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Mann‐Jackson L, Ravindran S, Perez A, Linton JM. Navigating immigration policy and promoting health equity: Practical strategies for clinicians. J Hosp Med 2022; 17:220-224. [PMID: 35504526 PMCID: PMC9305560 DOI: 10.1002/jhm.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Lilli Mann‐Jackson
- Department of Social Sciences and Health Policy, CTSI Program in Community-Engaged ResearchWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Senthuran Ravindran
- Departments of Medicine and PediatricsUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
- Department of PediatricsPrisma Health UpstateGreenvilleSouth CarolinaUSA
| | - Alexander Perez
- Departments of Medicine and PediatricsUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
- Department of PediatricsPrisma Health UpstateGreenvilleSouth CarolinaUSA
| | - Julie M. Linton
- Departments of Medicine and PediatricsUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
- Department of PediatricsPrisma Health UpstateGreenvilleSouth CarolinaUSA
- Office of Student Affairs and AdmissionsUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
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Mann-Jackson L, Simán FM, Hall MA, Alonzo J, Linton JM, Rhodes SD. State Preemption of Municipal Laws and Policies that Protect Immigrant Communities: Impact on Latine Health and Well-Being in North Carolina. Inquiry 2022; 59:469580221087884. [PMID: 35343266 PMCID: PMC8961392 DOI: 10.1177/00469580221087884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Some U.S. municipalities have proclaimed themselves "sanctuary cities" and/or adopted laws and policies limiting local involvement in enforcement of federal immigration policies. Several states, however, have adopted laws that preempt municipal laws and policies designed to protect immigrants. We explored the consequences of House Bill (H.B.) 318, one such preemption law in North Carolina (NC), on the health and well-being of Latine immigrants. METHODS We conducted focus groups with Latine immigrants (n=49) and in-depth interviews with representatives from health, social service, and immigrant-serving organizations and local government (including law enforcement) (n=21) in NC municipalities that, before HB 318, adopted laws and policies supporting immigrants. Data were analyzed using constant comparison. RESULTS Twelve themes emerged, including the positive impacts of municipal sanctuary laws and policies are limited by preemption and other state and federal actions; laws and policies like HB 318 are confusing, have a chilling effect on health services use, and make life harder overall for Latine communities; intensified federal immigration enforcement has increased fear among Latine communities; Trump administration policies worsened anti-immigrant climates; and use of community identification cards and greater information dissemination and inter-organization coordination can lessen the consequences of preemption and other restrictive laws and policies. CONCLUSION State preemption of protective municipal laws and policies negatively and profoundly affects immigrant health and well-being. However, creative strategies have been implemented to respond to preemption. These findings provide critical data for decision-makers and community leaders regarding the detrimental impacts of preemption laws and mitigation of these impacts.
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Affiliation(s)
- Lilli Mann-Jackson
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- CTSI Program in Community-Engaged
Research, Wake Forest School of
Medicine, Winston-Salem, NC, USA
| | | | - Mark A. Hall
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- Wake Forest University School of
Law, Winston-Salem, NC, USA
| | - Jorge Alonzo
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- CTSI Program in Community-Engaged
Research, Wake Forest School of
Medicine, Winston-Salem, NC, USA
| | - Julie M. Linton
- University of South Carolina (UofSC)
School of Medicine Greenville, Greenville, SC, USA
- Prisma Health Upstate, Greenville, SC, USA
| | - Scott D. Rhodes
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- CTSI Program in Community-Engaged
Research, Wake Forest School of
Medicine, Winston-Salem, NC, USA
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Ayalew B, Dawson-Hahn E, Cholera R, Falusi O, Haro TM, Montoya-Williams D, Linton JM. The Health of Children in Immigrant Families: Key Drivers and Research Gaps Through an Equity Lens. Acad Pediatr 2021; 21:777-792. [PMID: 33529739 DOI: 10.1016/j.acap.2021.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/13/2021] [Accepted: 01/24/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The United States benefits economically and socially from the diverse skill-set and innovative contributions of immigrants. By applying a socioecological framework with an equity lens, we aim to provide an overview of the health of children in immigrant families (CIF) in the United States, identify gaps in related research, and suggest future areas of focus to advance health equity. METHODS The literature review consisted of identifying academic and gray literature using a MeSH Database, Clinical Queries, and relevant keywords in 3 electronic databases (PubMed, Web of Science, and BrowZine). Search terms were selected with goals of: 1) conceptualizing a model of key drivers of health for CIF; 2) describing and classifying key drivers of health for CIF; and 3) identifying knowledge gaps. RESULTS The initial search produced 1120 results which were screened for relevance using a meta-narrative approach. Of these, 224 papers were selected, categorized by topic, and reviewed in collaboration with the authors. Key topic areas included patient and family outcomes, institutional and community environments, the impact of public policy, and opportunities for research. Key inequities were identified in health outcomes; access to quality health care, housing, education, employment opportunities; immigration policies; and inclusion in and funding for research. Important resiliency factors for CIF included strong family connections and social networks. CONCLUSIONS Broad structural inequities contribute to poor health outcomes among immigrant families. While resiliency factors exist, research on the impact of certain important drivers of health, such as structural and cultural racism, is missing regarding this population. More work is needed to inform the development and optimization of programs and policies aimed at improving outcomes for CIF. However, research should incorporate expertise from within immigrant communities. Finally, interventions to improve outcomes for CIF should be considered in the context of the socioecological model which informs the upstream and downstream drivers of health outcomes.
