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Kailey Urban - One of the best experts on this subject based on the ideXlab platform.
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health screenings administered during the domestic Medical Examination of refugees and other eligible immigrants in nine us states 2014 2016 a cross sectional analysis
PLOS Medicine, 2020Co-Authors: Clelia Pezzi, Deborah Lee, Gayathri Kumar, Breanna Kawasaki, Lori Kennedy, Jenny Aguirre, Melissa Titus, Rebecca Ford, Blain Mamo, Kailey UrbanAbstract:Background Refugees and other select visa holders are recommended to receive a domestic Medical Examination within 90 days after arrival to the United States. Limited data have been published on the coverage of screenings offered during this Examination across multiple resettlement states, preventing evaluation of this voluntary program’s potential impact on postarrival refugee health. This analysis sought to calculate and compare screening proportions among refugees and other eligible populations to assess the domestic Medical Examination’s impact on screening coverage resulting from this Examination. Methods and findings We conducted a cross-sectional analysis to summarize and compare domestic Medical Examination data from January 2014 to December 2016 from persons receiving a domestic Medical Examination in seven states (California, Colorado, Minnesota, New York, Kentucky, Illinois, and Texas); one county (Marion County, Indiana); and one academic Medical center in Philadelphia, Pennsylvania. We analyzed screening coverage by sex, age, nationality, and country of last residence of persons and compared the proportions of persons receiving recommended screenings by those characteristics. We received data on disease screenings for 105,541 individuals who received a domestic Medical Examination; 47% were female and 51.5% were between the ages of 18 and 44. The proportions of people undergoing screening tests for infectious diseases were high, including for tuberculosis (91.6% screened), hepatitis B (95.8% screened), and human immunodeficiency virus (HIV; 80.3% screened). Screening rates for other health conditions were lower, including mental health (36.8% screened). The main limitation of our analysis was reliance on data that were collected primarily for programmatic rather than surveillance purposes. Conclusions In this analysis, we observed high rates of screening coverage for tuberculosis, hepatitis B, and HIV during the domestic Medical Examination and lower screening coverage for mental health. This analysis provided evidence that the domestic Medical Examination is an opportunity to ensure newly arrived refugees and other eligible populations receive recommended health screenings and are connected to the US healthcare system. We also identified knowledge gaps on how screenings are conducted for some conditions, notably mental health, identifying directions for future research.
Clelia Pezzi - One of the best experts on this subject based on the ideXlab platform.
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health screenings administered during the domestic Medical Examination of refugees and other eligible immigrants in nine us states 2014 2016 a cross sectional analysis
PLOS Medicine, 2020Co-Authors: Clelia Pezzi, Deborah Lee, Gayathri Kumar, Breanna Kawasaki, Lori Kennedy, Jenny Aguirre, Melissa Titus, Rebecca Ford, Blain Mamo, Kailey UrbanAbstract:Background Refugees and other select visa holders are recommended to receive a domestic Medical Examination within 90 days after arrival to the United States. Limited data have been published on the coverage of screenings offered during this Examination across multiple resettlement states, preventing evaluation of this voluntary program’s potential impact on postarrival refugee health. This analysis sought to calculate and compare screening proportions among refugees and other eligible populations to assess the domestic Medical Examination’s impact on screening coverage resulting from this Examination. Methods and findings We conducted a cross-sectional analysis to summarize and compare domestic Medical Examination data from January 2014 to December 2016 from persons receiving a domestic Medical Examination in seven states (California, Colorado, Minnesota, New York, Kentucky, Illinois, and Texas); one county (Marion County, Indiana); and one academic Medical center in Philadelphia, Pennsylvania. We analyzed screening coverage by sex, age, nationality, and country of last residence of persons and compared the proportions of persons receiving recommended screenings by those characteristics. We received data on disease screenings for 105,541 individuals who received a domestic Medical Examination; 47% were female and 51.5% were between the ages of 18 and 44. The proportions of people undergoing screening tests for infectious diseases were high, including for tuberculosis (91.6% screened), hepatitis B (95.8% screened), and human immunodeficiency virus (HIV; 80.3% screened). Screening rates for other health conditions were lower, including mental health (36.8% screened). The main limitation of our analysis was reliance on data that were collected primarily for programmatic rather than surveillance purposes. Conclusions In this analysis, we observed high rates of screening coverage for tuberculosis, hepatitis B, and HIV during the domestic Medical Examination and lower screening coverage for mental health. This analysis provided evidence that the domestic Medical Examination is an opportunity to ensure newly arrived refugees and other eligible populations receive recommended health screenings and are connected to the US healthcare system. We also identified knowledge gaps on how screenings are conducted for some conditions, notably mental health, identifying directions for future research.
