Asylum-Seeking Children with Medical Complexity and Rare Diseases in a Tertiary Hospital in Switzerland

The aim of this study was to assess the characteristics of asylum-seeking children with medical complexity visiting a tertiary care hospital in Switzerland, detailing their underlying medical conditions and management. Asylum-seeking patients with frequent visits between January 2016 and December 2017 were identified using administrative and electronic health records. Of 462 patients, 19 (4%) fulfilled the inclusion criteria with 811 (45%) visits. The age of the 19 patients ranged from 0 to 16.7 years (median of 7 years) with two main age groups identified:?<?2 years and?>?12 years. Nine (47%) patients originated from Syria. A total of 34/811(4%) visits were hospital admissions, 66/811 (8%) emergency department visits and 320/811(39%) outpatient department visits. In children?<?2 years genetic diseases (5/8; 63%) and nutritional problems (6/8; 75%) were most common; in adolescents, orthopedic diseases (4/8; 50%) and mental health problems (4/8; 50%). Asylum-seeking children with medical complexity represent a small but important group of patients requiring frequent medical consultations. The high proportion of young patients with genetic diseases and severe nutritional problems suggests that new strategies are required in the management of this specific group of asylum-seeking children. This could be achieved by improved co-ordination between hospital and non-hospital care exploring options for integrated care.

     

The healthy migrant effect in primary care

ObjectiveTo compare the morbidity burden of immigrants and natives residing in Aragón, Spain, based on patient registries in primary care, which represents individuals’ first contact with the health system.MethodsA retrospective observational study was carried out, based on linking electronic primary care medical records to patients’ health insurance cards. The study population consisted of the entire population assigned to general practices in Aragón, Spain (1,251,540 individuals, of whom 12% were immigrants). We studied the morbidity profiles of both the immigrant and native populations using the Adjusted Clinical Group System. Logistic regressions were conducted to compare the morbidity burden of immigrants and natives after adjustment for age and gender.ResultsOur study confirmed the “healthy immigrant effect”, particularly for immigrant men. Relative to the native population, the prevalence rates of the most frequent diseases were lower among immigrants. The percentage of the population showing a moderate to very high morbidity burden was higher among natives (52%) than among Latin Americans (33%), Africans (29%), western Europeans (27%), eastern Europeans and North Americans (26%) and/or Asians (20%). Differences were smaller for immigrants who had lived in the country for 5 years or longer.ConclusionLength of stay in the host country had a decisive influence on the morbidity burden represented by immigrants, although the health status of both men and women worsened with longer stay in the host country.     

Adult Sexual Assault Evaluations at Rhode Island Emergency Departments, 1995–2001

The objectives of this study were to estimate the incidence and identify the temporal patterns of visits to Rhode Island emergency departments (EDs) by adults who were sexually assaulted. Visits to all Rhode Island EDs from January 1995–June 2001 by adults who were sexually assaulted were identified using International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9) codes. Medical records of these visits were reviewed. Frequency distributions of the assault characteristics and patient demographics were generated. Incidence rates (IRs) of ED visits after sexual assault were estimated using 2000 US Census data. Analyses of the temporal patterns of the ED visits after sexual assault were conducted. Of the 823 ED visits, 796 (96.7%) were by females and 27 (3.3%) were by males. The median age for females was 25 years (range, 18–96 years) and was 28 years (range, 18–87 years) for males. Among the female patients, 76.6% sustained a vaginal/anal assault. Among the male patients, 59.3% sustained an anal assault. The average annual IR of ED visits after sexual assault was 30.3/100,000/year for females and 1.2/100,000/year for males, which is a 25-fold greater incidence of these visits for females than males. ED visits after adult sexual assault were more frequent during warmer months and around 5 p.m. There was a gradual 43% increase in the IRs of ED visits after sexual assault over the 6.5-year period. These findings should help direct EDs to maximize supportive services when they are needed most often.     

