The Health Status of Undocumented Immigrants from Asian Countries in the United States: A Scoping Review and Recommendations for Future Directions.

Immigrants from Asian countries are the fastest-growing undocumented population in the United States (U.S.), yet not much is known about their health. This scoping review identifies the nature and extent of scientific literature on the health of undocumented Asian immigrants in the U.S. We conducted a comprehensive search of six electronic databases in 2024. Inclusion criteria were empirical articles written in English, published in peer-reviewed scientific journals from 2010 to 2024, and focused on a health outcome or health-related issue involving undocumented Asian immigrants. Results are summarized narratively. We identified 13 peer-reviewed publications. Nine studies were quantitative, and four were qualitative. Eight studies were conducted in California; two studies used national secondary data sources. Studies were mixed in their research focus. They covered a range of health outcomes and issues, such as mental health (n = 4), health services and access (n = 2), contraceptive use (n = 1), COVID-19 (n = 2), and HIV (n = 1). Three studies measured self-rated health alongside other conditions, such as disability, health insurance coverage, chronic health conditions, and obesity. Scholarship on the health of undocumented Asian immigrants is a growing research area. Given the small number of studies identified, future research with larger diverse samples, more robust methodology, and greater topical variety are warranted to understand the health of this population better and reduce potential inequities.

Pathway Programs That Support Students From Immigrant Backgrounds in Becoming Physicians.

Pathways programs are critical to promoting access and success for careers in healthcare for students from immigrant backgrounds. Three cases are presented that demonstrate the successful elements of pathways programs. Excellence in pediatrics requires the inclusion of talent from immigrant communities. Community capacity building and systems level change can be achieved through coliberatory practice of mutual action, investment, and benefit. Navigation, mentorship, and structural support for educational, social, and monetary capital are key components of pathways programs.

Effect of Physiotherapy on an Elderly Patient With Distal Anterior Cerebral Artery Aneurysm Clipping.

This case study analyzes the effectiveness of physiotherapy in the treatment of a female patient, aged 65 years, with hypertension who had a history of subdural hematoma (SDH) secondary to a distal anterior cerebral artery (DACA) aneurysm rupture. For that, she underwent DACA aneurysm clipping surgery and developed a disability on the right side of her body. The patient had diminished functional independence, weak muscles, and restricted mobility when she first arrived. A thorough physiotherapy program was developed with the goals of increasing mobility, building independence in daily living tasks, and improving motor function. Adapted to the patient's particular requirements and limits, the intervention included therapeutic exercises, gait training, balancing exercises, and functional training. Assessments were carried out on a regular basis to track improvement and modify the treatment plan as necessary. The patient's motor function, mobility, and functional independence were significantly improved during the intervention. Physiotherapy played a crucial role in significantly improving the patient's recovery, quality of life, and right-side disability following the DACA aneurysm clipping surgery. The presented case study clearly highlights the value of early and focused physiotherapy intervention in the effective management of neurological impairments and in achieving better rehabilitation outcomes in patients with similar medical presentations.

Navigating a climate of administrative burden: the perspectives of young adult undocumented immigrants in applying for COVID-19 disaster relief assistance for immigrants in California.

Undocumented immigrants experienced high levels of economic insecurity during the COVID-19 pandemic while being excluded from government-based relief and unemployment benefits. In April 2020, California became the first state to offer financial aid to undocumented immigrants through the innovative Disaster Relief Assistance for Immigrants (DRAI) program in collaboration with several community-based organizations (CBOs). However, the process of applying for aid was marked by many implementation challenges, such as intake and language access; however, little data exists on the direct experiences of the undocumented community. This qualitative study examines the experiences of undocumented Asian and Latinx young adults living in California in applying for DRAI through framework of administrative burden. Themes distilled from participant experiences highlight how administrative burden via learning, psychological, and compliance costs shape the ways in which undocumented immigrants navigate policies and programs, such as DRAI. These experiences highlight the need for policymakers to address structural and programmatic administrative burdens in policy development; failure to do so result in detrimental impacts that outweigh financial benefits or cause communities to forgo needed resources.

Advantages of computed tomography-based navigation in clipping distal anterior cerebral artery aneurysms: a retrospective cohort study.

