Cost of care for asylum seekers and refugees entering the United States: The case of volunteer medical providers in El Paso, Texas

BACKGROUND

Between October 2018, and February 2020, the United States saw an unprecedented increase in the number of asylum seekers and refugees arriving unexpectedly at international crossings along the US-Mexico Border. Many of these migrants needed proper medical attention, and consequently created significant pressure on local health systems. In El Paso, Texas, volunteer clinicians, collaborating closely with religious organizations and non-governmental organizations, provided outpatient medical care for the new arrivals; the county hospital provided in-patient care at local tax payers' expense. The objective of this study was to estimate costs of healthcare services offered by these volunteers in order to formulate sustainable and appropriate healthcare policies to address the needs of refugees and asylum seekers in the United States.

METHODS

A mixed methods approach was used including personal interviews with stakeholders, and follow up surveys with volunteer clinicians. The cost analysis was done from the payer perspective using Medicaid reimbursement rates.

RESULTS

Total costs of care provided to asylum seekers and refugees varied between $1.9MM to $4.4MM during the study period. The number of patient visits was estimated at 15,736 to 19,236, and cost per patient ranged between $99 and $281. Most common conditions treated by volunteer providers were abdominal pain, dermatological conditions, headaches, dehydration and hypertension.

CONCLUSIONS

This is the first study looking at the cost of healthcare for refugees and asylum seekers provided by volunteer clinicians, in a binational context. The resources invested by volunteer providers were significant, and essential to meet medical needs of migrant populations. Without appropriate financial support, a strategy relying on volunteer and local community resources will prove unsustainable in the long term. Findings from this study will help formulate federal and local policies to support local health systems along the US-Mexico Border in providing care to future migrations into the United States.

Virucidal Activity of Different Mouthwashes Using a Novel Biochemical Assay

BACKGROUND

Saliva of patients with COVID-19 has a high SARS-CoV-2 viral load. The risk of spreading the virus is not insignificant, and procedures for reducing viral loads in the oral cavity have been proposed. Little research to date has been performed on the effect of mouthwashes on the SARS-CoV-2 virus, and some of their mechanisms of action remain unknown.

METHODS

SARS-CoV-2 positive nasopharyngeal swabs measured by RT-PCR were used for virucidal activity in a 1:1 ratio, with an incubation time of 1 min. The solutions used in this study were: iodopovidone (8 mg); * D-limonene, a terpene extracted from citrus peels (0.3%); † cetylpyridinium chloride (0.1%) (CPC); ‡ chlorhexidine gluconate (10%) (CHX); § a CPC (0.12%) and CHX (0.05%) containing formula; ** a formula containing essential oils; †† a CPC containing formula (0.07%); ‡‡ a D-limonene (0.2%) and CPC (0.05%) containing formula; §§ a solution containing sodium fluoride (0.05%) and CPC (0.075%); *** a solution containing CHX (0.12%) and; ††† a CHX (0.2%) containing formula. ‡‡‡ As a control reaction, saline solution or excipient solution (water, glycerin, citric acid, colorant, sodium citrate) was used.

CONCLUSION

Within the limitations of this study, we can conclude that a mouthwash containing both D-limonene and CPC reduced the virucidal activity in about 6 logs (>99.999% reduction). Hence, establishing a clinical protocol for dentists is suggested, where all patients to be treated rinse pre-operatively with a mouthwash containing both D-limonene and CPC to reduce the likelihood of infection with SARS-CoV-2 for dentists. This is a relatively inexpensive way to reduce viral transmission of SARS-CoV-2 from infected individuals within the community. It is also a simple way to decrease infections from asymptomatic and pre-symptomatic patients.

Predictors of peri-implant bone loss during long-term maintenance of patients treated with 10-mm implants and single crown restorations

PURPOSE

The aim of this retrospective study was to evaluate the predictors of peri-implant bone loss in a sample of patients treated with 10-mm implants and single crowns who underwent periodontal/peri-implant maintenance (PM) in a Mexican private periodontal practice.

MATERIALS AND METHODS

Outcomes of a group of systemically healthy, partially edentulous patients attended up to July 2012 were assessed. Patient data were considered for inclusion if they involved treatment of partially edentulous sites with 10-mm-long implants and single crown restorations, as well as at least 3 years of regular PM following implant placement. Peri-implant bone loss was evaluated from data recorded at the most recent examination. Logistic regression analysis was performed to investigate associations between peri-implant bone loss and sex, duration of PM, location and number of implants placed per patient, region of the mouth, smoking status, type of implant, and retention of restoration.

RESULTS

A sample of 104 subjects who had been treated with four different types of dental implants and maintained for at least 3 years was selected. Of the 148 implants placed and followed for an average period of continuing PM of 6 years (range, 3 to 15 years), only one implant (1.8%) was lost. The outcomes of logistic regression analysis showed that the independent variables smoking, retention of restoration (cemented vs screw-retained), and type of implant (internal- or external-hex) were found to be correlated with peri-implant bone loss, with odds ratios of 39.64, 4.85, and 0.04, respectively.

CONCLUSIONS

Peri-implant bone loss was significantly associated with smoking status, the type of implant (ie, externally hexed), and type of retention (ie, cemented). Overall, all patients maintained low rates of bone loss.