Growth of Pediatric Refugees after Resettlement to the Southeastern United States.

OBJECTIVE: To compare weight status and body mass index z-scores (BMIz) of refugee children upon arrival to the Southeastern US and after resettlement with age- and sex-matched controls of nonrefugee children. METHODS: We identified refugee children resettled between July 2014 and June 2018 to Forsyth County, NC. Refugees were assigned age- and sex-matched controls (3 controls:1 refugee) who received care at the same health care site, were Medicaid insured, and had height and weight recorded at time of their matched refugee's resettlement plus at least 2 additional visits. BMI and BMIz were calculated. Pearson chi-square test assessed differences in weight status at the time of refugee resettlement and at the last measured time point. Multilevel linear mixed-effects regression models assessed change in BMIz by refugee status, adjusting for sex, race/ethnicity, age, and time since resettlement. RESULTS: This study examined 139 pediatric refugees and 417 nonrefugee controls; 46% were female. At the time of resettlement, refugees had a higher rate of underweight (3.3%  vs 1.9%), higher rate of healthy weight (68.9% vs 48.2%), and lower rate of overweight/obesity (27.8% vs 50%), compared to controls P < .001. At the last available time point, compared to controls, refugees had higher rates of underweight (3.3% vs 3.0%) and healthy weight (69.5% vs 54.2%) and lower rates of overweight/obesity (27.2%  vs 42.7%), P = .005. Refugees had a lower predicted BMIz compared with controls (adjusted ß: -0.78; 95%  confidence interval -0.91, -0.66). CONCLUSIONS: Resettled pediatric refugees were found to have significantly lower predicted BMIz than their age- and sex-matched nonrefugee controls.

Change in Knowledge and Preferred Scenario Responses After Completion of the Advanced Life Support in Obstetrics Course in Serbia.

BACKGROUND AND OBJECTIVES: The Advanced Life Support in Obstetrics (ALSO) course is widely utilized in the United States as an evidence-based program that bridges knowledge gaps and improves skills via hands-on training, group learning, and memorization of standardized mnemonics in a team-based approach to patient care. This reduces communication barriers among maternity care providers, ultimately decreasing potential negative outcomes. A needs assessment identified that Serbian providers would benefit from structured learning and hands-on simulation approaches in obstetrics from a structured training like the ALSO course. The objective of this study was to explore the changes in clinicians' knowledge and preferred scenario responses in managing obstetrics cases before and after participation in the ALSO course. METHODS: The ALSO training lasted 2 days and included lecture sessions, interactive workshops, a written knowledge test, and a simulated skills test. Participants completed an additional 20-item questionnaire assessing their knowledge and preferred scenario responses two weeks pre- and immediately post-ALSO training. Using a paired t test we assessed changes between pre- and posttest knowledge and preferred scenario response scores. RESULTS: Twenty-seven participants provided complete data. For the entire sample, the pretest mean number of correct items on the knowledge and preferred scenario response assessment was 10.8 and the posttest mean number correct was 15.2, representing an increase of 4.4 correct answers (P<.001). CONCLUSIONS: The current results suggest that the ALSO course can successfully increase knowledge and preferred scenario responses in Serbian providers and may be a viable approach to improving birth outcomes.

Maternal Health Care Challenges Confronting Arab Muslim Refugee Women in Triad North Carolina.

Arab Muslim refugee women represent a new underserved population in North Carolina with many health needs and challenges. Barriers in language, economic and social status, culture, and health all play a role in this population's successful assimilation. Without support, fear and isolation may impede them from becoming active in society. Moreover, the impact on overall wellness of families may be at stake. Highlighting these issues can bring awareness to the needs.

Connecting Refugees to Medical Homes Through Multi-Sector Collaboration.

As increasing numbers of refugees have resettled globally, an interdisciplinary group of stakeholders in Forsyth, North Carolina, recognized obstacles preventing coordinated medical care, which inspired the development of our Refugee Health Collaborative. This study assessed the Collaborative's impact on access to coordinated care within patient-centered medical homes (PCMH). A Collaborative-developed novel algorithm guided the process by which refugees establish care in PCMHs. All refugees who established medical care in the two primary health systems in our county (n = 285) were included. Logistic non-linear mixed models were used to estimate the differences between three time frames: pre-algorithm, algorithm implementation and refinement, and ongoing algorithm implementation. After algorithm implementation, there has been a significant decrease in the time required to establish care in PCMHs, increased provider acknowledgment of refugee status, and decreased emergency department (ED) visits. Multi-disciplinary, organized collaboration can facilitate enhanced access to care for refugee families at the population level.

