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Amarasena L, Zwi K, Hu N, Lingam R, Raman S. Changing landscape of paediatric refugee health in South Western Sydney, Australia: a retrospective observational study. BMJ Open 2023; 13:e064497. [PMID: 37852766 PMCID: PMC10603544 DOI: 10.1136/bmjopen-2022-064497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/04/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVES To examine the changing health needs of refugee children and young people (CYP) entering Australia, in relation to key government policy changes. STUDY DESIGN Retrospective analysis of health service use data over 11 years. SETTING Paediatric refugee clinics in South Western Sydney (SWS), the Australian region with the largest annual resettlement of refugees. PARTICIPANTS Refugee CYP (≤25 years) attending the SWS paediatric refugee clinics for their first visit between 2009 and 2019. MEASURES Clinician defined health conditions categorised as communicable and non-communicable disease (NCD). RESULTS Data were analysed for 359 CYP, mean age 9.3 years; 212 male (59.1%). Most CYP (n=331, 92.2%) had health problems identified; 292 (81.3%) had ≥1 NCD and 24 (6.7%) had ≥1 communicable disease. The most frequent individual NCDs were dental disease (n=128, 35.7%) and vitamin D deficiency (n=72, 20.1%). Trend analysis showed increased odds of identifying an NCD from 2013 onwards (crude OR 1.77, 95% CI 1.06 to 2.96). Neurodevelopmental problems, especially Global Developmental Delay (n=31, 8.6%), emerged as more prevalent issues in the latter half of the decade. There were significantly increased odds of identifying a neurodevelopmental problem in 2016-2019, especially in 2016-2017 (adjusted OR 2.93, 95% CI 1.34 to 6.40). Key policy changes during this period included acceptance of refugees with disabilities from 2012, additional Australian Humanitarian Programme intake from the Eastern Mediterranean region and mandatory offshore processing for those seeking asylum by boat from 2013. In response to the changing needs, local health services adopted nurse-led primary healthcare screening, early childhood services, youth and disability clinics. CONCLUSIONS Refugee CYP in Australia are presenting with a growing burden of NCDs, with neurodevelopmental problems contributing. Government policy changes affect the sociodemographics of resettled populations, influencing health profiles. Paediatric refugee health services need to be responsive to the changing needs of these populations to optimise well-being.
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Affiliation(s)
- Lahiru Amarasena
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Karen Zwi
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Nan Hu
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Raghu Lingam
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Community Child Health, Sydney Children's Hospitals Network Randwick and Westmead, Sydney, New South Wales, Australia
| | - Shanti Raman
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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Kareff S, Diaz C, Zeigler A, Faulkenberry JG, Utter BF, Barber CM, Symes S. Characterization of the Demographics and Psychiatric Co-Morbidites Among Clients of a Human Rights Clinic in Miami-Dade County, Florida, United States. Cureus 2020; 12:e8944. [PMID: 32765989 PMCID: PMC7398692 DOI: 10.7759/cureus.8944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Miami-Dade County (MDC) represents a major port of entry for people seeking asylum in the United States, and few studies have systematically evaluated the demographic characteristics of this vulnerable population. Moreover, while the burden of post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) are thought to be higher in this population, the prevalence of these psychiatric conditions in our community is unknown. An analysis of demographics and psychiatric co-morbidities of the Human Rights Clinic (HRC) of Miami’s 93 clients between 2010 and 2015 was conducted. The HRC cohort had the following characteristics: median age of 30 years, 52% female, 46% male, 2% transgender or intersex, and 88% originating from Latin America and the Caribbean. The prevalence of PTSD was 67% and MDD was 53% in the HRC population. We conclude that the mental health burden in asylum-seekers in MDC is alarmingly high and that healthcare providers should remain keenly attentive to the unique needs of this population.