K Whitmore - One of the best experts on this subject based on the ideXlab platform.
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the Medical Examination of children on entry to school the results and use of neurodevelopmental assessment
Developmental Medicine & Child Neurology, 2008Co-Authors: K WhitmoreAbstract:SUMMARY In the North Paddington Primary School Study 350 children were identified at five and studied over a five-year period. The children were given a comprehensive Examination on entry to school, the findings from which are briefly described. Here the results of the neurodevelopmental assessment are reviewed. Children with a high (abnormal) neurodevelopmental score (NDS) are shown to be a very vulnerable group with significantly higher rates of learning difficulty by the age of 10. The NDS alone does not give as good a prediction of such difficulty as the school doctor's clinical judgement. It is emphasised that prediction of difficulties is not an objective of the school entrant Examination but clearly the clinical tests from which a NDS can be calculated provide a sound basis for clinical practice. Attention is drawn to the need for the school doctor with discretion to pass on to teachers the results of their Examination that may increase the teachers' insight into their pupils and help them in their methods of teaching and care. RESUME Examen Medical des enfants a l'entree de l'ecole. Resultats et usage de l'evaluation neurodevelopmentale 351 enfants venant de 15 ecoles primaires de nord Paddington ont fait l'objet d'une etude sur une periode de cinq ans, a partir de l'âge de cinq ans. Les donnees des examens etendus pratiques a l'ecole ont ete decrits dans la partie I de cette etude; les resultats des evaluations neurodevelopmentales sont revues dans cet article. Les enfants avec un score neurodevelopmental (NDS) eleve (anormal) formaient un groupe tres vulnerable avec des taux significativement plus eleves de difficultes d'apprentissage a l'âge de dix ans, bien que le NDS seul n'ait pas donne une prediction de ces difficultes aussi bonne que l'appreciation clinique du medecin scolaire. La prediction de difficulte n'est pas un objectif de l'examen a l'entree scolaire mais manifestement, les tests cliniques a partir desquels un NDS peut etre calcule fournissent une base valable pour la pratique clinique. L'attention est attiree sur la necessite pour le medecin scolaire de communiquer (avec discretion) aux enseignants les resultats de leurs examens car cela peut accroitre l'attention des enseignants sur le probleme de leurs eleves et les aider dans leurs methodes d'enseignement et de soin. ZUSAMMENFASSUNG Die medizinische Einschulungsuntersuchung von Kinder. Die Ergebnisse und Beurteilungen der neurologischen Entwicklung 351 Kinder aus Grundschulen von Nord Paddington wurden vom funften Lebensjahr an uber einen Zeitraum von funf Jahren untersucht. Die Befunde der umfassenden Untersuchungen, die bei der Einschulung vorgenommen wurden, sind in Teil I dieser Studie beschrieben worden; hier werden die Ergebnisse uber die neurologische Entwicklung dargestellt. Kinder mit einem hohen (abnormen) neurologischen Entwicklungs-Score (NDS) bildeten eine sehr auffallige Gruppe, bis zum Alter von 10 Jahren hatten sie signifikant haufiger Lernprobleme, obwohl der NDS allein fur die Prognose dieser Schwierigkeiten nicht so gut geeignet war wie die Beurteilung des Schularztes. Die Prognose von Lernproblemen ist nicht Gegenstand einer Einschulungsuntersuchung, aber die klinischen Tests, von denen ein NDS abgeleitet werden kann, geben eine gute Basis fur die klinische Praxis. Es wird darauf hingewiesen, das die Schularzte (mit Diskretion) den Lehrern solche Befunde mitteilen sollten, die das Verstandnis der Lehrer fur die Probleme ihrer Schuler fordern und ihnen bei ihren Lehr- und Betreuungsprogrammen helfen konnen. RESUMEN Examen medico del nino al entrar en la escueia. Resultados y uso de la evaluation neuroevolutiva 351 ninos de 15 escuelas primarias del Norte de Paddington, fueron estudiados por un periodo de cinco anos a partir de los cinco anos de edad. Los hallazgos de los examenes hechos al entrar en la escueia fueron descritos en la parte 1 de este estudio; aqui se revisan los resultados de la evaluacion neuroevolutiva. Los ninos con un nivel alto (anormal) de puntaje neuroevolutivo (PNE) constituian un grupo muy vulnerable, con un proportion significativamente mas alta de dificultad para el aprendizaje a la edad de los 10 anos, aunque el PNE solo no daba una buena prediccion de tal dificultad. Segun juicio del doctor de la escueia la prediction de las dificultades no es un objetivo del examen de entrada a la escueia, pero esta claro que los tests clinicos por los que se calcula el PNE proporcionan una base so1ida para la practica clinica. Se atrae la atencion sobre la necesidad de que el medico escolar pase (con discretion) a los maestros aquellos resultados de su examen que les puedan facilitar la vision interna de los problemas de sus alumnos y ayudarles en sus metodos de ensenanza y trato.
