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Henderson EJ, Rutt JN, Albertini LW. What Parents Should Know About Bugs and Bug Repellents. JAMA Pediatr 2023:2807917. [PMID: 37523201 DOI: 10.1001/jamapediatrics.2023.2370] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/01/2023]
Abstract
This Patient Page describes how to protect children against insect bites, how to choose a bug repellent, and tips for applying bug repellent.
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Affiliation(s)
- Emily J Henderson
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Jennifer N Rutt
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Laurie W Albertini
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Monroe BS, Rengifo LM, Wingler MR, Auriemma JR, Taxter AJ, Ramirez B, Albertini LW, Montez KG. Assessing and Improving WIC Enrollment in the Primary Care Setting: A Quality Initiative. Pediatrics 2023:e2022057613. [PMID: 37439134 DOI: 10.1542/peds.2022-057613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food and other resources to mitigate the harmful effects of food insecurity on child and maternal health. From a 2009 peak, nationwide WIC participation declined through 2020. Our objectives were to understand factors influencing WIC engagement and improve WIC enrollment through novel, primary care-based quality improvement interventions. METHODS Plan-do-study-act cycles were implemented at a majority Medicaid-insured pediatric primary care clinic. Universal WIC screening at <5-year-old well-child visits was initiated, with counseling and referrals offered to nonparticipants. Clinic providers received WIC education. WIC screening, counseling reminders, and referrals were streamlined via the electronic health record. Families were surveyed on WIC participation barriers. Patient demographic data were analyzed for predictors of WIC participation. RESULTS Mean new WIC enrollments increased significantly (42%) compared with baseline, with sustained special cause variation after study interventions. Provider WIC knowledge improved significantly at study end (P <.001). Rates of WIC screening, counseling, and referrals remained stable for >1 year after study interventions. The most common family-reported barriers to WIC participation were "Access problems" and "WIC knowledge gap." Factors associated with decreased WIC participation in multivariable analysis were increasing age (P <.001), and non-Medicaid insurance status (P = .03). CONCLUSIONS We demonstrate feasible primary care-based screening, education, and referral interventions that appear to improve WIC enrollment. We identify knowledge gap and access problems as major potentially modifiable barriers to WIC participation. The expansion of similar low-cost interventions into other settings has the potential to benefit under-resourced children and families.
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Affiliation(s)
- Bryan S Monroe
- Wake Forest University School of Medicine, Winston-Salem, North Carolina; and
| | - Lina M Rengifo
- Wake Forest University School of Medicine, Winston-Salem, North Carolina; and
| | - Meagan R Wingler
- Wake Forest University School of Medicine, Winston-Salem, North Carolina; and
| | - Jeanna R Auriemma
- Wake Forest University School of Medicine, Winston-Salem, North Carolina; and
| | | | - Brenda Ramirez
- Wake Forest University School of Medicine, Winston-Salem, North Carolina; and
| | - Laurie W Albertini
- Wake Forest University School of Medicine, Winston-Salem, North Carolina; and
| | - Kimberly G Montez
- Wake Forest University School of Medicine, Winston-Salem, North Carolina; and
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Wood AC, Albertini LW, Thompson LA. What Parents Should Know About Sun and Sunburns in Children. JAMA Pediatr 2023; 177:547. [PMID: 36972060 DOI: 10.1001/jamapediatrics.2022.5907] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/02/2023]
Abstract
This Patient Page discusses how to prevent sunburns by avoiding midday sun exposure, using sunscreen, and wearing protective clothing.
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Affiliation(s)
- Anna C Wood
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Laurie W Albertini
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Lindsay A Thompson
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Touhy PC, Albertini LW, Thompson LA. What Parents Should Know About Iron-Deficiency Anemia in Children. JAMA Pediatr 2023:2804208. [PMID: 37093592 DOI: 10.1001/jamapediatrics.2023.0653] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/25/2023]
Abstract
This Patient Page describes how children may develop iron-deficiency anemia and provides information on how to make sure children have enough iron in their bodies.
