Among patients with COVID-19 evaluated in outpatient settings, factors associated with hospitalization remain poorly understood. Multivariable regressions were used to assess sociodemographic and clinical factors associated with increased odds of hospitalization among patients with confirmed COVID-19 between March 18, 2020 through April 25, 2020 at a community-based outpatient clinic in Massachusetts. Older age, BMI ≥ 25, self-reported dizziness/lightheadedness, temperature ≥ 99.5°F, tachycardia, and oxygen saturation < 95% were associated with increased odds of hospitalization after adjustment for age, sex, and BMI. There was also an association between speaking Spanish as primary language and increased odds of hospitalization (compared to English, adjusted OR = 2.99 [95% CI 1.39, 6.39]). Speaking Portuguese as primary language was not associated with increased odds of hospitalization (compared to English, adjusted OR = 1.83 [0.78, 4.28]). In addition to several clinical risk factors established among inpatients, our study found that primarily speaking Spanish, but not Portuguese, was a marker of hospitalization risk among a diverse outpatient cohort of patients with COVID-19.

Humanitarian aid workers caring for Syrian refugees face major stressors as they attend to refugees’ needs on the field. Without adequate psychosocial support, evidence has shown that fieldworkers experience high burnout and turnover as well as long-term poor mental health. Unfortunately, scarce training in this regard leaves them ill-equipped to care for themselves and practice resilience while handling trauma in the field. This paper highlights our reflection on working with mindfulness programs during humanitarian crises, specifically how our program, Stress Management and Relaxation Response Training (SMART), has helped over time fieldworkers and the community they cared for. We propose that programs targeting the wellbeing of fieldworkers should be prioritized as part of efforts to improve the international aid response although they may require impeccable coordination and generous resources. We encourage donors to fund those projects viewed as special social protection programs building resilience and strengthening within system support. We argue that this will increase the efficacy of the crisis intervention and work towards sustainable peace building.

Background: Student-run asylum clinics handle an increasing proportion of forensic medical evaluation requests for asylum cases across the country, but the impact on medical students participating in these evaluations remains poorly understood. This study investigates the self-reported backgrounds, roles, and experiences of medical students who directly participated in forensic evaluations of asylum-seekers at a student-run forensic asylum clinic between 2017 and 2021.Methods: Electronic surveys were sent to 40 medical students who had completed at least one asylum evaluation through the student clinic. Survey questions asked about student background, motivations, volunteer roles, and learning experiences during the evaluation process. Frequencies were calculated for multiple choice and 10-point Likert scale responses. Reviewers independently identified themes in free-response answers. Responses were subsequently coded using a consensus theme bank.Results: Eighteen of 40 (45%) students emailed completed the survey. Seventy-eight percent of respondents reported a personal or familial history of immigration. Almost all wrote the first draft of the medical affidavit. All respondents to the question reported improvement in their confidence working with patients who had experienced physical or psychological trauma as a result of persecution or feared persecution, because of their participation in an asylum evaluation. Conclusions: Students frequently were motivated to participate in forensic examinations of asylum-seekers for personal reasons related to their immigrant backgrounds. Our findings suggest that asylum evaluations promote professional development and skills working with survivors of trauma, though there remain technical and emotional challenges that mandate adequate training and support for student volunteers.