Background: The occurrence rate of distal anterior cerebral artery (DACA) aneurysms is relatively low, primarily due to their deep-seated location, which makes surgical clamping challenging. The objective of this study was to investigate the efficacy and safety of computed tomography (CT) navigation-assisted clipping of DACA aneurysms compared to traditional clipping without navigation. Methods: A retrospective cohort study involving retrospective data collection was performed. The retrospective analysis was conducted on 139 patients with ruptured DACA aneurysms who underwent clipping. From January 2013 to November 2021, 164 patients were retrieved at the Department of Neurosurgery, Renmin Hospital of Wuhan University. The inclusion criteria were patients diagnosed with DACA aneurysms via CT angiography (CTA) or digital subtraction angiography (DSA), those with complete clinical data, and those who underwent craniotomy for aneurysm clipping. Meanwhile, the exclusion criteria were as follows: aneurysm recurrence, traumatic brain injury or surgery history, blood disorders or recent anticoagulant use, and severe organ dysfunction. Data on gender, age, Hunt-Hess grade, Fisher grade, modified Rankin Scale (mRS) score, aneurysm location, hospitalization time, aneurysm found time (the duration from incision to aneurysm discovery), and intraoperative bleeding volume were collected from medical records and neurosurgical databases. Patients were followed up in the clinic or by telephone in May 2022. All patients were divided into a navigation group or a traditional group for statistical analysis. Results: No statistically significant differences were observed in age, sex, Fisher grade, Hunt-Hess grade, hospitalization time, or aneurysm site between the navigation group and traditional group (P>0.05). Intraoperative blood loss was lower in the navigation group than in the traditional group {370 [280-460] vs. 430 [310-610] mL, P=0.045}. Patients in the traditional group had a shorter aneurysm found time than did those in the navigation group {49 [42-53] vs. 79 [63-84] min, P<0.001}. There was no significant difference in the mRS score at hospital discharge (P=0.336) or follow-up (P=0.157) between the two groups. Conclusions: CT neuronavigation-assisted microsurgery for clipping DACA aneurysms may improve surgical accuracy, shorten the time to locate aneurysms, and reduce intraoperative blood loss. Although no significant difference in prognosis was observed, this technique shows promise as a safe and effective alternative to traditional clipping without navigation.

Microsurgery and Endovascular Therapy for Distal Anterior Cerebral Artery Aneurysm: A Multicenter Retrospective Cohort Study.

BACKGROUND: Distal anterior cerebral aneurysm (DACA) represents 4% of intracranial aneurysms. Two treatment modalities are available: microsurgery and endovascular therapy (EVT). OBJECTIVE: To compare the results between microsurgery and EVT in a modern French cohort. METHODS: A multicenter retrospective cohort study of 3 French neurosurgical units was carried out from January 1, 2015, to December 31, 2020. All participants were adult patients who required treatment for a ruptured or unruptured DACA aneurysm. RESULTS: A total of 69 patients were included; 16 patients (23.2%) were treated by microsurgery and 53 (76.8%) were treated by EVT. Thirty-one patients (44.9%) had ruptured aneurysms. The complication rate was low, with 1 death and 1 symptomatic ischemia. There was no difference in complications between microsurgery and EVT (P = 0.22). The number of retreatments was higher in EVT (15% vs. 0%) but not significantly (P = 0.18). CONCLUSIONS: In the specific subgroup of DACA, both treatment modalities are effective in ruptured and unruptured aneurysms, with a low rate of complications. Retreatment may be more frequent in EVT but it does not lead to more complications.

DACA Recipient Health Care Workers' Barriers to Professionalization and Deployment of Navigational Capital in Pursuit of Health Equity for Immigrants.

