Refugee Rights and Legal Questions

Refugees in the United States face tremendous social pressures while being forced to navigate the health care system with cultural and language barriers confounding the problems of diminished access to services and information. 

One specific risk refugees face is significantly higher rates of communicable illnesses due to the amount of travel and stress associated with relocation, especially combined with the trauma often associated with asylum-seeking.  In order to supplement the health care costs associated with becoming healthy in their new community, refugees are given six to nine months of governmentally-provided health insurance.  While this gesture attempts to satisfy the U.S.’s obligations to provide health care to refugees, it is often insufficient in the face of the red tape refugees are forced to go through to find health care providers willing to care for them with this type of insurance. 

           

A secondary problem is that the period of time they are provided with insurance is often insufficient for completing the vaccine schedules or medication courses in their entirety which is, at best, ineffective for preventing future disease or curing current disease, and, at worst, dangerously promoting mutations of contagious illnesses which produce potentially deadly strains of viruses (in the case of Multi-Drug Resistant Tuberculosis, specifically). 

The dichotomy between the public good and the rising health care costs leave the United States with a choice to make about how they are going to handle the ever-increasing number of refugees who seek asylum within it’s borders.  Balancing the obligations informed by international treaties with the realistic budget constraints of the country poses a challenge to health care for this at-risk population.  

However, questions without a clear answer are ever-present in this largely unexplored area of policy.  To what extent is the U.S. responsible for providing care to refugees?  How can we balance the needs of the communities in which they reside with the needs of the refugees themselves?  How can we focus on preventative health care to save money and increase productivity? How can we prevent communicable illnesses from spreading or mutating due to a lack of access to thorough courses of treatment?  All of these questions come secondarily to whether or not the United States is even obligated to provide care at all; if they are not, is it still within their best interest to do so? The answer seems to be overwhelmingly: yes.

For more information about refugee health, visit the Office of Refugee Resettlement at: http://www.acf.hhs.gov/. 

Resources

Basic TB Facts. (2012, March 13). Retrieved September 1, 2015.

Global Tuberculosis (TB). (2014, March 20). Retrieved September 1, 2015.

Positive Purpose; The Escape

Bailey Leftwich

In recent years, a great amount of research has been done regarding the effectiveness of optimism as a psychological phenomenon and whether it leads to various theoretical formulations of two closely-correlated concepts. One concept is that optimism can be defined as ‘the inclination to hope.’ Another concept, as told by German philosopher Gottfried Wilhelm Leibniz, it is better to think of optimism as being ‘the best of all possible worlds.’ Both concepts are considered to be true, but optimism is most correctly identified by the individual’s state of mind. The expectations we have regarding the future – both positive and negative – are important for understanding our personal vulnerability to mental disorders. Recent studies have also shown that there is an inverse correlation between optimism and depressive symptoms; they have even found that there is an inverse correlation between optimism and suicidal ideation. Though this sounds obvious, a majority of people still choose to think pessimistically. The results of this same research show that pessimists, when compared to optimists, were at more risk for depressive and anxiety disorders in the future. Since they chose to feed the negative energy for their future, they put themselves at risk. Whereas, if people chose to feed positive energy to themselves, nurturing hope, they would result in a better outcome. A question was then raised about the use of psychotherapy to promote an optimistic disposition in pessimistic subjects. In this particular study, subjects were those that were past victims of natural disasters. It was observed that there were positive results even after a single cognitive-behavioral therapy session that was targeted at enhancing the sense of control and coping with devastating disturbances. After viewing the results of this brief study, a focused therapy session of active coping strategies and regaining personal control showed to be significant for the initially pessimistic subjects. Before the study, the subjects were more inclined to avoid their problems and furthermore ‘give up’ on their futures. There have been a limited number of studies done concerning optimism and mental health. However, the question does not stop there; the correlation between optimism and physical health has deemed just as important. Like the results found in the studies described above, optimism has been shown to be a direct connection of better and more positive physical health. Pessimism, on the other hand, is correlated with excessive somatic complaints. In a study on a population of elderly subjects of both sexes 65-85 years of age, it was noted that dispositional optimism predicted less probability of mortality in general and of cardiovascular mortality in particular. This data has also been confirmed in a subsequent longitudinal study on a population of males ages 64-84 in which an inverse correlation was reported between dispositional optimism and the risk of cardiovascular death. It was even found that carotid atherosclerosis tended to progress more slowly in optimistic women in the three years following the menopause, as opposed to the pessimistic subjects. Among the patients with prior neck or head cancer, optimists demonstrated significantly greater survival a year after diagnosis when compared to pessimistic patients. Overall, it can be confirmed that there is a direct correlation with optimism and both mental and physical health in individuals. Though studies have been limited, results continuously show that those who think with a more positive attitude will better their quality of life and lower their health risk. Coping strategies have even had a significant impact on multiple patients and has also been connected with optimism. The ‘inclination of hope’ and the ‘better[ing] of all possible worlds’ are directly correlated with living a better and more fulfilled life.

