Moving Toward Inclusion: Access to Care Models for Uninsured Immigrant Children.

Policy Points Models for access to care for uninsured immigrant children that mitigate structural and sociopolitical barriers to inclusive health care include funding structures (e.g., state-sponsored coverage) and care delivery systems (e.g., federally qualified health centers,). Although the quintessential model of access to care necessitates health coverage for all children regardless of immigration status or date of United States entry, incremental policy change may more realistically and efficiently advance equitable access to high-quality health care. Intentional advocacy efforts should prioritize achievable goals that are grounded in data, are attentive to the sociopolitical milieu, are inclusive of diverse perspectives, and would meaningfully impact health care access and outcomes.

Pediatric Hospitalizations from Immigration Detention in Texas, 2015-2018.

Although there are concerns regarding children's health in immigration detention, there are little data regarding hospitalizations in this population. Using 2015-2018 Texas inpatient data, we identified 95 hospitalizations of children in detention and found that most (60%) were driven by infectious causes, and that 37% of these children were admitted to an intensive care unit (ICU) or intermediate ICU.

Immigrant and Refugee Health Curricula in US-Based Medical Training: A Scoping Review to Inform Integration Into Pediatric Residency Programs.

OBJECTIVE: Despite increases in the US foreign-born population, medical education opportunities in immigrant and refugee health (IRH) remain limited. We summarize findings for published IRH curricula and offer recommendations for integrating IRH into pediatric residency programs. METHODS: We performed a literature review of articles describing the design, implementation, or assessment of IRH curricula for US-based undergraduate and graduate medical trainees. RESULTS: The literature review identified 36 articles from 21 institutions describing 37 unique curricula. Three curricula included pediatric residency programs. Commonly taught topics included cultural humility, interpreter use, and immigration status as a social determinant of health. Immigrant-focused training experiences existed at continuity clinics, clinics for refugees or asylum seekers, and dedicated electives/rotations. Curricula were most frequently described as stand-alone electives/rotations. CONCLUSIONS: IRH curricula provide opportunities to develop skills in clinical care, advocacy, and community partnerships with immigrant populations. Pediatric residency programs should align the IRH curriculum with existing learning priorities, support and hire faculty with expertise in IRH, and partner with community organizations with expertise. Programs can also consider how to best support learners interested in careers focusing on immigrant populations. Further work is needed to establish competencies and validated tools measuring trainee satisfaction and clinical competency for IRH curricula.

Adult hospitalizations from immigration detention in Louisiana and Texas, 2015-2018.

Poor health conditions within immigration detention facilities have attracted significant concerns from policymakers and activists alike. There is no systematic data on the causes of hospitalizations from immigration detention facilities or their relative morbidity. The objective of this study, therefore, was to analyze the causes of hospitalizations from immigration detention facilities, as well as the percentage of hospitalizations necessitating ICU or intermediate-ICU (i.e, "step-down") admission and the types of surgical and interventional procedures conducted during these hospitalizations. We conducted a cross-sectional study of statewide adult (age 18 and greater) hospitalization data, with hospitalizations attributed to immigration facilities via payor designations (from Immigration and Customs Enforcement) and geospatial data in Texas and Louisiana from 2015-2018. Our analysis identified 5,215 hospitalizations of which 887 met inclusion criteria for analysis. Average age was 36 (standard deviation, 13.7), and 23.6% were female. The most common causes of hospitalization were related to infectious diseases (207, 23.3%) and psychiatric illness (147, 16.6%). 340 (38.3%) hospitalizations required a surgical or interventional procedure. Seventy-two (8.1%) hospitalizations required ICU admission and 175 (19.5%) required intermediate ICU. In this relatively young cohort, hospitalizations from immigration detention were accompanied with significant morbidity. Policymakers should mitigate the medical risks of immigration detention by improving access to medical and psychiatric care in facilities.

Forensic Medical Evaluation of Children Seeking Asylum: A Guide for Pediatricians.

Applications for asylum in the United States have increased significantly in the past decade, including those by children fleeing persecution. Pediatricians may serve as a resource for children seeking asylum by participating in specialized training and performing forensic medical evaluations for use in the legal process. A forensic medical evaluation comprises an interview to elicit a narrative of reported abuse, a psychological assessment, and/or a medical assessment. Evaluators document an impression of the consistency of medical and psychological findings with the trauma, which forms the legal basis for a child's asylum claim. This article provides guidance to pediatrician evaluators with an emphasis on an age- and development-specific approach to a forensic medical evaluation of children seeking asylum. Collaboration with primary care pediatricians and community partners about asylum evaluations is important to building support for immigrant children who have experienced trauma. [Pediatr Ann. 2020;49(5):e215-e221.].

How Should Academic Medical Centers Administer Students' "Domestic Global Health" Experiences?

Academic medical centers (AMCs) promote educational benefits to students of immersive global health experiences (GHE), both abroad and locally in low-resource settings. Within the United States, these opportunities are called domestic GHEs and tend to take place in student-run indigent care clinics (SRCs) that serve vulnerable populations. Domestic GHEs offer perspectives on the health care system that are similar to those of GHEs. In both, AMCs must balance benefits to students and patients against potential harms of student caregiving. This article reviews the roles of AMCs in preparing students for domestic GHEs with a focus on SRCs.

Building Immigration-Informed, Cross-Sector Coalitions: Findings from the Los Angeles County Health Equity for Immigrants Summit.