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the Medical Examination of children on entry to school the results and use of neurodevelopmental assessment
Developmental Medicine & Child Neurology, 2008Co-Authors: K WhitmoreAbstract:SUMMARY In the North Paddington Primary School Study 350 children were identified at five and studied over a five-year period. The children were given a comprehensive Examination on entry to school, the findings from which are briefly described. Here the results of the neurodevelopmental assessment are reviewed. Children with a high (abnormal) neurodevelopmental score (NDS) are shown to be a very vulnerable group with significantly higher rates of learning difficulty by the age of 10. The NDS alone does not give as good a prediction of such difficulty as the school doctor's clinical judgement. It is emphasised that prediction of difficulties is not an objective of the school entrant Examination but clearly the clinical tests from which a NDS can be calculated provide a sound basis for clinical practice. Attention is drawn to the need for the school doctor with discretion to pass on to teachers the results of their Examination that may increase the teachers' insight into their pupils and help them in their methods of teaching and care. RESUME Examen Medical des enfants a l'entree de l'ecole. Resultats et usage de l'evaluation neurodevelopmentale 351 enfants venant de 15 ecoles primaires de nord Paddington ont fait l'objet d'une etude sur une periode de cinq ans, a partir de l'âge de cinq ans. Les donnees des examens etendus pratiques a l'ecole ont ete decrits dans la partie I de cette etude; les resultats des evaluations neurodevelopmentales sont revues dans cet article. Les enfants avec un score neurodevelopmental (NDS) eleve (anormal) formaient un groupe tres vulnerable avec des taux significativement plus eleves de difficultes d'apprentissage a l'âge de dix ans, bien que le NDS seul n'ait pas donne une prediction de ces difficultes aussi bonne que l'appreciation clinique du medecin scolaire. La prediction de difficulte n'est pas un objectif de l'examen a l'entree scolaire mais manifestement, les tests cliniques a partir desquels un NDS peut etre calcule fournissent une base valable pour la pratique clinique. L'attention est attiree sur la necessite pour le medecin scolaire de communiquer (avec discretion) aux enseignants les resultats de leurs examens car cela peut accroitre l'attention des enseignants sur le probleme de leurs eleves et les aider dans leurs methodes d'enseignement et de soin. ZUSAMMENFASSUNG Die medizinische Einschulungsuntersuchung von Kinder. Die Ergebnisse und Beurteilungen der neurologischen Entwicklung 351 Kinder aus Grundschulen von Nord Paddington wurden vom funften Lebensjahr an uber einen Zeitraum von funf Jahren untersucht. Die Befunde der umfassenden Untersuchungen, die bei der Einschulung vorgenommen wurden, sind in Teil I dieser Studie beschrieben worden; hier werden die Ergebnisse uber die neurologische Entwicklung dargestellt. Kinder mit einem hohen (abnormen) neurologischen Entwicklungs-Score (NDS) bildeten eine sehr auffallige Gruppe, bis zum Alter von 10 Jahren hatten sie signifikant haufiger Lernprobleme, obwohl der NDS allein fur die Prognose dieser Schwierigkeiten nicht so gut geeignet war wie die Beurteilung des Schularztes. Die Prognose von Lernproblemen ist nicht Gegenstand einer Einschulungsuntersuchung, aber die klinischen Tests, von denen ein NDS abgeleitet werden kann, geben eine gute Basis fur die klinische Praxis. Es wird darauf hingewiesen, das die Schularzte (mit Diskretion) den Lehrern solche Befunde mitteilen sollten, die das Verstandnis der Lehrer fur die Probleme ihrer Schuler fordern und ihnen bei ihren Lehr- und Betreuungsprogrammen helfen konnen. RESUMEN Examen medico del nino al entrar en la escueia. Resultados y uso de la evaluation neuroevolutiva 351 ninos de 15 escuelas primarias del Norte de Paddington, fueron estudiados por un periodo de cinco anos a partir de los cinco anos de edad. Los hallazgos de los examenes hechos al entrar en la escueia fueron descritos en la parte 1 de este estudio; aqui se revisan los resultados de la evaluacion neuroevolutiva. Los ninos con un nivel alto (anormal) de puntaje neuroevolutivo (PNE) constituian un grupo muy vulnerable, con un proportion significativamente mas alta de dificultad para el aprendizaje a la edad de los 10 anos, aunque el PNE solo no daba una buena prediccion de tal dificultad. Segun juicio del doctor de la escueia la prediction de las dificultades no es un objetivo del examen de entrada a la escueia, pero esta claro que los tests clinicos por los que se calcula el PNE proporcionan una base so1ida para la practica clinica. Se atrae la atencion sobre la necesidad de que el medico escolar pase (con discretion) a los maestros aquellos resultados de su examen que les puedan facilitar la vision interna de los problemas de sus alumnos y ayudarles en sus metodos de ensenanza y trato.
