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Packard SE, Verzani Z, Finsaas MC, Levy NS, Shefner R, Planey AM, Boehme AK, Prins SJ. Maintaining disorder: estimating the association between policing and psychiatric hospitalization among youth in New York City by neighborhood racial composition, 2006-2014. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02738-7. [PMID: 39088094 DOI: 10.1007/s00127-024-02738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/21/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE To assess whether neighborhood-level measures of policing are spatio-temporally associated with psychiatric hospialization among adolescents and young adults in New York City, and whether this association varies by neighborhood racial composition. METHODS We derived population-based measures of policing from the New York City Police Department (NYPD), psychiatric hospitalization from Statewide Planning and Research Cooperative System (SPARCS) data, and socio-demographic data from the American Community Survey (ACS), aggregated by month and ZIP Code Tabulation Area (ZCTA) from 2006 to 2014. Multi-level negative binomial regression models assessed hospitalization-time of youth aged 10-24 as the dependent variable and the rate of policing events as the primary independent variable, adjusting for neighborhood poverty, unemployment, and educational attainment. Multiplicative interaction was assessed between policing and tertiles of the percentage of Black residents. RESULTS A total of 11,900,192 policing incidents and 2,118,481 person-days of hospitalization were aggregated to 19,440 ZCTA-months. After adjusting for neighborhood-level sociodemographic characteristics, an increase in one policing incident per 1,000 residents was associated with a 0.3% increase in the rate of youth psychiatric hospitalization time (IRR 1.003 [1.001-1.005]). Neighborhood racial composition modified this effect; not only was the rate of psychiatric hospitalization and policing higher in neighborhoods with a higher proportion of Black residents, but the association between these was also significantly higher in neighorhoods with a larger share of Black residents compared with predominantly non-Black neighborhoods. CONCLUSION Neighborhoods experiencing higher rates of policing during the study period experienced higher burdens of psychiatric hospitalization among adolescent and young adult residents. This association was larger in neighborhoods of color which have been disproportionately targeted by "hot spot" and order-maintenance policing practices and policies.
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Affiliation(s)
- Samuel E Packard
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Zoe Verzani
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Megan C Finsaas
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Natalie S Levy
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ruth Shefner
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Arrianna M Planey
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Amelia K Boehme
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Neurology, Columbia University, New York, NY, USA
| | - Seth J Prins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
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de Sousa Mascena Veras MA, Menezes NP, Mocello AR, Leddy AM, Saggese GSR, Bassichetto KC, Gilmore HJ, de Carvalho PGC, Maschião LF, Neilands TB, Sevelius J, Lippman SA. Correlation between gender-based violence and poor treatment outcomes among transgender women living with HIV in Brazil. BMC Public Health 2024; 24:791. [PMID: 38481195 PMCID: PMC10938823 DOI: 10.1186/s12889-024-18224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Transgender women are disproportionately affected by both HIV and gender-based violence (GBV), defined as physical, sexual, or emotional violence perpetrated against an individual based on their gender identity/expression. While a growing body of evidence demonstrates that GBV leads to poor HIV care and treatment outcomes among cisgender women, less research has examined this association among transgender women. We assessed the impact of lifetime experiences of GBV on subsequent retention in HIV care and laboratory confirmed viral suppression among a sample of transgender women living with HIV (TWH) in Brazil. METHODS A pilot trial of a peer navigation intervention to improve HIV care and treatment among TWH was conducted in São Paulo, Brazil between 2018 and 2019. TWH were recruited and randomized into the intervention or control arm and participated in a baseline and 9-month follow-up survey and ongoing extraction of clinical visit, prescribing, and laboratory data. Generalized linear model regressions with a Poisson distribution estimated the relative risk (RR) for the association of lifetime physical and sexual violence reported at baseline with treatment outcomes (retention in HIV care and viral suppression) at follow-up, adjusting for baseline sociodemographic characteristics. RESULTS A total of 113 TWH participated in the study. At baseline, median age was 30 years, and the prevalence of lifetime physical and sexual violence was 62% and 45%, respectively. At follow-up, 58% (n = 66/113) were retained in care and 35% (n = 40/113) had evidence of viral suppression. In adjusted models, lifetime physical violence was non-significantly associated with a 10% reduction in retention in care (aRR: 0.90, 95% CI: 0.67, 1.22) and a 31% reduction in viral suppression (aRR: 0.69; 95% CI: 0.43, 1.11). Lifetime sexual violence was non-significantly associated with a 28% reduction in retention in HIV care (aRR: 0.72, 95% CI: 0.52, 1.00) and significantly associated with a 56% reduction in viral suppression (aRR: 0.44; 95% CI: 0.24, 0.79). CONCLUSION Our findings are among the first to demonstrate that lifetime experiences with physical and sexual violence are associated with poor HIV outcomes over time among transgender women. Interventions seeking to improve HIV treatment outcomes should assess and address experiences of GBV among this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03525340.
