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Cruz Herrera E, Figueroa-Nieves AI, Woo Baidal JA. The potential role of social care in reducing childhood obesity. Curr Opin Pediatr 2024; 36:10-16. [PMID: 37972976 DOI: 10.1097/mop.0000000000001309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW This review evaluates the current evidence for relationships of social factors with childhood obesity and for a role of social care in reduction of childhood obesity. RECENT FINDINGS Most literature on the relationship between social factors and childhood obesity has examined food insecurity as a risk factor for obesity. Associations between food insecurity and excess weight in children are most consistent during infancy and among those with food insecurity at more than one time point. A few pilot food security interventions that link patients with produce or groceries show feasibility and potential promise for reducing childhood obesity risk factors. However, full-scale, randomized studies to examine interventions that reduce social needs and their effects on childhood obesity are lacking. Future research is needed to examine holistic social care approaches to effectively reduce childhood obesity risk factors. SUMMARY Food insecurity acts as a barrier to childhood obesity prevention and treatment. Patient-centered, validated measures of social needs and effective interventions to address social needs are needed to equitably prevent and treat childhood obesity.
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Affiliation(s)
- Evianna Cruz Herrera
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center and NewYork-Presbyterian, New York, New York, USA
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Woo Baidal J, Finkel MA, Kelman E, Duong N, Bien-Aime C, Goldsmith J, Albrecht SS, Hulse E, Rosenthal A, Reiss J, Schwartz R, Meyer D. Longitudinal Associations of Food Security with Health and Dietary Factors among Food FARMacy Participants during COVID-19 in New York City. Nutrients 2024; 16:434. [PMID: 38337718 PMCID: PMC10857290 DOI: 10.3390/nu16030434] [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: 12/14/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
In cross-sectional studies, food insecurity is associated with adverse health and dietary outcomes. Whether self-reported health and dietary outcomes change in response to improvements in food security has not been examined. We sought to examine how increases in food security are related to changes in health and dietary factors. In this longitudinal, observational study, we included adult participants in a clinical-community emergency food assistance program in New York City from July 2020 to November 2021. Program staff measured food security with a validated six-item measure at program enrollment and six-month re-enrollment. Participants self-reported health and dietary factors (vegetable, fruit, juice, and sugar-sweetened beverage (SSB) consumption frequency). We used multivariable regression to examine associations between change in food security with change in health and dietary factors over six months. Among 310 participants, the mean food security score improved by 1.7 ± 2.3 points over six months. In unadjusted models, each point improvement in food security was associated with increased vegetable (β = 0.10 times; 95% CI: 0.05-0.15); fruit (β = 0.08 times; 95% CI: 0.03-0.14); and juice (β = 0.10 times; 95% CI: 0.05-0.15) consumption. In adjusted models, results remained significant for vegetable and fruit consumption, but not juice. Change in food security was not associated with change in health or SSB outcomes. In this cohort during COVID-19, improved food security was associated with improved vegetable and fruit consumption. Randomized trials that examine the effectiveness of clinical-community partnerships focused on improving food security and nutrition are warranted.
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Affiliation(s)
- Jennifer Woo Baidal
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (M.A.F.); (N.D.); (C.B.-A.); (D.M.)
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA
| | - Morgan A. Finkel
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (M.A.F.); (N.D.); (C.B.-A.); (D.M.)
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA
| | - Elizabeth Kelman
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (M.A.F.); (N.D.); (C.B.-A.); (D.M.)
| | - Ngoc Duong
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (M.A.F.); (N.D.); (C.B.-A.); (D.M.)
| | - Celine Bien-Aime
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (M.A.F.); (N.D.); (C.B.-A.); (D.M.)
| | - Jeff Goldsmith
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
| | - Sandra S. Albrecht
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY 10032, USA;
| | - Emma Hulse
- Division of Community and Population Health, New York Presbyterian Hospital, New York, NY 10032, USA;
| | | | - Jeremy Reiss
- Henry Street Settlement, New York, NY 10002, USA;
| | | | - Dodi Meyer
- Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (M.A.F.); (N.D.); (C.B.-A.); (D.M.)
