The impact of immigration detention on the health of asylum seekers during the COVID-19 pandemic.

COVID-19 disproportionately affects racial and ethnic minority groups as well as people in jails and immigration detention centers in the United States. Between April and August of 2020, the mean monthly COVID-19 case ratio for ICE detainees was 13.4 times that of the general U.S. population. This study aims to understand the experiences of detained asylum seekers during the pandemic and to provide insight into COVID-19's impact on this population's health. This qualitative study employed first-person, in-depth narratives obtained from 12 asylum seekers, all of whom were detained in immigration detention centers or prisons during the initial surge of the COVID-19 pandemic and were subsequently released. Detained asylum seekers reported inadequate medical care, obstacles to receiving care, an inability to social distance, poor hygiene, restricted movement, and a lack of infection control-- all which increased their risk of contracting and spreading COVID-19 and exacerbated health inequalities brought to the forefront by the pandemic. Advocating for improved disease prevention and screening, prompt access to health care and treatment, cohorting of infectious cases, and community alternatives to detention to decrease the detained immigrant population sizes are crucial to halt communicability of the virus and its subsequent morbidity and mortality in this vulnerable population.

Addressing the need for forensic psychological evaluations of asylum seekers: The potential role of the general practitioner.

Asylum seekers who have survived torture and other abuses may experience a wide range of psychological symptoms associated with depression, anxiety, and posttraumatic stress disorder. During the asylum process, attorneys might refer their clients to clinicians who document these psychological sequelae of human rights violations. However, the need for forensic psychological evaluations exceeds the number of mental health clinicians available to provide these assessments. It has been suggested that primary care physicians, professionals who already play essential roles in the identification and treatment of mental health issues, may be able to conduct these evaluations. Yet, there is little empirical knowledge of what prior training and clinical experiences support mental health and non-mental health professionals who engage in this work, and what is needed to prepare general practitioners to provide forensic psychological evaluations to asylum seekers. This pilot study found non-mental health practitioners with experience in psychological forensic evaluations reached a level of confidence in conducting evaluations of asylum seekers comparable to general mental health practitioners. The study also identified clinicians' perceptions of training that supports them in their forensic psychological evaluations, their professional development needs, and the potential for general practitioners to leverage their current skill sets in this work.

Interindividual Variations in Foveal Anatomy and Artifacts Seen on Inner Retinal Probability Maps from Spectral Domain OCT Scans of the Macula.

PURPOSE: We tested the hypothesis that variations in foveal morphology can account for artifacts seen on optical coherence tomography (OCT) retinal ganglion cell (RGC) layer probability maps. METHODS: A total of 126 healthy subjects were tested with spectral domain (sd) OCT. Thickness and probability maps of the macular RGC plus inner plexiform layer (RGC+) were obtained with customized software. Macular b-scans were analyzed to derive three foveal anatomic parameters: width, depth, and slope. The distribution of these parameters was compared between eyes with and without circumfoveal artifacts seen in the central 4° of macular RGC+ probability maps. RESULTS: Of 126 healthy subjects, 12 (9.5%) had an abnormal circumfoveal region (artifact) on RGC+ probability maps. Based upon the normal distribution of the three anatomic parameters, only three of the 12 eyes (25%) fell outside the 95% confidence interval of one or more of the three foveal morphologic parameters. Multivariable logistic regression revealed that the parameter slope was significantly associated with the presence of these artifacts (odds ratio = 0.26; P = 0.019). However, the combination of these parameters and age explained only 11% of the total variance of these artifacts. CONCLUSIONS: Fovea morphology, as measured based upon width, depth, and slope, has a minor role in explaining artifacts seen on macular scans. Variations in the distribution of RGC+ thickness that are not reflected in our measures warrant further investigation as potential sources of artifacts. TRANSLATIONAL RELEVANCE: A small proportion of circumfoveal artifacts seen on RGC+ probability maps can be explained by variations in foveal anatomy.