional groups and analyzed based on CDC pre-departure treatment recommendations. Results: Of the 3,199 records, 1,653 had stool testing. 354 (51%) refugee camp children tested positive compared to 326 (33.9%) non-camp children. Giardia and Blastocystis were most commonly identified. Treatment aligned with CDC guidelines 64.7% of the time. CDC compliance was 83%, 79.8%, and 30.2% from Regions 1, 2, and 3 respectively. Discussion: Pre-departure treatment of pediatric refugees needs improved compliance with CDC recommendations through education of refugee camp workers. Giardia and Blastocystis are common and metronidazole is recommended for symptomatic children

Healthcare Barriers for Congolese Refugee Children in Louisville, KY: Parental Perception and Narratives through Focus Group Discussions

Background: There are up to 3500 refugees who resettle in Kentucky annually with 66% of refugee children originating from the Democratic Republic of the Congo. Little is known about the barriers to healthcare perceived by Congolese parents. This information can direct interventions to improve the care of these children. Methods: Focus group discussions (FGD) were used to allow families to share personal anecdotes, compare experiences, and encourage discussion between group members. Between August 2018 to May 2020, three FGDs were conducted with Congolese parents who have at least one child ≤18 years old. An interpreter was utilized for each session to allow participants to communicate in their preferred language. FGDs were recorded, transcribed, and analyzed by three research members using qualitative content analysis to generate frequent themes. Results: A total of 3 focus groups were performed with a total of 13 participants. The majority of participants were female (85%), have lived in Louisville for less than 2 years (54%) and are currently unemployed (38%). Content analysis of the three focus groups discussions reveal three major themes of healthcare barriers: transportation, language, and provider-related factors. Sub-themes include heavy reliance on public transportation despite access to cars, confusion about emergency service utilization, language barriers outside of the traditional healthcare space, long wait times, and re-traumatization during encounters with providers. Conclusions: Although parents report a wide variety of obstacles for their children, future interventions in Louisville should focus on improving transportation, language barriers, and parental experiences with providers

A novel streamlined trauma response team training improves imaging efficiency for pediatric blunt abdominal trauma patients

Background/purpose The morbidity and mortality of children with traumatic injuries are directly related to the time to definitive management of their injuries. Imaging studies are used in the trauma evaluation to determine the injury type and severity. The goal of this project is to determine if a formal streamlined trauma response improves efficiency in pediatric blunt trauma by evaluating time to acquisition of imaging studies and definitive management. Methods This study is a chart review of patients < 18 years who presented to a pediatric trauma center following blunt trauma requiring trauma team activation. 413 records were reviewed to determine if training changed the efficiency of CT acquisition and 652 were evaluated for FAST efficiency. The metrics used for comparison were time from ED arrival to CT image, FAST, and disposition. Results Time from arrival to CT acquisition decreased from 37 (SD 23) to 28 (SD27) min (p < 0.05) after implementation. The proportion of FAST scans increased from 315 (63.5%) to 337 (80.8%) and the time to FAST decreased from 18 (SD15) to 8 (SD10) min (p < 0.05). The time to operating room (OR) decreased after implementation. Conclusion The implementation of a streamlined trauma team approach is associated with both decreased time to CT, FAST, OR, and an increased proportion of FAST scans in the pediatric trauma evaluation. This could result in the rapid identification of injuries, faster disposition from the ED, and potentially improve outcomes in bluntly injured children

Predicting Hemolytic Uremic Syndrome and Renal Replacement Therapy in Shiga Toxin-producing Escherichia coli-infected Children.

BACKGROUND: Shiga toxin-producing Escherichia coli (STEC) infections are leading causes of pediatric acute renal failure. Identifying hemolytic uremic syndrome (HUS) risk factors is needed to guide care. METHODS: We conducted a multicenter, historical cohort study to identify features associated with development of HUS (primary outcome) and need for renal replacement therapy (RRT) (secondary outcome) in STEC-infected children without HUS at initial presentation. Children agedeligible. RESULTS: Of 927 STEC-infected children, 41 (4.4%) had HUS at presentation; of the remaining 886, 126 (14.2%) developed HUS. Predictors (all shown as odds ratio [OR] with 95% confidence interval [CI]) of HUS included younger age (0.77 [.69-.85] per year), leukocyte count ≥13.0 × 103/μL (2.54 [1.42-4.54]), higher hematocrit (1.83 [1.21-2.77] per 5% increase) and serum creatinine (10.82 [1.49-78.69] per 1 mg/dL increase), platelet count \u3c250 \u3e× 103/μL (1.92 [1.02-3.60]), lower serum sodium (1.12 [1.02-1.23 per 1 mmol/L decrease), and intravenous fluid administration initiated ≥4 days following diarrhea onset (2.50 [1.14-5.46]). A longer interval from diarrhea onset to index visit was associated with reduced HUS risk (OR, 0.70 [95% CI, .54-.90]). RRT predictors (all shown as OR [95% CI]) included female sex (2.27 [1.14-4.50]), younger age (0.83 [.74-.92] per year), lower serum sodium (1.15 [1.04-1.27] per mmol/L decrease), higher leukocyte count ≥13.0 × 103/μL (2.35 [1.17-4.72]) and creatinine (7.75 [1.20-50.16] per 1 mg/dL increase) concentrations, and initial intravenous fluid administration ≥4 days following diarrhea onset (2.71 [1.18-6.21]). CONCLUSIONS: The complex nature of STEC infection renders predicting its course a challenge. Risk factors we identified highlight the importance of avoiding dehydration and performing close clinical and laboratory monitoring

The implementation of a longitudinal POCUS curriculum for physicians working at rural outpatient clinics in Chiapas, Mexico

Abstract Background Medical care in resource limited settings is challenging, particularly with limited access to diagnostic and imaging studies. The most portable and cost effective diagnostic imaging in these areas is ultrasound. Ultrasound is a very teachable skill with a short, single intensive training course and hands-on teaching; however, there are limited data on a longitudinal point-of-care ultrasound (POCUS) curriculum in resource limited settings. The goal of this intervention is to develop an effective longitudinal POCUS curriculum for local physicians working in rural clinics in the state of Chiapas, Mexico, and evaluate its effectiveness on patient care. Methods This is a 12-month longitudinal ultrasound educational curriculum for local supervising physicians working in rural clinics in Chiapas, Mexico. The 10 clinics are a collaboration of the Mexican government and Compañeros En Salud with limited access to any diagnostic imaging or laboratory studies. The investigators assisted in obtaining four portable ultrasound machines for use in the clinics. Next, they organized four point-of-care ultrasound (POCUS) teaching sessions over a year, each session focusing on several distinct concepts. The sessions included lectures and hands-on teaching with both healthy volunteers and with patients in the various communities. Over the 12 months, the POCUS were logged and the majority of images saved. The logs were analyzed to determine if POCUS affected the medical management of the patients. The primary investigator reviewed 35.2% of the total ultrasounds completed, which was 52.2% of the save images, for quality assurance and feedback. Results Over the 12 months, there were 584 ultrasound studies documented. The most common study was a transabdominal obstetric examination (45.5%) followed by abdomen/pelvis (26.6%) and musculoskeletal (5.7%) and skin and soft tissue (5.7%). The use of POCUS changed the patient diagnosis after 194 scans (34%) and changed the clinical management for the patient encounter in 171 (30%) scans. In the 194 scans in which POCUS changed the diagnosis, the clinical management was changed, as a direct result of the scan results, in 152 (78.4%) of those patient encounters. Conclusion A longitudinal POCUS educational curriculum is an effective way to equip local physicians in resource limited countries with a tool to improve their clinical management of patients