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Affiliation(s)
| | - Neia Prata Menezes
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Adrienne Rain Mocello
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Anna M Leddy
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Gustavo Santa Roza Saggese
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Hailey J Gilmore
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | | | - Luca Fasciolo Maschião
- Department of Collective Health, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Jae Sevelius
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Sheri A Lippman
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, USA
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Gilles de la Londe J, Aïm-Eusébi A, Cadwallader D, Rincon Murillo G, Cadwallader JS, Aubert JP. The Experience of HIV-Positive Transgender Women Engaging in Physical Activity: An Interpretative Phenomenological Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:3541-3552. [PMID: 37452265 DOI: 10.1007/s10508-023-02655-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
Regular physical activity should benefit HIV-positive transgender women because they are a particularly vulnerable population. However, engaging in physical activity seems particularly difficult among this population. To inform the development of interventions to increase adherence to physical activity, we explored perceptions of physical activity in 10 semi-structured interviews with HIV-positive transgender women. Interviews were subjected to a qualitative approach named interpretative phenomenological analysis (IPA). Inspired by Cooley's theory, we chose to illustrate the results according to a three-level structure, i.e., confronting oneself to oneself with a specific identity, then confronting oneself with others on an interpersonal level, and eventually confronting oneself with society as a normative frame through the specific prism of physical activity, and thus relationship to one's body. The idea of practicing physical activity meant for them: having to face what they tried to be kept hidden, being ostracized by the cis population, and facing social heteronormativity. The fears about health were mostly about HIV and the transitioning process side effects. The psychological issues were mostly about the fear of developing male shaped bodies and worsened by traumatic life stories. External factors were often related to the passing concept and violence caused by stigma and discrimination. The group appeared as a strong motivation factor, facilitating self-acceptance and socialization.
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Affiliation(s)
| | - Amélie Aïm-Eusébi
- Département de Médecine Générale, Université Paris Cité, Paris, France
| | | | | | - Jean Sébastien Cadwallader
- Department of General Practice, Sorbonne University, Paris, France.
- Institut Pierre Louis d'Épidémiologie Et de Santé Publique, INSERM, Sorbonne University, 75012, Paris, France.
| | - Jean Pierre Aubert
- Département de Médecine Générale, Université Paris Diderot, Paris, France
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Muyanga N, Isunju JB, Ssekamatte T, Nalugya A, Oputan P, Kiguli J, Kibira SPS, Wafula ST, Ssekamatte D, Mugambe RK, Wanyenze RK, Orza L. Understanding the effect of gender-based violence on uptake and utilisation of HIV prevention, treatment, and care services among transgender women: a qualitative study in the greater Kampala metropolitan area, Uganda. BMC Womens Health 2023; 23:250. [PMID: 37161437 PMCID: PMC10170825 DOI: 10.1186/s12905-023-02402-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/28/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Transwomen (also known as transgender women) are disproportionately affected by all forms of gender-based violence (GBV). The high prevalence of physical, sexual and emotional violence not only predisposes transwomen to HIV infection but also limits the uptake/access to HIV prevention, care, and treatment services. Despite the high prevalence of HIV infection and GBV among transwomen, there is limited evidence on how GBV affects the uptake and utilisation of HIV prevention, care, and treatment services. Therefore, this qualitative study explored how GBV affects uptake and utilisation of HIV prevention, treatment, and care services among transwomen in the Greater Kampala Metropolitan Area (GKMA), Uganda. METHODS This participatory qualitative study was conducted among transwomen in the GKMA. A total of 20 in-depth interviews, 6 focus group discussions, and 10 key informant interviews were conducted