Biosimilars for Immune-Mediated Chronic Diseases in Primary Care: What a Practicing Physician Needs to Know.

The introduction of biologics has revolutionized the treatment of immune-mediated diseases, but high cost and limited patient access remain hurdles, and some physicians are concerned that biosimilars are not similar enough. The purpose of this narrative review is to describe biosimilar safety, efficacy, nomenclature, extrapolation and interchangeability. In the United States, the Biologics Price Competition and Innovation Act created an abbreviated pathway for licensing of a biologic that is biosimilar to another licensed product (i.e., the reference product). This approval pathway differs from that of generic small-molecule drugs because biologics are too complex to be perfectly duplicated, and follows a process designed to demonstrate that any differences between the biosimilar and its reference product have no significant impact on safety and efficacy. The US approval process requires extensive analytical assessments, animal studies and clinical trials, assuring that biosimilar products provide clinical results similar to those of the reference product.

Clinical inquiries: which women should we screen for gestational diabetes mellitus?

It's unclear which women we should screen. No randomized controlled trials (RCTs) demonstrate that either universal screening or risk factor screening for gestational diabetes mellitus (GDM) prevents maternal and fetal adverse outcomes. That said, the common practice of universal screening is more sensitive than screening based on risk factors. Historic risk factors are poor predictors of GDM in a current pregnancy.

Diabetes: Rethinking risk and the Dx that fits.

Routinely screen adult patients with a sustained blood pressure >135/80 mm Hg for type 2 diabetes. Closely monitor pregnant women with 1 or more elevated glucose test results; although a diagnosis of gestational diabetes mellitus requires 2 or more abnormal values, even 1 may be associated with a higher risk of adverse outcomes. Include latent autoimmune diabetes in adults (LADA), a progressive form of type 1 with a slower onset, in the differential diagnosis for symptomatic patients who do not fit the classic patterns for type 1 or type 2 diabetes.

T-cell proliferative responses following sepsis in neonatal rats.

Both experimental and clinical evidence suggest a suppression of T-cell function in burn and sepsis. The objective of the present study was to evaluate splenocyte and purified T-cell proliferative response and IL-2 production in septic neonatal rats. We also examined if alterations in T-cell proliferation and IL-2 production in neonatal sepsis is due to elevation in PGE2. PGE2 is known to play a significant role in T-cell suppression during sepsis in adults. Sepsis was induced in 15-day-old neonatal Sprague-Dawley rats by implanting 0.1 cm3 of fecal pellet impregnated with Escherichia coli (50 CFU) and Bacteroides fragilis (10(3) CFU). Animals receiving fecal pellets without the bacteria were designated as sterile. A group of septic and sterile rats were treated with PGE2 synthesis inhibitors, NS398 and resveratrol. These treatments of animals allowed us to evaluate the role of PGE2 in T-cell suppression during neonatal sepsis. Splenocytes as well as purified T cells were prepared and then proliferative response and IL-2 productive capacities were measured. A significant suppression of splenocyte proliferation and IL-2 production was noticed in both sterile and septic animals compared to the T cells from unoperated control rats. In contrast, the proliferation and IL-2 production by nylon wool purified T cells in sterile rats was not significantly different from control rats, whereas, a significant suppression in Con A-mediated T-cell proliferation and IL-2 production noticed in septic rat T cells compared to the sterile and control rat T cells. Such decrease in T-cell proliferation and IL-2 production was accompanied with 20-25% deaths in neonates implanted with septic pellets. No mortality was noted in sterile-implanted neonates. Treatment of animals with COX-1 inhibitor had no effect on T-cell proliferation response in both septic and sterile groups, whereas COX-2 inhibitor abrogated the decrease in T-cell proliferative response in the septic group. The treatment of animals with COX-2 inhibitor also significantly prevented the sepsis-associated mortality in neonates. In conclusion, the present study demonstrated T-cell suppression during neonatal sepsis is accompanied by a decrease in IL-2 production. Such suppressions were ameliorated with COX-2 inhibitor suggesting a role for PGE2 in the suppressed T-cell-mediated immune function in neonatal sepsis.