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA
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Bao J, Sun L, Nguyen-Hoang P, Momany ET. Exploring the Effect of Anti-immigration Rhetoric on Emergency Department Use by Undocumented Adults. J Immigr Minor Health 2024; 26:110-116. [PMID: 37587245 DOI: 10.1007/s10903-023-01531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/18/2023]
Abstract
An unwelcoming policy climate can create barriers to health care access and produce a 'Chilling Effect' among immigrant communities. For undocumented immigrants, barriers may be unique and have a greater impact. We used administrative emergency department (ED) data from 2015 to 2019 for a Midwestern state provided under a data use agreement with the state hospital association. General linear modelling was used to estimate the impact of anti-immigrant rhetoric on ED visit intensity among non-elderly adults who were likely Hispanic/Latino with undocumented status. Compared to 2015, the average ED visit intensity among adults who were likely Hispanic/Latino with undocumented status was significantly higher during 2016-2019 when anti-immigrant rhetoric was heightened. The magnitude of this change increased over time (0.013, 0.014, 0.021, and 0.020, respectively). Additionally, this change over time was not observed in the comparison groups. Our findings suggest that anti-immigrant rhetoric may alter health care utilization for adults who are likely Hispanic/Latino with undocumented status. Limitations to our findings include the use of only those likely to be Hispanic/Latino, data from only one Midwestern state and the loss of data due to non-classification using the NYU ED algorithm. Further research should focus on validating these findings and investigating these identification methods and anti-immigrant rhetoric effects among other undocumented groups including children and adults of different race or ethnicity such as black, both those that identify as Hispanic/Latino and those that do not. Developing strategies to improve health care access for undocumented Hispanic/Latino adults also warrants future research.
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Affiliation(s)
- Juan Bao
- College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Leon Sun
- College of Public Health, University of Iowa, Iowa City, IA, USA
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Elizabeth T Momany
- College of Public Health, University of Iowa, Iowa City, IA, USA.
- College of Public Health, 145 N Riverside Drive, College of Public Health Building, Iowa City, IA, 52242, USA.
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Masciale M, DiValerio Gibbs K, Asaithambi R, Murillo MC, Espinoza-Candelaria G, Jaramillo M, Domínguez J, Haq H, Fredricks K, Lopez MA, Bocchini C. Qualitative Study of Barriers and Facilitators to Care Among Children in Immigrant Families. Hosp Pediatr 2023; 13:1087-1096. [PMID: 37986609 DOI: 10.1542/hpeds.2023-007276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVES Children in immigrant families comprise ∼25% of US children and live in families with high levels of poverty and food insecurity. Studies suggest a decline in public benefit enrollment among children in immigrant families. We aimed to explore perspectives on barriers and facilitators in accessing care among immigrant caregivers of hospitalized children. METHODS With a general qualitative descriptive design, we developed a semistructured interview guide using an iterative process informed by literature and content expertise. Using purposive sampling, we recruited immigrant caregivers of hospitalized children in March 2020 and conducted interviews in English or Spanish. Interviews were recorded, transcribed, and translated to English. Three authors coded transcripts using Dedoose and identified themes via thematic analysis. RESULTS Analysis of 12 caregiver interviews revealed barriers and facilitators in accessing healthcare and public benefit use. Barriers included healthcare system barriers, immigration-related fear, and racism and discrimination. Within healthcare system barriers, subthemes included language barriers, cost, complexity of resource application, and lack of guidance on available benefits. Within immigration-related fear, subthemes included fear of familial separation, fear of deportation, fear that benefit use affects immigration status, and provider distrust. Healthcare system facilitators of resource use included recruiting diverse workforces, utilizing language interpretation, guidance on benefit enrollment, legal services, and mental health services. Participants also recommended hospital partnership with trusted information sources, including media stations and low-cost clinics. CONCLUSIONS Immigrant caregivers of hospitalized children identified barriers and facilitators in access to care. Further research is needed to assess the efficacy of caregiver-suggested interventions.
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Affiliation(s)
- Marina Masciale
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Rathi Asaithambi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | | | | | - José Domínguez
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Karla Fredricks
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Michelle A Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
| | - Claire Bocchini
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
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Raffa BJ, Swartz JJ, Ranapurwala SI, Zhao C, Cholera R. Immigration Policy and the Health of Latina Mothers and Their Infants. J Immigr Minor Health 2023:10.1007/s10903-023-01476-3. [PMID: 37020058 DOI: 10.1007/s10903-023-01476-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/07/2023]
Abstract
Restrictive immigration policies may adversely affect the health of Latina mothers and their infants. We hypothesized that undocumented Latina mothers and their US born children would have worse birth outcomes and healthcare utilization following the November 2016 election. We used a controlled interrupted time series to estimate the impact of the 2016 presidential election on low birth weight (LBW), preterm birth, maternal depression, well child visit attendance, cancelled visits, and emergency department (ED) visits among infants born to Latina mothers on emergency Medicaid, a proxy for undocumented immigration status. There was a 5.8% (95% CI: -0.99%, 12.5%) increase in LBW and 4.6% (95% CI: -1.8%, 10.9%) increase in preterm births immediately after the 2016 election compared to controls. While these findings were not statistically significant at p < 0.05, the majority of our data suggest worsened birth outcomes among undocumented Latina mothers after the election, consistent with larger prior studies. There was no difference in well child or ED visits. While restrictive policies may have contributed to worse birth outcomes among undocumented Latina mothers, our findings suggest that Latino families still attend infants' scheduled visits.