The COVID-19 pandemic has laid bare entrenched health inequalities in the U.S. health care system faced by structurally marginalized immigrant communities. Deferred Action for Childhood Arrivals (DACA) recipients are well suited to address these social and political determinants of health due to their large presence in service positions and skill sets. Yet their potential in health-related careers is limited by unique barriers related to uncertainty about their status and training and licensure processes. We report findings from a mixed-method (interview and questionnaire) study of 30 DACA recipients in Maryland. Nearly half of participants (14; 47%) worked in health care and social service fields. The longitudinal design featured three research phases conducted between 2016 and 2021, which enabled us to observe participants' evolving career trajectories and capture their experiences during a tumultuous period (due to the DACA rescission and COVID-19 pandemic). Using a community cultural wealth (CCW) framework, we present three case studies that demonstrate challenges recipients encountered as they embarked on health-related careers, including protracted educational journeys, concerns about program completion/licensure, and uncertainty about future employment. Yet participants' experiences also revealed valuable forms of CCW they deploy, including building on social networks/collective knowledge, forging navigational capital and sharing experiential knowledge, and leveraging identity to devise innovative strategies. Results highlight the critical value of DACA recipients' CCW that renders them particularly apt brokers and advocates in promoting health equity. Yet they also reveal the urgent need for comprehensive immigration and state-licensure reform to promote DACA recipients' inclusion in the health care workforce.

Exclusion by design: The undocumented 1.5 generation in the U.S.

This article focuses on Mexican individuals who grew up in the U.S. (1.5 generation) without documents and were not able to benefit from Deferred Action for Childhood Arrivals (DACA) or who were unable to renew their DACA. A 2012 Executive Action by former president Obama, DACA gave some undocumented youth relief from deportation and a 2-year renewable work permit provided they met certain criteria. Undocumented individuals DACA failed to reach have generally been overlooked in immigration research in favor of examining how DACA recipients' lives have been transformed by DACA. This project helps fill this gap by examining life outside of DACA, and how the program acted as an internal U.S. border of exclusion for many. This research also aids in understanding the impacts of changing government policies on vulnerable populations, especially those who are in some respects made even more vulnerable by their faith in the government, fear of the government, or are actively excluded from government programs. This investigation is part of a study that compares 20 DACA beneficiaries to 20 individuals without DACA. Through ethnographic methodologies and one-on-one interviews, this article examines the 20 research participants who fall outside DACA. It investigates why people who qualified for DACA did not apply, barriers to applying/renewing, and how members of the 1.5 generation were excluded from the program by restrictions such as date of arrival requirements. The article discusses what it means for research participants to live outside of DACA, and how they see their lives because they do not have DACA while others do. For example, what does it mean to age out of qualifying for DACA? What actions did individuals then take regarding their lack of legal status?

Mini anterior interhemispheric approach for A3 segment distal anterior cerebral artery aneurysms.

INTRODUCTION: Aneurysms of the A3 segment of the distal anterior cerebral artery (DACA), in relation to the genu of the corpus callosum, are specific sub-group which pose unique surgical challenges due to their discrete anatomical location. We describe a mini-anterior interhemispheric approach which can be safely utilised to clip these aneurysms rather than the traditional bifrontal approach. METHODS: Retrospective analysis of the clinical and radiological data of ruptured DACA-A3 aneurysms operated between 2014 and 2021 at our institute. A curvilinear scalp incision within the hairline followed by raising small, unilateral, free frontal bone flap, avoiding the opening of frontal sinus. Superior sagittal sinus is displaced medially, inter-hemispheric dissection carried out with posterior trajectory and small callosotomy is performed. DACA is skeletonised, proximal control is established, and the A3 aneurysm is dissected and clipped. RESULT: Our cohort of 18 patients had a definite female preponderance (F:M::2:1) with mean age of 55.6 years. On admission three patients were categorized as WFNS Grade I, thirteen in Grade II, and two in Grade III for subarachnoid haemorrhage. All the patients had evidence of blood in the interhemispheric fissure; intraparenchymal haemorrhage was seen in seven, with intraventricular haemorrhage in six patients. Within the A3 segment six aneurysms were infragenu (inferior), eight were at the genu (anterior) and four were supragenu (superior). Two (11.1%) elderly patients succumbed post-surgery following ischemic infarcts and associated complications. At the time of follow-up at 3 months of the remaining sixteen (72.2%) patients, thirteen had a good outcome (mRS 0-3) and three (16.7%) had a poor outcome (mRS > 3). CONCLUSION: The mini anterior interhemispheric is an effective minimally invasive alternative for A3 segments aneurysms and helps to avoid the complications of the conventional bifrontal interhemispheric approach.

