Effect of country of origin, age, and body mass index on prevalence of vitamin D deficiency in a US immigrant and refugee population.

OBJECTIVE: To determine the prevalence of vitamin D deficiency (VDD) (25-hydroxyvitamin D level <20 ng/mL) and severe VDD (25[OH]D level <10 ng/mL) in a Minnesota immigrant and refugee population. PATIENTS AND METHODS: This retrospective study evaluated a cohort of adult immigrants and refugees seen at Health Partners Center for International Health in St Paul, Minnesota. Study participants were all patients seen from August 1, 2008, through July 31, 2009, with a first vitamin D screen (N=1378). Outcomes included overall prevalence of VDD and severe VDD. Covariates included country of origin, sex, age, month of test, and body mass index (BMI). RESULTS: Vitamin D deficiency was significantly more prevalent in our Minnesota clinic immigrant and refugee population than among US-born patients (827 of 1378 [60.0%] vs 53 of 151 [35.1%]; P<.001). Severe VDD was also significantly more prevalent (208 of 1378 [15.1%] vs 12 of 151 [7.9%]; P=.02). Prevalence of VDD varied significantly according to country of origin (42 of 128 Russian patients [32.8%] vs 126 of 155 Ethiopian patients [81.3%]; P<.001). The BMI correlated [corrected] with VDD (488 of 781 [62.5%] when BMI was ≥ 25 vs 292 of 520 [56.2%] when BMI was <25; P=.02). Vitamin D deficiency was present in 154 of 220 individuals (70.0%) 16 to 29 years old vs 123 of 290 (42.4%) in those older than 66 years (P<.001). CONCLUSION: Immigrants and refugees in a Minnesota clinic have a substantially higher rate and severity of VDD when compared with a US-born population. Country of origin, age, and BMI are specific risk factors for VDD and should influence individualized screening practices.

Essential factors for the development of a residency global health track.

OBJECTIVE: There is increasing awareness of the importance of global health (GH) residency education but little guidance on what departmental, financial, and human resource support is required to develop a GH track. The authors aimed to identify essential factors and major obstacles to the development of a GH track. METHODS: A survey assessing curriculum, support, and factors considered essential to or obstacles to successful development of a GH track was sent to 24 GH education directors within pediatric residencies. RESULTS: In all, 19 programs (79%) completed the survey, and 6 factors were identified as essential for developing and sustaining a GH track by ≥ 95% of all GH education directors: supportive residency program director, resident commitment, supportive department chair, protected resident elective time, dedicated budget, and GH faculty with protected time. CONCLUSIONS: Residency programs aiming to start a GH track should start by assessing the availability and sustainability of these identified essential factors within their program.

International electives at the university of Minnesota global pediatric residency program: opportunities for education in all Accreditation Council for Graduate Medical Education competencies.

PURPOSE: Globally competent pediatricians are in demand because of the increasing numbers of children from immigrant families living in the United States and the shortages of health care workers in low-income countries where the majority of the worlds' children live. This study sought to better understand the educational outcomes of international electives taken by pediatric residents training in global health. METHODS: Thirty-two pediatric residents who participated in an international elective as part of a global health curriculum completed reflective essays which were analyzed for themes from 2006 to 2010. During the first-order analysis, the emergent themes mapped to the Accreditation Council for Graduate Medical Education (ACGME) competencies. In response, a second-order analysis re-examined the essays with an additional researcher to support categorization consistent with the ACGME competencies. RESULTS: More than 90% of essays described experiences related to medical knowledge, patient care and systems-based practice. More than 50% included reflections on practice-based learning and improvement, professionalism, and interpersonal and communication skills. Residents also described the impact on their personal and professional development. CONCLUSION: International electives can provide educational opportunities for residents to develop competency in each of the 6 ACGME domains and to reevaluate their life purpose and career goals. In addition to opportunities to increase their medical knowledge, patient care and communication skills, residents find international electives rich learning environments for systems-based practice, practice-based learning/improvement, and professionalism, domains that can be challenging to teach. These findings support the importance of international electives in global health in meeting core requirements in residency training.

Advances in global biotechnology and local resources to treat malaria.

The global campaign toward malaria eradication has received a tremendous boost with the addition of artemisinin compounds to the therapeutic armament. Artemisinin drugs are now being recommended in combination with existing antimalarials, a pairing often referred to as artemisinin-based combination therapy (ACT). The World Health Organization considers ACT first-line treatment for uncomplicated malaria in endemic regions. In the United States, ACT is not currently FDA-approved. The Walter Reed Army Institute of Research, however, is studying its use and developing artemisinin compounds for the treatment of severe malaria. Artesunate, one of the artemisinin derivatives, is available to eligible patients in the United States free of charge. The drug is stocked at the CDC headquarters, as well as at 7 of the 20 quarantine stations.