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Affiliation(s)
- Brittany J Raffa
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jonas J Swartz
- Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University, Durham, NC, USA
| | - Shabbar I Ranapurwala
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Congwen Zhao
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Rushina Cholera
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Margolis Center for Health Policy, Duke University, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Lopez MA, Yu X, Hetrick R, Raman S, Lee J, Hall J, Tran K, Vonasek B, Garg A, Raphael J, Bocchini C. Social Needs Screening in Hospitalized Pediatric Patients: A Randomized Controlled Trial. Hosp Pediatr 2023; 13:95-114. [PMID: 36594231 DOI: 10.1542/hpeds.2022-006815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Addressing adverse social determinants of health is an upstream approach to potentially improve child health outcomes and health equity. We aimed to determine if systematically screening and referring for social needs in hospitalized pediatric patients increased families' enrollment in publicly available resources. METHODS Randomized controlled trial at a large urban children's hospital enrolled English-speaking caregivers of patients 0 to 36 months of age on the general pediatrics service from June 2016 to July 2017. The intervention arm received the WE CARE Houston social needs intervention (screener and resource referrals based on screening results and receptiveness to help); the control arm received standard of care. Baseline social risk data were collected for all participants. Caregivers who screened positive for mental health need, substance abuse, or domestic violence received additional support, including from social workers. The primary outcome was enrollment in resources at 6 months postdischarge. Univariate and multivariable analysis was performed to identify associations. RESULTS Our study sample consisted of 413 caregivers from diverse sociodemographic/socioeconomic backgrounds. Overall, 85% of study participants had ≥1 social risk (median 2, range 0-9). WE CARE Houston identified caregiver employment, health insurance, primary care physician, depression, childcare, smoking, and food resources as the most prevalent social needs. Among these, caregivers were most receptive to resources for childcare, mental health, health insurance, and primary care. There was no significant difference in enrollment in new resources by study arm. CONCLUSION Screening for social needs in the hospital is feasible and can result in the identification of social needs, but further work is needed to successfully address these needs.
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Affiliation(s)
- Michelle A Lopez
- Departments of Pediatrics.,Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
| | | | - Rebecca Hetrick
- Department of Pediatric Rheumatology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | | | | | - Bryan Vonasek
- Department of Pediatrics, University of WisconsinSchool of Medicine and Public Health, Madison, Wisconsin
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Chan Medical School, Boston, Massachusetts
| | - Jean Raphael
- Departments of Pediatrics.,Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
| | - Claire Bocchini
- Departments of Pediatrics.,Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
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Liberman DB, Pham PK, Semple-Hess JE. Social Emergency Medicine: Capitalizing on the Pediatric Emergency Department Visit to Screen and Connect Patients and Families to Community Resources. Acad Pediatr 2022; 22:1049-1056. [PMID: 34995821 DOI: 10.1016/j.acap.2021.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe the social needs of families screened by the Community Health Advocates Team (CHAT) Desk, situated within a pediatric emergency department (PED); and to evaluate the effectiveness of this help desk in connecting families to community resources. METHODS Trained undergraduates, onsite in the PED 30 hours/week during daytime and evening hours, weekdays and weekends, screened a convenience sample of families of patients in the PED for social needs, and provided information on available community resources. Families were offered a follow-up phone call several weeks after their PED visit to assess program satisfaction and success, and identify remaining social needs. RESULTS Between January 2019 and March 2020, CHAT Desk screened and assisted 682 families. CHAT routinely provided resources about free outdoor recreational activities for families, but after that, the most commonly provided informational resources pertained to: health care (n = 200), housing (n = 143), and food (n = 137). Of families who completed the follow-up phone call (n = 294), almost half (n = 134, 46%) reported being able to contact at least one of the resources; 100 reported that the resource was able to assist them, and 99 families planned to continue using the resource. When asked about satisfaction, 93% (n = 274) reported being very satisfied or somewhat satisfied with CHAT; 94% (n = 276) said they would recommend it to others. CONCLUSIONS The PED of a busy tertiary care children's hospital is an opportune location to screen families for social needs, and provide them with information on requested community resources.
