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Goren LR, Lehman AC, Luquette M, Howard C, Thielen BK. A Lytic Bone Lesion in a 23-month-old Boy from Kenya. Pediatr Rev 2024; 45:225-229. [PMID: 38556514 DOI: 10.1542/pir.2021-005473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Lea R Goren
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN
| | - Alice C Lehman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Mark Luquette
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN
| | - Cynthia Howard
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Beth K Thielen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, MN
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2
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Jantausch BA, Bost JE, Bhansali P, Hefter Y, Greenberg I, Goldman E. Assessing trainee critical thinking skills using a novel interactive online learning tool. MEDICAL EDUCATION ONLINE 2023; 28:2178871. [PMID: 36871259 PMCID: PMC9987719 DOI: 10.1080/10872981.2023.2178871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/26/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Critical thinking is essential for the accurate diagnosis and management of patients. It is correlated with academic success. OBJECTIVE Our objective was to design a novel tool for interactive online learning to improve knowledge and to assess trainees' critical thinking skills using the framework of the American Philosophical Association (APA). METHODS Residents, fellows and students participated in an online, self-directed case-based vignette activity to learn malaria diagnosis and management. Pre and post-tests with multiple choice and open-ended case-based questions assessed knowledge and critical thinking. Comparison between pre and post-test scores across subgroups were performed using paired t-tests or one-way ANOVA. RESULTS Between 4 April 2017 to 14 July 2019, 62 of 75 (82%) eligible subjects completed both the pre and the post-test. Improved post-test scores occurred in 90% of medical students, p=0.001, 77% of residents, p<0.001, 60% of fellows, p=0.72 and 75% of trainees overall, p=<0.001. Fellows had higher pre-test scores than students or residents but there was no difference by level of training on the post-test. CONCLUSIONS This interactive online learning activity effectively imparted medical knowledge and improved trainee responses to questions requiring critical thinking. To our knowledge, this is the first time the APA's critical thinking framework has been incorporated into interactive online learning and assessment of critical thinking skills in medical trainees. We applied this innovation specifically in global health education, but there is obvious potential to expand it to a wide variety of areas of clinical training.
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Affiliation(s)
- Barbara A. Jantausch
- Division of Infectious Diseases, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - James E. Bost
- Children’s National Research Institute, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Priti Bhansali
- Division of Hospital Medicine, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Yosefa Hefter
- Division of Infectious Diseases, Children’s National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | | | - Ellen Goldman
- Human and Organizational Learning, Master Teacher Leadership Development Program, George Washington University, Washington, DC, USA
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3
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Newberry DM, Spies LA, Jones JJ, Perez PY. Evaluation of Social Determinants of Health in Nursing Education through Service Learning. Creat Nurs 2023; 29:383-388. [PMID: 37990479 DOI: 10.1177/10784535231212410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Background: This manuscript describes an in-state nursing student global health-care experience. The 2021 Rio Grande Valley service learning team at Louise Herrington School of Nursing at Baylor University traveled from Dallas to McAllen, Texas to volunteer in a COVID vaccination clinic and refugee respite center on the U.S.-Mexican border. Method: A competency-based evaluation utilized the American Association of Colleges of Nursing's The Essentials: Core Competencies for Professional Nursing Education Featured Concepts, with a focus on social determinants of health, as a framework. Results: The evaluation of the service learning trip through the lens of social determinants of health and the Core Competencies can serve as a guideline for the design of future trips. Conclusion: The Rio Grande Valley service learning trip contributed to nursing students' self-reports of competency in global health education, in identifying the social determinants of health that characterized the immigrants and refugees, and in service and advocacy.
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Affiliation(s)
- Desi M Newberry
- Duke University School of Nursing, 307 Trent Dr., Durham, NC 27710, USA
| | - Lori A Spies
- Baylor University Louise Herrington School of Nursing, Dallas, Texas, USA
| | - Jennifer J Jones
- Baylor University Louise Herrington School of Nursing, Dallas, Texas, USA
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4
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Jain R, Stone GS, Gartland MG. Medical Care for Newly Arrived Displaced Persons. NEJM EVIDENCE 2023; 2:EVIDra2200286. [PMID: 38320529 DOI: 10.1056/evidra2200286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Medical Care for Displaced PersonsThe United Nations High Commissioner for Refugees reports that more than 100 million people have been forcibly displaced from their homes due to persecution, conflict, violence, and human rights violations. Displacement has profound health impacts. Here, Jain and colleagues review medical care for newly displaced persons.
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Affiliation(s)
- Radhika Jain
- Department of Medicine, Division of General Medicine, Washington University School of Medicine, St. Louis
| | - Geren S Stone
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston
| | - Matthew G Gartland
- Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston
- Department of Pediatrics, Massachusetts General Hospital, Boston
- Center for Global Health, Massachusetts General Hospital, Boston
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5
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Oberg C, Goldhagen J, Spencer N. Renewing our commitment to protect children experiencing armed conflict. J Paediatr Child Health 2023; 59:427-430. [PMID: 36794666 DOI: 10.1111/jpc.16367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/17/2023]
Abstract
Civilian casualties from armed conflicts have increased, such that 90% of deaths from armed conflicts in the first decade of the 21st century have been civilians, a significant number of whom are children. The acute and chronic effects of armed conflict on child health and well-being are among the most significant children's rights violations of the 21st century. Children are increasingly exposed to armed conflict and targeted by governmental and non-governmental combatants. Despite International Human Rights and Humanitarian laws and multiple international declarations, conventions, treaties and courts, injury and death of children due to armed conflicts have worsened over the decades. It is critically important that a concerted effort be undertaken to address and rectify this issue. Toward this end, the Internal Society of Social Pediatrics and Chid Health (ISSOP) and others have called for a renewed commitment to children experiencing armed conflict with an immediate call to implement a new UN Humanitarian Response on Child Casualties in Armed Conflict.
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Affiliation(s)
- Charles Oberg
- Department of Pediatrics, Global Pediatric Program, University of Minnesota, Minneapolis, Minnesota, United States
| | - Jeffrey Goldhagen
- Department of Pediatrics, Division of Community and Societal Pediatrics, University of Florida, Jacksonville, Florida, United States
| | - Nicholas Spencer
- Warwick Medical School, Division of Mental Health and Wellbeing, University of Warwick, Coventry, United Kingdom
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6
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Including Children in Immigrant Families in Policy Approaches to Reduce Child Poverty. Acad Pediatr 2021; 21:S117-S125. [PMID: 34740418 DOI: 10.1016/j.acap.2021.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/15/2021] [Accepted: 06/26/2021] [Indexed: 01/19/2023]
Abstract
Although they are an increasing share of the US child population (26% in 2020) and have much higher poverty rates than children in nonimmigrant families (20.9% vs 9.9%), children in immigrant families have much more restricted access to the social safety net, which can lead to increased economic hardship and health and developmental risks. More than 90% of children in immigrant families are US citizens, but they are excluded from the safety net due to restrictions that affect their parents and other family members. Exclusions that affect children in immigrant families include restricted categorical eligibility based on immigrant status, stricter income eligibility, reduced benefit levels, high administrative burden, and interactions with immigration policy such as public charge. These exclusions limit the ability of both existing and enhanced social programs to reduce child poverty among this population. Results derived from the Transfer Income Model simulations for the National Academy of Sciences, Engineering and Medicine's 2019 report A Roadmap to Reducing Child Poverty show that the poverty-reducing effects of potential enhancements to three main antipoverty programs result in unequal poverty reduction effects by family citizenship/immigration status with disproportionate negative effects on Hispanic children, 54% of whom live in immigrant families. Policy principles to improve equitable access and poverty-reduction effects of social programs for children in immigrant families include basing eligibility and benefit levels on the developmental, health and nutrition needs of the child instead of the immigration status of other family members, reducing administrative burden, and eliminating the link between immigration policy and access to the safety net.
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7
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Cooper SH, Phipps EJ, Lawson D, Meier ER. How we coordinate care for uninsured children with nonmalignant hematologic disorders. Pediatr Blood Cancer 2021; 68:e29103. [PMID: 34125474 DOI: 10.1002/pbc.29103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 11/12/2022]
Abstract
Providing medical care for uninsured children with nonmalignant hematologic diagnoses presents unique challenges to medical providers and multidisciplinary staff. Financial and psychosocial stressors can hinder optimal care of the uninsured child. Maximizing coverage of medical costs through patient enrollment in state and charity care programs and capitalizing upon community partnerships can help providers achieve comprehensive care for these children. Collaboration between primary care providers, subspecialists, and multidisciplinary teams can be optimized to facilitate provision of hematology care for uninsured children. We detail our experience in establishing these collaborations to improve access to subspecialty care for children with nonmalignant hematologic disorders.