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Affiliation(s)
- Betlihem Ayalew
- UofSC School of Medicine Greenville (B Ayalew and JM Linton), Greenville, SC
| | - Elizabeth Dawson-Hahn
- University of Washington, Seattle Children's Research Institute, Harborview Medical Center (E Dawson-Hahn), Seattle, Wash
| | - Rushina Cholera
- Department of Pediatrics, National Clinician Scholars Program, Duke School of Medicine and the Margolis Center for Health Policy, Duke University (R Cholera), Durham NC
| | - Olanrewaju Falusi
- Child Health Advocacy Institute and Division of General and Community Pediatrics, The George Washington University School of Medicine and Health Sciences, Children's National Hospital (O Falusi), Washington, DC
| | - Tamar Magarik Haro
- Federal and State Advocacy, American Academy of Pediatrics (TM Haro), North Washington, DC
| | - Diana Montoya-Williams
- Division of Neonatology, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research 2714 (D Montoya-Williams), Philadelphia, Pa
| | - Julie M Linton
- UofSC School of Medicine Greenville (B Ayalew and JM Linton), Greenville, SC; Prisma Health Children's Hospital (JM Linton), Greenville, SC.
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Cholera R, Falusi OO, Linton JM. Sheltering in Place in a Xenophobic Climate: COVID-19 and Children in Immigrant Families. Pediatrics 2020; 146:peds.2020-1094. [PMID: 32345687 DOI: 10.1542/peds.2020-1094] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Rushina Cholera
- National Clinician Scholars Program, Department of Pediatrics, Duke School of Medicine, and the Margolis Center for Health Policy, Duke University, Durham, North Carolina;
| | - Olanrewaju O Falusi
- Goldberg Center for General and Community Pediatrics, Child Health Advocacy Institute, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC; and
| | - Julie M Linton
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Greenville, South Carolina
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Abstract
In the United States, 1 in 4 children lives in an immigrant family. State and national policies have historically precluded equitable access to health care among children in immigrant families. More recently, increasingly restrictive policies, political rhetoric, and xenophobic stances have made immigrant families less able to access health care and less comfortable in attempting to do so, thus increasing the likelihood that patients will present to the emergency department. Once in the emergency department, language, cultural, and health literacy barriers make providing high-quality care potentially challenging for some families. Emergency care professionals can therefore glean critical insight regarding inequities from clinical work to inform advocacy and policy changes at institutional, community, regional, and national levels.
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Affiliation(s)
- Eric A Russell
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Carmelle Tsai
- Department of Pediatrics, Division of Emergency Medicine, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie M Linton
- Department of Pediatrics and Assistant Dean for Admissions, University of South Carolina School of Medicine Greenville and Prisma Health Children's Hospital, Greenville, SC
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Linton JM, Green A, Chilton LA, Duffee JH, Dilley KJ, Gutierrez JR, Keane VA, Krugman SD, McKelvey CD, Nelson JL. Providing Care for Children in Immigrant Families. Pediatrics 2019; 144:peds.2019-2077. [PMID: 31427460 DOI: 10.1542/peds.2019-2077] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children in immigrant families (CIF), who represent 1 in 4 children in the United States, represent a growing and ever more diverse US demographic that pediatric medical providers nationwide will increasingly encounter in clinical care. Immigrant children are those born outside the United States to non-US citizen parents, and CIF are defined as those who are either foreign born or have at least 1 parent who is foreign born. Some families immigrate for economic or educational reasons, and others come fleeing persecution and seeking safe haven. Some US-born children with a foreign-born parent may share vulnerabilities with children who themselves are foreign born, particularly regarding access to care and other social determinants of health. Therefore, the larger umbrella term of CIF is used in this statement. CIF, like all children, have diverse experiences that interact with their biopsychosocial development. CIF may face inequities that can threaten their health and well-being, and CIF also offer strengths and embody resilience that can surpass challenges experienced before and during integration. This policy statement describes the evolving population of CIF in the United States, briefly introduces core competencies to enhance care within a framework of cultural humility and safety, and discusses barriers and opportunities at the practice and systems levels. Practice-level recommendations describe how pediatricians can promote health equity for CIF through careful attention to core competencies in clinical care, thoughtful community engagement, and system-level support. Advocacy and policy recommendations offer ways pediatricians can advocate for policies that promote health equity for CIF.
