Initial Health Assessment Research Articles

Health of asylum seeker children in Finland: a total population health examination survey (TERTTU)

Abstract Background There is scarcity of representative population-based data on the health and wellbeing of asylum seekers in Europe, especially children and adolescents. The Asylum Seekers Health and Wellbeing Survey (TERTTU) was launched to inform evidence-based policy-making and development of services. Methods A sample of all first-time asylum applicants was drawn from the Finnish Immigration Services electronic asylum database. Data on 303 children aged 0-17 years was gathered with a standardised health examination (including a dental assessment for 7-17 year-olds) and face-to-face-interview including the Minimum European Health Module and somatic and behavioural symptoms over the past 30 days. Guardians of 0-12 year-olds were interviewed, 13-17 year-olds responded themselves. Participation rate was 72%. Results 62% (95% CI 49,4-73,0) of 13-17 year-olds have had their growth and development monitored compared with 91% (95% CI 83,6-95,6) of 7-12 year-old and 86% (95% CI 79,4-91,0) of 0-6 year-olds. Long-standing health problems were more common among 13-17 year-olds (28%, 95% CI 18,2-39,7) and 7-12 year-olds (25%, 95% CI 16,8-34,2) compared 0-6 year-olds (13%, 95% CI 8,2-19,5). Sleep disturbances were more common among 13-17 year-olds (35%, 95% CI 24,2-47,4) and 7-12 year-olds (28%, 95% CI 19,6-37,5) than 2-6 year-olds (18%, 95% CI 11,3-26,7). Approximately fifth of children aged 7-17 years and slightly more than tenth of younger children had fears and anxieties. Signs of dental caries were found in 46% (95% CI 35,4-55,9) of 7-12 year-olds and in 23% (95% CI 14,1-35,1) of 13-17 year-olds. Conclusions Timely and accurate assessment of healthcare needs is crucial to support and improve the health and wellbeing of children and adolescents. Survey data will be used for developing the national initial health assessment protocol for asylum seeking children and adolescents. Key messages The TERTTU Survey is the largest population-based health examination survey among newly-arrived asylum seeking adults, adolescents and children in Europe, allowing for examining family units. Health information on asylum seeking children and adolescents in Finland, is relevant for service development, also for other European countries.

Health experiences of asylum seekers and refugees in Wales

BackgroundThe numbers of asylum seekers and refugees in Wales have recently increased sharply, but we know little of their health experiences.AimTo investigate asylum seekers’ and refugees’ experiences of health care, especially what helped or hindered.MethodEight volunteer peer researchers were recruited from asylum-seeking and refugee communities; and trained to run the quantitative survey. They worked in small groups with support from team members. The Statistical Package for Social Sciences (SPSS) was used to describe, analyse, and present results.ResultsThe 210 responders included 90 known refugees, 89 known asylum seekers, and 11 known to have been refused asylum. Although 79% of responders reported attending an initial health assessment on arriving in Wales, and 94% reported that they were currently registered with a GP, only 36% found it easy or very easy to make an appointment with their GPs. Awareness of services was mixed: best known was the 999 service, with 77% reporting that they knew how to access it. Sixty-six per cent reported using health care in working hours, and 28% reported use out of hours. Key influences on these statistics included knowledge of the NHS and how to navigate it, language barriers, and cultural factors.ConclusionThis study provides valuable insight into asylum seekers’ and refugees’ experiences of health care. Together with our complementary qualitative study it suggests that a compassionate approach to providing care, building on existing good practice, and with additional resources for training and support services, can reduce healthcare inequalities for asylum seekers and refugees.

Clinical Effectiveness and Safety of Treatment With Anti-Tumor Necrosis Factor α Drugs in a Cohort of Colombian Patients With Rheumatoid Arthritis.