Manoeuvering through the Multilayered Jurisdictional Policy Patchwork: DACA Recipients' Navigational Capital in the Washington, D.C. Metropolitan Region.

During its almost-decade of existence, Deferred Action for Childhood Arrivals (DACA) has been a focal point of immigration policy debate. Liminally legal DACA recipients have endured a rollercoaster of lawsuits and court decisions, yet are simultaneously incorporating into local communities characterized by distinctive socio-legal contexts. Drawing from a longitudinal qualitative study of 30 DACA recipients in the Washington, D.C. Metropolitan region, we argue that DACA recipients draw from their legal-spatial consciousness and local knowledge to forge navigational capital that allows them to adeptly maneuver between different jurisdictions. Over time, they deploy this navigational capital to strategically access distinct yet interconnected educational, health care, housing, and employment sectors and expand their spatial mobility, underscoring their capacity for adaptation and resilience. As forms of collective knowledge, their navigational capital reverberates through their social networks as they broker on-the-ground forms of inclusion for themselves and their families and communities within these socio-legal contexts.

Intra-aneurysmatic thrombectomy in a distal anterior cerebral artery aneurysm.

Thrombectomy procedures following intra-aneurysmatic lesions are extremely rare, and few cases have been reported. This article describes a microsurgical intra-aneurysmatic thrombectomy (MIaT) for a distal anterior cerebral artery (DACA) aneurysm. We present the case of a 48-year-old female that was admitted to the emergency room, showing neurologic deterioration with focal deficits. A computed tomography angiography (CTA) scan revealed an aneurysm located in the distal segment of the left anterior cerebral artery. During the surgical procedure, after clipping, a wellformed clot was visualized through the aneurysm's wall obstructing the left DACA flow. We proceeded to open the aneurysm's dome to remove the thrombus and clip the aneurysm neck, re-establishing the flow of the left DACA. Intra-aneurysmatic thrombosis can occur as a complication during clipping, obstructing the distal flow of vital arteries and causing fatal results in the patient's postoperative status. MIaT is a good technique for restoring the flow of the affected vessel and allows a secure aneurysm clipping after thrombus removal.

Study of SarA by DNA Affinity Capture Assay (DACA) Employing Three Promoters of Key Virulence and Resistance Genes in Methicillin-Resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA), one of the most well-known human pathogens, houses many virulence factors and regulatory proteins that confer resistance to diverse antibiotics. Although they have been investigated intensively, the correlations among virulence factors, regulatory proteins and antibiotic resistance are still elusive. We aimed to identify the most significant global MRSA regulator by concurrently analyzing protein-binding and several promoters under same conditions and at the same time point. DNA affinity capture assay (DACA) was performed with the promoters of mecA, sarA, and sarR, all of which significantly impact survival of MRSA. Here, we show that SarA protein binds to all three promoters. Consistent with the previous reports, ΔsarA mutant exhibited weakened antibiotic resistance to oxacillin and reduced biofilm formation. Additionally, production and activity of many virulence factors such as phenol-soluble modulins (PSM), α-hemolysin, motility, staphyloxanthin, and other related proteins were decreased. Comparing the sequence of SarA with that of clinical strains of various lineages showed that all sequences were highly conserved, in contrast to that observed for AgrA, another major regulator of virulence and resistance in MRSA. We have demonstrated that SarA regulates antibiotic resistance and the expression of various virulence factors. Our results warrant that SarA could be a leading target for developing therapeutic agents against MRSA infections.

The Deferred Action for Childhood Arrivals program and birth outcomes in California: a quasi-experimental study.