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Affiliation(s)
- Sarah Hall Cooper
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Erin Jane Phipps
- Eskenazi Health/Indiana University Health, Indianapolis, Indiana, USA
| | - DeAuntae Lawson
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Emily Riehm Meier
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
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8
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Ayalew B, Dawson-Hahn E, Cholera R, Falusi O, Haro TM, Montoya-Williams D, Linton JM. The Health of Children in Immigrant Families: Key Drivers and Research Gaps Through an Equity Lens. Acad Pediatr 2021; 21:777-792. [PMID: 33529739 DOI: 10.1016/j.acap.2021.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/13/2021] [Accepted: 01/24/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The United States benefits economically and socially from the diverse skill-set and innovative contributions of immigrants. By applying a socioecological framework with an equity lens, we aim to provide an overview of the health of children in immigrant families (CIF) in the United States, identify gaps in related research, and suggest future areas of focus to advance health equity. METHODS The literature review consisted of identifying academic and gray literature using a MeSH Database, Clinical Queries, and relevant keywords in 3 electronic databases (PubMed, Web of Science, and BrowZine). Search terms were selected with goals of: 1) conceptualizing a model of key drivers of health for CIF; 2) describing and classifying key drivers of health for CIF; and 3) identifying knowledge gaps. RESULTS The initial search produced 1120 results which were screened for relevance using a meta-narrative approach. Of these, 224 papers were selected, categorized by topic, and reviewed in collaboration with the authors. Key topic areas included patient and family outcomes, institutional and community environments, the impact of public policy, and opportunities for research. Key inequities were identified in health outcomes; access to quality health care, housing, education, employment opportunities; immigration policies; and inclusion in and funding for research. Important resiliency factors for CIF included strong family connections and social networks. CONCLUSIONS Broad structural inequities contribute to poor health outcomes among immigrant families. While resiliency factors exist, research on the impact of certain important drivers of health, such as structural and cultural racism, is missing regarding this population. More work is needed to inform the development and optimization of programs and policies aimed at improving outcomes for CIF. However, research should incorporate expertise from within immigrant communities. Finally, interventions to improve outcomes for CIF should be considered in the context of the socioecological model which informs the upstream and downstream drivers of health outcomes.
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Affiliation(s)
- Betlihem Ayalew
- UofSC School of Medicine Greenville (B Ayalew and JM Linton), Greenville, SC
| | - Elizabeth Dawson-Hahn
- University of Washington, Seattle Children's Research Institute, Harborview Medical Center (E Dawson-Hahn), Seattle, Wash
| | - Rushina Cholera
- Department of Pediatrics, National Clinician Scholars Program, Duke School of Medicine and the Margolis Center for Health Policy, Duke University (R Cholera), Durham NC
| | - Olanrewaju Falusi
- Child Health Advocacy Institute and Division of General and Community Pediatrics, The George Washington University School of Medicine and Health Sciences, Children's National Hospital (O Falusi), Washington, DC
| | - Tamar Magarik Haro
- Federal and State Advocacy, American Academy of Pediatrics (TM Haro), North Washington, DC
| | - Diana Montoya-Williams
- Division of Neonatology, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research 2714 (D Montoya-Williams), Philadelphia, Pa
| | - Julie M Linton
- UofSC School of Medicine Greenville (B Ayalew and JM Linton), Greenville, SC; Prisma Health Children's Hospital (JM Linton), Greenville, SC.
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9
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Barnert E, Katsanis SH, Mishori R, Wagner JK, Selden RF, Madden D, Berger D, Erlich H, Hampton K, Kleiser A, La Vaccara A, Parsons TJ, Peccerelli FA, Piñero MH, Stebbins MJ, Vásquez P, Warf CW, White TJ, Stover E, Svetaz MV. Using DNA to reunify separated migrant families. Science 2021; 372:1154-1156. [PMID: 34045324 DOI: 10.1126/science.abh3979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Elizabeth Barnert
- The list of author affiliations is available in the supplementary materials
| | - Sara H Katsanis
- The list of author affiliations is available in the supplementary materials.
| | - Ranit Mishori
- The list of author affiliations is available in the supplementary materials
| | - Jennifer K Wagner
- The list of author affiliations is available in the supplementary materials
| | - Richard F Selden
- The list of author affiliations is available in the supplementary materials
| | - Diana Madden
- The list of author affiliations is available in the supplementary materials
| | - Dan Berger
- The list of author affiliations is available in the supplementary materials
| | - Henry Erlich
- The list of author affiliations is available in the supplementary materials
| | - Kathryn Hampton
- The list of author affiliations is available in the supplementary materials
| | - Andreas Kleiser
- The list of author affiliations is available in the supplementary materials
| | | | - Thomas J Parsons
- The list of author affiliations is available in the supplementary materials
| | - Fredy A Peccerelli
- The list of author affiliations is available in the supplementary materials
| | | | - Michael J Stebbins
- The list of author affiliations is available in the supplementary materials
| | - Patricia Vásquez
- The list of author affiliations is available in the supplementary materials
| | - Curren W Warf
- The list of author affiliations is available in the supplementary materials
| | - Thomas J White
- The list of author affiliations is available in the supplementary materials
| | - Eric Stover
- The list of author affiliations is available in the supplementary materials
| | - M Veronica Svetaz
- The list of author affiliations is available in the supplementary materials
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Janse van Rensburg GH, Feucht UD, Makin J, le Clus N, Avenant T. Healthcare without borders: A cross-sectional study of immigrant and nonimmigrant children admitted to a large public sector hospital in the Gauteng Province of South Africa. PLoS Med 2021; 18:e1003565. [PMID: 33755665 PMCID: PMC8023456 DOI: 10.1371/journal.pmed.1003565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 04/06/2021] [Accepted: 02/16/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Human migration is a worldwide phenomenon that receives considerable attention from the media and healthcare authorities alike. A significant proportion of children seen at public sector health facilities in South Africa (SA) are immigrants, and gaps have previously been noted in their healthcare provision. The objective of the study was to describe the characteristics and differences between the immigrant and SA children admitted to Kalafong Provincial Tertiary Hospital (KPTH), a large public sector hospital in the urban Gauteng Province of SA. METHODS AND FINDINGS A cross-sectional study was conducted over a 4-month period during 2016 to 2017. Information was obtained through a structured questionnaire and health record review. The enrolled study participants included 508 children divided into 2 groups, namely 271 general paediatric patients and 237 neonates. Twenty-five percent of children in the neonatal group and 22.5% in the general paediatric group were immigrants. The parents/caregivers of the immigrant group had a lower educational level (p < 0.0001 neonatal and paediatric), lower income (neonatal p < 0.001; paediatric p = 0.024), difficulty communicating in English (p < 0.001 neonatal and paediatric), and were more likely residing in informal settlements (neonatal p = 0.001; paediatric p = 0.007) compared to the SA group. In the neonatal group, there was no difference in the number of antenatal care (ANC) visits, type of delivery, gestational age, and birth weight. In the general paediatric group, there was no difference in immunisation and vitamin A supplementation coverage, but when comparing growth, the immigrant group had more malnutrition compared to the SA group (p = 0.029 for wasting). There was no difference in the prevalence of maternal human immunodeficiency virus (HIV) infection, with equally good prevention of mother-to-child transmission (PMTCT) coverage. There was also no difference in reported difficulties by immigrants in terms of access to healthcare (neonatal p = 0.379; paediatric p = 0.246), although a large proportion (10%) of the neonates of immigrant mothers were born outside a medical facility. CONCLUSIONS Although there were health-related differences between immigrant and SA children accessing in-hospital care, these were fewer than expected. Differences were found in parental educational level and socioeconomic factors, but these did not significantly affect ANC attendance, delivery outcomes, immunisation coverage, HIV prevalence, or PMTCT coverage. The immigrant population should be viewed as a high-risk group, with potential problems including suboptimal child growth. Health workers should advocate for all children in the community they are serving and promote tolerance, respect, and equal healthcare access.
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Affiliation(s)
| | - Ute Dagmar Feucht
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital and University of Pretoria, Pretoria, South Africa
- District Clinical Specialist Team, Tshwane District Health Services, Gauteng Department of Health, Pretoria, South Africa
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, Medical Research Council, Pretoria, South Africa
| | - Jennifer Makin
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Pretoria, South Africa
- Maternal and Infant Health Care Strategies Unit, Medical Research Council, Pretoria, South Africa
| | - Nanya le Clus
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital and University of Pretoria, Pretoria, South Africa
| | - Theunis Avenant
- Department of Paediatrics, Kalafong Provincial Tertiary Hospital and University of Pretoria, Pretoria, South Africa
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Dawson-Hahn EE, Pidaparti V, Hahn W, Stauffer W. Global mobility, travel and migration health: clinical and public health implications for children and families. Paediatr Int Child Health 2021; 41:3-11. [PMID: 33769218 DOI: 10.1080/20469047.2021.1876821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Exponential growth of the world's population combined with increased travel has dramatically increased the spread of infectious diseases. Although there has been significant focus on migration, the major contributors to the transmission of communicable diseases are travel and tourism not migration. Given that children represent up to 10% of international travellers, it is critical to the health of all age groups to ensure that tailored guidance for children is considered in public health policy and guidelines, and pandemic responses. To further support pandemic preparedness, public health systems need to strengthen ties with communities and health systems. In addition, travel and migration issues need to be included as core competencies in medical education. Ensuring that clinicians who care for children have knowledge of travel and migration health will foster a better health outcome in an increasingly mobile population at risk of emerging infectious diseases.Abbreviations CDC: Centers for Disease Control and Prevention; DGMQ: CDC Division of Global Migration and Quarantine; EID: emerging infectious diseases; EU: European Union; VFR: visiting friends and relatives; IOM: United Nations International Organization for Migration; LPR: lawful permanent resident; US: United States of America; WHO: World Health Organization.
