Kevin Scott

Factors associated with use of urban emergency departments by the U.S. homeless population.

Objective. Homeless individuals frequently use emergency departments (EDs), but previous studies have investigated local rather than national ED utilization rates. This study sought to characterize homeless people who visited urban EDs across the U.S. Methods. We analyzed the ED subset of the National Hospital Ambulatory Medical Care Survey (NHAMCS-ED), a nationally representative probability survey of ED visits, using methods appropriate for complex survey samples to compare demographic and clinical characteristics of visits by homeless vs. non-homeless people for survey years 2005 and 2006. Results. Homeless individuals from all age groups made 550,000 ED visits annually (95% confidence interval [CI] 419,000, 682,000), or 72 visits per 100 homeless people in the U.S. per year. Homeless people were older than others who used EDs (mean age of homeless people = 44 years compared with 36 years for others). ED visits by homeless people were independently associated with male gender, Medicaid coverage and lack of insurance, and Western geographic region. Additionally, homeless ED visitors were more likely to have arrived by ambulance, to be seen by a resident or intern, and to be diagnosed with either a psychiatric or substance abuse problem. Compared with others, ED visits by homeless people were four times more likely to occur within three days of a prior ED evaluation, and more than twice as likely to occur within a week of hospitalization. Conclusions. Homeless people who seek care in urban EDs come by ambulance, lack medical insurance, and have psychiatric and substance abuse diagnoses more often than non-homeless people. The high incidence of repeat ED visits and frequent hospital use identifies a pressing need for policy remedies.

Health Profiles of Newly Arrived Refugee Children in the United States, 2006–2012

OBJECTIVES We conducted a large-scale study of newly arrived refugee children in the United States with data from 2006 to 2012 domestic medical examinations in 4 sites: Colorado; Minnesota; Philadelphia, Pennsylvania; and Washington State. METHODS Blood lead level, anemia, hepatitis B virus (HBV) infection, tuberculosis infection or disease, and Strongyloides seropositivity data were available for 8148 refugee children (aged < 19 years) from Bhutan, Burma, Democratic Republic of Congo, Ethiopia, Iraq, and Somalia. RESULTS We identified distinct health profiles for each country of origin, as well as for Burmese children who arrived in the United States from Thailand compared with Burmese children who arrived from Malaysia. Hepatitis B was more prevalent among male children than female children and among children aged 5 years and older. The odds of HBV, tuberculosis, and Strongyloides decreased over the study period. CONCLUSIONS Medical screening remains an important part of health care for newly arrived refugee children in the United States, and disease risk varies by population.

Community-Based Partnerships for Improving Chronic Disease Management

With the growing burden of chronic disease, the medical and public health communities are re-examining their roles and opportunities for more effective prevention and clinical interventions. The potential to significantly improve chronic disease prevention and have an impact on morbidity and mortality from chronic conditions is enhanced by adopting strategies that incorporate a social ecology perspective, realigning the patient-physician relationship, integrating population health perspectives into the Chronic Care Model, and effectively engaging communities using established principles of community engagement.

Cervical Cancer Screening Outcomes in a Refugee Population

Cervical cancer is the second most common cause of female cancer mortality worldwide, accounting for approximately 274,000 deaths annually (Parikh, Brennan, & Boffetta, 2003; World Health Organization, 2002). Of the estimated 500,000 new cases of cervical cancer diagnosed each year, 80% of these occur in developing countries, with the highest rates occurring in Africa, Asia, and Central and South America (de Sanjose et al., 2010; Ferlay et al., 2010; Lipson et al., 1995; Parikh et al., 2003; World Health Organization, 2002, 2011). Human papillomavirus (HPV) has been detected in 99% of cervical cancer cases, and infection with HPV is a prerequisite to the development of invasive cervical cancer (de Sanjose et al., 2010; Dunne et al., 2007; Ferlay et al., 2010; Lipson et al., 1995; Parikh et al., 2003; World Health Organization, 2002, 2011). Seventy percent of cervical cancers are due to high-risk (HR) HPV types 16 and 18, and although there is some geographic variation in the prevalence of HPV, global data suggests that the eight most common high-risk oncogenic HPV genotypes (16, 18, 21, 33, 35, 45, and 52) contribute to over 90% of the cervical cancer in all world regions [de Sanjose, 2010; Dunne, 2007; World Health Organization, 2011].

How Multidimensional Health Locus of Control predicts utilization of emergency and inpatient hospital services

Health locus of control may be an important predictor of health care utilization. We analyzed associations between health locus of control and frequency of emergency department visits and hospital admissions, and investigated self-rated health as a potential mediator. Overall, 863 patients in an urban emergency department completed the Multidimensional Health Locus of Control instrument, and self-reported emergency department use and hospital admissions in the last year. We found small but significant associations between Multidimensional Health Locus of Control and utilization, all of which were mediated by self-rated health. We conclude that interventions to shift health locus of control may change patients’ perceptions of their own health, thereby impacting utilization.