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Affiliation(s)
- Julie M. Linton
- Departments of Pediatrics and Public Health, School of Medicine Greenville, University of South Carolina, Greenville, South Carolina
- Department of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; and
| | - Andrea Green
- Larner College of Medicine, The University of Vermont, Burlington, Vermont
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Affiliation(s)
- Stephen Ludwig
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Andrew P Steenhoff
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
| | - Julie M Linton
- University of South Carolina School of Medicine Greenville, Prisma Health Upstate Children's Hospital, Wake Forest School of Medicine, 1200 North Martin Luther King Jr Drive, Winston-Salem, NC 27101, USA.
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Abstract
Immigration laws and policies, as well as related media and public discourse, have a direct and significant effect on the health and well-being of children and families. The purpose of this article is to identify the impact of family immigration status and immigration laws on children's health, to understand the legal system that immigrant children face, and to describe opportunities for health care professionals to engage in advocacy at the systems level, from the local community to Capitol Hill.
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Affiliation(s)
- Julie M Linton
- University of South Carolina School of Medicine Greenville, Prisma Health Upstate Children's Hospital, 20 Medical Ridge Drive, Greenville, SC 29605, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Jennifer Nagda
- Young Center for Immigrant Children's Rights, 6020 South University Avenue, Chicago, IL 60637, USA
| | - Olanrewaju O Falusi
- George Washington University School of Medicine and Health Sciences, Children's National Health System, 2233 Wisconsin Avenue Northwest, Suite 317, Washington, DC 20007, USA
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Abstract
At a time of evolving demographics and turbulent policy changes, pediatric providers have a critical role in the care of all children, regardless of where the child or parent was born. Pediatric providers can facilitate access to high-quality care and critical community-based resources for immigrant children and families. In this article, we delineate the primary domains for clinical care and offer clinical tools to achieve the provision of accessible, comprehensive, high-quality care within a family-centered medical home.
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Affiliation(s)
- Chloe Turner
- Unity Health Care, Inc., 3020 14th Street Northwest, Washington, DC 20009, USA; A.T. Still University of Health Sciences, Mesa, AZ, USA
| | - Anisa Ibrahim
- Department of Pediatrics, University of Washington, Harborview Medical Center, 325 9th Avenue Box 359774, Seattle, WA 98104, USA
| | - Julie M Linton
- University of South Carolina School of Medicine Greenville, Prisma Health Upstate Children's Hospital, 20 Medical Ridge Drive, Greenville, SC 29605, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Michael L, Brady AK, Russell G, Rhodes SD, Namak S, Cody L, Vasquez A, Caldwell A, Foy J, Linton JM. Connecting Refugees to Medical Homes Through Multi-Sector Collaboration. J Immigr Minor Health 2019; 21:198-203. [PMID: 29767402 DOI: 10.1007/s10903-018-0757-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As increasing numbers of refugees have resettled globally, an interdisciplinary group of stakeholders in Forsyth, North Carolina, recognized obstacles preventing coordinated medical care, which inspired the development of our Refugee Health Collaborative. This study assessed the Collaborative's impact on access to coordinated care within patient-centered medical homes (PCMH). A Collaborative-developed novel algorithm guided the process by which refugees establish care in PCMHs. All refugees who established medical care in the two primary health systems in our county (n = 285) were included. Logistic non-linear mixed models were used to estimate the differences between three time frames: pre-algorithm, algorithm implementation and refinement, and ongoing algorithm implementation. After algorithm implementation, there has been a significant decrease in the time required to establish care in PCMHs, increased provider acknowledgment of refugee status, and decreased emergency department (ED) visits. Multi-disciplinary, organized collaboration can facilitate enhanced access to care for refugee families at the population level.
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Affiliation(s)
| | | | - Greg Russell
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Shahla Namak
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Laura Cody
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Andrea Caldwell
- Forsyth County Department of Public Health, Winston-Salem, NC, USA
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Linton JM, Ameenuddin N, Falusi O. Pediatricians Awakened: Addressing Family Immigration Status as a Critical and Intersectional Social Determinant of Health. Am J Bioeth 2019; 19:69-72. [PMID: 30994428 DOI: 10.1080/15265161.2019.1577643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Julie M Linton
- a University of South Carolina School of Medicine Greenville
| | | | - Olanrewaju Falusi
- c George Washington University School of Medicine and Health Sciences
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12
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Mohammed M, Simha S, Clarke-Pearson K, Pereda L, Hurtado R, Esmaili E, Tayloe DT, Linton JM. Community Engagement and Equitable Policy: Promoting Resilience and Stability for Children in Immigrant Families in North Carolina. N C Med J 2019; 80:94-100. [PMID: 30877157 DOI: 10.18043/ncm.80.2.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Immigrant families in North Carolina, despite multidimensional challenges in the context of national, state, and local policies, enrich our communities. Over the last 18 months, a small group of North Carolina Pediatric Society (NCPS) physicians with concerns about the health and emotional well-being of children in immigrant families have come together to address the challenges facing this vulnerable population. Our goal, as the newly formed NCPS Committee on Immigration, is to advance policy to support immigrant families in obtaining equitable health, educational, and economic opportunities in our state. We are in the process of building a task force to bring together those who work closely with the North Carolina immigrant population to promote resilience and stability through legislative and policy advocacy.