To compare the clinical response at 24 months and evaluate the adverse events (AEs) of patients with rheumatoid arthritis (RA) treated with etanercept 50 (injectable solution 50 mg prefilled syringe), etanercept 25 (lyophilized 25 mg), infliximab, adalimumab, or golimumab. A cohort study was carried out in patients with RA, in treatment with etanercept (injectable solution 50 mg prefilled syringe or lyophilized 25 mg), infliximab, adalimumab, or golimumab. Duration of study: follow-up was carried out for 24 months. The difference of initial and final 28-joint Disease Activity Score, remission incidence, difference of initial and final Health Assessment Questionnaire score, disability recovery, and AE rate were evaluated. The study enrolled 435 patients (108 adalimumab, 107 infliximab, 92 etanercept 25 mg, 81 etanercept 50 mg, and 47 golimumab). For etanercept 50, the median difference between basal and at the end of follow-up 28-joint Disease Activity Score was 1.7. For golimumab, it was 1.4; for adalimumab, it was 1.1; for etanercept 25, it was 1.02; and for infliximab, it was 0.96 (p = 0.001). The median difference between basal and final Health Assessment Questionnaire ranged was 1.66 for etanercept 50, 1.34 for etanercept 25, 1.3 for golimumab, 1.24 for adalimumab, and 1.07 for infliximab (p = 0.0005). Comparatively, etanercept 50 presented the highest cumulative incidence (77%; 95% confidence interval [CI], 67%-86%) and remission incidence (64 cases per 100 person-months; 95% CI, 4.9-8.1 cases per 100 person-months) and the lowest AE rate (8.6 per 100 person-years; 95% CI, 5.3-15 per 100 person-years). In patients with RA treated with anti-tumor necrosis factor α drugs, the highest incidence of remission and the lowest rate of AEs were documented for the cohort exposed to etanercept 50 mg.

Asylum seekers health and wellbeing (TERTTU) survey: study protocol for a prospective total population health examination survey on the health and service needs of newly arrived asylum seekers in Finland

IntroductionHealth, well-being and health service needs of asylum seekers have emerged as urgent topics following the arrival of 2.5 million asylum seekers to the European Union (EU) between 2015 and...

Prevalence of Mental Health Screening and Associated Factors Among Refugees and Other Resettled Populations ≥ 14 Years of Age in Georgia, 2014–2017

Mental health screening (MHS) during the initial health assessment is recommended within 90days of arrival to the U.S. Yet, MHS prevalence is not well understood. Screening prevalence [prevalence ratio (PR), adjusted prevalence ratio (adjPR)] and factors associated with MHS were assessed among refugees, Special Immigrant Visa holders, parolees, asylees, and victims of human trafficking ≥ 14years old resettling in Georgia from 2014 to 2017. Of the 2019 individuals included, 55% received a MHS. Screening was more common among older individuals [reference: 13-22years old; adjPR 23-35 = 1.20 (1.12-1.29), adjPR 36-49 = 1.14 (1.03-1.26), adjPR ≥ 50 = 1.27 (1.15-1.41)] and those without Medicaid [adjPR Medicaid vs. none = 0.75 (0.63-0.89)]. MHS also differed by country of birth. Although MHS has increased within recent years, gaps exist within sub-populations and geographic regions. Efforts should focus on increasing MHS to ensure timely identification of concerns and linkage to services.

ADAPTING A COLLABORATIVE CARE MODEL TO FACILITATE REDUCTION OF HIGH DOSES OF PRESCRIPTION OPIOIDS IN COMMUNITY DWELLING ELDERS

