Community-Based Trauma-Informed Care Following Immigrant Family Reunification: A Narrative Review.

Many immigrant families made the decision to separate from their children and migrate to the United States (US) hoping to reunite when able. Contrary to what is envisioned, the ultimate reunification can be a challenging transition. Reestablishing the parent-child relationship can be hindered by the anger, distress, vulnerability, and abuse the child may have experienced during the separation leading to behavioral concerns and depressive symptoms. The culmination of trauma and adverse childhood events prior to and following reunification is associated with an increased risk of anxiety, depression, behavioral disorders, and toxic stress. Unaddressed, these issues can lead to poor adult psychiatric health and limit a child's educational success and potential lifetime earnings. Trauma-informed programming has been an effective tool in addressing the mental health needs of refugee and immigrant children and may benefit this particular group of reunified families when held in a community setting alongside peer support. Familias Reunidas and Family Reunification and Resiliency Training (FUERTE) are 2 community-based programs that successfully guided recently reunified families through the process of reconnecting. Review of these programs suggests there is significance in the collaboration of health care providers, education specialists, and community liaisons in program creation, cultivation of a supportive group environment, incorporation of trauma-informed principles, and partnership with a community establishment. These components can lead to a reunification program that provides access to mental health services in order to work toward eliminating the health disparities affecting these families. Brief Summary: Family reunification can be a challenging transition for recently immigrated children whose parent(s) immigrated to the US years before them. Community programming could provide access to trauma-informed care to overcome the emotional distress reunification can cause within families.

The Influence of the Smart Glucose Manager Mobile Application on Diabetes Management.

BACKGROUND: Smartphone use is rapidly growing in developing countries, providing opportunity for development of new health-based mobile applications. The present study investigated the efficacy of a newly designed mobile application, Smart Glucose Manager (SGM), in Sri Lankan patients with diabetes. METHODS: A total of 67 patients with access to Android smartphones were randomized into an SGM (n = 27) and a control group (n = 25). Glycosylated hemoglobin (A1c) levels were measured at baseline and every 3 months afterward. The SGM group utilized the application daily, while control-group patients were instructed to continue their standard methods of diabetes management. Independent t-tests were utilized to assess A1c differences at 3 and 6 months postrandomization. A1c improvement, defined as A1c at 6 months minus baseline, was compared with SGM usage to assess effectiveness of diabetic management. RESULTS: At the 6-month follow up, the SGM group had significant lower A1c levels than the control group (7.2% vs 8.17%, P < .0001). For both groups, A1c values decreased from baseline to the 3 months (SGM: 9.52% to 8.16%, P < .0001; control: 9.44% to 8.31%, P < .0001). From 3 months to 6 months, the SGM group showed further improvement of A1c (-0.96% P < .0001), whereas the control group did not ( P = 0.19). A1c improvement was positively correlated with SGM usage ( R = .81, P < .001). CONCLUSION: The SGM, a mobile application specifically designed to support self-management of diabetes, appeared to show long-term improvement of A1c levels in patients with diabetes residing in Sri Lanka.

Massive levothyroxine ingestion in a pediatric patient: case report and discussion.

We describe the course of a toddler who ingested a massive amount of levothyroxine and review treatment options for such overdoses. A 2½-year-old boy presented shortly after an ingestion of up to 7.6 mg of levothyroxine (potentially as much as 700 µg/kg). He was initially asymptomatic, treated with oral charcoal 1 g/kg, and discharged home from the emergency department after a few hours. He returned approximately 24 hours later with a temperature of 38.5°C, heart rate of 163 beats per minute, respiratory rate of 30 breaths per minute, and blood pressure of 136/70 mm Hg. He had a slightly decreased appetite and no signs or symptoms of infection. He was admitted to hospital and treated with oral acetaminophen. The initial free thyroxine (T4) was > 100 pmol/L and free triiodothyronine (T3) was 35.3 pmol/L. The patient had desquamation of the palms and soles, hair loss, and irritability during the month following the ingestion. Resolution of the elevated free T4 occurred by 12 days post-ingestion and normalization of the thyroid-stimulating hormone by 7 weeks post-ingestion. There were no long-term sequelae. Levothyroxine overdose can result in significant complications, including seizures and arrhythmias, both of which should be monitored for. However, as our case illustrates, massive ingestion of levothyroxine in children typically follows a benign course.

Best practice smoking cessation intervention and resource needs of prenatal care providers.

OBJECTIVE: To describe smoking cessation interventions by prenatal care providers and to identify factors associated with best practice. METHODS: A mailed survey assessed implementation of the "5 A's" of best practice (Ask about smoking; Advise patients to quit; Assess willingness to quit; Assist with a cessation plan; and Arrange follow-up), practice characteristics, intervention training, resources, barriers, and attitudes toward reimbursement. Each factor in association with provider type and best practice implementation was analyzed. RESULTS: Of 1,138 eligible North Carolina health professionals, 844 responded (74%); 549 were providing prenatal care and returned completed surveys. Most asked about smoking (98%) and advised cessation (100%). Across provider type, one third (31%) consistently implemented all "5 A's" of best practice. Most providers (90%) had at least one material resource (eg, pamphlets), which correlated with nearly 10 times the adjusted odds of best practice (odds ratio [OR] 9.6, 95% confidence interval [CI] 1.3-72.9). Seventy percent had at least one counseling resource. Having a counseling resource (OR 2.5, 95% CI 1.4-4.4) and a written protocol to identify staff responsibilities (OR 2.5, 95% CI 1.5-4.3) were equally associated with best practice. More than one half of providers endorsed reimbursement as influential on best practice. CONCLUSION: Best practice is well-established to promote prenatal smoking cessation yet implemented by only one third of prenatal care providers in North Carolina. In this study, best practice was associated with resources, practice organization, and reimbursement. Augmented use of available resources (eg, toll-free hotlines) and adequate reimbursement may promote best practice implementation.