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Affiliation(s)
- Mariya Mohammed
- medical student, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Shruti Simha
- pediatrician, Tim and Carolynn Rice Center for Child & Adolescent Health, Cone Health Medical Group, Greensboro, North Carolina; adjunct faculty, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathleen Clarke-Pearson
- board of directors, NC Child, Raleigh, North Carolina; pediatric representative, AAP Committee on Federal Government Affairs, Washington, DC
| | - Lourdes Pereda
- pediatrician and owner, Kidz Pediatrics, Angier, North Carolina; board of directors, North Carolina Pediatric Society, Raleigh, North Carolina
| | - Ricky Hurtado
- cofounder, LatinxEd, Chapel Hill, North Carolina; executive director, Scholars' Latino Initiative, Center for Global Initiatives, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily Esmaili
- Global Health Pathway fellow, Duke University, Durham, North Carolina; pediatrician, Lincoln Community Health Center, Durham, North Carolina
| | - David T Tayloe
- retired pediatrician, Goldsboro Pediatrics, P.A., Goldsboro, North Carolina; former president, American Academy of Pediatrics, Itasca, Illinois
| | - Julie M Linton
- associate professor of pediatrics, University of South Carolina School of Medicine Greenville, Greenville, South Carolina; pediatrician, Prisma Health Children's Hospital-Upstate, Columbia, South Carolina; adjunct assistant professor of pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Marsh MC, Supples S, McLaurin-Jiang S, Brown CL, Linton JM. Introducing the Concepts of Advocacy and Social Determinants of Health Within the Pediatric Clerkship. MedEdPORTAL 2019; 15:10798. [PMID: 30800998 PMCID: PMC6376941 DOI: 10.15766/mep_2374-8265.10798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/14/2018] [Indexed: 05/30/2023]
Abstract
Introduction Although advocacy and social determinants of health (SDH) are fundamental components of pediatrics and other areas of health care, medical education often lacks formal training about these topics and the role of health care professionals as advocates. SDH are common targets of advocacy initiatives; however, little is known about optimal ways to incorporate this content into medical education curricula. Methods We developed a lecture and assessment for third-year medical students that included interactive discussion of advocacy, SDH issues specific to children, and opportunities for learners to engage in advocacy. Learners attended the lecture during the pediatric clerkship. Over the course of a year, questionnaires assessing knowledge of advocacy, SDH, and incorporation of advocacy into practice were administered to 75 students before the lecture and as the clerkship ended. We used chi-square and Fisher's exact tests to compare knowledge before and after the lecture. Results Students showed significant improvement on most individual questions and overall passing rates. Learners provided positive feedback on the quality of the lecture material and demonstrated interest in engaging in current advocacy projects to address SDH. Discussion As recognition of the importance of advocacy and SDH increases, the development of educational tools for teaching this information is critical. Our lecture produced significant improvement in knowledge of these topics and was well received by students. Early introduction to advocacy and SDH during relevant clinical rotations emphasizes the importance of these topics and may establish a foundation of advocacy as fundamental to health care.
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Affiliation(s)
- Melanie C. Marsh
- Pediatric Resident, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
| | - Sarah Supples
- Pediatric Resident, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
| | - Skyler McLaurin-Jiang
- Instructor, Department of Pediatrics, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
| | - Callie L. Brown
- Assistant Professor, Department of Pediatrics, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
- Assistant Professor, Department of Epidemiology and Prevention, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
| | - Julie M. Linton
- Assistant Professor, Department of Pediatrics, Wake Forest School of Medicine of Wake Forest Baptist Medical Center
- Associate Director, Integrating Special Populations Program, Maya Angelou Center for Health Equity
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Johnson SM, Trejo G, Beck KL, Worsley C, Tranberg H, Plax KL, Linton JM. Building Community Support Using a Modified World Café Method for Pregnant and Parenting Teenagers in Forsyth County, North Carolina. J Pediatr Adolesc Gynecol 2018; 31:614-619. [PMID: 29960076 DOI: 10.1016/j.jpag.2018.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/31/2018] [Accepted: 06/20/2018] [Indexed: 12/01/2022]
Abstract
STUDY OBJECTIVE To identify community priorities, foster awareness of existing supports, and recognize barriers and opportunities to enhance support services for pregnant and parenting teens (PPTs). DESIGN AND SETTING A modified World Café event incorporated parallel, rotating focus groups with semistructured, case-based discussions of salient issues. The event was organized and took place in Forsyth County, North Carolina. PARTICIPANTS Seventy-eight local health and social service professionals and 15 PPT representatives. INTERVENTIONS AND MAIN OUTCOME MEASURES Qualitative coding was used to thematically analyze transcript data. Quantitative data pre-/post-event comparisons were made using Fisher exact test. RESULTS Key community-based support services for PPTs were identified. Qualitative analysis yielded 10 key codes regarding barriers and opportunities to enhance community-based support services, resulting in 4 themes. Themes included maximizing access and efficient delivery of high-quality health care, engaging a 3-generation approach to meet the current and future needs of at-risk families, focusing efforts to meet the unique needs of each teen and his/her family, and emphasizing teen self-advocacy. Pre/post survey responses were overwhelmingly positive regarding use of the modified World Café format for discussion and network building. CONCLUSION The modified World Café Method offered a platform to collaboratively identify challenges and opportunities and to develop networks to improve health and well-being of PPTs. Engaging multiple stakeholders in meaningful dialogue might foster multidisciplinary, cross-sector collaboration that mitigates risk and enhances resilience among PPTs and their children.