Introduction In 2008, the Pennsylvania Department of Aging (PA DoA) and its pharmacy benefits programs for low- to low-middle income older Pennsylvanians—the Pharmaceutical Assistance Contract for the Elderly (PACE) and PACE Needs Enhancement Tier (PACENET)—partnered with the University of Pennsylvania (Penn) to establish a telephone-delivered clinical service that supported geriatric patients and their primary care providers in delivering mental health care integrated within the primary care setting. This evidence-based collaborative care service improved outcomes for elderly Pennsylvanians with disorders of mood or cognition. In the context of the current opioid epidemic, PACE/PACENET and Penn agreed to pilot a new telephone-delivered collaborative care service to help geriatric patients with chronic pain who receive continuing prescriptions for very high doses of opioids. Objectives: To report preliminary findings from a pilot project that adapted an existing collaborative care service to facilitate reduction of high doses of prescription opioids in community dwelling elders. The principle aims were to measure levels of patient participation and engagement, and to determine the extent to which engaged patients and their prescribers achieve opioid dose reduction. Methods Patient Sample: From May through October 2018, a convenience sample of elderly patients receiving chronic opioid prescriptions for > 120 mg morphine-equivalent dose (MED) was referred by PACE/PACENET to the Penn collaborative care service. Clinical Intervention: Patients who agree to participate undergo comprehensive assessments of mental health, cognition, sleep, pain, and functional status by a Behavioral Health Lab (BHL) technician. Measures include the Patient Health Questionnaire-9 (PHQ-9); Generalized Anxiety Disorder -7 (GAD-7); Blessed Orientation-Memory-Concentration test (BOMC); Insomnia Severity Index (ISI); Pain intensity, interference with Enjoyment of life, and interference with General activity (PEG); pain self-efficacy questionnaire (PSEQ); and Veterans RAND 12-item Health Survey (VR-12) for mental and physical function. A follow up baseline interview with a BHL clinician (LSW or RN) includes self-reported daily opioid dose, assessment of medical-psychiatric co-morbidity, other medications and pain treatment modalities, and identification of unmet biopsychosocial needs. The BHL clinician engages the patient in individualized treatment planning, with emphasis on goals of opioid dose reduction to safer levels. Modalities of treatment offered include but are not limited to (1) behavioral pain management, (2) general medication education, (3) reinforcing positive health behaviors, (4) addressing barriers to change, (5) scheduling positive activities, and (6) relaxation techniques. Summary reports are sent to prescribers with recommendations for pain care management and opioid dose reduction. Program Evaluation: “Participation” was defined as patient agreement to participate in the initial health assessment with a BHL technician. “Engagement” was defined as completion of the baseline health assessment and at least two follow-up contacts with a BHL clinician. “Substantial dose reduction” was defined as at least 20% reduction from the self-reported baseline MED within the first 12 weeks of program engagement. Results 71 patients were referred over the first 5 months, 3 of whom were unable to participate due to communication barriers. Of the remaining 68 eligible patients, 49 (72%) participated in the initial health assessment. Of these participants, 25 (36.8% of eligibles) had at least 2 follow-up contacts with a BHL clinician and were considered “engaged” in the program. Participants’ mean age was 73.9 years (range, 65-87); 61.5% were male; 94.2% were White, 1.9% were Black; 96.2% were non-Hispanic, 1.9% were Hispanic. Participants’ mean PHQ-9 score was 8.3; mean GAD-7 score 4.3; mean BOMC score 4.1; and mean ISI score was 6.3. Mean baseline PEG and PSEQ scores were 7.1 and 6.0, respectively. Mean VR 12 mental health score was 47.4 indicating average overall functioning, and VR-12 physical score was 20.4 indicating low overall functioning. Of the 25 engaged patients, 21 (84%) achieved dose reductions, with a mean MED of 420 mg on initial assessment and 276 mg at the last contact. 36% of engaged individuals achieved dose reductions of >20%. Conclusions In this pilot program for elderly patients taking very high doses of prescription opioids, we found a high rate of participation in the initial assessment, and a moderate rate of engagement in follow-up. Although 36% of the engaged patients achieved substantial opioid dose reductions, these patients were still receiving unsafe doses. Nevertheless, these findings suggest that it is possible to adapt a collaborative care model to help some older adults achieve substantial reductions from high doses of prescription opioids. This research was funded by Pennsylvania Department of Aging

어류를 이용한 한국의 하천생태계 건강성 평가

The objective of this study was to describe the development and testing of an initial ecological health assessment model, based on the index of biological integrity (IBI) using fish assemblages, before establishing the final and currently used model for ecological health assessment, conservation and management of freshwater fish in Korea. The initial fish IBI model was developed during 2004~2006 and included 10 metrics, and in 2007 the final IBI 8-metric model was established for application to streams and rivers in four major Korean watersheds. In this paper, we describe how we developed fish sampling methods, determined metric attributes and categorized tolerance guilds and trophic guilds during the development of the multi-metric model. Two of the initial metrics were removed and the initial evaluation categories were reduced from six to four (excellent, good, fair, poor) before establishing the final national fish model. In the development phase, IBI values were compared with chemical parameters (BOD and COD as indicators of organic matter pollution) and physical habitat parameters to identify differences in IBI model values between chemical and physical habitat conditions. These processes undertaken during the development of the IBI model may be helpful in understanding the modifications made and contribute to creating efficient conservation and management strategies for stream environments to be used by limnologists and fish ecologists as well as stream/watershed managers.

