{"title":"Factors in Primary Care Use Among Young Adult Refugees from Burma and Bhutan in Early Resettlement: Findings from Colorado","authors":"Sarah Brewer, Jini E. Puma","doi":"10.55504/2473-0327.1074","DOIUrl":"https://doi.org/10.55504/2473-0327.1074","url":null,"abstract":"","PeriodicalId":198307,"journal":{"name":"Journal of Refugee & Global Health","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128664584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vitamin D deficiency during pregnancy and lactation has neg- ative impacts on maternal, fetal, and infant health. Low health literacy and other social determinants of health may increase the risk of deficiency among refugee women. This qualitative study used a survey and in-depth individual interviews to ex- amine knowledge of vitamin D among ten pregnant or breastfeeding Iraqi refugee women in the United States, and sought participants’ recommendations on culture-centered and participatory health promotion strategies. All participants re- ported having insufficient information and understanding of vitamin D, its health benefits, and the risks of deficiency. The four primary themes that emerged from the interviews were the quality of available vitamin D information, barriers to seeking such information, intersectionality of health and environ- ment, and power differentials and the control of the health agenda. Participants’ recommendations included bridging the language barrier and training health care providers to deliver the information needed to raise awareness. The findings of this study provide an opportunity for public health systems to design culture-centered health education and promotion strategies to ensure vitamin D adequacy among this vulnerable population.
{"title":"Knowledge and Awareness of Vitamin D Among Pregnant or Lactating Iraqi Refugee Women: a Call for Different Approaches in Health Education and Outreach","authors":"Someireh Amirfaiz, Ed.D.","doi":"10.55504/2473-0327.1095","DOIUrl":"https://doi.org/10.55504/2473-0327.1095","url":null,"abstract":"Vitamin D deficiency during pregnancy and lactation has neg- ative impacts on maternal, fetal, and infant health. Low health literacy and other social determinants of health may increase the risk of deficiency among refugee women. This qualitative study used a survey and in-depth individual interviews to ex- amine knowledge of vitamin D among ten pregnant or breastfeeding Iraqi refugee women in the United States, and sought participants’ recommendations on culture-centered and participatory health promotion strategies. All participants re- ported having insufficient information and understanding of vitamin D, its health benefits, and the risks of deficiency. The four primary themes that emerged from the interviews were the quality of available vitamin D information, barriers to seeking such information, intersectionality of health and environ- ment, and power differentials and the control of the health agenda. Participants’ recommendations included bridging the language barrier and training health care providers to deliver the information needed to raise awareness. The findings of this study provide an opportunity for public health systems to design culture-centered health education and promotion strategies to ensure vitamin D adequacy among this vulnerable population.","PeriodicalId":198307,"journal":{"name":"Journal of Refugee & Global Health","volume":"337 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132303245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Lyons, M. H. O’Connor, I. Feinberg, Daniel K Whitaker, M. Eriksen, A. Owen‐Smith, Saiza Jivani, Mohammad Tamer, Esther M. Kim, Ganaro Makor
Refugees are a vulnerable population who experience sig- nificant health disparities. They may also be at disproportionately high risk of adverse outcomes due to the COVID- 19 pandemic. This paper presents the results of a community needs assessment to investigate the impact of the pan- demic on health and welfare in a refugee relocation community in the United States. A multilingual data collection team made up of refugees surveyed 179 participants (128 refugees vs. 51 non-refugees). Only 55.9% of refugee re- spondents said they would be able to provide enough food for their family this week, compared with 84.0% of non-refugees (p < 0.01), and this difference was even greater for food next week (29.4% vs. 76.0%, p < 0.01). A non-significantly smaller proportion of refugees reported knowing where to go if they were sick (69.1% vs. 81.6%, χ 2 = 2.8, p = 0.10), and being able to get the medicine they need (75.0% vs. 87.8%, p = 0.07), while significantly fewer refugees reported feeling safe at home (72.8 vs. 87.8%, χ 2 = 4.5, p = 0.04). Overall, refugees fared worse on nearly every measure. These findings should motivate further observational research and inform clinicians about the significant disparities in social de- terminants of health that refugees may experience during the pandemic.