Evaluation of latent tuberculous infection and treatment completion for refugees in Philadelphia, PA, 2010-2012.

SETTING Philadelphia, PA, USA. OBJECTIVES To compare the evaluation and treatment of latent tuberculous infection (LTBI) in refugees seen at member clinics of the Philadelphia Refugee Health Collaborative (PRHC) vs. non-PRHC clinics. DESIGN Refugees with Class B (non-communicable) tuberculosis (TB) admitted to the United States from 2010 to 2012 who were being treated at PRHC clinics were compared to those treated at non-PRHC clinics. Odds ratios (ORs) for attending a follow-up appointment, completing treatment, and time from arrival to the United States to the first TB screening test were calculated. RESULTS Of the 2094 refugees who arrived in Philadelphia in 2010-2012, the Philadelphia Department of Public Health was notified of 149 who required additional evaluation for TB. Among these, 57 (38.3%) were confirmed to have LTBI, and none were diagnosed with active TB. All LTBI cases were recommended for anti-tuberculosis prophylaxis and 43 (75.4%) completed treatment. Refugees receiving care from PRHC clinics were more likely to be screened within 30 days of arrival (OR 4.70, 95%CI 2.12-10.44), attend a follow-up appointment (OR 4.53, 95%CI 1.36-16.27), and complete treatment (OR 9.44, 95%CI 2.39-37.3). CONCLUSION Refugees who attended PRHC clinics were more likely to be evaluated promptly and to complete LTBI treatment. The PRHC clinics serve as a model for communities seeking to improve refugee health care.

Increasing Hepatitis B Vaccine Prevalence Among Refugee Children Arriving in the United States, 2006–2012

OBJECTIVES To determine whether the addition of hepatitis B virus (HBV) vaccine to national immunization programs improved vaccination rates among refugee children, a marginalized population with limited access to care. METHODS The sample included 2291 refugees younger than 19 years who completed HBV screening after arrival in the United States. Children were categorized by having been born before or after the addition of the 3-dose HBV vaccine to their birth countrys national immunization program. The outcome was serological evidence of immunization. RESULTS The odds of serological evidence of HBV immunization were higher for children born after the addition of HBV vaccine to their birth countrys national immunization program (adjusted odds ratio = 2.54; 95% confidence interval = 2.04, 3.15). CONCLUSIONS National HBV vaccination programs have contributed to the increase in HBV vaccination coverage observed among US-bound refugee children. PUBLIC HEALTH IMPLICATIONS Ongoing public health surveillance is needed to ensure that vaccine rates are sustained among diverse, conflict-affected, displaced populations.

Confirmatory factor analysis and invariance testing between Blacks and Whites of the Multidimensional Health Locus of Control scale

The factor structure of the Multidimensional Health Locus of Control scale remains in question. Additionally, research on health belief differences between Black and White respondents suggests that the Multidimensional Health Locus of Control scale may not be invariant. We reviewed the literature regarding the latent variable structure of the Multidimensional Health Locus of Control scale, used confirmatory factor analysis to confirm the three-factor structure of the Multidimensional Health Locus of Control, and analyzed between-group differences in the Multidimensional Health Locus of Control structure and means across Black and White respondents. Our results indicate differences in means and structure, indicating more research is needed to inform decisions regarding whether and how to deploy the Multidimensional Health Locus of Control appropriately.

ASSOCIATION BETWEEN THE “PUFFY‐HAND SIGN” AND CHRONIC HEPATITIS C IN A GERIATRIC PATIENT

ported the presence of Y chromosome–positive renal tubular cells in the kidneys of male patients who have received a renal transplant from a female recipient, suggesting that cells outside the kidney can populate the renal tubule. Infusion of bone marrow cells partially reversed the acute rise in blood urea nitrogen, as seen in mice subjected to lethal irradiation, suggesting a functional role in the recovery process for these cells. As far as the kidney is concerned, environmental agents may influence tissue damage in young and elderly people, but genetic factors act in single subjects to extend the aptitude to functional adaptations and preserving GFR. Continuous and sustained EPCs mobilization might represent a particular mechanism for improving renal microvascular reparation that is genetically developed in a limited number of subjects.

Vaccine delivery to newly arrived refugees and estimated costs in selected U.S. clinics, 2015

BACKGROUND Newly arrived refugees are offered vaccinations during domestic medical examinations. Vaccination practices and costs for refugees have not been described with recent implementation of the overseas Vaccination Program for U.S.-bound Refugees (VPR). We describe refugee vaccination during the domestic medical examination and the estimated vaccination costs from the US government perspective in selected U.S. clinics. METHODS Site-specific vaccination processes and costs were collected from 16 clinics by refugee health partners in three states and one private academic institution. Vaccination costs were estimated from the U.S. Vaccines for Children Program and Medicaid reimbursement rates during fiscal year 2015. RESULTS All clinics reviewed overseas vaccination records before vaccinating, but all records were not transferred into state immunization systems. Average vaccination costs per refugee varied from