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Affiliation(s)
- Elizabeth E Dawson-Hahn
- Division of General Paediatrics, Department of Pediatrics, University of Washington, Seattle, WA, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Vaidehi Pidaparti
- Division of General Paediatrics, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - William Hahn
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, WA, USA
| | - William Stauffer
- Division of Infectious Disease, Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis, MN, USA.,Program for Human Migration and Health, Center for Social Responsibility and Global Health, University of Minnesota, Minneapolis, MN, USA
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Abstract
This article describes the current state of migration of immigrant children into the United Sates and the various categories of immigrant children, including refugees, asylum seekers, unaccompanied minors, adoptees, and Special Immigrant Visa holders, hereafter called immigrant children. It focuses on guidelines for medical screening and management of newcomer immigrant children and adolescents and their ongoing preventive care. This article also addresses challenges unique to immigrant children and adolescents and the importance of culturally sensitive anticipatory guidance.
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Affiliation(s)
- Shruti Simha
- Tim and Carolynn Rice Center for Child and Adolescent Health, Cone Health, 301 East Wendover Avenue, Suite 400, Greensboro, NC 27401, USA; Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Amy C Brown
- Department of Pediatrics, University of Virginia, PO Box 800386, Charlottesville, VA 22908-0386, USA
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13
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Nehal US, Kanahara S, Tanabe M, Hayner G, Nelson BD. Pediatric Refugee Health Care Delivery in the Community Setting: An Educational Workshop for Multidisciplinary Family-Centered Care During Resettlement. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10988. [PMID: 33204831 PMCID: PMC7666829 DOI: 10.15766/mep_2374-8265.10988] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION With 70.8 million people displaced worldwide, there is an increasing need for medical professionals to provide medical care to refugees. Insufficient training on refugee health poses a barrier to effective care delivery. METHODS This workshop addressed common challenges in providing family-centered pediatric refugee care in community settings as well as barriers related to policy changes. Presentations covered prearrival experiences, medical screening, and trauma-based care. In small groups, participants discussed cases that featured medical, behavioral health, social, and cultural factors impacting the provision of family-centered pediatric care that was culturally respectful and included shared decision-making. After the breakout session, each small group informed the larger group of topics discussed. Facilitators identified themes and reinforced key learning points. At the workshop's conclusion, participants were guided to create their own personalized action plan. RESULTS This workshop was presented at two international conferences to more than 47 participants, including clinicians, nurse practitioners, pediatric residents, and medical students. Evaluations were completed by 34 individuals. Participants' overall comfort level with taking care of refugee patients increased from 3.3 to 4.0 (on a 5-point scale, p = .24) during the 3-hour version of the workshop and from 3.8 to 4.0 (p = .43) in the 1-hour version of the workshop. Mean overall ratings of the 3- and 1-hour workshop versions on conference-administered evaluations were 4.8 and 4.2, respectively, on a 5-point scale. DISCUSSIONS This workshop was well received and equipped participants with knowledge, tools, and strategies regarding pediatric refugee health in a community setting.
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Affiliation(s)
- Umbereen S. Nehal
- Chief Medical Officer and Vice President of Medical Affairs, Community Healthcare Network; Assistant Professor, Department of Pediatrics, University of Massachusetts Medical School
| | - Satoko Kanahara
- Medical Director of South Bronx Center, Community Healthcare Network
| | - Mihoko Tanabe
- Medical Student, Philadelphia College of Osteopathic Medicine
| | - Grace Hayner
- Advanced Practice Nurse, Community Healthcare Network
| | - Brett D. Nelson
- Associate Professor, Department of Pediatrics, Harvard Medical School
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14
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Butteris SM, Leyenaar JK, Leslie LK, Turner AL, Batra M. International Experience of US Pediatricians and Level of Comfort Caring for Immigrant Children and Children Traveling Internationally. J Pediatr 2020; 225:124-131.e1. [PMID: 32553863 PMCID: PMC7293846 DOI: 10.1016/j.jpeds.2020.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine whether international experience is associated with greater comfort in providing care to US children who are immigrants, refugees, and traveling internationally. STUDY DESIGN Following enrollment into the 2018 American Board of Pediatrics Maintenance of Certification program, general pediatricians and subspecialists received a voluntary, online survey with questions about their experience and self-reported comfort caring for immigrant, refugee, and internationally traveling children and previous international experiences. Using multivariable logistic regression, we examined how previous international experiences, and other personal characteristics, were associated with self-reported comfort. RESULTS A total of 5461 eligible participants completed the survey; 76.3%, (n = 4168) reported caring for immigrant children, 35.8% (n = 1957) cared for refugee children, and 79.8% (n = 4358) cared for children traveling internationally. High levels of comfort caring for immigrant children were reported by 68.5% (n = 3739), for refugee children by 50.1% (n = 2738), and for children traveling internationally by 72.7% (n = 3968). One-third of respondents (34.1%, n = 1866) reported past international experiences. In multivariable analysis, respondents with previous international experience and of Hispanic origin were significantly more likely to report high levels of comfort caring for all 3 populations. CONCLUSIONS The majority of pediatricians report caring for children in the US who are immigrants, refugees, and traveling internationally, and previous international experience was associated with greater comfort with care. Training programs and professional organizations should consider ways to encourage a more diverse workforce and to support all pediatricians in achieving the skills and confidence required to care for children in our highly mobilized society.
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Affiliation(s)
- Sabrina M. Butteris
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, WI,Reprint requests: Sabrina M. Butteris, MD, Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Box 4108, CSC H4/470, Madison, WI 53792-4108
| | - JoAnna K. Leyenaar
- Department of Pediatrics & The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Laurel K. Leslie
- The American Board of Pediatrics, Chapel Hill, NC,Tufts University School of Medicine, Boston, MA
| | | | - Maneesh Batra
- Department of Pediatrics, University of Washington, Seattle, WA
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Stephen JM, Zoucha R. A Call for Nurse Leader Action: Ethical Nursing Care of Latinx Unauthorized Immigrant Children and Families. NURSE LEADER 2020; 19:S1541-4612(20)30212-3. [PMID: 32952460 PMCID: PMC7492073 DOI: 10.1016/j.mnl.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 08/10/2020] [Indexed: 06/11/2023]
Abstract
Latinx unauthorized immigrant children and children of unauthorized immigrant parents are at risk for care disparities and negative health outcomes. Unauthorized immigration from South and Central America to the United States has elevated to crisis level, exposing many children to poor health conditions, human rights violations, and risk of death. Unauthorized status greatly influences care access and delivery in the hospital setting. Restricted nursing care creates ethical dilemmas. Nurse leaders are in key positions to influence and advocate care. This article explores issues surrounding nursing care using the Theory of Bureaucratic Caring and identifies opportunities for nurse leader action.
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16
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Dinleyici EC, Borrow R. Meningococcal infections among refugees and immigrants: silent threats of past, present and future. Hum Vaccin Immunother 2020; 16:2781-2786. [PMID: 32347773 PMCID: PMC7746237 DOI: 10.1080/21645515.2020.1744979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Globally, there is an increasing number of international migrants. The majority are forced displaced refugees and children unaccompanied by a caregiver, and have limited access to essential public health interventions. Routine vaccination might be interrupted or be incomplete due to conflict areas with limited public health services or a long-unplanned journey. Refugees and migrants may bring infectious disease risks to their country of destination and may be exposed to new risk factors during transit or at their destination. There are lessons learned strategies among refugees and asylum seekers in different countries (vaccination campaign during outbreak, maintain vaccination systems for refugees and medical screening and/or vaccination on arrival) against vaccine-preventable diseases – other than meningococcal infections. Since the 1980s, invasive meningococcal disease (IMD) has been reported as a critical healthcare issue in places of humanitarian crisis such as Thailand and African’s meningitis belt. Refugees and migrants are at increased risk of IMD compared with the overall population due to sero-epidemiology in their country of origin, specific characteristics of the IMD, and a number of contacts during the journey. Recently, IMD cases due to serogroups X and W have been reported and are an emerging health threat for persons arriving from Africa to refugee camps in Italy. There have been sporadic case reports of IMD due to serogroup B in Turkey; however, there has not yet been increased disease activity in this population and no outbreaks have been observed. Outbreaks of IMD in refugee camps have been and could be successfully controlled through the implementation of timely and high-coverage vaccination campaigns, and individual cases of IMD can be treated with antibiotics. Research is needed to determine the prevalence of meningococcal carriage and serogroup distribution among refugees and migrants to inform vaccine recommendations. There is no official recommendation for meningococcal vaccination of refugees. Further strategies for prevention and treatment of human immunodeficiency virus, tuberculosis and antibiotic resistance among refugees are directly related to potential prevention methods for IMD. Meningococcal vaccines have been administered only to risk groups in most host countries Thus, further strategies for the definition of new/emerging risk factors for IMD would be helpful to guide vaccine implementation for refugees and immigrants.