{"title":"Comparing the health and welfare of refugees and non-refugees at the outset of the COVID-19 pandemic: the results of a community needs assessment.","authors":"M. Lyons, M. H. O’Connor, I. Feinberg, Daniel K Whitaker, M. Eriksen, A. Owen‐Smith, Saiza Jivani, Mohammad Tamer, Esther M. Kim, Ganaro Makor","doi":"10.55504/2473-0327.1065","DOIUrl":"https://doi.org/10.55504/2473-0327.1065","url":null,"abstract":"Refugees are a vulnerable population who experience sig- nificant health disparities. They may also be at disproportionately high risk of adverse outcomes due to the COVID- 19 pandemic. This paper presents the results of a community needs assessment to investigate the impact of the pan- demic on health and welfare in a refugee relocation community in the United States. A multilingual data collection team made up of refugees surveyed 179 participants (128 refugees vs. 51 non-refugees). Only 55.9% of refugee re- spondents said they would be able to provide enough food for their family this week, compared with 84.0% of non-refugees (p < 0.01), and this difference was even greater for food next week (29.4% vs. 76.0%, p < 0.01). A non-significantly smaller proportion of refugees reported knowing where to go if they were sick (69.1% vs. 81.6%, χ 2 = 2.8, p = 0.10), and being able to get the medicine they need (75.0% vs. 87.8%, p = 0.07), while significantly fewer refugees reported feeling safe at home (72.8 vs. 87.8%, χ 2 = 4.5, p = 0.04). Overall, refugees fared worse on nearly every measure. These findings should motivate further observational research and inform clinicians about the significant disparities in social de- terminants of health that refugees may experience during the pandemic.","PeriodicalId":198307,"journal":{"name":"Journal of Refugee & Global Health","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134063001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jamarie Geller, M. Starrs, A. Bartholomew, Sara Kaliszak, Jeri Kessenich
Introduction: Haiti has one of the highest rates of childhood undernutrition in the world, devastating overall health. This study focuses on the growth of children offered longitudinal healthcare by Kids Health for Haiti, using BMI to indicate developmental and nutritional status. Objectives include collecting baseline prevalence data, examining the impact of longitudinal interventions, and discussing future investigation and programming areas. Methods: A retrospective longitudinal observational chart review on 245 students over a six-year period analyzing height, weight, and BMI. All data were collected as part of routine health provision and underwent statistical analysis using a single-subject design. Results: 46.3%, 42%, and 37.1% of participants started in the lowest percentile groups (0-25th) for weight, height, and BMI, respectively. Among all participants, there was not a significant difference between the proportion of students that increased versus decreased percentile groups for weight (p = 0.39), height (p = 0.782), or BMI (p = 0.064) from first to most recent visit. Among students below the 25th percentile in each growth domain at the first visit, there was a statistically significant increase of at least one percentile group versus a decrease in weight (p <0.001), height (p <0.001), and BMI (p <0.006). Conclusion: These results highlight the significant burden of underdevelopment in this population and the potential for improvement with early interventions targeting general health and nutrition. Visits corresponded with improvements in growth, especially for the smallest children. Future investigations should target outcomes of specific treatments, assessing how programming can best improve growth outcomes. RGH | https://ir.library.louisville.edu/rgh/vol4/iss1/2 1 The Health of Haitian Schoolchildren