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Affiliation(s)
- Samuel Kareff
- Internal Medicine, MedStar Georgetown University Hospital, Washington, D.C., USA
| | - Chanelle Diaz
- Internal Medicine, Montefiore Medical Center, New York, USA
| | - Amy Zeigler
- Emergency Medicine, University of Pittsburgh, Pittsburgh, USA
| | - J Grey Faulkenberry
- Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, USA
| | | | - Cecily M Barber
- Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, USA
| | - Stephen Symes
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, USA
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Proença R, Mattos Souza F, Lisboa Bastos M, Caetano R, Braga JU, Faerstein E, Trajman A. Active and latent tuberculosis in refugees and asylum seekers: a systematic review and meta-analysis. BMC Public Health 2020; 20:838. [PMID: 32493327 PMCID: PMC7268459 DOI: 10.1186/s12889-020-08907-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background In 2018, there were 70.8 million refugees, asylum seekers and persons displaced by wars and conflicts worldwide. Many of these individuals face a high risk for tuberculosis in their country of origin, which may be accentuated by adverse conditions endured during their journey. We summarised the prevalence of active and latent tuberculosis infection in refugees and asylum seekers through a systematic literature review and meta-analyses by country of origin and host continent. Methods Articles published in Medline, EMBASE, Web of Science and LILACS from January 2000 to August 2017 were searched for, without language restriction. Two independent authors performed the study selection, data extraction and quality assessment. Random effect models were used to estimate average measures of active and latent tuberculosis prevalence. Sub-group meta-analyses were performed according to country of origin and host continent. Results Sixty-seven out of 767 identified articles were included, of which 16 entered the meta-analyses. Average prevalence of active and latent tuberculosis was 1331 per 100 thousand inhabitants [95% confidence interval (CI) = 542–2384] and 37% (95% CI = 23–52%), respectively, both with high level of heterogeneity (variation in estimative attributable to heterogeneity [I2] = 98.2 and 99.8%). Prevalence varied more according to countries of origin than host continent. Ninety-one per cent of studies reported routine screening of recently arrived immigrants in the host country; two-thirds confirmed tuberculosis bacteriologically. Many studies failed to provide relevant information. Conclusion Tuberculosis is a major health problem among refugees and asylum seekers and should be given special attention in any host continent. To protect this vulnerable population, ensuring access to healthcare for early detection for prevention and treatment of the disease is essential.
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Affiliation(s)
- Raquel Proença
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | | | - José Ueleres Braga
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | | | - Anete Trajman
- State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil. .,McGill University, Montreal, QC, Canada. .,Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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Yun K, Matheson J, Payton C, Scott KC, Stone BL, Song L, Stauffer WM, Urban K, Young J, Mamo B. Health Profiles of Newly Arrived Refugee Children in the United States, 2006-2012. Am J Public Health 2015; 106:128-35. [PMID: 26562126 DOI: 10.2105/ajph.2015.302873] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We conducted a large-scale study of newly arrived refugee children in the United States with data from 2006 to 2012 domestic medical examinations in 4 sites: Colorado; Minnesota; Philadelphia, Pennsylvania; and Washington State. METHODS Blood lead level, anemia, hepatitis B virus (HBV) infection, tuberculosis infection or disease, and Strongyloides seropositivity data were available for 8148 refugee children (aged < 19 years) from Bhutan, Burma, Democratic Republic of Congo, Ethiopia, Iraq, and Somalia. RESULTS We identified distinct health profiles for each country of origin, as well as for Burmese children who arrived in the United States from Thailand compared with Burmese children who arrived from Malaysia. Hepatitis B was more prevalent among male children than female children and among children aged 5 years and older. The odds of HBV, tuberculosis, and Strongyloides decreased over the study period. CONCLUSIONS Medical screening remains an important part of health care for newly arrived refugee children in the United States, and disease risk varies by population.