Sources
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894461/
http://www.hhs.gov/ash/oah/adolescent-health-topics/mental-health/positive-health.html

Flu Season Preparedness

Flu Season Preparation

The Influenza virus is not something to be taken lightly. Every year the seasonal flu kills roughly 24,000 people in the United States (CDC). While this may not seem like a high number, most, if not all, of these deaths could easily be prevented.

The first topic of discussion for flu season preparedness is general hygiene. On average, the typical person thoroughly washes their hands only 6 times per day (Clean Institute). Throughout the day, people touch many surfaces and objects used by others such as door handles, desks, tables, pens, counter tops, and much more. Imagine being at a store and you hand the clerk your credit card, they swipe it, and then hand it back to you. You had not noticed that previous to your interaction with this clerk, they had coughed into their hands. Once you leave the store, you get something in your eye and you rub it with your hands. Guess what? You now have the flu. This could easily be prevented by increasing the number of times per day that you and others wash your hands. According to the CDC, 21% of respiratory illnesses like colds and flus can be prevented through regular thorough hand washing. (CDC, Water, Sanitation, and Environmentally-related Hygiene).

Many people do not properly wash their hands after using the restroom or before handling food. There are proper procedures that need to be followed in order to greater reduce the risk of spreading infections disease. The CDC has outline when and how to properly wash your hands. The times in which washing your hands is necessary include: Before, during, and after preparing food, before eating food, after caring for the ill, after using the toilet, and after blowing your nose, sneezing, or coughing. The following procedure should be followed when washing your hands: Wet your hands with clean running water, later your hands with soap between fingers and under your nails, scrub your hands for at least 20 seconds, rinse your hands with clean running water, and finally dry your hands with a clean towel or air dry them (CDC, When and how to wash your hands).

Another important way to prevent getting the flu is to get your annual flu vaccine. The flu shots you get differ from year to year depending on the projections of which strains will be most prevalent during the upcoming flu season. Vaccines work by injecting your body with dead or injured flu viruses so your immune system can build a tolerance to the viruses without getting sick. If your immune system is strengthened to the virus, then your body will be more efficient at fighting off the illness when/if you come into contact with a live virus. Not only will you be protected from the flu, but you will also be less likely to spread the illness to others around you. When mass amounts of people get vaccinated for the flu, then it is less likely that they will spread it to others that are non-vaccinated, supporting the herd-immunity hypothesis.

While the above stated precautions greatly decrease your risk of getting the flu, it is still possible for you to be infected by the virus. It is very important that the flu not go untreated, seeing as it could turn into pneumonia and other related lower respiratory problems (CDC, Flu Preparedness). While these conditions can also be treated, it is more likely that serious damage could occur. As stated by the CDC, the most at risk people are children under the age of 5, adults over the age of 65, pregnant women, and people coming into contact with many others on a daily basis (CDC, High Risk). 