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Affiliation(s)
- Ener Cagri Dinleyici
- Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine , Eskisehir, Turkey
| | - Ray Borrow
- Vaccine Evaluation Unit, Public Health England , Manchester, UK
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Sisk B, Green A, Chan K, Yun K. Caring for Children in Immigrant Families: Are United States Pediatricians Prepared? Acad Pediatr 2020; 20:391-398. [PMID: 31790799 DOI: 10.1016/j.acap.2019.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE A growing number of children in the United States are from immigrant families. We conducted a national survey to examine pediatricians' self-rated preparedness to care for children in immigrant families. METHODS A 2017 survey of American Academy of Pediatrics members assessed respondent characteristics, formal training in and experience with global, public, or immigrant health, and preparedness to care for children in immigrant families. Descriptive statistics and a multivariable logistic regression model examined associations between characteristics, formal training, experience, and preparedness. RESULTS The survey response rate was 47% (n = 758/1628). One third of respondents (33.6%) reported being unprepared to care for children in immigrant families. In bivariate analyses, respondents who had graduated from medical school outside of the United States, had previous education on immigrant health care, or had recent international global health experience were most likely to report feeling prepared to care for children in immigrant families. Multivariable regression model results indicated that prior education on immigrant health (adjusted odds ratio [AOR] 4.07; 95% confidence interval [CI] 2.68, 6.32), graduation from medical school outside the United States (AOR 2.35; 95% CI 1.22, 4.67), and proficiency in a language other than English (AOR 1.78; 95% CI 1.14, 2.80) were independently associated with preparedness. CONCLUSIONS One in 3 US pediatricians report being unprepared to care for children in immigrant families. Wider implementation of graduate and continuing medical education on immigrant child health is needed to ensure that practicing pediatricians have the appropriate skills and knowledge to care for this patient population.
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Affiliation(s)
- Blake Sisk
- Department of Research, American Academy of Pediatrics (B Sisk), Itasca, Ill.
| | - Andrea Green
- Department of Pediatrics, University of Vermont Children's Hospital, Larner College of Medicine at the University of Vermont (A Green), Burlington, Vt
| | - Kevin Chan
- Institute of Better Health and Children's and Women's Health, Trillium Health Partners (K Chan), Mississauga, ON, Canada; Department of Pediatrics, University of Toronto (K Chan), Toronto, ON, Canada
| | - Katherine Yun
- Department of Pediatrics, Children's Hospital of Philadelphia (K Yun), Philadelphia, Pa; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine (K Yun), Philadelphia, Pa
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18
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Agrawal H, Dokania G, Allen HD, Acosta S, Caracostis A, Havemann LM, Lara A, Riley AF, Seery TJ. Bridging the Cardiac Needs of a Large, Underserved Immigrant and Resettled Refugee Population. J Pediatr 2020; 219:83-88. [PMID: 31987651 DOI: 10.1016/j.jpeds.2019.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/23/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To describe a monthly outreach pediatric cardiology clinic established to better understand the cardiac needs of immigrant/resettled refugee children. STUDY DESIGN Data obtained between 2014 and 2017 from a monthly pediatric cardiology clinic at a Federally Qualified Health Center were analyzed using descriptive statistics. RESULTS A total of 366 patients (222 male, 61%) were evaluated. Indications for referral included murmur (242, 66%), nonexertional symptoms (31, 9%), exertional symptoms (16, 4%), history of cardiac surgery/transcatheter interventions (15, 4%), previous diagnosis of heart conditions without intervention (13, 4%), arrhythmia/bradycardia (13, 4%), and others (36, 10%). Echocardiograms were performed on 136 patients (67 were abnormal, 49%). The most common final diagnoses include innocent murmur in 201 (55%), simple congenital heart disease in 61 (16%), complex congenital heart disease in 3 (1%), and acquired heart disease in 3 (1%). A total of 15 patients (4%) were ultimately determined to require surgical or cardiac catherization as an intervention. Patients have been followed for a median of 0.7 years (range 0-3.3 years). CONCLUSIONS Rates of abnormal echocardiograms suggest a greater likelihood of congenital or acquired heart disease at time of initial consultation compared with nonimmigrant/refugee populations. The most common indication for referral to the outreach pediatric cardiology clinic was a murmur. Collaborative efforts between physicians and support services are essential in assisting this vulnerable population access pediatric subspecialty care.
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Affiliation(s)
- Hitesh Agrawal
- Invasive Cardiac Imaging and Interventional Catheterization Laboratory, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
| | - Gunjan Dokania
- Pediatric Consultants, Le Bonheur Children's Hospital, Memphis, TN
| | - Hugh D Allen
- The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Stephanie Acosta
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Andrea Caracostis
- Hope Clinic, The Asian American Health Coalition of the Greater Houston Area, Houston, TX
| | - Luke M Havemann
- The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Anna Lara
- Pediatrics, Ochsner Health Center for Children, New Orleans, LA
| | - Alan F Riley
- The Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Thomas J Seery
- Division of Cardiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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19
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de Leon Siantz ML. Living in Crisis: Latino Children held at the Southern Border. J Pediatr Nurs 2020; 50:A7-A8. [PMID: 31889571 DOI: 10.1016/j.pedn.2019.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Mary Lou de Leon Siantz
- Betty Irene Moore School of Nursing, United States of America; Center for the Advancement of Multicultural Perspectives in Science, University of California Davis, United States of America.
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20
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Shetty AK. Infectious Diseases among Refugee Children. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E129. [PMID: 31783605 PMCID: PMC6955676 DOI: 10.3390/children6120129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 11/23/2019] [Indexed: 12/24/2022]
Abstract
In recent years, there has been a substantial increase in refugee and asylum-seeking adults, adolescents and children to high-income countries. Infectious diseases remain the most frequently identified medical diagnosis among U.S.-bound refugee children. Medical screening and immunization are key strategies to reduce the risk of infectious diseases in refugee, internationally adopted, and immigrant children. Notable infectious diseases affecting refugee and other newly arriving migrants include latent or active tuberculosis, human immunodeficiency virus type 1 (HIV), hepatitis B, hepatitis C, vaccine-preventable diseases, malaria, and other parasitic infections. The U.S. Centers for Disease Control and Prevention and the American Academy of Pediatrics have published guidelines for health assessment of newly arriving immigrant, refugee, and internationally adopted children. Although, data on the health risks and needs of refugee exists in some high-income countries, there is an urgent need to develop robust evidence-informed guidance on screening for infectious diseases and vaccination strategies on a broader scale to inform national policies. Innovative approaches to reach migrant communities in the host nations, address health and other complex barriers to improve access to high-quality integrated health services, and strong advocacy to mobilize resources to improve health, safety, and wellbeing for refugee children and their families are urgent priorities.
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Affiliation(s)
- Avinash K Shetty
- Department of Pediatrics and Office of Global Health, Wake Forest School of Medicine and Brenner Children's Hospital, Medical Center Blvd, Winston-Salem, NC 27157, USA
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21
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Immigrant Women's Experiences as Mothers in the United States: A Scoping Review. MCN Am J Matern Child Nurs 2019; 45:6-16. [PMID: 31651421 DOI: 10.1097/nmc.0000000000000582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Immigrant mothers are raising an increasing proportion of the population of children in the United States. PURPOSE The purpose of this review was to explore existing research on immigrant women's experiences of being mothers in the United States and identify key concepts, gaps in the literature, and implications for future research that builds on the strengths of immigrant women while addressing their unique challenges. STUDY DESIGN AND METHODS In this scoping review, Ovid MEDLINE, CINAHL, SCOPUS, Web of Science, JUSTOR, and PsycINFO databases were searched using a combination of applicable key words. RESULTS Twenty-two articles were selected. Few studies were identified. Analyses revealed a broad array in purpose, populations, theoretical frameworks, settings, study instruments, and practices, making comparison difficult. Although mothering is a universal experience among women who have children, little is known about the broad experiences of immigrant women from different cultures. CLINICAL IMPLICATIONS Immigrant mothers are not a monolithic group. More research is needed to provide a deeper understanding of strengths, challenges, and solutions of various immigrant groups, which can facilitate development of nursing interventions that support immigrant women and their children in the United States, and strengthen their families.
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Choe AY, Unaka NI, Schondelmeyer AC, Bignall WJR, Vilvens HL, Thomson JE. Inpatient Communication Barriers and Drivers When Caring for Limited English Proficiency Children. J Hosp Med 2019; 14:607-613. [PMID: 31339836 PMCID: PMC6817305 DOI: 10.12788/jhm.3240] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Achieving effective communication between medical providers and families with limited English proficiency (LEP) in the hospital is difficult. OBJECTIVE Our objective was to identify barriers to and drivers of effective interpreter service use when caring for hospitalized LEP children from the perspectives of pediatric medical providers and interpreters. DESIGN/PARTICIPANTS/SETTING We used Group Level Assessment (GLA), a structured qualitative participatory method that allows participants to directly produce and analyze data in an interactive group session. Participants from a single academic children's hospital generated individual responses to prompts and identified themes and relevant action items. Themes were further consolidated by our research team and verified by stakeholder groups. RESULTS Four GLA sessions were conducted including 64 participants: hospital medicine physicians and pediatric residents (56%), inpatient nursing staff (16%), and interpreter services staff (28%). Barriers identified included: (1) difficulties accessing interpreter services; (2) uncertainty in communication with LEP families; (3) unclear and inconsistent expectations and roles of team members; and (4) unmet family engagement expectations. Drivers of effective communication were: (1) utilizing a team-based approach between medical providers and interpreters; (2) understanding the role of cultural context in providing culturally effective care; (3) practicing empathy for patients and families; and (4) using effective family-centered communication strategies. CONCLUSIONS Participants identified unique barriers and drivers that impact communication with LEP patients and their families during hospitalization. Future directions include exploring the perspective of LEP families and utilizing team-based and family-centered communication strategies to standardize and improve communication practices.