to explore how GBV affects the uptake and utilisation of HIV prevention, treatment, and care services among transwomen. Data were analysed using a thematic content analysis framework. Data were transcribed verbatim, and NVivo version 12 was used for coding. RESULTS At the individual level, emotional violence suffered by transwomen led to fear of disclosing their HIV status and other health conditions to intimate partners and healthcare providers respectively; inability to negotiate condom use; and non-adherence to antiretroviral therapy (ART). Sexual violence compromised the ability of transwomen to negotiate condom use with intimate partners, clients, and employers. Physical and emotional violence at the community level led to fear among transwomen traveling to healthcare facilities. Emotional violence suffered by transwomen in healthcare settings led to the limited use of pre-exposure prophylaxis and HIV testing services, denial of healthcare services, and delays in receiving appropriate care. The fear of emotional violence also made it difficult for transwomen to approach healthcare providers. Fear of physical violence such as being beaten while in healthcare settings made transwomen shun healthcare facilities. CONCLUSION The effects of GBV on the uptake and utilisation of HIV prevention, care, and treatment services were observed in individual, community, and healthcare settings. Across all levels, physical, emotional, and sexual violence suffered by transwomen led to the shunning of healthcare facilities, denial of healthcare services, delays in receiving appropriate care, and the low utilisation of post-exposure prophylaxis, and HIV testing services. Given its effects on HIV transmission, there is a need to develop and implement strategies/ interventions targeting a reduction in GBV. Interventions should include strategies to sensitize communities to accept transwomen. Healthcare settings should provide an enabling environment for transwomen to approach any healthcare provider of their choice without fear of experiencing GBV.
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Affiliation(s)
- Naume Muyanga
- Programs Department, Transgender Equality Uganda, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda.
| | - Aisha Nalugya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Patience Oputan
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Simon Peter S Kibira
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Solomon Tsebeni Wafula
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - David Ssekamatte
- Department of Management, Uganda Management Institute, K.A.R. Road, Kampala, Uganda
| | - Richard K Mugambe
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hill Road, Mulago Kampala, Uganda
| | - Luisa Orza
- Frontline AIDS, 35 New England Street, Brighton, United Kingdom
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Pamplin JR, Kelsall NC, Keyes KM, Bates LM, Prins SJ. Race, criminalization and urban mental health in the United States. Curr Opin Psychiatry 2023; 36:219-236. [PMID: 36762668 PMCID: PMC10079600 DOI: 10.1097/yco.0000000000000857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW As efforts to increase policing and roll back criminal legal system reforms in major U.S. cities rise, the collateral consequences of increased criminalization remain critical to document. Although the criminalization of mental illness has been well studied in the U.S., the mental health effects of criminalization are comparatively under-researched. In addition, despite extreme racial disparities in U.S. policing, there is limited understanding of how criminalization may contribute to racial disparities in mental health. RECENT FINDINGS Literature included in this review covers various types of criminalization, including direct and indirect impacts of incarceration, criminalization of immigration, first-hand and witnessed encounters with police, and the effects of widely publicized police brutality incidents. All forms of criminalization were shown to negatively impact mental health (depression, anxiety and suicidality), with evidence suggestive of disproportionate impact on Black people. SUMMARY There is evidence of significant negative impact of criminalization on mental health; however, more robust research is needed to address the limitations of the current literature. These limitations include few analyses stratified by race, a lack of focus on nonincarceration forms of criminalization, few longitudinal studies limiting causal inference, highly selected samples limiting generalizability and few studies with validated mental health measures.