Terri L Myhr - One of the best experts on this subject based on the ideXlab platform.
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sexual assault forensic Medical Examination is evidence related to successful prosecution
Annals of Emergency Medicine, 2002Co-Authors: Margaret J Mcgregor, Janice Du Mont, Terri L MyhrAbstract:Abstract Study Objective: We describe the Medical-legal findings in a population of adult sexual assault cases assessed in an emergency department setting and reported to the police, document the law enforcement and legal disposition of cases seen over the study period, and determine whether Medical-legal findings are associated with filing of charges and conviction after adjusting for demographic factors and assault characteristics. Methods: This was a retrospective chart review of all police-reported cases seen from January 1993 to December 1997 at the British Columbia Women's Sexual Assault Service, a 24-hour hospital-based emergency service. Information on patient demographics, assault characteristics, and Medical-legal findings was merged with data extracted from police and court files on the cases' legal outcomes and sperm-semen test results of collected forensic evidence. Cases were assigned a clinical injury extent score reflecting the degree of documented genital and extragenital injury. The association of Medical-legal variables, patient demographics, and assault characteristics with filing of charges (among the subset of cases in which a suspect was identified by police) and conviction (among the subset of cases in which charge were filed) was examined by using logistic regression. Results: Charges were filed in 151 (32.7%) and a conviction secured in 51 (11.0%) of the 462 cases examined in this study. Genital injury was observed in 193 (41.8%), and sperm-semen-positive forensic results were obtained in 100 (38.2%) of the 262 samples tested. A gradient association was found for injury extent score and charge filing in the following categories: mild injury (odds ratio [OR] 2.85; 95% confidence interval [CI] 1.09 to 7.45); moderate injury (OR 4.00; 95% CI 1.63 to 9.84); and severe injury (OR 12.29; 95% CI 3.04 to 49.65). Documentation on the police file of receipt of forensic samples collected by the Sexual Assault Service examiner was also significantly associated with charges being filed (OR 3.45; 95% CI 1.82 to 6.56). Injury extent score defined as severe was the only variable significantly associated with conviction (OR 6.51; 95% CI 1.31 to 32.32). Conclusion: The finding that documented injury extent had a significant positive association with both filing of charges and conviction is an important step in confirming the value of injury documentation in the forensic Examination of sexual assault victims. [McGregor MJ, Du Mont J, Myhr TL. Sexual assault forensic Medical Examination: is evidence related to successful prosecution? Ann Emerg Med. June 2002;39:639-647.]
David J Kolko - One of the best experts on this subject based on the ideXlab platform.
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which sexual abuse victims receive a forensic Medical Examination the impact of children s advocacy centers
Child Abuse & Neglect, 2007Co-Authors: Wendy A Walsh, Theodore P Cross, Lisa M Jones, Monique Simone, David J KolkoAbstract:Abstract Objective This study examines the impact of Children's Advocacy Centers (CAC) and other factors, such as the child's age, alleged penetration, and injury on the use of forensic Medical Examinations as part of the response to reported child sexual abuse. Methods This analysis is part of a quasi-experimental study, the Multi-Site Evaluation of Children's Advocacy Centers, which evaluated four CACs relative to within-state non-CAC comparison communities. Case abstractors collected data on forensic Medical exams in 1,220 child sexual abuse cases through review of case records. Results Suspected sexual abuse victims at CACs were two times more likely to have forensic Medical Examinations than those seen at comparison communities, controlling for other variables. Girls, children with reported penetration, victims who were physically injured while being abused, White victims, and younger children were more likely to have exams, controlling for other variables. Non-penetration cases at CACs were four times more likely to receive exams as compared to those in comparison communities. About half of exams were conducted the same day as the reported abuse in both CAC and comparison communities. The majority of caregivers were very satisfied with the Medical professional. Receipt of a Medical exam was not associated with offenders being charged. Conclusions Results of this study suggest that CACs are an effective tool for furthering access to forensic Medical Examinations for child sexual abuse victims.