Impact of non-routine rotavirus vaccination on hospitalizations for diarrhoea and rotavirus infections in Spain

This study shows hospital discharges related to all-cause diarrhoea and rotavirus infection in children up to five years of age from 2005 to 2009 in Spain. Rotavirus vaccines have been available in Spain since late 2006 and early 2007. They are neither funded nor reimbursed by the National Health Care System. However, they are recommended by the Spanish Association of Pediatricians and prescribed by paediatricians. The vaccination coverage was 17% in 2007, 35% in 2008 and 38% in 2009. Among a total of 111,738 hospitalizations recorded, 24% (N = 26,500) were coded as rotavirus and 14% (N = 16,217) as diarrhoea of undetermined aetiology. The overall annual incidence of hospitalization was 991,235 and 144 per 100,000 children up to five years of age for all-causes diarrhoea, rotavirus infection and diarrhoea of undetermined aetiology respectively. The annual rate significantly decreased during the study period.     

Evolución del riesgo cardiovascular de los inmigrantes residentes en España según procedencia y años de estancia

ObjectiveTo assess whether there are differences in the immigrant population in terms of the years since their arrival in Spain and their geographical area of origin.DesignA cross-sectional study was conducted in three immigrant groups.ParticipantsThe groups selected were: a group of Latin American immigrants (298), a group of North African immigrants (130) and a group from Eastern Europe (114). A control group of 100 from a Spanish population of similar age and sex was also included.MethodsAnthropometric variables were measured, including biochemical inflammatory markers, blood pressure and cardiovascular risk estimation according to the tables of the European Societies of Hypertension and Cardiology.ResultsThe cardiovascular risk of the three groups of immigrants is similar between them (added cardiovascular risk high or very high at 5.5% in Latin Americans, 4.3% in North Africans, and 1.6% in immigrants from eastern countries), but significantly lower than the Spanish control group (28%). After 8 years in Spain, cardiovascular risk increases in the three groups of immigrants, with those from North Africa and eastern countries being comparable to the Spanish group (added cardiovascular risk high or very high of 18.5% in North Africans, and 20% in group from eastern countries). This cardiovascular risk was higher than the other groups, including the Spanish control group (Latin American immigrants 48.7% vs 28% in Spanish group).ConclusionsThe cardiovascular risk of immigrants increases over the years in Spain, with this increase being higher if they come from Latin America. This increase becomes clinically significant after the 8 years of stay in Spain.     

Burden of heart failure in primary healthcare

ObjectivesTo determine the epidemiology of heart failure registered in primary healthcare clinical records in Catalunya, Spain, between 2010 and 2014, focusing on incidence, mortality, and resource utilization.DesignRetrospective observational cohort study.SettingStudy was carried out in primary care setting.Participants and interventionsPatients registered as presenting a new heart failure diagnosis. The inclusion period ran from 1st January 2010 to 31st December 2013, but patients were followed until 31st December 2013 in order to analyze mortality.Main measuresInformation came from electronic medical records.ResultsA total of 64 441 patients were registered with a new diagnosis of heart failure (2.76 new cases per 1000 persons-year). Among them, 85.8% were ≥65 years. The number of cases/1000 persons-year was higher in men in all age groups. Incidence ranged from 0.04 in women <45 years to 27.61 in the oldest group, and from 0.08 in men <45 years to 28.52 in the oldest group. Mortality occurred in 16 305 (25.3%) patients. Primary healthcare resource utilization increased after the occurrence of heart failure, especially the number of visits made by nurses to the patients’ homes.ConclusionHeart failure incidence increases with age, is greater in men, and remains stable. Mortality continues to be high in newly diagnosed patients in spite of the current improvements in treatment. Home visits represent the greatest cost for the management of this disease in primary care setting.     