{"title":"The Health of Haitian Schoolchildren: Longitudinal Effect of Annual Visits on Growth","authors":"Jamarie Geller, M. Starrs, A. Bartholomew, Sara Kaliszak, Jeri Kessenich","doi":"10.55504/2473-0327.1070","DOIUrl":"https://doi.org/10.55504/2473-0327.1070","url":null,"abstract":"Introduction: Haiti has one of the highest rates of childhood undernutrition in the world, devastating overall health. This study focuses on the growth of children offered longitudinal healthcare by Kids Health for Haiti, using BMI to indicate developmental and nutritional status. Objectives include collecting baseline prevalence data, examining the impact of longitudinal interventions, and discussing future investigation and programming areas. Methods: A retrospective longitudinal observational chart review on 245 students over a six-year period analyzing height, weight, and BMI. All data were collected as part of routine health provision and underwent statistical analysis using a single-subject design. Results: 46.3%, 42%, and 37.1% of participants started in the lowest percentile groups (0-25th) for weight, height, and BMI, respectively. Among all participants, there was not a significant difference between the proportion of students that increased versus decreased percentile groups for weight (p = 0.39), height (p = 0.782), or BMI (p = 0.064) from first to most recent visit. Among students below the 25th percentile in each growth domain at the first visit, there was a statistically significant increase of at least one percentile group versus a decrease in weight (p <0.001), height (p <0.001), and BMI (p <0.006). Conclusion: These results highlight the significant burden of underdevelopment in this population and the potential for improvement with early interventions targeting general health and nutrition. Visits corresponded with improvements in growth, especially for the smallest children. Future investigations should target outcomes of specific treatments, assessing how programming can best improve growth outcomes. RGH | https://ir.library.louisville.edu/rgh/vol4/iss1/2 1 The Health of Haitian Schoolchildren","PeriodicalId":198307,"journal":{"name":"Journal of Refugee & Global Health","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128679292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Lamptey, D. Serwaa, M. Antwi, Theckla Ikome, N. Odogwu
Introduction: In Africa, COVID-19 associated stigmatization still remains the contextual fac- tor that poses a challenge for the mitigation and suppression of COVID-19 spread, especially among the illiterate populations. This comparative study was therefore conducted to assess the knowledge and willingness of Ghanaians and Nigerians to associate with COVID-19 survivors. Methods: A cross-sectional study was conducted to collect information from 290 Ghanaian and 220 Nigerian nationals aged 18 years and above between 11th July-30th October 2020. An electronic-based questionnaire was developed to collect information on the public. The data were analyzed with SPSS v 22 and factors influencing knowledge and willingness to associate with COVID-19 survivors were identified using chi-square and logistic regression at p=0.05. Results: The mean age of all participants was 26.18(SD=6.87), about 75% of the Ghanaians and 81.8% of Nigerians were within 25-34 years of age. . Ghanaians were more knowledgeable about COVID-19, 230(79.3%) compared with Nigerians 60(27.3%). High stigmatizing attitude was dominant among Nigerians 140(73.7) than Ghanaian 50 (26.3). While age significantly in-creased knowledge [OR: 2.83(1.461,5.495), p=0.002] and deceased stigmatizing attitude [OR: 0.35(0.182,0.684), p=0.002] in Ghana, it wasn’t significant in Nigeria. In both countries, religious affiliation and education were not statistically associated with knowledge and stigmatizing attitude. Conclusions: The overall knowledge and willingness to associate with COVID-19 survivors among these study participants were fairly adequate and welcoming for the integration of COV-ID-19 survivors into normal living. Stakeholders should embark on COVID-19 stigmatization campaigns through a timely online update, van mobilization and mass media broadcasting aimed at stopping and preventing further stigma surrounding infected and recovered persons.