Improving completion of the initial comprehensive health assessment for children entering foster care

•The child welfare system exists to ensure safety, permanence, and wellbeing of children.•Case manager training on health and wellbeing needs of children in foster care is often minimal.•National advocacy groups recommend comprehensive health assessments within one month.•Children in foster care have more health problems compared to general pediatrics.

The clinical use of Subjective Units of Distress scales (SUDs) in child mental health assessments: a thematic evaluation

Background: Despite the ubiquitous use of Subjective Units of Distress scales (SUDs) in mental health settings to establish levels of distressing emotion, there has been little empirical research in this area. SUDs are commonly used in therapy and assessments, and are a particularly useful tool for establishing current and previous levels of distress in children and young people.Aims: To explore the use of the SUD analogue rating scale in initial child mental health assessments to better understand its application in this context.Method: The data corpus consisted of 28 naturally-occurring video recordings of children and young people attending their first assessment appointment at Child and Adolescent Mental Health Services (CAMHS). A thematic analysis was utilised to explore the specific interactional use of SUDs.Results: Four themes were identified; recency, longevity, context and miscommunication. The first three themes were found to supplement the child’s emotional score on the scale and were important in establishing the necessity for further therapeutic support. Miscommunication as a theme highlighted the need for clarity when using SUDs with children and young people.Conclusions: Recommendations were suggested for practitioners working with children and young people relating to the extended use of rating scales in clinical assessments.

Patient satisfaction and its potential impact on refugee integration into the healthcare system

Background: Health care constitutes an important aspect of services in the resettlement processes for newly arriving and resettling refugees. Objectives: We conducted a study to investigate levels of satisfaction related to health services delivered to refugee populations in a resettlement community and its surrounding areas. Methods: We used the experience of 92 adult refugee patients to examine social-cultural, clinical and economic characteristics affecting satisfaction with health care. A cross-sectional study using the Patient Satisfaction Questionnaire (PSQ) was conducted. Item analysis was conducted by considering each question on the PSQ as an item and by developing dimensions of satisfaction. Chi-square analyses were used to assess the relationships between satisfaction and patient factors. Results: Patients were satisfied with the initial health assessment (90%) and overall quality (86%). Only 59% of the patients were satisfied with phone interpreters. The general satisfaction dimension had a score of 4.05 on a scale of 5, while time spent with the doctor had the lowest score of 2.98. Having pre-arrival medical conditions was associated with poor satisfaction with both the initial health assessment (χ2=10.260; p=.036) and regular health services (χ2=4.550; p=.033). Conclusion: Although patients were generally satisfied with health services, improvements are recommended in different aspects of care to create a favorable environment of care and increase levels of satisfaction and trust with the healthcare system among refugee populations.

Physical and mental health needs of unaccompanied children seeking asylum: a descriptive analysis in Kent, UK

BackgroundA humanitarian crisis associated with the mass movement of refugees across Europe has been occurring since 2014. The county of Kent, located in the south east of England and containing the port Dover, has seen large increases in arrivals of unaccompanied children. We aimed to carry out a structured assessment of their health needs. MethodsIn accordance with the Children's Act 1989 and 2004, looked-after children, including unaccompanied children, should be offered an initial health assessment to identify their needs. We analysed the results of 154 initial health assessments of unaccompanied children arriving in Kent in 2015. Although selection of the assessments was opportunistic, the sample was broadly representative of the wider cohort of unaccompanied children in Kent. The need for interventions such as immunisation and screening was reviewed. Findings989 unaccompanied young people entered Kent in 2015. Median age of the 154 children given an initial health assessment was 16 years (IQR 15·9–17·2); 145 (94%) were boys. The most common country of origin was Eritrea (62 children, 41%), followed by Afghanistan (24, 16%) and Syria (20, 13%). Psychological symptoms were reported in 63 children (41%), including symptoms of post-traumatic stress disorder (24, 16%). Dental disease (eg, decay and caries) was reported in 60 (46%) of 130 children examined. Dermatology signs, including fungal infection, scabies, and scars, were seen in 26 children (17%). Most symptoms reported were easily treatable, although symptoms of acute infection were recorded in a small number of children. Almost all the 989 unaccompanied young people needed catch-up immunisation. All of them came from countries with a moderate to high prevalence of chronic hepatitis B infection, and 700 children (71%) met WHO criteria for tuberculosis screening. InterpretationThe key health needs identified were psychological symptoms (particularly of post-traumatic stress disorder), dental health, and dermatology complaints. Although physical complaints were common, most were non-acute and could be managed in the community. Infectious disease is an important issue in this cohort, which can be managed through simple, preventive measures such as immunisation and screening. FundingNone.