Health inequalities between male and female immigrants in Spain after the beginning of the economic crisis

The aim of this study was to analyse health inequalities in the immigrant population in Spain in 2014, while differentiating between immigrant and native‐born men and women. We have designed a cross‐sectional study on the population aged over 15 years resident in Spain and the data were obtained from the 2014 European Health Survey in Spain (n = 22,842). Among immigrant men and women, we observed a lower risk of having a Chronic Physical Problem (CPP) or a Mental Health Problem (MHP) and a lower consumption of psychiatric drugs. We also observed a higher risk of lack of medical care in immigrant men compared to native‐born. The country of origin was not significantly related to self‐perception of health or use of Primary Care (PC) and Emergency Care services. In conclusion, we observed that now that the peak of the crisis has passed it seems that the “healthy immigrant” effect is being recovered, although the gender inequalities observed in the general population are transferred to the immigrant population. We need to approach the feminisation of migration from a new perspective and understand how inequalities affect immigrant women.     

Vaccination coverage in indigenous and immigrant children under 3 years of age in Catalonia (Spain)

Vaccination coverage in a representative sample of children under 3 years of age in Catalonia (Spain) was studied. Parents of children selected were contacted and asked for the child's vaccination card. A total of 630 children were included, of whom 570 were indigenous and 60 immigrants. Primary vaccination coverage was 96.5% for indigenous and 85% for immigrant children (p=0.0001), while the coverage of primary vaccination plus booster doses was 88.6% in indigenous and 78.3% in immigrant children (p=0.02). Efforts should be made to increase primary vaccination coverage in immigrant children and booster dose coverage in both indigenous and immigrant children.     

Utilization of Hospital Emergency Departments for Non-Traumatic Dental Care in New Hampshire, 2001–2008

Hospital Emergency Departments (ED) provide a variety of medical care, some of which is for non-urgent, chronic conditions. We describe the statewide use of hospital ED for selected non-traumatic dental conditions that occurred during 2001–2008 in New Hampshire. Using the administrative hospital discharge dataset for 2001–2007, and provisional 2008 data, we identified all visits for selected dental conditions and calculated age-adjusted rates per 10,000 New Hampshire residents by several socio-demographic characteristics. The Spearman correlation coefficient was used to assess the statistical significance for trend over time. Emergency department visits for non-traumatic dental conditions increased significantly from 11,067 in 2001 to 16,238 visits in 2007 (P < 0.007). There were persistent differences in ED visits by age, county and primary payor, and varying difference by gender. Self-paying individuals and those 15–44 years old were the most frequent ED dental care users. The most frequent dental complains (46%) were diseases of the teeth and supporting structures, diagnostic code ICD-9-CM-525. Dental care associated ED visits have increased in New Hampshire. Individuals seeking dental treatment in ED are not receiving definitive treatment, and they misuse limited resources. Future studies need to determine the specific barriers to timely and effective dental care in dental offices. Ongoing consistent monitoring of ED use for non-traumatic dental conditions is essential.     

Les angines aiguës de l’enfant dans la région de Sfax (Tunisie) : épidémiologie et intérêt du test de diagnostic rapide

Objective

The authors studied the epidemiology of pharyngitis in children and evaluated the contribution of a rapid streptococcal test.

Patients and methods

This prospective study was conducted from June 2007 to May 2008 in a primary health care institution (Policlinique de la Caisse Nationale de Sécurité Sociale) in Tunisia. Clinical findings were recorded; throat swabs were performed, and a rapid streptococcal test was made.

Results

Five hundred and four children were included in this study. The mean age was 5 years and 8 months. Culture was positive for group A streptococcus in 166 cases (32.9 %). Group A streptococcus was more frequently isolated in children aged 5 to 8 years. There was no difference in clinical features between groups of streptococcal and non-streptococcal pharyngitis. The sensitivity and specificity of the rapid test were respectively 93.2 and 95.3 %.

Conclusion

Pharyngitis was of bacterial origin in one third of cases; among these, group A streptococcus was the most frequent bacterium. The rapid test is a quick and reliable tool for the diagnosis of pharyngitis and hence an appropriate treatment.     