导言:在非洲，与COVID-19相关的污名化仍然是一个背景因素，对缓解和抑制COVID-19的传播构成挑战，特别是在文盲人群中。因此，进行这项比较研究是为了评估加纳人和尼日利亚人与COVID-19幸存者交往的知识和意愿。方法:通过横断面研究收集了2020年7月11日至10月30日期间年龄在18岁及以上的290名加纳人和220名尼日利亚人的信息。编制了一份电子问卷，以收集有关公众的资料。采用SPSS v 22对数据进行分析，采用卡方回归和logistic回归(p=0.05)确定影响与COVID-19幸存者相关知识和意愿的因素。结果:所有参与者的平均年龄为26.18岁(SD=6.87)，约75%的加纳人、81.8%的尼日利亚人年龄在25-34岁之间。加纳人对新冠肺炎的了解程度为230人(79.3%)，尼日利亚人为60人(27.3%)。高度污名化的态度在尼日利亚(140名，73.7名)比加纳(50名，26.3名)多。年龄在加纳显著影响知识[OR: 2.83(1.461,5.495)， p=0.002]和死者污名化态度[OR: 0.35(0.182,0.684)， p=0.002]，而在尼日利亚无显著影响。在这两个国家，宗教信仰和受教育程度与知识和污名化态度没有统计上的联系。结论:在这些研究参与者中，与COVID-19幸存者联系的总体知识和意愿相当充分，并且欢迎COVID-19幸存者融入正常生活。利益攸关方应通过及时的在线更新、面包车动员和大众媒体广播开展COVID-19污名化运动，旨在制止和防止对感染者和康复者的进一步污名化。
{"title":"A Comparative Analysis of the Knowledge and Stigmatizing Attitude of Ghanaians and Nigerians towards COVID-19 Survivors","authors":"E. Lamptey, D. Serwaa, M. Antwi, Theckla Ikome, N. Odogwu","doi":"10.55504/2473-0327.1080","DOIUrl":"https://doi.org/10.55504/2473-0327.1080","url":null,"abstract":"Introduction: In Africa, COVID-19 associated stigmatization still remains the contextual fac- tor that poses a challenge for the mitigation and suppression of COVID-19 spread, especially among the illiterate populations. This comparative study was therefore conducted to assess the knowledge and willingness of Ghanaians and Nigerians to associate with COVID-19 survivors. Methods: A cross-sectional study was conducted to collect information from 290 Ghanaian and 220 Nigerian nationals aged 18 years and above between 11th July-30th October 2020. An electronic-based questionnaire was developed to collect information on the public. The data were analyzed with SPSS v 22 and factors influencing knowledge and willingness to associate with COVID-19 survivors were identified using chi-square and logistic regression at p=0.05. Results: The mean age of all participants was 26.18(SD=6.87), about 75% of the Ghanaians and 81.8% of Nigerians were within 25-34 years of age. . Ghanaians were more knowledgeable about COVID-19, 230(79.3%) compared with Nigerians 60(27.3%). High stigmatizing attitude was dominant among Nigerians 140(73.7) than Ghanaian 50 (26.3). While age significantly in-creased knowledge [OR: 2.83(1.461,5.495), p=0.002] and deceased stigmatizing attitude [OR: 0.35(0.182,0.684), p=0.002] in Ghana, it wasn’t significant in Nigeria. In both countries, religious affiliation and education were not statistically associated with knowledge and stigmatizing attitude. Conclusions: The overall knowledge and willingness to associate with COVID-19 survivors among these study participants were fairly adequate and welcoming for the integration of COV-ID-19 survivors into normal living. Stakeholders should embark on COVID-19 stigmatization campaigns through a timely online update, van mobilization and mass media broadcasting aimed at stopping and preventing further stigma surrounding infected and recovered persons.","PeriodicalId":198307,"journal":{"name":"Journal of Refugee & Global Health","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125021266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter from the Editor-in-Chief: Journal of Refugee & Global Health Volume 2 Issue 1","authors":"R. Carrico","doi":"10.55504/2473-0327.1036","DOIUrl":"https://doi.org/10.55504/2473-0327.1036","url":null,"abstract":"","PeriodicalId":198307,"journal":{"name":"Journal of Refugee & Global Health","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124174123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-11DOI: 10.18297/RGH/VOL1/ISS2/5/
Anne Duckles, Aba Barden-Maja, Julie A. Caplow