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Affiliation(s)
- Soren M Johnson
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Grisel Trejo
- Clinical and Translational Science Institute Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Keli L Beck
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Carrie Worsley
- Forsyth County Department of Public Health, Winston-Salem, North Carolina
| | - Hope Tranberg
- Forsyth County Department of Public Health, Winston-Salem, North Carolina; Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Katie L Plax
- Division of Adolescent Medicine, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Julie M Linton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina; Clinical and Translational Science Institute Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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Mann-Jackson L, Song EY, Tanner AE, Alonzo J, Linton JM, Rhodes SD. The Health Impact of Experiences of Discrimination, Violence, and Immigration Enforcement Among Latino Men in a New Settlement State. Am J Mens Health 2018; 12:1937-1947. [PMID: 29962271 PMCID: PMC6199437 DOI: 10.1177/1557988318785091] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Among Latinos in the United States, particularly in new settlement states, racial/ethnic discrimination, violence, and immigration enforcement contribute to health disparities. These types of experiences were explored among Latino men in North Carolina through quantitative assessment data ( n = 247). Qualitative in-depth interviews were also conducted with a subsample of Latino men who completed the assessment ( n = 20) to contextualize quantitative findings. Participants reported high rates of unfair treatment, discrimination or violence, and questioning about their immigration status. Having been questioned about one's immigration status was significantly associated with increased drug use (adjusted odds ratio [AOR] = 2.16; 95% confidence interval [CI] [1.07, 4.38]) and increased depressive symptoms (AOR = 2.87; 95% CI [1.07, 7.67]). Qualitative themes included: reports of frequent discrimination based on immigration status, race/ethnicity, and language; workplaces and police interactions as settings where reported discrimination is most common and challenging; frequent violent victimization; psychological consequences of experiences of discrimination and violence and concerns related to immigration enforcement for Latino men and their families; inter- and intra-community tensions; health-care services as safe spaces; use of coping strategies; and system-level approaches for reducing discrimination and violent victimization of Latinos. Findings point to the need to address underlying causes of discrimination and violence toward Latinos, particularly those related to immigration enforcement, to support health and well-being.
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Affiliation(s)
- Lilli Mann-Jackson
- 1 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eunyoung Y Song
- 1 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanda E Tanner
- 2 Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Jorge Alonzo
- 1 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Julie M Linton
- 3 Department of Pediatrics and Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Scott D Rhodes
- 1 Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Linton JM, Reichard E, Peters A, Albertini LW, Miller-Fitzwater A, Poehling K. Enhancing Resident Education and Optimizing Care for Children With Special Health Care Needs in Resident Continuity Clinics. Acad Pediatr 2018; 18:366-369. [PMID: 29269030 DOI: 10.1016/j.acap.2017.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Julie M Linton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Clinical and Translational Science Institute Program in Community Engagement, Wake Forest School of Medicine, Winston-Salem, NC; Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, NC.
| | - Elizabeth Reichard
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Abby Peters
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Laurie W Albertini
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Katherine Poehling
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
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Linton JM, Stockton MP, Andrade B, Daniel S. Integrating Parenting Support Within and Beyond the Pediatric Medical Home. Glob Pediatr Health 2018; 5:2333794X18769819. [PMID: 29761138 PMCID: PMC5946342 DOI: 10.1177/2333794x18769819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/29/2022] Open
Abstract
Positive parenting programs, developmental support services, and evidence-based home visiting programs can effectively provide parenting support and improve health and developmental outcomes for at-risk children. Few models, however, have integrated referrals for on-site support and home visiting programs into the provision of routine pediatric care within a medical home. This article describes an innovative approach, through partnership with a community-based organization, to deliver on-site and home visiting support services for children and families within and beyond the medical home. Our model offers a system of on-site services, including parenting, behavior, and/or development support, with optional intensive home visiting services. Assessment included description of the population served, delineation of services provided, and qualitative identification of key themes of the impact of services, illustrated by case examples. This replicable model describes untapped potential of the pediatric medical home as a springboard to mitigate risk and optimize children's health and development.