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Affiliation(s)
- Angela Y Choe
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Corresponding Author: Angela Y. Choe, MD; E-mail: ; Telephone: 513-636-3893; Twitter: @AChoeMD
| | - Ndidi I Unaka
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Whitney J Raglin Bignall
- Division of Psychology in the Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Heather L Vilvens
- Allied Health Department, University of Cincinnati Blue Ash College, Cincinnati, Ohio
| | - Joanna E Thomson
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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23
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Schrier L, Wyder C, Del Torso S, Stiris T, von Both U, Brandenberger J, Ritz N. Medical care for migrant children in Europe: a practical recommendation for first and follow-up appointments. Eur J Pediatr 2019; 178:1449-1467. [PMID: 31240389 DOI: 10.1007/s00431-019-03405-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 12/21/2022]
Abstract
Between 2015 and 2017, an estimated 200,000 to 400,000 children were seeking asylum each year in EU/EEA countries. As access to high-quality health care is important, we collected and compared current recommendations across Europe for a consensus recommendation on medical care for migrant (asylum-seeking and refugee) children. Existing recommendations were collected from published literature and identified through national representatives from paediatric societies of 31 EU/EEA countries through the European Academy of Paediatrics (EAP). Recommendations were systematically extracted and collected in a database. Those mentioned in at least one recommendation were evaluated for inclusion, and evidence on recommendations was specifically identified in literature searches focused on recent evidence from Europe. For eight EU/EEA countries, a national recommendation was identified. Growth and development, vision and hearing impairment, skin and dental problems, immunisations, anaemia, micronutrient deficiency, helminths, hepatitis B and C, human immunodeficiency virus, malaria, schistosomiasis, syphilis, tuberculosis, mental health disorder and sexual health were most frequently mentioned and therefore selected for inclusion in the recommendation.Conclusion: The current document includes general recommendations on ethical standards, use of interpreters and specific recommendations for prevention or early detection of communicable and non-communicable diseases. It may serve as a tool to ensure the fundamental right that migrant children in Europe receive a comprehensive, patient-centred health care.
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Affiliation(s)
- Lenneke Schrier
- Willem Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Corinne Wyder
- Kinderaerzte KurWerk, Poststrasse 9, 3400, Burgdorf, Switzerland
- Department of Paediatrics, University of Bern, Bern, Switzerland
| | | | - Tom Stiris
- Department of Neonatology, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ulrich von Both
- Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- German Centre for Infection Research (DZIF), partner site, Munich, Germany
- Paediatric Infection and Immunity, Section of Paediatric, Department of Medicine, Imperial College London, London, UK
| | - Julia Brandenberger
- Migrant Health Service, University Children's Hospital Basel, University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland
| | - Nicole Ritz
- Migrant Health Service, University Children's Hospital Basel, University of Basel, Spitalstrasse 33, 4056, Basel, Switzerland.
- Infectious Diseases and Vaccinology Unit, University Children's Hospital Basel, University of Basel, Basel, Switzerland.
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Parkville, Australia.
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Abstract
Immigrant and refugee children are at increased risk for physical, developmental, and behavioral health challenges. This article provides an overview of physical, developmental, and behavioral health considerations for immigrant and refugee children within an ecological framework that highlights family, community, and sociocultural influences. Experiences and exposures relevant to immigrant and refugee children are discussed. Clinical pearls are provided for topics of chronic disease, nutrition, infectious disease, developmental screening, and mental health assessment. Interdisciplinary and community partnerships are emphasized as a means to decrease barriers to care and facilitate family navigation of complex social, educational, and health care systems.
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Affiliation(s)
- Abigail L H Kroening
- Division of Developmental and Behavioral Pediatrics, Golisano Children's Hospital, University of Rochester, 601 Elmwood Avenue Box #671, Rochester, NY 14623, USA.
| | - Elizabeth Dawson-Hahn
- Division of General Pediatrics, University of Washington, 6200 Northeast 74th Street Suite 110, Seattle, WA 98115-81860, USA
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25
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Villela VA, Dixon AM, Steele R. Health Care Without Borders: A Case Report of an Immigrant Child Who Lost His Voice. Clin Pediatr (Phila) 2019; 58:1019-1021. [PMID: 31027442 DOI: 10.1177/0009922819845891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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26
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Trent M, Dooley DG, Dougé J, Cavanaugh RM, Lacroix AE, Fanburg J, Rahmandar MH, Hornberger LL, Schneider MB, Yen S, Chilton LA, Green AE, Dilley KJ, Gutierrez JR, Duffee JH, Keane VA, Krugman SD, McKelvey CD, Linton JM, Nelson JL, Mattson G, Breuner CC, Alderman EM, Grubb LK, Lee J, Powers ME, Rahmandar MH, Upadhya KK, Wallace SB. The Impact of Racism on Child and Adolescent Health. Pediatrics 2019; 144:peds.2019-1765. [PMID: 31358665 DOI: 10.1542/peds.2019-1765] [Citation(s) in RCA: 515] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics is committed to addressing the factors that affect child and adolescent health with a focus on issues that may leave some children more vulnerable than others. Racism is a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families. Although progress has been made toward racial equality and equity, the evidence to support the continued negative impact of racism on health and well-being through implicit and explicit biases, institutional structures, and interpersonal relationships is clear. The objective of this policy statement is to provide an evidence-based document focused on the role of racism in child and adolescent development and health outcomes. By acknowledging the role of racism in child and adolescent health, pediatricians and other pediatric health professionals will be able to proactively engage in strategies to optimize clinical care, workforce development, professional education, systems engagement, and research in a manner designed to reduce the health effects of structural, personally mediated, and internalized racism and improve the health and well-being of all children, adolescents, emerging adults, and their families.
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Affiliation(s)
- Maria Trent
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Danielle G. Dooley
- Division of General Pediatrics and Community Health and Child Health Advocacy Institute, Children’s National Health System, Washington, District of Columbia; and
| | - Jacqueline Dougé
- Medical Director, Howard County Health Department, Columbia, Maryland
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Abstract
At a time of evolving demographics and turbulent policy changes, pediatric providers have a critical role in the care of all children, regardless of where the child or parent was born. Pediatric providers can facilitate access to high-quality care and critical community-based resources for immigrant children and families. In this article, we delineate the primary domains for clinical care and offer clinical tools to achieve the provision of accessible, comprehensive, high-quality care within a family-centered medical home.
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Affiliation(s)
- Chloe Turner
- Unity Health Care, Inc., 3020 14th Street Northwest, Washington, DC 20009, USA; A.T. Still University of Health Sciences, Mesa, AZ, USA
| | - Anisa Ibrahim
- Department of Pediatrics, University of Washington, Harborview Medical Center, 325 9th Avenue Box 359774, Seattle, WA 98104, USA
| | - Julie M Linton
- University of South Carolina School of Medicine Greenville, Prisma Health Upstate Children's Hospital, 20 Medical Ridge Drive, Greenville, SC 29605, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA.
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28
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Khullar D, Chokshi DA. Challenges for immigrant health in the USA-the road to crisis. Lancet 2019; 393:2168-2174. [PMID: 30981536 DOI: 10.1016/s0140-6736(19)30035-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/16/2018] [Accepted: 12/21/2018] [Indexed: 11/30/2022]
Abstract
The USA is home to more immigrants than any other country-about 46 million, just less than a fifth of the world's immigrants. Immigrant health and access to health care in the USA varies widely by ethnicity, citizenship, and legal status. In recent decades, several policy and regulatory changes have worsened health-care quality and access for immigrant populations. These changes include restrictions on access to public health insurance programmes, rhetoric discouraging the use of social services, aggressive immigration enforcement activities, intimidation within health-care settings, decreased caps on the number of admitted refugees, and rescission of protections from deportation. A receding of ethical norms has created an environment favourable for moral and public health crises, as evident in the separation of children from their parents at the southern US border. Given the polarising immigration rhetoric at the national level, individual states rather than the country as a whole might be better positioned to address the barriers to improved health and health care for immigrants in the USA.
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Affiliation(s)
- Dhruv Khullar
- Department of Healthcare Policy and Research and Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Dave A Chokshi
- New York City Health and Hospitals Corporation, New York, NY, USA; Departments of Population Health and Medicine, New York University Langone Health, New York, NY, USA
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29
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Congdon J. Beyond the Stethoscope: Learning to Harness Our Collective Power to Advocate for Patients. J Grad Med Educ 2019; 11:124-126. [PMID: 31024640 PMCID: PMC6476099 DOI: 10.4300/jgme-d-18-00726.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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30
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Kadir A, Battersby A, Spencer N, Hjern A. Children on the move in Europe: a narrative review of the evidence on the health risks, health needs and health policy for asylum seeking, refugee and undocumented children. BMJ Paediatr Open 2019; 3:bmjpo-2018-000364. [PMID: 30815582 PMCID: PMC6361329 DOI: 10.1136/bmjpo-2018-000364] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Europe has experienced a marked increase in the number of children on the move. The evidence on the health risks and needs of migrant children is primarily from North America and Australia. OBJECTIVE To summarise the literature and identify the major knowledge gaps on the health risks and needs of asylum seeking, refugee and undocumented children in Europe in the early period after arrival, and the ways in which European health policies respond to these risks and needs. DESIGN Literature searches were undertaken in PubMed and EMBASE for studies on migrant child health in Europe from 1 January 2007 to 8 August 2017. The database searches were complemented by hand searches for peer-reviewed papers and grey literature reports. RESULTS The health needs of children on the move in Europe are highly heterogeneous and depend on the conditions before travel, during the journey and after arrival in the country of destination. Although the bulk of the recent evidence from Europe is on communicable diseases, the major health risks for this group are in the domain of mental health, where evidence regarding effective interventions is scarce. Health policies across EU and EES member states vary widely, and children on the move in Europe continue to face structural, financial, language and cultural barriers in access to care that affect child healthcare and outcomes. CONCLUSIONS Asylum seeking, refugee and undocumented children in Europe have significant health risks and needs that differ from children in the local population. Major knowledge gaps were identified regarding interventions and policies to treat and to promote the health and well-being of children on the move.
