scholarly journals Inadequate Measles, Mumps, Rubella, and Varicella Immunity Among Employees

2021 ◽  
Vol 12 ◽  
pp. 215013272110059
Author(s):  
Stephen Ezeji-Okoye ◽  
Brittney L. Bilodeau ◽  
Divya K. Madhusudhan ◽  
Eileen Pruett ◽  
Sujith Thokala ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Health Center ◽  
Low Cost ◽  
Country Of Origin ◽  
International Travel ◽  
Morbidity And Mortality ◽  
Foreign Born ◽  
Green Card ◽  
Measles Outbreaks

Objectives: The purpose of this cohort study was to evaluate measles, mumps, rubella (MMR), and varicella immunity among a population of adult employees receiving primary care in an employer-sponsored health center. Methods: Participants were eligible for MMR and varicella immunity screening if they were an employee receiving primary care in an employer-sponsored health center between January 1, 2019 and November 1, 2020 who could not provide proof of immunization and 1) had it recommended by their provider, 2) specifically requested immunity testing (often because they had heard of measles outbreaks in their country of origin), or 3) were seen for an immigration physical for their Green Card application. Results: Overall, 3494 patients were screened for their MMR immunity. Of these, 3057 were also screened for varicella immunity. Among these patients, 13.9% lacked measles immunity, 0.83% lacked immunity to all 3 components of MMR, and 13.2% lacked varicella immunity. Among the 262 patients who presented specifically for immunity screening, the rates of lacking immunity were higher for all conditions: 22.7% lacked measles immunity and 9.2% lacked varicella immunity. Conclusion: Given declines in immunizations during the COVID-19 pandemic, there is reason to be concerned that measles and varicella-associated morbidity and mortality may rise. Employers, especially those with large foreign-born populations or who require international travel may want to educate their populations about common contagious illnesses and offer immunity validation or vaccinations at no or low cost.

Passenger fitness to fly

2021 ◽  
pp. 175573802110194
Author(s):  
Andrew Godden
Keyword(s):  
Primary Care ◽  
Low Cost ◽  
Air Travel ◽  
International Travel ◽  
Civil Aviation ◽  
Travel Information ◽  
Co Morbidity

The COVID-19 pandemic has reduced the amount of international travel, however, the speed and convenience of jet travel is unparalleled and our love of visiting far flung places at low cost will not have gone away for good. Now is an ideal time to review the health considerations of travelling in order to provide safe advice to our patients, who are increasingly elderly and travel with a wider range of medical co-morbidity. The purpose of this article is to consolidate guidance from the Civil Aviation Authority and the International Air Travel Association with supplementary travel information from other specialist organisations to help develop understanding of the issues air travel may pose for patients in primary care.

scholarly journals Investigating fever in the returning tropical traveller

2020 ◽  
Vol 13 (8) ◽  
pp. 459-463
Author(s):  
Advaith Gummaraju
Keyword(s):  
Primary Care ◽  
Country Of Origin ◽  
International Travel ◽  
Infectious Agents ◽  
Suitable Framework ◽  
The Uk ◽  
Tropical Infections ◽  
Timely Treatment

Globalisation has led to increased international travel for work, leisure, and to visit friends and relatives in a country of origin; this has led to greater exposure to tropical infectious agents. Many serious tropical infections encountered in primary care in the UK present as fever in a returning traveller. GPs must recognise potentially serious causes of fever in this population to ensure patients receive timely treatment. This article aims to provide a suitable framework for safe assessment, investigation and management of a patient with fever following international travel.

scholarly journals Paternal country of origin and adverse neonatal outcomes in births to foreign-born women in Norway: A population-based cohort study

PLoS Medicine ◽  
2020 ◽  
Vol 17 (11) ◽  
pp. e1003395
Author(s):  
Eline S. Vik ◽  
Vigdis Aasheim ◽  
Roy M. Nilsen ◽  
Rhonda Small ◽  
Dag Moster ◽  
...  
Keyword(s):  
Cohort Study ◽  
Country Of Origin ◽  
Population Based ◽  
Neonatal Outcomes ◽  
Foreign Born ◽  
Adverse Neonatal Outcomes

scholarly journals Acculturation and 4-Year Caries Increment Among Children of Foreign-Born Mothers in Sweden: A Register-Based Cohort Study