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Kuo AA, Thomas PA, Chilton LA, Mascola L, Flanagan PJ, Dilley KJ, Duffee JH, Green AE, Gutierrez JR, Keane VA, Krugman SD, Linton JM, McKelvey CD, Nelson JL, Woods CR, Aguirre AA, Eissa MA, Lewis LM, Nelson CA, Palevsky SL, Smith MJ. Pediatricians and Public Health: Optimizing the Health and Well-Being of the Nation's Children. Pediatrics 2018; 141:peds.2017-3848. [PMID: 29358481 DOI: 10.1542/peds.2017-3848] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Ensuring optimal health for children requires a population-based approach and collaboration between pediatrics and public health. The prevention of major threats to children's health (such as behavioral health issues) and the control and management of chronic diseases, obesity, injury, communicable diseases, and other problems cannot be managed solely in the pediatric office. The integration of clinical practice with public health actions is necessary for multiple levels of disease prevention that involve the child, family, and community. Although pediatricians and public health professionals interact frequently to the benefit of children and their families, increased integration of the 2 disciplines is critical to improving child health at the individual and population levels. Effective collaboration is necessary to ensure that population health activities include children and that the child health priorities of the American Academy of Pediatrics (AAP), such as poverty and child health, early brain and child development, obesity, and mental health, can engage federal, state, and local public health initiatives. In this policy statement, we build on the 2013 AAP Policy Statement on community pediatrics by identifying specific opportunities for collaboration between pediatricians and public health professionals that are likely to improve the health of children in communities. In the statement, we provide recommendations for pediatricians, public health professionals, and the AAP and its chapters.
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Affiliation(s)
- Alice A. Kuo
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Pauline A. Thomas
- Department of Medicine, New Jersey Medical School, Rutgers University, Newark, New Jersey
- Summit Medical Group, New Brunswick, New Jersey
| | - Lance A. Chilton
- School of Medicine, University of New Mexico, Albuquerque, New Mexico; and
| | - Laurene Mascola
- Los Angeles County Department of Public Health, Los Angeles, California
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19
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Singer MA, Velez MG, Rhodes SD, Linton JM. Discrimination against Mixed-Status Families and its Health Impact on Latino Children. J Appl Res Child 2018; 10:6. [PMID: 31528499 PMCID: PMC6746556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Restrictive immigration policies and discrimination are associated with negative health outcomes for immigrant and Latino families. Mixed-status families represent a unique subpopulation of Latinos affected by restrictive immigration policies. This qualitative study explored discrimination against mixed-status families and its potential health impact on Latino children from the perspective of Latina mothers. METHODS In 2017, twenty in-depth interviews with Latina mothers of mixed-status families living in northwestern North Carolina were conducted, transcribed, and analyzed. Constant comparison, an approach to grounded theory development, was used. RESULTS Nine themes emerged that reflected experiences with discrimination and its negative impact on children. Themes included more frequent and severe discrimination during and after the 2016 US presidential election, determination to stay together and remain in the US, experiences of discrimination in multiple settings, the impact of discrimination on child health and well-being, the impact of fear and stress on meeting the needs of children, the burdening role of children as liaisons between families and services, the inability of citizenship to protect against the effects of discrimination, positive and hopeful responses to discrimination, and the potential role of education in building a foundation for reducing discrimination (and thus promoting the health and well-being of Latino children) in the future. CONCLUSIONS Discrimination against mixed-status, Latino families constitutes a critical threat to the health and well-being of Latino children. Further research should inform immigration policies that support (rather than threaten) the health, well-being, and health care practices that mitigate the stresses experienced by Latino children.