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Affiliation(s)
- Danica B Liberman
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles (DB Liberman, PK Pham, and JE Semple-Hess), Los Angeles, Calif; Department of Pediatrics, Keck School of Medicine, University of Southern California (DB Liberman and JE Semple-Hess), Los Angeles, Calif; Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California (DB Liberman), Los Angeles, Calif.
| | - Phung K Pham
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles (DB Liberman, PK Pham, and JE Semple-Hess), Los Angeles, Calif; Division of Behavioral and Organizational Sciences, Claremont Graduate University of the Claremont Colleges (PK Pham), Claremont, Calif
| | - Janet E Semple-Hess
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles (DB Liberman, PK Pham, and JE Semple-Hess), Los Angeles, Calif; Department of Pediatrics, Keck School of Medicine, University of Southern California (DB Liberman and JE Semple-Hess), Los Angeles, Calif
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Payan T. Understanding the Nexus between Undocumented Immigration and Mental Health. Curr Opin Psychol 2022; 47:101414. [DOI: 10.1016/j.copsyc.2022.101414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
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Woo Baidal JA, Meyer D, Partida I, Duong N, Rosenthal A, Hulse E, Nieto A. Feasibility of Food FARMacia: Mobile Food Pantry to Reduce Household Food Insecurity in Pediatric Primary Care. Nutrients 2022; 14:1059. [PMID: 35268034 PMCID: PMC8912842 DOI: 10.3390/nu14051059] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022] Open
Abstract
Despite recommendations for systematic food insecurity screening in pediatric primary care, feasible interventions in clinical settings are lacking. The goal of this study was to examine reach, feasibility, and retention in Food FARMacia, a pilot clinically based food insecurity intervention among children aged <6 years. We examined electronic health record data to assess reach and performed a prospective, longitudinal study of families in Food FARMacia (May 2019 to January 2020) to examine attendance and retention. We used descriptive statistics and bivariate analyses to assess outcomes. Among 650 pediatric patients, 172 reported household food insecurity and 50 registered for Food FARMacia (child mean age 22 ± 18 months; 88% Hispanic/Latino). Demographic characteristics of Food FARMacia participants were similar to those of the target group. Median attendance rate was 75% (10 sessions) and retention in both the study and program was 68%. Older child age (retention: age 26.7 ± 18.7 months vs. attrition: age 12.1 ± 13.8 months, p = 0.01), Hispanic/Latino ethnicity (retention: 97% vs. attrition: 69%, p < 0.01), and larger household size (retention: 4.5 ± 1.1 vs. attrition: 3.7 ± 1.4, p = 0.04) correlated with retention. A clinically based mobile food pantry pilot program and study reached the target population and were feasible.
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Affiliation(s)
- Jennifer A. Woo Baidal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (I.P.); (N.D.)
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA;
| | - Dodi Meyer
- NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY 10032, USA;
- Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA
| | - Ivette Partida
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (I.P.); (N.D.)
| | - Ngoc Duong
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians & Surgeons, New York, NY 10032, USA; (I.P.); (N.D.)
| | | | - Emma Hulse
- Division of Community and Population Health, NewYork-Presbyterian, New York, NY 10032, USA; (E.H.); (A.N.)
| | - Andres Nieto
- Division of Community and Population Health, NewYork-Presbyterian, New York, NY 10032, USA; (E.H.); (A.N.)
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Fanta ML, Rule ARL, Beck AF. The Time is Now: Equity and Inclusion in Newborn Quality Improvement. Hosp Pediatr 2021; 11:e339-e342. [PMID: 34649933 DOI: 10.1542/hpeds.2021-006279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Amy R L Rule
- Divisions of Hospital Medicine and.,Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Andrew F Beck
- Divisions of Hospital Medicine and.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,General and Community Pediatrics and
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Lopez MA, Raphael JL. Increasing Diversity in Pediatric Hospital Medicine: An Enduring Priority for a Young Subspecialty. Hosp Pediatr 2021; 11:e161-e163. [PMID: 34312212 DOI: 10.1542/hpeds.2021-005991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Michelle A Lopez
- Center for Child Health Policy and Advocacy at Texas Children's Hospital, Houston, Texas .,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jean L Raphael
- Center for Child Health Policy and Advocacy at Texas Children's Hospital, Houston, Texas.,Department of Pediatrics, Baylor College of Medicine, Houston, Texas
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