BACKGROUND: The Deferred Action for Childhood Arrivals (DACA) program provides temporary relief from deportation and work permits for previously undocumented immigrants who arrived as children. DACA faced direct threats under the Trump administration. There is select evidence of the short-term impacts of DACA on population health, including on birth outcomes, but limited understanding of the long-term impacts. METHODS: We evaluated the association between DACA program and birth outcomes using California birth certificate data (2009-2018) and a difference-in-differences approach to compare post-DACA birth outcomes for likely DACA-eligible mothers to birth outcomes for demographically similar DACA-ineligible mothers. We also separately compared birth outcomes by DACA eligibility status in the first 3 years after DACA passage (2012-2015) and in the subsequent 3 years (2015-2018) - a period characterized by direct threats to the DACA program - as compared to outcomes in the years prior to DACA passage. RESULTS: In the 7 years after its passage, DACA was associated with a lower risk of small-for-gestational age (- 0.018, 95% CI: - 0.035, - 0.002) and greater birthweight (45.8 g, 95% CI: 11.9, 79.7) for births to Mexican-origin individuals that were billed to Medicaid. Estimates were consistent but of smaller magnitude for other subgroups. Associations between DACA and birth outcomes were attenuated to the null in the period that began with the announcement of the Trump U.S. Presidential campaign (2015-2018), although confidence intervals overlapped with estimates from the immediate post-DACA period. CONCLUSIONS: These findings suggest weak to modest initial benefits of DACA for select birthweight outcomes during the period immediately following DACA passage for Mexican-born individuals whose births were billed to Medicaid; any benefits were subsequently attenuated to the null. The benefits of DACA for population health may not have been sufficient to counteract the impacts of threats to the program's future and heightened immigration enforcement occurring in parallel over time.

Divergent Effects of Peptidoglycan Carboxypeptidase DacA on Intrinsic ß-Lactam and Vancomycin Resistance.

Vancomycin and ß-lactams are clinically important antibiotics that inhibit the formation of peptidoglycan cross-links, but their binding targets are different. The binding target of vancomycin is d-alanine-d-alanine (d-Ala-d-Ala), whereas that of ß-lactam is penicillin-binding proteins (PBPs). In this study, we revealed the divergent effects of peptidoglycan (PG) carboxypeptidase DacA on vancomycin and ß-lactam resistance in Escherichia coli and Bacillus subtilis. The deletion of DacA induced sensitivity to most ß-lactams, whereas it induced strong resistance toward vancomycin. Notably, both phenotypes did not have a strong association with ld-transpeptidases, which are necessary for the formation of PG 3-3 cross-links and covalent bonds between PG and an Lpp outer membrane (OM) lipoprotein. Vancomycin resistance was induced by an increased amount of decoy d-Ala-d-Ala residues within PG, whereas ß-lactam sensitivity was associated with physical interactions between DacA and PBPs. The presence of an OM permeability barrier strongly strengthened vancomycin resistance, but it significantly weakened ß-lactam sensitivity. Collectively, our results revealed two distinct functions of DacA, which involved inverse modulation of bacterial resistance to clinically important antibiotics, ß-lactams and vancomycin, and presented evidence for a link between DacA and PBPs. IMPORTANCE Bacterial PG hydrolases play important roles in various aspects of bacterial physiology, including cytokinesis, PG synthesis, quality control of PG, PG recycling, and stress adaptation. Of all the PG hydrolases, the role of PG carboxypeptidases is poorly understood, especially regarding their impacts on antibiotic resistance. We have revealed two distinct functions of PG carboxypeptidase DacA with respect to antibiotic resistance. The deletion of DacA led to sensitivity to most ß-lactams, while it caused strong resistance to vancomycin. Our study provides novel insights into the roles of PG carboxypeptidases in the regulation of antibiotic resistance and a potential clue for the development of a drug to improve the clinical efficacy of ß-lactam antibiotics.

Contraceptive use and consistency and the role of deferred action for childhood arrivals: A cross-sectional survey of undocumented young adults.