Integrated Behavioral Health in Pediatric Primary Care.

There are multiple barriers to accessing high quality, evidence-based behavioral health care for children and adolescents, including stigma, family beliefs, and the significant paucity of child and adolescent psychiatrists. Although equal access continues to be an unmet need in the USA, there is growing recognition that integrated behavioral health services in pediatric primary care have the potential to reduce health disparities and improve service utilization. In a joint position paper, the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP) highlighted the multiple benefits of children receiving initial behavioral health screening, assessment, and evidence-based behavioral health treatments in the medical home. The purpose of this paper is to review the current state of the literature related to integrated behavioral health services in pediatric primary care. Specifically, innovative models of integrated behavioral health care are discussed.

Treatment Controversies in Adult ADHD.

Treatment Controversies in Adult ADHD.

Magnitude ofGiardiacases among refugees, adoptees and immigrants in Monroe County, New York, 2003-2013

PurposeThe purpose of this paper is to determine the morbidity ofGiardiain Monroe County, New York attributed to refugees, foreign adoptees and immigrants, and to examine factors related to asymptomaticGiardiainfection.Design/methodology/approachA retrospective epidemiological analysis was conducted ofGiardiacase investigations submitted to the New York State Department of Health on the Communicable Disease Electronic Surveillance System, between January 1, 2003 and December 31, 2013 from Monroe County Department of Public Health. Univariate and multivariate logistic regression models were used to assess odds for asymptomaticGiardia.FindingsOf the 1,221Giardiacases reported in Monroe County during that time, 38 percent (n=467) were refugees, 6 percent (n=77) were foreign adoptees and 1.4 percent (n=17) were immigrants. In total, 95 percent of the refugees and 89 percent of the adoptees/immigrants were asymptomatic, compared to 15 percent of the non-refugee/adoptee/immigrant cases. Unadjusted odds for asymptomatic infection were 113.4 (95 percent CI: 70.6-183.7) for refugees, and 45.6 (95 percent CI: 22.9-91) for adoptees/immigrants.Originality/valueThis study demonstrates the importance of routine screening forGiardiaduring refugees’ initial health assessment.

Seasonal patterns of initial domestic health assessment for refugees in New York State, 2013

Seasonal patterns of initial domestic health assessment for refugees in New York State, 2013

Early Developmental Screening for Children in Foster Care

Limited data exist about the ideal timing of developmental screening for young children entering foster care, and current best practice recommends screening by 1 month into care to prioritize resources for evaluation. Therefore, we aimed to: (1) compare detection rates for potential developmental delay (DD) at foster care entry before and after implementation of a developmental screen and (2) examine accuracy of developmental screening when performed at entry and 1 month into care. Charts of 124 children <6 years evaluated for an initial foster care health assessment (IFCHA) were reviewed to determine baseline detection rates for potential DD. The Parents’ Evaluation of Developmental Status (PEDS) screening tool was then prospectively administered to 167 children <6 years during their IFCHA to determine detection rates. One month following the IFCHA, caregivers were re-contacted, and the screen was re-administered. Accuracy of the initial PEDS screen was compared to the 1 month PEDS screen by calculation of sensitivity and specificity. At baseline, potential DD was detected in 34 % of children at the IFCHA compared to 46 % after implementation of the PEDS (P = 0.041). Compared to the 1 month screen, the early screen had a sensitivity of 75 % and specificity of 88 %. Use of a developmental screening tool at foster care entry increased detection of potential DD, and the results remained consistent with screening 1 month later. These results support use of a developmental screen for children in foster care and suggest that screening be performed as early as possible to expedite necessary evaluations and referrals.