Prevalence of Overweight and Obesity in Chinese American Children in New York City

Childhood obesity has been a growing concern in recent years. The extent of obesity in various ethnic pediatric populations including Chinese Americans has not been fully explored. In this study, the prevalence of overweight and obesity in a Chinese American pediatric population (6–19 years) was determined through a chart review of 4,695 patients from a large community health center in New York City. Demographic characteristics including sex, age and immigrant status were used in a logistic regression to determine risk factors for obesity in this community. Overall, 24.6% of the children studied were overweight or obese (defined as BMI ≥ 85th percentile for age and sex). Among US born boys aged 6–12 years, the combined prevalence of overweight and obesity was found to be as high as 40%. Further studies are needed to understand the complex interplay of factors that contribute to obesity in pediatric immigrant groups.     

Prophylaxie antirétrovirale après expositions non professionnelles au VIH à Abidjan (Cote d’Ivoire)

Objective

The aim of this study was to assess the tolerability and adherence to all non-occupational post-exposure prophylaxis (PEP) for cases of HIV exposure in Abidjan.

Method

We retrospectively studied all post-exposure prophylaxis for non-occupational exposures to HIV prescribed from January 1st, 2000 to December 31st, 2007 in the Abidjan infectious diseases department. We analyzed the types of exposure, socio-demographic characteristics of patients, antiretroviral therapy regimens, adherence and tolerability, duration of the treatment, and post-exposure follow-up.

Results

Over these eight years, we managed 128 consultations for non-professional exposures to HIV (50 male [39 %], 78 female patients [61 %]), average age 24.8 years (four–54 years). The most frequent exposures were due to rape (n = 74), condom rupture (n = 29), and occasional unprotected sex (n = 21). The average delay before consultation was 20.8 hours. The antiretroviral chemoprophylaxis included a protease inhibitor in 93 % of the cases; 80.5 % of patients completed 28 days of chemoprophylaxis, while 8.6 % interrupted the treatment, and 10.9 % were lost to follow-up. The most frequent adverse effects were gastrointestinal, reported by 79 patients (61.7 %). Only 34 patients (26.6 %) returned for clinical and biological post-exposure follow-up with HIV control at third month, without documented seroconversion.

Conclusion

Cases of sexual exposure to HIV are the main indication for post-exposure prophylaxis in Abidjan, except for occupational exposure to blood. However, post-exposure prophylaxis should be available in the units of primary care, such as emergencies departments.     

Seasonal influenza vaccination trends from 2007–2011 in privately insured children and adults in the United States

Background

To ensure adequate protection from seasonal influenza in the US, the Advisory Committee on Immunization Practices recommends vaccination of all persons aged 6 months or older, with rare exceptions. It also advises starting vaccination as soon as available and continuing throughout the influenza season. This study examined US seasonal vaccination trends during five consecutive influenza seasons in privately-insured children and adults.

Methods

This retrospective, observational cohort study examined trends in influenza vaccination during the 2007–2008 through 2011–2012 influenza seasons using administrative claims data from a large national insurer.

Results

The size of analysis population ranged from 1144,098 to 1245,487 (children, ≥6 months-17 years of age) and from 3931,622 to 4158,223 (adults, 18–64 years of age). Vaccination frequency increased through 2010–2011, was most frequent in young children, and decreased with age. Vaccination rates were highest in the Northeast and lowest in the West and were higher in individuals with frequent outpatient office visits than in those with no or rare visits, with larger differences seen in children. Between 2007 and 2011, the use of preservative-free inactivated vaccine increased, the use of multidose vaccines containing preservatives decreased, and the use of live attenuated influenza vaccines increased among children 2–17 years of age. From 2007–2008 through 2009–2010, the timing of vaccination each year began earlier than the previous one; it remained stable from 2009–2010 through 2011–2012.

Conclusion

Annual influenza vaccination claims for privately-insured children and adults increased and shifted earlier from 2007 through 2009–2011. During the 2011–2012 influenza season, 25.4% of children aged 6 months-17 years and 12.3% of adults aged 18–64 years were vaccinated. Increasing influenza vaccination should remain a priority, and alternative venues for seasonal influenza vaccination should be considered in order to meet the Healthy People 2020 goal of 80% to 90% coverage among children.     

Inmigración y salud: desigualdades entre la población autóctona e inmigrante en el País Vasco

Objective

To analyze health inequalities between native and immigrant populations in the Basque Country (Spain) and the role of several mediating determinants in explaining these differences.