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Affiliation(s)
- Ayesha Kadir
- Institute for Studies of Migration, Diversity and Welfare, Malmo Hogskola, Malmo, Sweden
| | - Anna Battersby
- Kaleidoscope Centre for Children and Young People, London, UK
| | - Nick Spencer
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Anders Hjern
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity Studies (CHESS), Karolinska Institutet/Stockholm University, Stockholm, Sweden
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31
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Social Determinants of Health and Health Disparities Among Immigrants and their Children. Curr Probl Pediatr Adolesc Health Care 2019; 49:23-30. [PMID: 30595524 DOI: 10.1016/j.cppeds.2018.11.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In 2017, the United States (U.S.) foreign-born population was estimated to be 44.5 million, the highest share since 1910. It is unclear how many undocumented immigrants live in the U.S., but estimates in 2014 determined that there were at least 12.1 million. The immigrant population, particularly undocumented immigrants, has consistently been affected negatively by social determinants of health such as poverty, food and housing insecurity, lack of educational attainment, and challenges with health care access. Additionally, they face stigma and marginalization, difficulties with acculturation, and fear of deportation. Given these challenges that immigrants and their children face, physicians have a responsibility of assessing these social determinants of health and providing comprehensive care for this population.
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Sriraman Md Mph Faap Fabm NK. Providing Healthcare for Immigrant Children. Curr Probl Pediatr Adolesc Health Care 2019; 49:4-6. [PMID: 30583973 DOI: 10.1016/j.cppeds.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Natasha K Sriraman Md Mph Faap Fabm
- Division of General Academic Pediatrics; Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, VA 23507, United States.
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Shenoda S, Kadir A, Pitterman S, Goldhagen J, Suchdev PS, Chan KJ, Howard CR, McGann P, St Clair NE, Yun K, Arnold LD. The Effects of Armed Conflict on Children. Pediatrics 2018; 142:peds.2018-2585. [PMID: 30397166 DOI: 10.1542/peds.2018-2585] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children are increasingly exposed to armed conflict and targeted by governmental and nongovernmental combatants. Armed conflict directly and indirectly affects children's physical, mental, and behavioral health. It can affect every organ system, and its impact can persist throughout the life course. In addition, children are disproportionately impacted by morbidity and mortality associated with armed conflict. A children's rights-based approach provides a framework for collaboration by the American Academy of Pediatrics, child health professionals, and national and international partners to respond in the domains of clinical care, systems development, and policy formulation. The American Academy of Pediatrics and child health professionals have critical and synergistic roles to play in the global response to the impact of armed conflict on children.
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Affiliation(s)
- Sherry Shenoda
- Division of Community and Societal Pediatrics, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida
| | - Ayesha Kadir
- Centre for Social Paediatrics, Herlev Hospital, Herlev, Denmark; and
| | - Shelly Pitterman
- United Nations High Commissioner for Refugees, Washington, District of Columbia
| | - Jeffrey Goldhagen
- Division of Community and Societal Pediatrics, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida
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Medizinische Maßnahmen bei immigrierenden Kindern und Jugendlichen – Aktualisierung vom 28.02.2018. Monatsschr Kinderheilkd 2018. [DOI: 10.1007/s00112-018-0497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Migrating Children: The Need for Comprehensive Integrated Health Prevention Measures. CURRENT TROPICAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40475-018-0142-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Carrasco-Sanz A, Leiva-Gea I, Martin-Alvarez L, Del Torso S, van Esso D, Hadjipanayis A, Kadir A, Ruiz-Canela J, Perez-Gonzalez O, Grossman Z. Migrant children's health problems, care needs, and inequalities: European primary care paediatricians' perspective. Child Care Health Dev 2018; 44:183-187. [PMID: 29159977 DOI: 10.1111/cch.12538] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/22/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Primary care paediatricians' perception of migrant children's health in Europe has not been explored before. Our aim was to examine European paediatricians' knowledge on migrant children's health problems, needs, inequalities, and barriers to access health care. METHODS European primary care paediatricians were invited by the European Academy of Paediatrics Research in Ambulatory Setting Network country coordinators to complete a web-based survey concerning health care of migrant children. A descriptive analysis of all variables was performed. RESULTS The survey was completed by 492 paediatricians. Sixty-three per cent of the respondents reported that the general health of migrant children is worse than that of nonmigrants, chronic diseases cited by 66% of the respondents as the most frequent health problem. Sixty-six per cent of the paediatricians reported that migrant children have different health needs compared to nonmigrant children, proper oral health care mentioned by 86% of the respondents. Cultural/linguistic factors have been reported as the most frequent barrier (90%).to access health care. However, only 37% of providers have access to professional interpreters and cultural mediators. Fifty-two per cent and 32% do not know whether one or more of the family members are undocumented and whether they are refugees/asylum seekers, respectively. Updated guidelines for care of migrant children are available for only 35% of respondents, and 80% of them have not received specific training on migrant children's care. CONCLUSIONS European primary care paediatricians recognize migrant children as a population at risk with more frequent and specific health problems and needs, but they are often unaware of their legal state. Lack of interpreters augments the existing language barriers to access proper care and should be solved. Widespread lack of guidelines and specific providers' training should be addressed to optimize health care delivery to migrant children.
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Affiliation(s)
- A Carrasco-Sanz
- Primary Care Health Centre "Potosi", Madrid Health Service, Madrid, Spain
| | - I Leiva-Gea
- Regional University Hospital, Andalusian Health Service, Malaga, Spain
| | | | - S Del Torso
- Pediatra di Famiglia, ULSS 6 Euganea, Padova, Italy
| | - D van Esso
- Primary Care. SAP Muntanya Catalan Institute of Health, Barcelona, Spain
| | - A Hadjipanayis
- Paediatric Department, Larnaca General Hospital, Larnaca, European University Medical School, Nicosia, Cyprus
| | - A Kadir
- Herlev Hospital, Copenhagen, Denmark
| | - J Ruiz-Canela
- Primary Care Health Centre "Virgen de Africa", Andalusian Health Service, Sevilla, Spain
| | - O Perez-Gonzalez
- FIMABIS, Andalusian Public Foundation for Health and Biomedicine Research, Malaga, Spain
| | - Z Grossman
- Maccabi Health Services, Tel Aviv, Israel
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Abstract
PURPOSE OF REVIEW The current article reviews recent literature related to three groups whose health is affected by barriers to the healthcare system: refugee and immigrant populations; youth who are lesbian, gay, bisexual, transgender, queer, or questioning; and those with mental health problems. RECENT FINDINGS Refugee and immigrant populations are increasing worldwide, and recent work has focused on improving their access to mental, dental, and preventive care. Lesbian, gay, bisexual, transgender, queer, or questioning youth have unique healthcare needs but frequently lack a support system and may not be forthcoming about their sexuality or sex identity. A rising number of children are being diagnosed with mental health disorders, but due to multiple factors, youth are not receiving the care they need. SUMMARY Pediatric healthcare providers should be aware of the unique challenges faced by youth displaced from their country of origin, who are lesbian, gay, bisexual, or transgender or are questioning their sexuality or sex identity, and who struggle with mental health disorders. Toolkits, other educational resources, and novel technological advances can assist pediatricians in ensuring optimal health care of these at-risk groups.
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Karwowski MP, Morman SA, Plumlee GS, Law T, Kellogg M, Woolf AD. Toxicants in folk remedies: implications of elevated blood lead in an American-born infant due to imported diaper powder. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2017; 39:1133-1143. [PMID: 27704308 DOI: 10.1007/s10653-016-9881-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 09/26/2016] [Indexed: 06/06/2023]
Abstract
Though most childhood lead exposure in the USA results from ingestion of lead-based paint dust, non-paint sources are increasingly implicated. We present interdisciplinary findings from and policy implications of a case of elevated blood lead (13-18 mcg/dL, reference level <5 mcg/dL) in a 9-month-old infant, linked to a non-commercial Malaysian folk diaper powder. Analyses showed the powder contains 62 % lead by weight (primarily lead oxide) and elevated antimony [1000 parts per million (ppm)], arsenic (55 ppm), bismuth (110 ppm), and thallium (31 ppm). These metals are highly bioaccessible in simulated gastric fluids, but only slightly bioaccessible in simulated lung fluids and simulated urine, suggesting that the primary lead exposure routes were ingestion via hand-mouth transmission and ingestion of inhaled dusts cleared from the respiratory tract. Four weeks after discontinuing use of the powder, the infant's venous blood lead level was 8 mcg/dL. Unregulated, imported folk remedies can be a source of toxicant exposure. Additional research on import policy, product regulation, public health surveillance, and culturally sensitive risk communication is needed to develop efficacious risk reduction strategies in the USA. The more widespread use of contaminated folk remedies in the countries from which they originate is a substantial concern.