Initial Health Assessments and HIV Screening under the Affordable Care Act.

BackgroundThe Centers for Disease Control and Prevention (CDC) estimates that 156,300 (95% CI 144,100–165,900) Americans living with HIV in 2012 were unaware of their infection. To increase knowledge of HIV status, CDC guidelines seek to make HIV screening a routine part of medical care. This paper examines how routinely California primary care providers test for HIV and how providers’ knowledge of California’s streamlined testing requirements, use of sexual histories, and having an electronic medical record prompt for HIV testing, relate to test offers.MethodsWe surveyed all ten California health plans offered under health reform’s Insurance Exchange (response rate = 50%) and 322 primary care providers to those plans (response rate = 19%) to assess use of HIV screening and risk assessments.ResultsOnly 31.7% of 60 responding providers reported offering HIV tests to all or most new enrollees and only 8.8% offered an HIV test of blood samples all or most of the time despite the California law requiring that providers offer HIV testing of blood samples in primary care settings. Twenty-eight of the 60 providers (46.6%) were unaware that California had reduced barriers to HIV screening by eliminating the requirement for written informed consent and pre-test counseling. HIV screening of new enrollees all or most of the time was reported by 53.1% of the well-informed providers, but only 7.1% of the less informed providers, a difference of 46 percentage points (95% CI: 21.0%—66.5%). Providers who routinely obtained sexual histories were 29 percentage points (95% CI: 0.2%—54.9%) more likely to screen for HIV all or most of the time than those who did not ask sexual histories.ConclusionChanging HIV screening requirements is important, but not sufficient to make HIV testing a routine part of medical care. Provider education to increase knowledge about the changed HIV testing requirements could positively impact testing rates.

G442(P) What do looked after young people think about the specialist health services they use?

Aim There is limited research concerning the experiences, preferences and priorities of looked after children and young people (LACYP) relating to healthcare. LACYP have higher rates of physical, developmental and mental health problems than their peers, with worse longer–term outcomes. This study aims to capture young people’s views on health and mental health services specifically for LACYP. Method A questionnaire was created, incorporating issues identified as important to LACYP in existing literature, and modified with input from involved health and social care professionals and a LACYP participation group. Two LACYP health services and one LACYP mental health service were investigated over a four month period. All LACYP, aged 12 years and over, who attended for an initial or review health assessment or for specialist mental health services were given a questionnaire to complete anonymously in relation to their appointment. Results 136 questionnaires were completed. Mean age of participants was 15.1 years (range 12–18), with equal numbers of males and females. 92% were glad they had attended their appointment, 99% felt listened to, 95% thought professionals were easy to talk to and 97% considered their views were taken seriously. 8% were not offered an opportunity to speak with the practitioner alone, but 73% of this group would not have wanted to do so. 7% worried about who would see the information given. Free text comments corresponded closely to key themes regarded by LACYP as important in existing literature; LACYP want to talk to professionals who listen and have an ability to get things done. Conclusion It is clear the majority felt these services helped them; this is particularly relevant to health appointments where LACYP are not referred with a specific problem, but for statutory review. Recommendations include all LACYP being offered opportunities to speak with practitioners alone and ensuring confidentiality is discussed at the beginning of appointments. Acting on the results of this study forms the first step in ensuring local services meet the needs of LACYP more effectively.

A new service for Initial Health Assessments for 16+ young people across Kent Community Health NHS Trust, UK

A new service for Initial Health Assessments for 16+ young people across Kent Community Health NHS Trust, UK

Completion of primary care referrals among New York state refugees.

An important component of the New York State Refugee Health Program's (NYSRHP) mission is to ensure refugees with identified medial conditions are referred to primary and specialty care. A programmatic evaluation was conducted to assess the completion rate for primary care referral appointments made during the initial domestic health assessment among refugees in NYS (exclusive of New York City). Upon arrival in NYS, refugees may receive a domestic health assessment by one of NYSRHP contracted providers. As part of the assessment, referrals for primary and specialty care may be assigned. From July 2010 to June 2011, 69 % of NYS-bound refugees that received a primary care referral by a NYSRHP contracted provider completed their appointment.