The number of forcibly displaced individuals worldwide is increasing each year, reaching 65 million persons by the end of 2015, half of which were women and children. As the population of displaced persons grows, it is every physician’s responsibility to understand these patients and their health needs. Refugee patients and the providers who care for them face many barriers to effective patient care, including language barriers, cultural differences, and systematic inequalities. Female refugees commonly experience gender-based violence, repetitive trauma, stigmatized mental illness, and cultural barriers to women’s healthcare. This review is intended to be a comprehensive guide for the provider caring for the recently resettled female refugee patient. It addresses general considerations for working with refugee patients, initial medical evaluation guidelines, specific women’s health issues, and mental health care of female refugee patients. DOI: 10.18297/rgh/vol1/iss2/5 Website: https://ir.library.louisville.edu/rgh Received Date: September 12, 2017 Accepted Date: April 3, 2018 Affiliations: 1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 2Department of Medicine, University of Pennsylvania, Philadelphia, PA *Correspondence To: Anne Duckles (1) or Aba Barden-Maja M.D., M.S. (2) Work Address: (1) Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104; (2) M.S. Department of Medicine, Penn Center for Primary Care, MAB Suite 102, 3801 Market Street, Philadelphia, PA 19104. Work Email: (1) aduckles@mail.med.upenn.edu; (2) aba.barden-maja@uphs.upenn.edu Phone: (1) (585) 880-8435; (2) (215) 662-9990
全世界被迫流离失所的人数每年都在增加，截至2015年底已达到6500万人，其中一半是妇女和儿童。随着流离失所者人数的增加，每个医生都有责任了解这些病人及其健康需求。难民病人和照顾他们的提供者在有效的病人护理方面面临许多障碍，包括语言障碍、文化差异和系统不平等。女性难民通常遭受基于性别的暴力、反复的创伤、被污名化的精神疾病以及妇女保健方面的文化障碍。这项审查的目的是一个全面的指导提供者照顾最近重新安置的女性难民病人。它涉及与难民病人一起工作的一般考虑、初步医疗评价准则、具体的妇女健康问题以及女性难民病人的精神保健。DOI: 10.18297/rgh/vol1/iss2/5网站:https://ir.library.louisville.edu/rgh接收日期:2017年9月12日接收日期:2018年4月3日所属单位:1宾夕法尼亚大学费城佩雷尔曼医学院2宾夕法尼亚大学费城医学系*通讯作者:Anne Duckles(1)或Aba Barden-Maja M.D, M.S.(2)工作地址:(1)佩雷尔曼医学院，3400 Civic Center Blvd, Philadelphia, PA 19104;(2)宾夕法尼亚大学初级保健中心医学硕士系，MAB套房102，市场街3801号，费城，宾夕法尼亚州19104。工作邮箱:(1)aduckles@mail.med.upenn.edu;(2) aba.barden-maja@uphs.upenn.edu电话:(1)(585)880-8435;(2) (215) 662-9990
{"title":"The Medical Evaluation of the Newly Resettled Female Refugee: A Narrative\u0000 Review","authors":"Anne Duckles, Aba Barden-Maja, Julie A. Caplow","doi":"10.18297/RGH/VOL1/ISS2/5/","DOIUrl":"https://doi.org/10.18297/RGH/VOL1/ISS2/5/","url":null,"abstract":"The number of forcibly displaced individuals worldwide is increasing each year, reaching 65 million persons by the end of 2015, half of which were women and children. As the population of displaced persons grows, it is every physician’s responsibility to understand these patients and their health needs. Refugee patients and the providers who care for them face many barriers to effective patient care, including language barriers, cultural differences, and systematic inequalities. Female refugees commonly experience gender-based violence, repetitive trauma, stigmatized mental illness, and cultural barriers to women’s healthcare. This review is intended to be a comprehensive guide for the provider caring for the recently resettled female refugee patient. It addresses general considerations for working with refugee patients, initial medical evaluation guidelines, specific women’s health issues, and mental health care of female refugee patients. DOI: 10.18297/rgh/vol1/iss2/5 Website: https://ir.library.louisville.edu/rgh Received Date: September 12, 2017 Accepted Date: April 3, 2018 Affiliations: 1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 2Department of Medicine, University of Pennsylvania, Philadelphia, PA *Correspondence To: Anne Duckles (1) or Aba Barden-Maja M.D., M.S. (2) Work Address: (1) Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA 19104; (2) M.S. Department of Medicine, Penn Center for Primary Care, MAB Suite 102, 3801 Market Street, Philadelphia, PA 19104. Work Email: (1) aduckles@mail.med.upenn.edu; (2) aba.barden-maja@uphs.upenn.edu Phone: (1) (585) 880-8435; (2) (215) 662-9990","PeriodicalId":198307,"journal":{"name":"Journal of Refugee & Global Health","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124890722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-11DOI: 10.18297/RGH/VOL1/ISS2/3/