In December 2017, the Los Angeles County Office of Immigrant Affairs and Board of Supervisors, alongside local health care and legal providers, convened the Health Equity for Immigrants and Families Summit to advance a vision for immigrant health. We describe the four critical concepts identified by stakeholders to address the varied needs of immigrants in an increasingly anti-immigrant political environment: (1) Recognizing immigration status as a modifiable social determinant of health; (2) Adopting the concept of "Immigration-Informed Care" within health care institutions; (3) Establishing immigration-focused medical-legal partnerships; and (4) Building coordinated systems based on knowledge of local stakeholders, policies, and funding mechanisms.

Interest in Collaborative, Practice-Based Research Networks in Pediatric Refugee Health Care.

Over the last decade, approximately 200,000 refugee children have resettled across the United States. This population is dispersed, resulting in limited data. Collaborative research networks, where clinicians across distinct practice sites work together to answer research questions, can improve the evidence base regarding clinical care. We distributed a web-based survey to pediatric refugee providers around North America to assess priorities, perceived barriers and benefits to collaborative research. We recruited 57 participants. Of respondents, 89 % were interested in collaborative research, prioritizing: (1) access to health care (33 %), (2) mental health (24 %) and (3) nutrition/growth (24 %). Perceived benefits were "improving clinical practice" (98 %) and "raising awareness about the needs of pediatric refugees" (94 %). Perceived barriers were "too many other priorities" (89 %) and "lack of funding for data entry" (78 %). There is widespread interest in collaborative networks around pediatric refugee healthcare. A successful network will address barriers and emphasize priorities.

Clinical research and global health: mentoring the next generation of health care students.

Interest in global health and opportunities to conduct clinical research at international sites have increased markedly for health profession trainees. With this increase in demand comes an increase in the need for mentors at international and home institutions to provide guidance with designing, implementing and analysing clinical research projects that benefit both the trainees and the research site. In this article, we provide an overview of our insights gained through mentoring in the international setting and suggest a series of key points to help ensure an enjoyable and productive international clinical research experience for both trainees and mentors.

Sexo, información y uso de condón en adolescentes peruanos / Sex, information and condom use among peruvian adolescents

Introduction: there is an increasing concern for the STI /HIV infection risks within adolescents. Condoms are one of the most effective preventionstrategies for STI/HIV, but there is no information available regarding knowledge, information and condom use among adolescents in Peru. Objective: to evaluate knowledge on STI/HIV, sources of information and sexual behaviors and analyze factors associated with sexual experience and condom use among Peruvian adolescents. Methods: we conducted a cross-sectional survey using a household-based multistage sampling in three Peruvian cities. The survey included 2,607 12-19 year-old adolescents. Results: over 80% of adolescents reported having ever heard of STIs, acknowledging teachers as their main source of information, though 40% considered school-based sexual education insuffi cient. 21.8% females, 41.8% males 15-19 year-old, and 1.4% females, 4.1% males 12-14 year-old reported having had sex. Only a third of adolescents reported using a condom on sexual debut. About 6.5% of males and 43% of women reported STI-related symptoms last year. Sexual experience was negatively associated with being enrolled in school for both genders (OR: 0.2 [0.1-0.3]) and positively associated with report of insufficient sexual education for males (OR: 1.7 [1.1-2.6]). School as a source of sexual knowledge was associated with condom use at last intercourse (OR: 35.7 [6.0-213.4]) for women whereas for males was knowledge of where to obtain condoms (OR: 39.6 [3.8-414.6]). For both genders, use of condom at first sexual intercourse was associated with use at recent sexual intercourse. (OR: 5.7 [1.2- 27.9]).Conclusion: results emphasize gender disparities in predictors of sexual experience and condom use in adolescents, and stress the connection between sexual education and risk behaviors.

Introducción: existe una creciente preocupación por el riesgo de los adolescentes ante la infección de por ITS/VIH. El condón es una de las estrategias más efectivas de prevención de las ITS/VIH, pero no se cuenta con información acerca de conocimiento, información o uso de condón en adolescentes en el Perú. Objectivo: evaluar conocimientos acerca de ITS/VIH, fuentes de información y conductas sexuales y analizar los factores asociados a experiencia sexual y uso de condones en adolescentes peruanos.Métodos: se realizó una encuesta de base poblacional utilizando un muestreo multietápico en 3 ciudades del Perú. La encuesta incluyó a 2,607 adolescentes con edades entre 12 y 19 años. Resultados: más de 80% de los adolescentes reportaron haberescuchado alguna vez acerca de las ITS, reconociendo como principal fuente de información a sus profesores(as) de colegio, sin embargo el 40% describió la educación sexual ofrecida en la escuela como insufi ciente. 21.8% de las mujeres, 41.8% de los varones de 15-19 años, y 1.4% de las mujeres, 4.1% de los varones de 12-14 años reportaron haber tenido alguna vez sexo. Sólo un tercio de los adolescentes reportaron haber usado condón en su primera relación sexual. Se encontró una asociación positiva entre experiencia sexual y el reporte de insufi ciente educación sexual en el caso de los varones (OR: 1.7 [1.1-2.6]).En mujeres, el reporte de que la escuela era la principal fuente deinformación acerca de sexo se asoció de manera positiva con el uso de condón en su última relación sexual (OR: 35.7 [6.0-213.4]). En el caso de varones, el uso de condón en su última relación sexual se asoció al conocimiento de dónde obtenerlos (OR: 39.6 [3.8- 414.6]. Conclusión: los resultados enfatizan las diferencias por género en los predictores de experiencia sexual y uso de condón en adolescentes, y la importancia de la conexión entre educación sexual y conducta sexual.