2021 ◽  
Author(s):  
Anna Granlund ◽  
Fernanda Cunha Soares ◽  
Anders Hjern ◽  
Göran Dahllöf ◽  
Annika Julihn
Keyword(s):  
Cohort Study ◽  
Human Development Index ◽  
Maternal Age ◽  
Negative Binomial ◽  
Country Of Origin ◽  
Sociodemographic Factors ◽  
Foreign Born ◽  
Stockholm County ◽  
Caries Increment ◽  
Intergenerational Effect

Abstract Background: To study the association of maternal age upon arrival and length of residence in Sweden with the 4-year caries increment in their children between ages 3 and 7 years in relation to the human development index (HDI) of the maternal country of origin. Method: This registry-based cohort study included all children born in 2000–2003 who resided in Stockholm County, Sweden, at age 3 years and who were followed up at age 7 (n = 65 259). Negative binomial regressions were used to analyze different models adjusted for sociodemographic factors.Results: Children of foreign-born mothers, regardless of the HDI of the maternal country of origin, had a higher risk of caries increment between ages 3 and 7 years than children of Swedish-born mothers. The children of mothers who had arrived in Sweden from a low or medium HDI country, however, had a lower caries increment than the children of mothers arriving after age 7. Nearly half (44%) of the children whose mothers arrived in Sweden at age ≥ 20 years from a low HDI country had a caries increment compared to 22% of the children whose mothers had arrived in Sweden before 7 years of age. Furthermore, children whose mothers were born in a low HDI country and had resided in Sweden ≤ 19 years had approximately 1.5 times higher risk of caries increment compared to children of mothers who had resided in Sweden for more than 20 years. Conclusions: Caries increment in the children of foreign-born mothers was associated with the age of their mother when she arrived in Sweden and was lower when the mother had arrived before age 7 years. This indicates an intergenerational effect that carries over to the children and is greater the longer the mother has participated in Swedish dental healthcare.

A Retrospective Cohort Study of SARS-CoV-2 Infection in Hypertenses Patients in a Primary Care Center

2020 ◽  
Author(s):  
Esther Hernandez Castilla ◽  
Lucia Vallejo Serrano ◽  
Monica Saenz Ausejo ◽  
Beatriz Pax Sanchez ◽  
Katharina Ramrath ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Care Center ◽  
Primary Care Center

scholarly journals Characteristics and health status of patients with and without confirmed HFpEF

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Deaton ◽  
F Forsyth ◽  
J Mant ◽  
D Edwards ◽  
R Hobbs ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Cohort Study ◽  
Health Status ◽  
Functional Impairment ◽  
Funding Source ◽  
Walk Distance ◽  
Minute Walk Distance ◽  
Minute Walk