            Geographical location is a large factor to consider when looking at the risk of becoming infected by the flu virus. The most at risk locations in the United States are the states in the southeast region of the country and in the Midwest. Warm dry climates are least at risk and tropical regions have very minimal risk for flu due to climate (CDC, Flu Map). However, these tropical regions, like the United States Virgin Islands, are a hotspot for tourism during the winter months since people try to evade the cold weather in the contiguous United States. This high tourist traffic means that there is increased risk for spreading infectious diseases and viruses. This is why it is imperative that citizens of the Virgin Islands be prepare to handle the increased risk of getting the flu by getting vaccinated and making sure to take all precautionary measures to minimize their exposure and risk to the virus.

            Symptoms for the flu include: fever, cough, sore throat, runny nose, body aches, headache, chills, fatigue, and fever. Sometimes you can experience vomiting and diarrhea. If you come down with the flu, be sure to seek medical attention in a timely fashion. Doctors are able to best diagnose the condition and provide you with the best antiviral treatment for your case. If you have been positively diagnosed with the flu, be sure to stay home, rest, and eat vitamin rich foods and drink lots of water. This will help your body effectively fight the infection and will limit the risk of spreading the illness to others at work, school, or in your community.

References:

http://www.cdc.gov/healthywater/hygiene/hand/handwashing-corporate.html

Curtis V, Schmidt W, Luby S, Florez R, Touré O, Biran A. Hygiene: new hopes, new horizons. Lancet Infect Dis. 2011 Apr;11(4):312-21.

Aiello AE, Coulborn RM, Perez V, Larson EL. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis.Am J Public Health. 2008;98(8):1372-81.

Burton M, Cobb E, Donachie P, Judah G, Curtis V, Schmidt WP. The effect of handwashing with water or soap on bacterial contamination of hands. Int J Environ Res Public Health. 2011 Jan;8(1):97-104.

http://www.webmd.com/cold-and-flu/cold-guide/keeping-catchy-infections-contained?page=2

Aiello AE, Larson EL. What is the evidence for a causal link between hygiene and infections? Lancet Infect Dis. 2002;2:103–110.

Callwood, G. B., Campbell, D., Gary, F., & Radelet, M. L. (2012). Health and Health Care in the U.S. Virgin Islands: Challenges and Perceptions. The ABNF Journal : Official Journal of the Association of Black Nursing Faculty in Higher Education, Inc, 23(1), 4–7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573759/

Food is good.  Food is great!  In fact, according to Maslow's Hierarchy of needs, food falls into the physiological need supporting the base of the pyramid of life.  The physiological need for food goes far beyond simply consumption.  This need is fulfilled best with a well-rounded diet.  Having a well balanced diet encompasses many factors, such as portion control, consumption of fruits and vegetables, limited consumption of high fat food (fast food), etc.  The concept of a well-rounded diet does not sound too complicated; however it's not always a top priority with many people. With Americans always on the go, the convenience and low-cost of dining is made possible by the abundance of fast food restaurants. The Live Well Restaurant Campaign is making it a mission to enable consumers to easily identify and select healthy options when eating away from home and increase the number of healthier food options available in local restaurants.                      

Running from place to place, who has time to cook a healthy meal at home?  Why take the time to cook when a fast food restaurant is right around the corner at your beck and call? This mentality about fast food makes it easier for consumers to make poor decisions when it comes to nutrition. According to a Gallup poll, eight in ten Americans report eating at fast-food restaurants at least monthly with only about 4% of people saying they have never eaten fast food (Dugan, 2013). With that being said, it is difficult to find healthy options in restaurants.  Poor nutrition is a common factor underlying obesity in America (Hobbs, 2015). According to the Centers for Disease Control and Prevention, more than one-third of U.S. adults are obese.  Many people do not realize they consume about 200 extra calories each time they dine out and if they eat out twice a week for a year, those extra calories can add up to 6 extra pounds (Nguyen, 2014).