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Affiliation(s)
- John R. Pamplin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Nora Clancy Kelsall
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Katherine M. Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Lisa M. Bates
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Seth J. Prins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
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From Trauma to Transformation: the Role of the Trauma Surgeon in the Care of Black Transgender Women. CURRENT TRAUMA REPORTS 2023. [DOI: 10.1007/s40719-023-00254-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Stenersen MR, Thomas K, McKee S. Police and Transgender and Gender Diverse People in the United States: A Brief Note on Interaction, Harassment, and Violence. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP23527-NP23540. [PMID: 35133901 PMCID: PMC11196069 DOI: 10.1177/08862605211072161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Transgender and gender diverse (TGD) people in the United States continue to face dire rates of police violence and harassment. However, little research has examined this phenomenon using large-scale nationwide data. The current study utilized data from the United States Transgender Survey to examine the prevalence and correlates of police interaction, harassment, and violence among TGD people in the United States. Police harassment and violence types examined included reported incidences of (a) officers using the wrong pronouns, (b) officers asking about an individual's transition, (c) verbal harassment, (d) physical attack, (e) forcing sex to avoid arrest, and (f) unwanted sexual contact from an officer. Results from a weighted sample of 22,456 TGD people revealed that 40.3% reported having interacted with the police in the past year. Among those who interacted with the police in the past year, 45.7% reported experiencing at least one incident of police verbal harassment and 6.1% reported at least one incidence of police physical/sexual violence in the past year. Engaging in sex work was one of the most consistent predictors of police interaction, harassment, and violence. Notably, sex workers were approximately 11 times more likely to report being forced to engage in sex with the police to avoid arrest when compared to non-sex workers. Overall, people of color also reported significantly higher rates of police harassment and violence compared to their White counterparts. Additional correlates included income, educational attainment, and participation in other illegal work. Taken together, the findings of the current study highlight the urgent need for additional examination, intervention, and advocacy to eliminate police harassment and violence against members of the TGD community in the United States.
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Affiliation(s)
- Madeline R Stenersen
- Division of Prevention and Community Research, Department of Psychiatry, 12228Yale School of Medicine, New Haven, CT, USA
| | - Kathryn Thomas
- Justice Collaboratory, Yale Law School and SEICHE Center for Health and Justice, 33799Yale School of Medicine, New Haven, CT, USA
| | - Sherry McKee
- Department of Psychiatry, 12228Yale School of Medicine, New Haven, CT, USA
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Chyten-Brennan J, Patel VV, Anastos K, Hanna DB. Brief Report: Role of Gender-Affirming Hormonal Care in HIV Care Continuum Outcomes When Comparing Transgender Women With Cisgender Sexual Minority Men. J Acquir Immune Defic Syndr 2022; 91:255-260. [PMID: 36252240 PMCID: PMC9577885 DOI: 10.1097/qai.0000000000003056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transgender women (transwomen) are frequently conflated with cisgender sexual minority men (cis-SMM) in HIV research. We examined the impact of socioeconomic and health conditions, and gender-affirming hormones in comparing HIV-related outcomes between cis-SMM and transwomen. SETTING Large tertiary care health system in the Bronx, NY. METHODS Retrospective cohort study of people with HIV receiving care in 2008-2017. We compared retention in care, antiretroviral therapy (ART) prescription, and viral suppression between cis-SMM and transwomen, using modified Poisson regression, adjusting for demographic and clinical factors. Transwomen were further stratified by receipt of estrogen prescription. RESULTS We included 166 transwomen (1.4%), 1936 cis-SMM (17%), 4715 other cisgender men (41%), and 4745 cisgender women (41%). Transwomen were more likely to have public insurance (78% vs 65%) and mental health (49% vs 39%) or substance use (43% vs 33%) diagnoses than cis-SMM. Compared with cis-SMM, transwomen prescribed estrogen (67% of transwomen) were more likely to be retained [adjusted risk ratio (aRR) 1.15, 95% confidence interval (CI) 1.08 to 1.23), prescribed ART (aRR 1.06, CI 1.01 to 1.11), and virally suppressed (aRR 1.08, CI 1.01 to 1.16). Transwomen not prescribed estrogen were less likely to be retained (aRR 0.92, CI 0.83 to 1.02), prescribed ART (aRR 0.90, CI 0.82 to 0.98), or virally suppressed (aRR 0.85, CI 0.76 to 0.95). CONCLUSIONS In the context of HIV, socioeconomic factors, comorbidities, and gender-affirming care distinguish transwomen from cis-SMM. Compared with cis-SMM, transwomen who were prescribed estrogen had better HIV care continuum outcomes; transwomen not prescribed estrogen had worse outcomes. These differences should be accounted for in HIV-related research.
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Affiliation(s)
- Jules Chyten-Brennan
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States
| | - Viraj V. Patel
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States
| | - Kathryn Anastos
- Division of General Internal Medicine, Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, United States
| | - David B. Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, United States
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