Abstract Aims Patients with heart failure with preserved ejection fraction (HFpEF) are usually older and multi-morbid and diagnosis can be challenging. The aims of this cohort study were to confirm diagnosis of HFpEF in patients with possible HFpEF recruited from primary care, to compare characteristics and health status between those with and without HFpEF, and to determine factors associated with health status in patients with HFpEF. Methods Patients with presumed HFpEF were recruited from primary care practices and underwent clinical assessment and diagnostic evaluation as part of a longitudinal cohort study. Health status was measured by Montreal Cognitive Assessment (MOCA), 6-minute walk test, symptoms, and the Kansas City Cardiomyopathy Questionnaire (KCCQ), and quality of life (QoL) by EQ-5D-5L visual analogue scale (VAS). Results 151 patients (mean age 78.5±8.6 years, 40% women, mean EF 56% + 9.4) were recruited and 93 (61.6%) were confirmed HFpEF (those without HFpEF had other HF and cardiac diagnoses). Patients with and without HFpEF did not differ by age, MOCA, blood pressure, heart rate, NYHA class, proportion with atrial fibrillation, Charlson Comorbidity Index, or NT-ProBNP levels. Patients with HFpEF were more likely to be women, overweight or obese, frail, and to be more functionally impaired by 6 minute walk distance and gait speed than those without. Although not statistically significant, patients with HFpEF had clinically significant differences (>5 points) on the physical limitations, symptom burden and clinical summary subscales of the KCCQ, but did not differ by other subscales or by EQ-5D-5L VAS (70±17 vs 73±19, p=0.385). More patients with HFpEF reported daytime dyspnoea (63% vs 46%, p=0.035) and fatigue (81% vs 61%, p=0.008), but not other symptoms compared to those without HFpEF. For both groups BMI was moderately negatively correlated with KCCQ subscale scores, and 6 minute walk distance was positively correlated with KCCQ subscales. Conclusions Nearly 40% were not confirmed as HFpEF indicating the challenges of diagnosis. Patients with confirmed HFpEF differed by sex, overweight/obesity, frailty, functional impairment, and symptoms but not by age or comorbidities from those without HFpEF. These differences were reflected in some subscale scores of the KCCQ, but not how patients reported their quality of life on the KCCQ QoL subscale and EQ-5D-5L VAS. Older patients with HFpEF reported relatively high QoL despite poor health status by functional impairment, frailty and symptoms. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Research School of Primary Care Research

scholarly journals Integrating Genomic Screening into Primary Care: Provider Experiences Caring for Latino Patients at a Community-Based Health Center

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
Tarika Srinivasan ◽  
Erica J. Sutton ◽  
Annika T. Beck ◽  
Idali Cuellar ◽  
Valentina Hernandez ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Patient Care ◽  
Health Center ◽  
Care Provider ◽  
Primary Care Provider ◽  
Genomic Sequencing ◽  
Community Based ◽  
Genomic Screening

Introduction: Minority communities have had limited access to advances in genomic medicine. Mayo Clinic and Mountain Park Health Center, a Federally Qualified Health Center in Phoenix, Arizona, partnered to assess the feasibility of offering genomic screening to Latino patients receiving care at a community-based health center. We examined primary care provider (PCP) experiences reporting genomic screening results and integrating those results into patient care. Methods: We conducted open-ended, semi-structured interviews with PCPs and other members of the health care team charged with supporting patients who received positive genomic screening results. Interviews were recorded, transcribed, and analyzed thematically. Results: Of the 500 patients who pursued genomic screening, 10 received results indicating a genetic variant that warranted clinical management. PCPs felt genomic screening was valuable to patients and their families, and that genomic research should strive to include underrepresented minorities. Providers identified multiple challenges integrating genomic sequencing into patient care, including difficulties maintaining patient contact over time; arranging follow-up medical care; and managing results in an environment with limited genetics expertise. Providers also reflected on the ethics of offering genomic sequencing to patients who may not be able to pursue diagnostic testing or follow-up care due to financial constraints. Conclusions: Our results highlight the potential benefits and challenges of bringing advances in precision medicine to community-based health centers serving under-resourced populations. By proactively considering patient support needs, and identifying financial assistance programs and patient-referral mechanisms to support patients who may need specialized medical care, PCPs and other health care providers can help to ensure that precision medicine lives up to its full potential as a tool for improving patient care.

Medically indicated late preterm delivery and its impact on perinatal morbidity and mortality: a retrospective population-based cohort study

2018 ◽  
Vol 32 (19) ◽  
pp. 3278-3287 ◽  
Author(s):  
Limor Besser ◽  
Liat Sabag-Shaviv ◽  
Maayan Yitshak-Sade ◽  
Salvatore Andrea Mastrolia ◽  
Danielle Landau ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Delivery ◽  
Population Based ◽  
Late Preterm ◽  
Morbidity And Mortality ◽  
Perinatal Morbidity
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