By increasing the number of healthier choices in restaurants it becomes more convenient to eat healthy while dining out!! A well balanced diet is a melting pot of all the food groups.  For instance, healthy carbs (grains, beans, fruits, and veggies), healthy fats (olive oil, nuts, omega-3, etc.), and calcium are part of a balanced diet (Robinson, Paul, & Segal, 2015). In addition to choosing to right food, it is important to choose the right portions. Daily recommendations include specific servings of fruits and vegetables, fiber, protein, dairy, etc.  Likewise, caloric intake is important to manage on a day-to-day basis.  Simply put, by the United States Department of Agriculture (2015), calories are a tool to measure the energy a food or beverage provides -- from the carbohydrate, fat, protein, and alcohol it contains.  Amazingly, these thing are what provide the fuel needed to work and play, and are even needed to rest and sleep! Therefore it's important to get the right mix -- enough nutrients, but not too many calories.  The restaurants involved in the Live Well Campaign have a specific set of criteria for the food they serve to be considered “healthy” and are based on the aforementioned nutritional needs.

Enjoy Your Health Well-Done!

Columbia/Boone County Missouri has recognized obesity is a problem and something can be done to help reduce it, starting in restaurants. Polk County Live Well Alliance was the first to initiate the Live Well Campaign. The program was then extended to Missouri.  A state grant was obtained for the project so it is a statewide program.  The program extended to many areas in Missouri including Columbia.  The next step of the project is to reach out to the rest of the community around Columbia, Boone County. The purpose of this campaign is to enable consumers to make healthier choices when dining out by encouraging restaurants to have healthier menu item options.  By choosing to eat at these restaurants that are serving healthier food, you are helping the Live Well Campaign reach its goal of preventing disease and promoting the health of Boone County.

References:

Binh T Nguyen and Lisa M Powell (2014). The impact of restaurant consumption among US adults: effects on energy and nutrient intakes. Public Health Nutrition, 17, pp 2445-2452. doi:10.1017/S1368980014001153.

Center for Disease Control and Prevention.  (2015).  Adult Obesity Facts.  Retrieved from http://www.cdc.gov/obesity/data/adult.html

Choose MyPlate. (2015, February 27).  Retrieved from http://www.choosemyplate.gov/calories#sthash.KU1c5kw6.dpf

Dugan, A. (2013). Fast Food Still Major Part of U.S. Diet. Retrieved from http://www.gallup.com/poll/163868/fast-food-major-part-diet.aspx

Hobbs, J. (2015).  Leading Cause of Obesity in America.  Retrieved from http://www.livestrong.com/article/262489-the-leading-causes-of-obesity-in-america/

Robinson, L., Paul, W. M., & Segal, J. (2015). Healthy Eating. Easy Tips for Planning a Healthy Diet and Sticking to it.  Retrieved from http://www.helpguide.org/articles/healthy-eating/healthy-eating.htm

Kirksville, Missouri, a town with a population of roughly 17,000 people has a middle school, William Matthew Middle School, enrolling roughly 400 students. Teens experimenting with drugs has been a growing issue nation-wide and William Matthew Middle School is no exception. Programs such as D.A.R.E. help students become educated on the risks associated with drug use such as tobacco, alcohol, and other substances.

According to the Center of Disease Control and Prevention, Kirksville’s 2014 survey showed continued declines in alcohol use by all grades. Nine percent of 8th graders, 23.5 percent of 10th graders, and 37.4 percent of 12th graders reported past-month use of alcohol, which was significantly lower than the survey posted in 2009, when rates were 14.9 percent, 30.4 percent, and 43.5 percent, in comparison. There was also a significant five-year drop in binge drinking (five or more drinks in a row in the previous 2 weeks) by seniors: 19.4 percent reported binge drinking in 2014, whereas 31.5 percent had reported the practice at its peak in 1998.