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Affiliation(s)
- Mateusz P Karwowski
- Department of Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA.
- Pediatric Environmental Health Center, Boston Children's Hospital, 1295 Boylston St, Suite 100, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, 22 Shattuck St, Boston, MA, USA.
| | | | | | - Terence Law
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Mark Kellogg
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Alan D Woolf
- Department of Medicine, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA
- Pediatric Environmental Health Center, Boston Children's Hospital, 1295 Boylston St, Suite 100, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, 22 Shattuck St, Boston, MA, USA
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Hudak ML, Helm ME, White PH, Berman SK, Brandt ML, Carlson KM, Giardino AP, Hammer LD, Pearlman SA, Price J, Sood BG, Szilagyi PG. Principles of Child Health Care Financing. Pediatrics 2017; 140:peds.2017-2098. [PMID: 28864710 DOI: 10.1542/peds.2017-2098] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
After passage of the Patient Protection and Affordable Care Act, more children and young adults have become insured and have benefited from health care coverage than at any time since the creation of the Medicaid program in 1965. From 2009 to 2015, the uninsurance rate for children younger than 19 years fell from 9.7% to 5.3%, whereas the uninsurance rate for young adults 19 to 25 years of age declined from 31.7% to 14.5%. Nonetheless, much work remains to be done. The American Academy of Pediatrics (AAP) believes that the United States can and should ensure that all children, adolescents, and young adults from birth through the age of 26 years who reside within its borders have affordable access to high-quality and comprehensive health care, regardless of their or their families' incomes. Public and private health insurance should safeguard existing benefits for children and take further steps to cover the full array of essential health care services recommended by the AAP. Each family should be able to afford the premiums, deductibles, and other cost-sharing provisions of the plan. Health plans providing these benefits should ensure, insofar as possible, that families have a choice of professionals and facilities with expertise in the care of children within a reasonable distance of their residence. Traditional and innovative payment methodologies by public and private payers should be structured to guarantee the economic viability of the pediatric medical home and of other pediatric specialty and subspecialty practices to address developing shortages in the pediatric specialty and subspecialty workforce, to promote the use of health information technology, to improve population health and the experience of care, and to encourage the delivery of evidence-based and quality health care in the medical home, as well as in other outpatient, inpatient, and home settings. All current and future health care insurance plans should incorporate the principles for child health financing outlined in this statement. Espousing the core principle to do no harm, the AAP believes that the United States must not sacrifice any of the hard-won gains for our children. Medicaid, as the largest single payer of health care for children and young adults, should remain true to its origins as an entitlement program; in other words, future fiscal or regulatory reforms of Medicaid should not reduce the eligibility and scope of benefits for children and young adults below current levels nor jeopardize children's access to care. Proposed Medicaid funding "reforms" (eg, institution of block grant, capped allotment, or per-capita capitation payments to states) will achieve their goal of securing cost savings but will inevitably compel states to reduce enrollee eligibility, trim existing benefits (such as Early and Periodic Screening, Diagnostic, and Treatment), and/or compromise children's access to necessary and timely care through cuts in payments to providers and delivery systems. In fact, the AAP advocates for increased Medicaid funding to improve access to essential care for existing enrollees, fund care for eligible but uninsured children once they enroll, and accommodate enrollment growth that will occur in states that choose to expand Medicaid eligibility. The AAP also calls for Congress to extend funding for the Children's Health Insurance Program, a plan vital to the 8.9 million children it covered in fiscal year 2016, for a minimum of 5 years.
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Affiliation(s)
- Mark L. Hudak
- Department of Pediatrics, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida
| | - Mark E. Helm
- Childhood Health Associates of Salem, Salem, Oregon
| | - Patience H. White
- Got Transition: Center for Health Care Transition Improvement, Washington, District of Columbia; and
- Departments of Medicine and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Dal Corso M, Biagioli L. Practice Experiences With Latino Immigrant Children. Clin Pediatr (Phila) 2017; 56:889-893. [PMID: 28466649 DOI: 10.1177/0009922817702941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Getrich CM, García JM, Solares A, Kano M. Buffering the Uneven Impact of the Affordable Care Act: Immigrant-serving Safety-net Providers in New Mexico. Med Anthropol Q 2017; 32:233-253. [PMID: 28556358 DOI: 10.1111/maq.12391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 05/16/2017] [Accepted: 05/17/2017] [Indexed: 11/30/2022]
Abstract
We conducted a study in early 2014 to document how the initial implementation of the Affordable Care Act (ACA) affected health care provision to different categories of immigrants from the perspective of health care providers in New Mexico. Though ACA navigators led enrollment, a range of providers nevertheless became involved by necessity, expressing concern about how immigrants were faring in the newly configured health care environment and taking on advocacy roles. Providers described interpreting shifting eligibility and coverage, attending to vulnerable under/uninsured patients, and negotiating new bureaucratic barriers for insured patients. Findings suggest that, like past efforts, this recent reform to the fragmented health care system has perpetuated a condition in which safety-net clinics and providers are left to buffer a widening gap for immigrant patients. With possible changes to the ACA ahead, safety-net providers' critical buffering roles will likely become more crucial, underscoring the necessity of examining their experiences with past reforms.
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Affiliation(s)
| | | | - Angélica Solares
- Clinical and Translational Science Center, University of New Mexico
| | - Miria Kano
- Comprehensive Cancer Center, University of New Mexico
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Kim MS, Song IG, An AR, Kim KH, Sohn JH, Yang SW. Healthcare access challenges facing six African refugee mothers in South Korea: a qualitative multiple-case study. KOREAN JOURNAL OF PEDIATRICS 2017; 60:138-144. [PMID: 28592976 PMCID: PMC5461277 DOI: 10.3345/kjp.2017.60.5.138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/17/2017] [Accepted: 01/31/2017] [Indexed: 11/27/2022]
Abstract
Purpose Following legal reform in 2013, the annual number of asylum seekers entering South Korea has increased from 1,143 in 2012 to 5,711 in 2015. We interviewed six African refugee mothers of young children regarding their health needs and barriers to access maternal child health services. Methods We recruited mothers who had visited a clinic for immigrants between July 2013 and August 2015. Participants were African refugee women, aged over 18 years, who had given birth in Korea within the previous 5 years and had come to Korea over a year before recruitment. Interview questions examined participants' experiences in pregnancy and childbirth and concerns regarding their child's health status. Initial data analysis involved all researchers' immersion in the entire collection of transcripts. We then noted recurrent topics and themes and identified similar issues. Results At the time of giving birth, 5 participants were asylum seekers and one had undocumented status. The following barriers impeded their access to maternal child healthcare: socioeconomic factors (unstable social identity, low economic status, difficulty obtaining health insurance), language barriers (lack of linguistically appropriate health information, limited access to translation services), and cultural barriers (religious and cultural differences). Weak social support also hindered access to healthcare soon after migration; however, social links with the community emerged as a key coping strategy following settlement. Conclusion We identified barriers to maternal and child healthcare and coping strategies among African refugee mothers in Korea. Future research should assess refugees' health status and improve health access and literacy among refugee mothers.
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Affiliation(s)
- Min Sun Kim
- Institute of Public Health and Medical Service, Seoul, Korea.,Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - In Gyu Song
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
| | - Ah Reum An
- Institute of Public Health and Medical Service, Seoul, Korea
| | - Kyae Hyung Kim
- Institute of Public Health and Medical Service, Seoul, Korea
| | - Ji Hoon Sohn
- Institute of Public Health and Medical Service, Seoul, Korea
| | - Sei Won Yang
- Department of Pediatrics, Seoul National University Hospital, Seoul, Korea
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Pavlopoulou ID, Tanaka M, Dikalioti S, Samoli E, Nisianakis P, Boleti OD, Tsoumakas K. Clinical and laboratory evaluation of new immigrant and refugee children arriving in Greece. BMC Pediatr 2017; 17:132. [PMID: 28549451 PMCID: PMC5446762 DOI: 10.1186/s12887-017-0888-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 05/18/2017] [Indexed: 12/12/2022] Open
Abstract
Background Migrant children are a population at risk for various health problems. Despite the increased inflow of migrants in Greece, data regarding their health assessment are lacking. This study aims to describe the clinical and certain laboratory characteristics and identify possible associations in a group of new immigrant (I) and refugee (R) children, arriving in Athens, Greece. Methods A prospective, cross- sectional study was performed in a migrant outpatient clinic of a tertiary Children’s hospital. All immigrant and refugee children, examined to obtain a health certificate, within 3 months of their arrival in the country, were enrolled. Clinical and laboratory information was collected in a pre- designed form. We applied multiple logistic regression models to investigate the association between the child’s status (immigrant vs refugee) and health indicators controlling for possible confounding effects, mainly of age and area of origin. Results From 2010 to 2013, a total of 300 children (I/R:138/162) with a mean age of 7.08 (range 1–14) years were included. Overall, 79.3% presented unknown vaccination status, 21.3% dental and 7.3% additional clinical problems. Latent tuberculosis was identified in 2.7%, while anemia, low serum ferritin and eosinophilia were found in 13.7%, 17.3%, and 22.7% of subjects, respectively. 57.7% had protective antibodies to hepatitis B surface antigen (anti-HBs ≥ 10 IU/L) and 30.6% elevated blood lead levels (EBLLs). Immigrants had less likely unknown immunization (OR = 0.25, p < 0.001), but had increased odds of low ferritin (OR = 1.97, p = 0.043), EBLLs (OR = 2.97, p = 0.001) and protective anti-HBs (OR = 1.79, p = 0.03). Age was inversely associated with anemia (OR = 0.0.89, p = 0.017), low ferritin (OR = 0.91, p = 0.027), EBLLs (OR = 0.86, p = 0.001) or positive anti-HBs (OR = 0.92, p = 0.025). Children from Europe or Africa presented decreased probability of EBLLs (OR = 0.31, p = 0.001, and OR = 0.15, p = 0.005, respectively) compared to those from Asia. Conclusions New immigrant and refugee children presented distinct clinical problems and certain laboratory abnormalities. Some of these health issues differed according to their migration status, age and geographic area of origin. These findings provide evidence that may assist the optimal approach of this vulnerable population.