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Affiliation(s)
| | | | - Scott D. Rhodes
- Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Julie M. Linton
- Wake Forest School of Medicine, Winston-Salem, North Carolina
- University of South Carolina School of Medicine-Greenville, Greenville, SC
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20
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Uwemedimo OT, Monterrey AC, Linton JM. A Dream Deferred: Ending DACA Threatens Children, Families, and Communities. Pediatrics 2017; 140:peds.2017-3089. [PMID: 28993446 DOI: 10.1542/peds.2017-3089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Omolara T Uwemedimo
- Departments of Pediatrics and Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, New York; .,GLOhBAL (Global Learning. Optimizing health. Building Alliances Locally) at Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Ana C Monterrey
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Julie M Linton
- Department of Pediatrics, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina; and.,Maya Angelou Center for Health Equity, Wake Forest Clinical and Translational Science Institute, Winston-Salem, North Carolina
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21
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Duffee JH, Mendelsohn AL, Kuo AA, Legano LA, Earls MF, Chilton LA, Flanagan PJ, Dilley KJ, Green AE, Gutierrez JR, Keane VA, Krugman SD, Linton JM, McKelvey CD, Nelson JL, Flaherty EG, Gavril AR, Idzerda SM, Laskey A“T, Leventhal JM, Sells JM, Donoghue E, Hashikawa A, McFadden T, Peacock G, Scholer S, Takagishi J, Vanderbilt D, Williams PG. Early Childhood Home Visiting. Pediatrics 2017; 140:peds.2017-2150. [PMID: 28847981 DOI: 10.1542/peds.2017-2150] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
High-quality home-visiting services for infants and young children can improve family relationships, advance school readiness, reduce child maltreatment, improve maternal-infant health outcomes, and increase family economic self-sufficiency. The American Academy of Pediatrics supports unwavering federal funding of state home-visiting initiatives, the expansion of evidence-based programs, and a robust, coordinated national evaluation designed to confirm best practices and cost-efficiency. Community home visiting is most effective as a component of a comprehensive early childhood system that actively includes and enhances a family-centered medical home.
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Affiliation(s)
- James H. Duffee
- Boonshoft School of Medicine, Wright State University, Dayton Children’s Hospital, Dayton, Ohio
| | - Alan L. Mendelsohn
- Department of Pediatrics, School of Medicine, New York University, New York, New York
| | - Alice A. Kuo
- Internal Medicine Pediatrics, University of California, Los Angeles, California; and
| | - Lori A. Legano
- Department of Pediatrics, School of Medicine, New York University, New York, New York
| | - Marian F. Earls
- Pediatric Programs, Community Care of North Carolina, Raleigh, North Carolina
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Abstract
Immigrant children seeking safe haven in the United States, whether arriving unaccompanied or in family units, face a complicated evaluation and legal process from the point of arrival through permanent resettlement in communities. The conditions in which children are detained and the support services that are available to them are of great concern to pediatricians and other advocates for children. In accordance with internationally accepted rights of the child, immigrant and refugee children should be treated with dignity and respect and should not be exposed to conditions that may harm or traumatize them. The Department of Homeland Security facilities do not meet the basic standards for the care of children in residential settings. The recommendations in this statement call for limited exposure of any child to current Department of Homeland Security facilities (ie, Customs and Border Protection and Immigration and Customs Enforcement facilities) and for longitudinal evaluation of the health consequences of detention of immigrant children in the United States. From the moment children are in the custody of the United States, they deserve health care that meets guideline-based standards, treatment that mitigates harm or traumatization, and services that support their health and well-being. This policy statement also provides specific recommendations regarding postrelease services once a child is released into communities across the country, including a coordinated system that facilitates access to a medical home and consistent access to education, child care, interpretation services, and legal services.
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Kim SY, Linton JM, Kolasinski SL. Successful treatment of new onset Wegener’s granulomatosis with IVIG (intravenous immunoglobulin) during pregnancy: a case report. Mod Rheumatol 2014. [DOI: 10.3109/s10165-008-0020-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND Some children have persistent pain and instability following inversion injuries of the ankle. Radiographs may reveal a small osseous fragment distal to the lateral malleolus, suggesting an avulsion injury of the anterior talofibular ligament and/or calcaneofibular ligament. The avulsion injury may involve an os subfibulare, causing ligamentous laxity and chronic pain resulting from nonunion. This situation must be differentiated from an asymptomatic os subfibulare, which is a normal anatomic variant in 1% of children. The purpose of this study was to evaluate the intraoperative findings and long-term outcomes of patients treated operatively for symptomatic avulsion injuries or a symptomatic os subfibulare. METHODS Twenty-three patients presented with chronic ankle pain and instability, tenderness anterior and distal to the lateral malleolus, and imaging studies (magnetic resonance imaging and/or stress radiographs) suspicious for avulsion injury of the anterior talofibular ligament and/or calcaneofibular ligament. After unsuccessful nonoperative treatment, all patients underwent excision of the osseous fragments, anatomic reconstruction of the anterior talofibular ligament with use of drill holes through the lateral malleolus, and a modified Broström procedure. RESULTS The mean age of the patients was 10.4 years (range, eight to thirteen years) at the time of injury and 13.6 years (range, eight to seventeen years) at the time of surgery, representing a mean delay in diagnosis and treatment of 3.2 years. At a mean follow-up of 4.5 years (range, 2.1 to 13.2 years), the mean Foot and Ankle Outcome Score was 91.4 (range, 87 to 98) out of 100, with all but one patient returning to the preinjury recreational level. Only one patient had a long-term complication. CONCLUSIONS In children with chronic pain and instability associated with an os subfibulare, surgical excision of the os subfibulare combined with reconstruction of the anterior talofibular ligament and a modified Broström procedure was effective in restoring ankle stability, eliminating pain, and permitting return to the preinjury functional level.