Methods

A cross-sectional study was performed in the population aged 18 to 64 years in the Basque Country. We used data from the Basque Health Survey 2007 (n = 4,270) and the Basque Health Survey for Immigrants 2009 (n = 745). We calculated differences in health inequalities in poor perceived health between the native population and immigrant populations from distinct regions (China, Latin America, the Maghreb and Senegal). To measure the association between poor perceived health and place of origin, and to adjust this association by several mediating variables, odds ratios (OR) were calculated through logistic regression models.

Results

Immigrants had poorer perceived health than natives in the Basque Country, regardless of age. These differences could be explained by the lower educational level, worse employment status, lower social support, and perceived discrimination among immigrants, both in men and women. After adjustment was performed for all the variables, health status was better among men from China (OR: 0.18; 95% confidence interval [CI95%]: 0.04-0.91) and Maghreb (OR: 0.26; 95% CI: 0.08-0.91) and among Latin American women (OR: 0.36; 95% CI: 0.14-0.92) than in the native population.

Conclusions

These results show the need to continue to monitor social and health inequalities between the native and immigrant populations, as well as to support the policies that improve the socioeconomic conditions of immigrants.     

Growth patterns in early childhood: Better trajectories in Afro-Ecuadorians independent of sex and socioeconomic factors

The first years of life are the most dynamic period for childhood growth. There are limited data available on growth patterns of infants and children living in rural Latin America. The aim of this study was to describe the growth patterns from birth to 5 years in children living in a rural District of tropical coastal Ecuador using data from a birth cohort of 2404 neonates. We hypothesize that there would be growth differences according to ethnicity and sex. Evaluations were conducted at birth or until 2 weeks of age and at 7, 13, 24, 36 and 60 months during clinic and home visits. Individual growth trajectories for weight-for-age, height-for-age and weight/height-for-age Z-scores were estimated using multilevel models. Girls were lighter and shorter than boys at birth. However, Afro-Ecuadorian children (versus mestizo or indigenous) were longer/taller and heavier throughout the first 5 years of life and had greater mean trajectories for HAZ and WAZ independent of sex and socioeconomic factors. Our data indicate that ethnicity is a determinant of growth trajectories during the first 5 years of life independent of socioeconomic factors in a birth cohort conducted in a rural region of Latin America.     

Safety of measles and pertussis-containing vaccines in children with autism spectrum disorders

ObjectivesTo determine whether children aged 4–7 years with a diagnosis of autism spectrum disorders (ASD) were at increased risk of fever, febrile seizures, or emergency department (ED) visits following measles- or pertussis-containing vaccines compared with children without ASD.MethodsThe study included children born between 1995–2012, aged 4–7 years at vaccination, and members of six healthcare delivery systems within Vaccine Safety Datalink. We conducted self-controlled risk interval analyses comparing rates of outcomes in risk and control intervals within each group defined by ASD status, and then compared outcome rates between children with and without ASD, in risk and control intervals, by estimating difference-in-differences using logistic regressions.ResultsThe study included 14,947 children with ASD and 1,650,041 children without ASD. After measles- or pertussis-containing vaccination, there were no differences in association between children with and without ASD for fever (ratio of rate ratio for measles-containing vaccine = 1.07, 95% CI 0.58–1.96; for pertussis-containing vaccine = 1.16, 95% CI 0.63–2.15) or ED visits (ratio of rate ratio for measles-containing vaccine = 1.11, 95% CI 0.80–1.54; for pertussis-containing vaccine = 0.87, 95% CI 0.59–1.28). Febrile seizures were rare. Pertussis-containing vaccines were associated with small increased risk of febrile seizures in children without ASD.ConclusionChildren with ASD were not at increased risk for fever or ED visits compared with children without ASD following measles- or pertussis-containing vaccines. These results may provide further reassurance that these vaccines are safe for all children, including those with ASD.     