Enid F. Trucios-Haynes
{"title":"The Brandeis Human Rights Advocacy Program: Advancing Human Rights of the\u0000 Immigrant, Noncitizen and Refugee Community","authors":"Enid F. Trucios-Haynes","doi":"10.18297/RGH/VOL1/ISS2/3/","DOIUrl":"https://doi.org/10.18297/RGH/VOL1/ISS2/3/","url":null,"abstract":"","PeriodicalId":198307,"journal":{"name":"Journal of Refugee & Global Health","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134029218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-04-11DOI: 10.18297/RGH/VOL1/ISS2/2/
V. Corcino, A. Yaffee, M. Pecchio, M. Powell, F. Arnold
Tetanus was suspected at an outlying hospital where a partial dose of tetanus immune globulin and penicillin G were administered prior to her transfer to a tertiary care hospital. Her vital signs were normal. The patient was conscious, lying on her side with her neck arched back, jaw clenched. Because of laryngospasm and to prevent respiratory failure, the patient required intubation and mechanical ventilation. She continued to experience upper extremity contractures in response to any external stimuli; proximal greater than distal. She also experienced intermittent episodes of stiffening followed by tonic-clonic motion of her extremities. Initial laboratory values were within normal limits except for an elevated creatinine phosphokinase (CPK) of 2,352 IU/L (Figure 1). To eliminate ongoing potential source of infection from the uterus, dilation and suction curettage was performed, with limited products of conception removed and specimens sent for Gram stain, culture, and pathology evaluation. Considering the patient’s history of an absence of tetanus vaccination, muscle spasms, and increased CPK, the diagnosis was narrowed exclusively to tetanus, and broad-spectrum therapy was deescalated to metronidazole. In addition, the remaining dose of immune globulin was administered intramuscularly to complete a total dose of 6000 IU. Active vaccination with tetanus and diphtheria vaccine was provided. The Gram stain from the uterine sample revealed no organisms, the culture was negative, and pathology reported severe acute inflammation and necrosis. One week after hospitalization, she developed diaphoresis and severe upper extremity contractures provoked with minimal external stimuli and other complications (Figure 1). She was eventually discharged home in stable condition after a 41-day hospitalization. A public health response was initiated by the state and local health departments to prevent additional cases through vaccination (Yaffee et al., 2017). Tetanus in an Unvaccinated Amish Woman After a Breech Home Delivery in Kentucky, 2016
在一家边远医院怀疑她患了破伤风，在她转到三级保健医院之前，在那里给她注射了部分剂量的破伤风免疫球蛋白和青霉素G。她的生命体征正常。病人神志清醒，侧躺着，脖子后拱，下巴紧咬。由于喉痉挛和防止呼吸衰竭，患者需要插管和机械通气。她继续经历上肢挛缩对任何外部刺激的反应;近端大于远端。她还经历了间歇性的僵硬发作，随后是四肢强直阵挛性运动。最初的实验室值在正常范围内，除了肌酐磷酸激酶(CPK)升高2,352 IU/L(图1)。为了消除子宫持续的潜在感染源，进行了扩张和吸引刮除，取出有限的受孕产物，并将标本送去革兰氏染色，培养和病理评估。考虑到患者未接种破伤风疫苗、肌肉痉挛和CPK升高的病史，诊断仅限于破伤风，并将广谱治疗降级为甲硝唑。此外，剩余剂量的免疫球蛋白肌肉注射，以完成6000 IU的总剂量。提供了破伤风和白喉活疫苗接种。子宫革兰氏染色未见微生物，培养阴性，病理报告严重急性炎症和坏死。住院1周后，患者出现出汗和严重上肢挛缩，并伴有轻微的外界刺激和其他并发症(图1)。住院41天后，患者出院，病情稳定。州和地方卫生部门发起了一项公共卫生应对措施，通过接种疫苗预防更多病例(Yaffee et al.， 2017)。2016年，肯塔基州一名未接种疫苗的阿米什妇女在臀位分娩后感染破伤风
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