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Affiliation(s)
- Stephan G Pill
- The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Linton JM, Barnes HM, Seale RD, Jones PD, Lowell EC, Hummel SS. Suitability of live and fire-killed small-diameter ponderosa and lodgepole pine trees for manufacturing a new structural wood composite. Bioresour Technol 2010; 101:6242-6247. [PMID: 20378344 DOI: 10.1016/j.biortech.2010.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 03/03/2010] [Accepted: 03/04/2010] [Indexed: 05/29/2023]
Abstract
Finding alternative uses for raw material from small-diameter trees is a critical problem throughout the United States. In western states, a lack of markets for small-diameter ponderosa pine (Pinus ponderosa) and lodgepole pine (Pinus contorta) can contribute to problems associated with overstocking. To test the feasibility of producing structural composite lumber (SCL) beams from these two western species, we used a new technology called steam-pressed scrim lumber (SPSL) based on scrimming technology developed in Australia. Both standing green and fire-killed ponderosa and lodgepole pine logs were used in an initial test. Fire-killed logs of both species were found to be unsuitable for producing SPSL but green logs were suitable for producing SPSL. For SPSL from green material, ponderosa pine had significantly higher modulus of rupture and work-to-maximum load values than did SPSL from lodgepole pine. Modulus of elasticity was higher for lodgepole pine. The presence of blows was greater with lodgepole pine than with ponderosa. Blows had a negative effect on the mechanical properties of ponderosa pine but no significant effect on the mechanical properties of SPSL from lodgepole pine. An evaluation of non-destructive testing methods showed that X-ray could be used to determine low density areas in parent beams. The use of a sonic compression wave tester for NDE evaluation of modulus of rupture showed some promise with SPSL but requires further research.
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Affiliation(s)
- J M Linton
- Department of Forest Products, Mississippi State University, Mississippi State, MS 39762-9820, USA
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Linton JM, Feudtner C. What accounts for differences or disparities in pediatric palliative and end-of-life care? A systematic review focusing on possible multilevel mechanisms. Pediatrics 2008; 122:574-82. [PMID: 18762528 DOI: 10.1542/peds.2007-3042] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to clarify potential mechanisms underlying differences/disparities in pediatric palliative and end-of-life care. METHODS We systematically searched online databases to identify articles relating to differences/disparities in pediatric palliative and end-of-life care, retaining 19 studies for evaluation. We then augmented this search with a broader review of the literature on the mechanisms of differences/disparities in adult palliative and end-of-life care, general pediatrics, adult medicine, and pain. RESULTS The concept of reciprocal interaction can organize and illuminate interacting mechanisms across 3 levels of human organization, namely, broader contextual influences on patients and clinicians, specific patient-provider engagements, and specific patients. By using this rubric, we identified 10 distinct mechanisms proposed in the literature. Broader contextual influences include health care system structures; access to care; and poverty, socioeconomic status, social class, and family structure. Patient-clinician engagements encompass clinician bias, prejudice, and stereotypes; concordance of race; quality of information exchange; and trust. Patient-specific features include perceptions of control; religion and spirituality; and medical conditions. CONCLUSIONS Differences and disparities in pediatric palliative and end-of-life care can be understood as arising from various mechanisms that interact across different levels of human organization, and this interactive multilevel model should be considered in designing studies or planning interventions to understand differences and to ameliorate disparities.
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Affiliation(s)
- Julie M Linton
- Division of General Pediatrics, Children's Hospital of Philadelphia, 3535 Market St, Room 1523, Philadelphia, PA 19104, USA
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Kim SY, Linton JM, Kolasinski SL. Successful treatment of new onset Wegener's granulomatosis with IVIG (intravenous immunoglobulin) during pregnancy: a case report. Mod Rheumatol 2008; 18:177-80. [PMID: 18299958 DOI: 10.1007/s10165-008-0020-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Accepted: 10/05/2007] [Indexed: 01/31/2023]
Abstract
We describe a patient with limited Wegener's granulomatosis (WG) presenting during pregnancy with aggressive cutaneous involvement. She was treated with a combination of high-dose corticosteroids and intravenous immunoglobulin (IVIG) during her third trimester. The patient had otherwise uneventful pregnancy and a satisfactory outcome for both herself and her newborn. In the English literature, prior to this report, there have been de novo cases of WG in pregnant women that were diagnosed and treated during pregnancy and three cases of WG treated successfully with IVIG during pregnancy.
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Affiliation(s)
- Seo Young Kim
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Abstract
The experimentally manipulated sexual orientation of a female counselor was not related to the perceptions of her Expertness, Attractiveness, or Trustworthiness rated by 8 male and 22 female, heterosexual college students.
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Affiliation(s)
- L M Kurdelak
- Psychology Department, Valparaiso University, IN 46383, USA
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