Overcoming the Odds: Access to Care for Immigrant Children in Working Poor Families in California

Objectives: To explore the extent to which, among working poor families, uninsured immigrant children experience more barriers to care than uninsured nonimmigrants, and compare these differences to those of insured children. Methods: We used data from the 2001 California Health Interview Survey, a randomized, population-based telephone survey conducted from November 2000 through September 2001. Financial and nonfinancial access to health care and utilization of health services were examined for 3,978 nonimmigrant and 462 immigrant children and adolescents under the age of 18 years. We compared differences in crude rates across four subgroups (insured immigrants, uninsured immigrants, insured nonimmigrants, uninsured nonimmigrants) and in adjusted models controlling for socioeconomic and immigration characteristics, parental language, health status, and other demographic factors. Results: More immigrant than nonimmigrant children lacked health insurance at the time of the interview (44% vs. 17%, p < 0.0001). Among the uninsured, immigrants had higher odds of perceiving discrimination (11% vs. 5%, p < 0.05) and postponing emergency room (ER) (16% vs. 7%, p < 0.05) and dental care (40% vs. 30%, p < 0.05) after controlling for covariates. Among the insured, immigrants fared worse on almost every access and utilization outcome. Among insured immigrants, child and parent undocumented status and having a non-English-speaking parent contributed to missed physician and ER visits. Conclusions: Disparities in access and use remain for immigrant poor children despite public insurance eligibility expansions. Insurance does not guarantee equitable health care access and use for undocumented children. Financial and nonfinancial barriers to health care for immigrant children must be removed if we are to address disparities among minority children.     

Infectious Diseases in Immigrant Population Related to the Time of Residence in Spain

The aim of this study was to evaluate the data on the main imported infectious diseases and public health issues arising from the risk of transmission of tropical and common diseases in the immigrant population. During the period of study, 2,426 immigrants were attended in the Tropical Medicine Unit of the Hospital of Poniente. For each patient, a complete screening for common and tropical diseases was performed. The prevalence and main features of intestinal and urinary parasites, microfilarias, Chagas disease, malaria, hepatitis B (HBV) and C (HCV) viruses, extrapulmonary tuberculosis and syphilis was investigated taking into account the length of stay in Spain. Sub-Saharan Africa patients who had lived for <3 years in Spain had a high significantly number of infections produced by hookworms, Ascaris lumbricoides, Trichuris trichiura, Schistosoma mansoni, Giardia lamblia, Entamoeba histolytica/dispar and Plasmodium spp. In patients who had lived for more than 3 years, there were significantly high rates of HBV infections, although HBV rates in sub-Saharan African patients are high even if the patients have been in Spain for <3 years. However, patients with large stays in Spain had also an important number of parasitological diseases. The main objective of the diagnosis is to avoid important public health problems and further complications in patients. It is advisable to carry out a screening of the main transmissible infections in all immigrant population regardless of the time outside their country. This screening should be individualized according to the geographical area of origin.     

Trends in Well-Child Visits to Family Physicians by Children Younger Than 2 Years of Age

PURPOSE Provision of prenatal visits by family physicians decreased by 50% from 1995 to 2004. To determine the impact of this trend on the provision of well-child visits by these professionals, we measured trends in and factors associated with well-child visits by children younger than 2 years of age to family physicians and pediatricians.METHODS Using the National Ambulatory Medical Care Survey, we identified well-child visits made in the first 2 years of life to family physicians and pediatricians between 1995 and 2007. The primary outcome measure was the trend in the proportion of such visits that were specifically to family physicians.RESULTS We identified a total of 4,999 visits, representing 213 million well-child visits at the national level. Compared with visits to pediatricians, visits to family physicians were associated with higher rates of Medicaid insurance (P<.01) and were more likely to occur in non–metropolitan statistical area locations (P<.01) and in the Midwest and West geographic regions (P <.01). The percentage of all well-child visits for children younger than 2 years of age that were made to family physicians remained stable at 15% (95% confidence interval, 13%–17%; P = .29 for trend) during the study period.CONCLUSIONS The diminishing role of family physicians in prenatal care has not been accompanied by a similar decrease in provision of well-child care to children younger than 2 years of age.