OBJECTIVE: The Deferred Action for Childhood Arrivals (DACA) program grants young, undocumented immigrants work authorization and protections from deportation, with about 1.3 million eligible for the program. This exploratory study examines the association between DACA status and contraceptive use among undocumented young adults. STUDY DESIGN: We conducted an internet-based survey between June 2017 and August 2017 among Asian and Latinx undocumented immigrants (N = 204) aged 18-31 years in California. Bivariate and multivariate logistic regressions were conducted to examine the associations between DACA status and contraceptive use and consistency. RESULTS: Among undocumented participants who were sexually active, about 60% reported having unprotected sex (52% DACA vs. 63% non-DACA) and about 80% reported that documentation status affects how they access care for sexual/reproductive health at least a little. Overall, Asians were 81% less likely to have unprotected sex compared to Latinx individuals (aOR = 0.19, 95%CI: 0.06, 0.56). DACA recipients were more likely to report using contraception every time compared to non-recipients (42.9% vs. 30.5%, p = 0.04). DACA recipients were 63% less likely to report having unprotected sex in the past 12 months compared to those without DACA (aOR = 0.37, 95%CI: 0.14, 0.99). DACA recipients were more than three times as likely to use contraception during sex every time compared to those without DACA (aOR = 3.19, 95%CI: 1.19, 8.54). CONCLUSIONS: This study demonstrates that undocumented young adults have low rates of contraceptive use; however, DACA is associated with improved reproductive health for certain undocumented immigrants. IMPLICATIONS AND CONTRIBUTION: State and federal policies that extend protections and promote immigrant integration are needed to fully achieve reproductive justice for all.

When the United States says you do not belong: Suicide-related thoughts and behaviors among immigrant young adults varying in immigration legal status.

BACKGROUND: The number of immigrants in the United States and the risk of suicide among minoritized individuals have increased. Little research has examined the impact of immigration legal status on suicide-related thoughts and behaviors (SRTB), despite theoretical and empirical work suggesting that feelings of burdensomeness and failure to belong (prominent among immigrants) are risk factors. METHODS: We examined a diverse sample of foreign-born young adults (18-25; N = 366). Data collection utilized the Suicide Behaviors Questionnaire Revised and items probing belongingness and immigration status (undocumented/Deferred Action for Childhood Arrivals (DACA), permanent, and citizen). RESULTS: DACA/undocumented status was associated with increased SRTB compared with permanent and citizen categories. Increased SRTBs were associated with reduced feelings of acceptance in the United States, increased deportation fears, and increased fear of being harassed or hurt. Of these belongingness variables, only the interpersonal-not feeling welcome in the United States-partially mediated the risk relation between DACA/undocumented immigration legal status and SRTBs, whereas physical and legal threat, like deportation, did not. CONCLUSIONS: Our results highlight the interpersonal nature of SRTB risk in DACA/undocumented immigrants and the need for targeted culture and context-appropriate interventions, as well as advocacy and policy to reduce risk in this historically marginalized population.

Resiliency with Forced Migrants: A Qualitative Study of Providers and Forced Migrants through a Resilience Perspective.

In the last ten years, the world has experienced unprecedented, forced migration due to civil unrest, political persecution, and the ever-growing climate crisis. This is a qualitative study of the professional experiences of social workers (n = 73) working with forced migrants (n = 34) and the lived experiences of forced migrants in several countries: Germany, Greece, Iceland, Mexico, Switzerland, and the United States. Social workers reported that most of their interventions involved short-term case management that focused on securing initial housing and healthcare. Cognitive Behavioral Therapy (CBT) was the primary intervention for behavioral health issues. The recipients of these services were appreciative of the pragmatic approach of case management as it helped them meet concrete needs. When resiliency enhancing interventions were used, recipients reported a greater sense of self-control, greater optimism for the future, and less anxious symptoms. The resiliency model used is discussed. This is a possible universal approach to working with forced migrants.

Differences in Barriers to Healthcare and Discrimination in Healthcare Settings Among Undocumented Immigrants by Deferred Action for Childhood Arrivals (DACA) Status.

Undocumented immigrants face barriers to and discrimination in healthcare, but those with Deferred Action for Childhood Arrivals (DACA) status may fare better. This analysis uses the cross-sectional BRAVE Study of young undocumented Latinx and Asian immigrants to examine differences in barriers to and discrimination in healthcare by DACA status. A majority of respondents experienced financial, language, and cultural barriers, and up to half experienced documentation status barriers, discrimination when seeking healthcare or by a health provider, and negative experiences related to documentation status. In multivariable analyses, DACA recipients have over 90% lower odds of language and cultural barriers, approximately 80% lower odds of discrimination when seeking healthcare and by a health provider, and approximately 70% lower odds of documentation status barriers and negative experience related to documentation status compared to nonrecipients. These findings indicate that DACA recipients experience fewer barriers to healthcare and discrimination in healthcare compared to nonrecipients.