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Affiliation(s)
- Ioanna D Pavlopoulou
- Faculty of Nursing, Paediatric Clinic, P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str, 11527, Athens, Greece.
| | - Marsela Tanaka
- Faculty of Nursing, Postgraduate Program, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str, 11527, Athens, Greece
| | - Stavroula Dikalioti
- Faculty of Nursing, Paediatric Clinic, P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str, 11527, Athens, Greece
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Medical School, 75 M. Asias str, 11527, Athens, Greece
| | - Pavlos Nisianakis
- Center of Biological Research of Armed Forces, 414 Military Hospital, I. Velliou str, 15236, Athens, Greece
| | - Olga D Boleti
- Faculty of Nursing, Paediatric Clinic, P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str, 11527, Athens, Greece
| | - Konstantinos Tsoumakas
- Faculty of Nursing, Paediatric Clinic, P. & A. Kyriakou" Children's Hospital, National and Kapodistrian University of Athens, 123 Papadiamantopoulou str, 11527, Athens, Greece
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Takahashi K, Motoki Y, Tanimoto T, Kusumi E, Kami M. Concerns About the Attitudes of President Trump Toward Isolationism, Vaccination, and Climate Change. Clin Infect Dis 2017; 64:1465-1466. [DOI: 10.1093/cid/cix225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The emotional health and wellbeing of children and adolescents and their families is of utmost importance. Pediatricians are at the front line in identifying mental illness in children and adolescents and either linking them to resources in the community or providing treatment options themselves. Collaboration and integrative health care models is the cornerstone of effective strategies to provide access and quality mental health care to children and families in communities across the country.
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Ciaccia KA, John RM. Unaccompanied Immigrant Minors: Where to Begin. J Pediatr Health Care 2016; 30:231-40. [PMID: 26858232 DOI: 10.1016/j.pedhc.2015.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/22/2015] [Accepted: 12/30/2015] [Indexed: 11/18/2022]
Abstract
The number of unaccompanied immigrant minors (UIMs) from Central America significantly increased in 2014. Nearly 50,000 children from El Salvador, Guatemala, and Honduras crossed the United States-Mexico border in 2014, compared with 3,933 in 2011. Few resources exist to guide pediatric nurse practitioners (PNPs) in their care of UIM. The multifactorial reasons behind migration and the state of children's health in Central America provide insight into the needs of UIMs. Guidelines for similar groups such as foreign-born children and refugees offer direction for the health care considerations of UIMs. This article provides demographic information on UIMs, highlights the unique and challenging medical and mental health issues facing UIMs, and discusses the role of the PNP. A UIM's initial visit with a PNP serves as an opportunity to build trust through culturally competent, trauma-informed care, provide preventive care, assess for unmet health needs, and screen for mental health conditions.
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Abstract
Demographics indicate that pediatricians increasingly care for children in immigrant families in routine practice. Although these children may be at risk for health disparities relating to socioeconomic disadvantage and cultural or linguistic challenges, immigrant families have unique strengths and potential for resilience. Adaptive and acculturation processes concerning health and well-being can be mediated by cultural media. Pediatricians have a professional responsibility to address the medical, mental health, and social needs of immigrant families. Advocacy and research at the practice level and beyond can further explore the unique needs of this population and evidence-based strategies for health promotion.
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Salehi L, Lofters AK, Hoffmann SM, Polsky JY, Rouleau KD. Health and growth status of immigrant and refugee children in Toronto, Ontario: A retrospective chart review. Paediatr Child Health 2016; 20:e38-42. [PMID: 26744562 DOI: 10.1093/pch/20.8.e38] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To describe selected anthropometric and health status variables among immigrant and refugee children ≤6 years of age within an inner city clinic in Toronto, Ontario. METHODS A retrospective chart review of patients born between January 1, 1998 and December 31, 2008, was conducted at a Toronto community health centre serving a primarily immigrant and refugee population. Outcome measures included calculated age-specific percentiles for height and weight, and the prevalence of anemia, iron deficiency, enteric parasites, elevated lead levels, HIV and hepatitis B. Postal codes were collected and used to determine the patient's neighbourhood income quintile. RESULTS A total of 331 patients, born between January 1, 1998 and December 31, 2008, were identified. Of these, a total of 210 charts were manually reviewed. The prevalence of height-for-age and weight-for-age under the third percentile on the Centers for Disease Control and Prevention Growth Charts were 7.2% and 11.6%, respectively, and 8.4% and 5.0%, respectively, on the WHO Growth Standards Chart. Prevalence rates were also calculated for anemia (22.8%), iron deficiency (53.3%), hepatitis B (2.5%), parasitic infections (33.6%), elevated blood lead levels (4.9%) and HIV (0%). Neighbourhood income quintiles revealed that 46.7% of patients were residing in the lowest (ie, poorest) income quintile neighbourhoods. CONCLUSION These findings reveal a high burden of illness within the population presenting to an immigrant/refugee health clinic, and illustrate the need for further research in this area, as well as increased efforts to ensure appropriate screening within clinics serving a high volume of newcomer patients.
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Affiliation(s)
- Leila Salehi
- St Michael's Hospital Department of Family and Community Medicine, University of Toronto, Toronto, Ontario;; Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Aisha K Lofters
- St Michael's Hospital Department of Family and Community Medicine, University of Toronto, Toronto, Ontario;; Centre for Research on Inner City Health, St Michael's Hospital;; Institute for Clinical Evaluative Sciences
| | | | - Jane Y Polsky
- Dalla Lana School of Public Health, University of Toronto;; Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute of St Michael's Hospital
| | - Katherine D Rouleau
- St Michael's Hospital Department of Family and Community Medicine, University of Toronto, Toronto, Ontario
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Javier JR, Festa N, Florendo E, Mendoza FS. Children in Immigrant Families: The Foundation for America's Future. Adv Pediatr 2015. [PMID: 26205111 DOI: 10.1016/j.yapd.2015.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Joyce R Javier
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, 4650 Sunset Boulevard MS#76, Los Angeles, CA 90027, USA
| | - Natalia Festa
- Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, 1265 Welch Road, MSOB 238, Stanford, CA 94305-5459, USA
| | - Ellynore Florendo
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, 4650 Sunset Boulevard MS#76, Los Angeles, CA 90027, USA
| | - Fernando S Mendoza
- Division of General Pediatrics, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, 1265 Welch Road, MSOB 238, Stanford, CA 94305-5459, USA.
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Personal and environmental factors to consider when aiming to improve participation in physical activity in children with Spina Bifida: a qualitative study. BMC Neurol 2015; 15:11. [PMID: 25886148 PMCID: PMC4336512 DOI: 10.1186/s12883-015-0265-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 01/20/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Youth with spina bifida (SB) are less fit and active than other groups with childhood disability. While recent studies have shown benefits of exercise training, the increased fitness levels do not sustain or lead to increased levels of physical activity (PA) in these children. Therefore, it seems important to explore which factors are associated with participation in PA (or lack of) in youth with SB. The objective of this study is to describe both personal and environmental factors that are important for participation in physical activity as experienced by these children and their parents, in order to better develop intervention strategies to improve participation in PA in youth with SB. METHODS Eleven semi-structured interviews with parents of children with SB aged 4-7 years, nine focus groups with youth with SB (n = 33, age 8-18 years) and eight focus groups with their parents (n = 31) were conducted, recorded and transcribed verbatim. Two independent researchers analyzed the data. Central themes for physical activity were constructed, using the model for Physical Activity for Persons with a Disability (PAD model) as a background scheme. RESULTS Data showed that youth with SB encountered both personal and environmental factors associated with participation in PA on all levels of the PAD model. Bowel and bladder care, competence in skills, sufficient fitness, medical events and self-efficacy were important personal factors. Environmental factors that were associated with physical activity included the contact with and support from other people, the use of assistive devices for mobility and care, adequate information regarding possibilities for adapted sports and accessibility of playgrounds and sports facilities. CONCLUSIONS Our findings suggest that a variety of both personal and environmental factors were either positively or negatively associated with participation in PA. An individual approach, assessing possibilities rather than overcoming barriers within and surrounding the child may be a good starting point when setting up intervention programs to improve participation in PA. Therefore, assessment of both personal and environmental factors associated with physical activity should be standard care within multidisciplinary intervention programs aimed to encourage healthy active lifestyles in youth with SB.
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