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Affiliation(s)
- Katherine Yun
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Jasmine Matheson
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Colleen Payton
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Kevin C Scott
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Barbara L Stone
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Lihai Song
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - William M Stauffer
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Kailey Urban
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Janine Young
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
| | - Blain Mamo
- Katherine Yun is with PolicyLab, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA. Jasmine Matheson is with Refugee Health Program, Washington State Department of Health, Shoreline. Colleen Payton and Kevin C. Scott are with Family and Community Medicine, Thomas Jefferson University, Philadelphia. Barbara L. Stone is with Refugee Health Program, Colorado Department of Public Health and Environment, Denver. Lihai Song is with Healthcare Analytics Unit, Center for Pediatric Clinical Effectiveness, and Policylab, The Children's Hospital of Philadelphia. Kailey Urban and Blain Mamo are with Refugee Health Program, Minnesota Department of Health, Saint Paul. Janine Young is with General Pediatrics, Denver Health and Hospitals, Denver, CO. William M. Stauffer is with Departments of Medicine and Pediatrics, University of Minnesota, Minneapolis
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Yun K, Fuentes-Afflick E, Desai MM. Prevalence of chronic disease and insurance coverage among refugees in the United States. J Immigr Minor Health 2013; 14:933-40. [PMID: 22527741 DOI: 10.1007/s10903-012-9618-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Little is known about the health status of refugees beyond the immediate post-arrival period in the US. Using data from the 2003 New Immigrant Survey, a nationally representative survey of immigrants who had recently become legal permanent residents, we determined the prevalence of chronic conditions and health insurance coverage among adult refugees who had lived in the US for at least 1 year (n = 490). We compared their health status with that of other immigrants (n = 3,715) using multivariable logistic regression. The median duration of US residency was 5.6 and 8.0 years among refugees and other immigrants, respectively. Refugees were more likely than other immigrants to report at least one chronic condition (24.7 vs. 15.6 %, P < 0.001). After adjusting for sociodemographic differences, the odds of the following conditions remained significantly higher among refugees: arthritis (adjusted odds ratio [AOR] = 1.67, 95 % confidence interval [CI] = 1.07, 2.61), heart disease (AOR = 2.49, 95 % CI = 1.30, 4.74), stroke (AOR = 5.87, 95 % CI = 1.27, 27.25), activity-limitation due to pain (AOR = 1.96, 95 % CI = 1.31, 2.93), and any chronic condition (AOR = 1.37, 95 % CI = 1.03, 1.81). Although similar percentages of refugees (49.0 %) and other immigrants (47.4 %) were uninsured, 46.5 % of refugees with chronic conditions lacked health insurance. Refugees have a high burden of chronic disease and would benefit from expanded insurance coverage for adults with preexisting conditions.
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Affiliation(s)
- Katherine Yun
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA.
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Young J, O'Connor ME. Risk factors associated with latent tuberculosis infection in Mexican American children. Pediatrics 2005; 115:e647-53. [PMID: 15930191 DOI: 10.1542/peds.2004-1685] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine risk factors that are associated with the presence of latent tuberculosis infection (LTBI) in Mexican American children. METHODS In this prospective cohort study, we administered tuberculin skin tests (TSTs) and a tuberculosis (TB) risk factor questionnaire to children who were aged 1 to 18 years in immigrant families at a Denver inner-city community health center and elementary school-based health center. Information requested on the questionnaire included child demographics, child and parent birth location, Bacille Calmette-Guérin (BCG) vaccination, and a history and the duration of child and family travel to and visitors from countries where TB is endemic. TST results were read at 48 to 72 hours and were interpreted as positive at 5- and 10-mm induration, depending on risk factor history. All participants received $5 coupons on return for TST reading. RESULTS Of 584 children enrolled, 96% returned for TST evaluation, median age was 4 years, 48.6% were male, 98.5% were Latino, 66.3% were born in the United States, and 33% were born in Mexico. Overall, 12.4% of children had positive TSTs. For all children in the study, a positive TST was associated with birth in Mexico and no BCG received (adjusted odds ratio [OR]: 15.7; 95% confidence interval [CI]: 1.5-165.2), birth in Mexico and received BCG (adjusted OR: 29; 95% CI: 12.7-66.1), birth in the United States and received BCG (adjusted OR: 9.1; 95% CI: 2.4-34.1), and child travel to Mexico (adjusted OR: 2.8;95% CI: 1.5-5.4). Risk factors for having a positive TST in the 387 children who were born in the United States were travel to Mexico (unable to calculate the OR because all had traveled to Mexico), older age (median: 6 years; adjusted OR: 1.2/year; 95% CI: 1.02-1.40), and a history of BCG vaccination (adjusted OR: 8.2; 95% CI: 2.0-34.0). For the 195 children who were born in Mexico, logistic regression of the following variables showed that none of the variables remained in the model: child age, gender, BCG status, family travel to Mexico, visitors to the United States, child travel to Mexico, years lived in Mexico, and years since BCG. CONCLUSIONS In a population of primarily Mexican American children, those who were born in the United States had an increased risk for developing LTBI when they had a history of BCG vaccination or had traveled to Mexico. For children who were born in Mexico, we were unable to identify additional risk factors for the presence of LTBI, besides their birth in Mexico. Incentives for return for TST reading, such as grocery coupons, are highly effective.
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Affiliation(s)
- Janine Young
- Department of Pediatrics, Denver Health, University of Colorado Health Sciences Center, Denver, Colorado, USA.
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