According to the CDC (Centers of Disease Control), cigarette smoking by youth continues to drop and is currently at its lowest rate in the survey’s history. Only 1.4 percent of 8th graders reported smoking every day in 2014, compared to 2.7 percent in 2009; 3.2 percent of 10th graders reported smoking daily, compared to 4.4 percent in 2013 and 6.3 percent in 2009; and 6.7 percent of high school seniors reported smoking daily in 2014, down from 8.5 percent in 2013 and 11.2 percent in 2009. In 1997, at its peak, nearly a quarter of seniors were daily smokers.

Marijuana use remained stable in 2014, even though the percentage of youth perceiving the drug as harmful went down. Youth who used marijuana within the last month remained steady among 8th graders at 6.5 percent, among 10th graders at 16.6 percent, and among 12th graders at 21.2 percent. Close to 6 percent of seniors report daily use of marijuana (similar to 2013), and 81 percent of them said the drug is easy to get. Among 8th graders, there was a drop in perceived availability in 2014, with 36.9 percent saying it is easy to get marijuana, compared to 39.1 percent in 2013.

So if current rates of drug use in teens is dropping, what is the problem? Preferred Family Healthcare located in Kirksville is a substance abuse rehabilitation center that has two locations for adults and adolescents. Their program follows a weekly step by step phase work that is designed to pull their clients away from their substance and replace it with coping skills to use in the outside world. After speaking to the family therapist at Preferred Family Healthcare, she agreed that it is a growing problem that “communities do not want to talk about.” The adolescent unit at Preferred houses roughly 20 kids at a time and the kids stay anywhere from 40-60 days usually. The relapse rate after the program at Preferred is currently around 90 percent, and statistics show that most addicts go through rehab around 7-9 times before they find a working way to fight and beat their addiction.

The Kirksville School District offers numerous education classes for students to help teach them about the effects of drug use. One of the classes offered is the D.A.R.E. Program. “D.A.R.E. stands for Drug Abuse Resistance and Education. It is a program that is implemented into the 5th grade at Ray Miller Elementary,” The course teaches the youth about the effects that alcohol, tobacco, and other drugs on their bodies. The classes last for 10 weeks and the students write essays and participate in a special graduation. There are other aspects that this program addresses such as the peer pressure that youth faces to participate in drug use.

Programs can be set up through the school, but the outside family factors in as well. If students are around tobacco, alcohol, and other drugs while at school, they are more susceptible to try these themselves. Since middle school aged children are particularly susceptible to peer pressure, many decide to experiment with alcohol and drugs after seeing and hearing that other kids are doing it.

Parents are usually the last to know that their middle school aged child has a substance abuse problem.  When children move from elementary school to middle school, many parents decide that it’s time to step back and become less involved in their child’s life.  They are unaware of the warning signs of substance abuse and often find out the truth only after their child has developed a serious problem.

Kirksville schools have taken steps to ensure that their students are drug free as well. If a student participates in any outside extracurricular activity, or uses their vehicle to park on the school’s parking lots, they are agreeing to be randomly drug tested throughout the school year. If a student is caught using drugs while involved in an extracurricular activity, they are placed on suspension for a period of time from the activity. Increasing the rules and consequences for drug use prevents students from engaging in drug use.

For more information please check out the following links

References

Drug Facts. (2013, May 1). Retrieved September 2, 2015, from http://www.drugabuse.gov/sites/default/files/high_school_and_youth_trends_december_2014.pdf

Kirksville, Missouri. (2012, September 1). Retrieved September 1, 2015, from http://www.city-data.com/city/Kirksville-Missouri.html

Kirksville works to educate students about drug abuse - D.A.R.E. America. (2014, October 2). Retrieved September 16, 2015, from http://www.dare.org/kirksville-works-to-educate-students-about-drug-abuse/

Preferred Family Healthcare | Welcome to PFH. (n.d.). Retrieved September 1, 2015, from http://www.pfh.org/