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Affiliation(s)
- Patrick C Touhy
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Laurie W Albertini
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Lindsay A Thompson
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Palakshappa D, Brown CL, Skelton JA, Goodpasture M, Albertini LW, Montez K. Social Risk Screening and Interventions in Healthcare Settings: Opportunities, Challenges, and Future Research. Acad Pediatr 2022; 22:1278-1280. [PMID: 35970506 PMCID: PMC10154944 DOI: 10.1016/j.acap.2022.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/20/2022] [Accepted: 08/05/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Deepak Palakshappa
- Department of Internal Medicine (D Palakshappa), Wake Forest University School of Medicine, Winston-Salem, NC; Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC; Public Health Sciences (D Palakshappa, CL Brown, and JA Skelton), Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Callie L Brown
- Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC; Public Health Sciences (D Palakshappa, CL Brown, and JA Skelton), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Joseph A Skelton
- Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC; Public Health Sciences (D Palakshappa, CL Brown, and JA Skelton), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Meggan Goodpasture
- Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Laurie W Albertini
- Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC
| | - Kimberly Montez
- Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC
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Rigdon J, Montez K, Palakshappa D, Brown C, Downs SM, Albertini LW, Taxter AJ. Social Risk Factors Influence Pediatric Emergency Department Utilization and Hospitalizations. J Pediatr 2022; 249:35-42.e4. [PMID: 35697140 DOI: 10.1016/j.jpeds.2022.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize the association of children's social risk factors with total number of emergency department (ED) visits or hospitalization and time to first subsequent ED or hospitalization. STUDY DESIGN This was a retrospective cohort study of patients seen at a general pediatric clinic between 2017 and 2021 with documented ≥1 social risk factors screened per visit. Negative binomial or Poisson regression modeled ED utilization and hospitalizations as functions of the total number of risk factors or each unique risk factor. Time-varying Cox models were used to evaluate differences between those who screened positive and those who screened negative, controlling for demographic and clinical covariates. RESULTS Overall, 4674 patients (mean age, 6.6 years; 49% female; 64% Hispanic; 21% Black) were evaluated across a total of 20 927 visits. Children with risk factors had higher rates of attention-deficit hyperactivity disorder, failure to gain weight, asthma, and prematurity compared with children with no risk (all P < .01). Adjusted models show a positive association between increased total number of factors and ED utilization (incidence rate ratio [IRR], 1.18; 95% CI, 1.12-1.23) and hospitalizations (IRR, 1.36; 95% CI, 1.26-1.47). There were no associations between a positive screen and time to first ED visit (hazard ratio [HR], 0.95; 95% CI, 0.85-1.06; P = .36) or hospitalization (HR, 1.15; 95% CI, 0.84-1.59; P = .40). CONCLUSIONS Social risk factors were associated with increased ED utilization and hospitalizations at the patient level but were not significantly associated with time to subsequent acute care use. Future research should evaluate the effect of focused interventions on health care utilization, such as those addressing food insecurity and transportation challenges.
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Affiliation(s)
- Joseph Rigdon
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kimberly Montez
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, NC; Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Deepak Palakshappa
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Maya Angelou Center for Health Equity, Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC; Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, NC; Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Callie Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC; Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, NC
| | - Stephen M Downs
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Laurie W Albertini
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
| | - Alysha J Taxter
- Department of Pediatric Rheumatology, Nationwide Children's Hospital, Columbus, OH; Department of Clinical Informatics, Nationwide Children's Hospital, Columbus, OH.
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Koscielniak NJ, Dharod A, Moses A, Bundy R, Feiereisel KB, Albertini LW, Palakshappa D. Feasibility of computerized clinical decision support for pediatric to adult care transitions for patients with special healthcare needs. JAMIA Open 2021; 4:ooab088. [PMID: 34738078 PMCID: PMC8564708 DOI: 10.1093/jamiaopen/ooab088] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/21/2021] [Accepted: 10/07/2021] [Indexed: 11/14/2022] Open
Abstract
The objective of this study was to determine the feasibility of a computerized clinical decision support (cCDS) tool to facilitate referral to adult healthcare services for children with special healthcare needs. A transition-specific cCDS was implemented as part of standard care in a general pediatrics clinic at a tertiary care academic medical center. The cCDS alerts providers to patients 17-26 years old with 1 or more of 15 diagnoses that may be candidates for referral to an internal medicine adult transition clinic (ATC). Provider responses to the cCDS and referral outcomes (e.g. scheduled and completed visits) were retrospectively analyzed using descriptive statistics. One hundred and fifty-two patients were seen during the 20-month observation period. Providers referred 87 patients to the ATC using cCDS and 77% of patients ≥18 years old scheduled a visit in the ATC. Transition-specific cCDS tools are feasible options to facilitate adult care transitions for children with special healthcare needs.
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Affiliation(s)
- Nikolas J Koscielniak
- Clinical and Translational Science Institute, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Biomedical Informatics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center for Healthcare Innovation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Adam Moses
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Richa Bundy
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kirsten B Feiereisel
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Laurie W Albertini
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Montez K, Brown CL, Garg A, Rhodes SD, Song EY, Taxter AJ, Skelton JA, Albertini LW, Palakshappa D. Trends in food insecurity rates at an academic primary care clinic: a retrospective cohort study. BMC Pediatr 2021; 21:364. [PMID: 34452604 PMCID: PMC8390339 DOI: 10.1186/s12887-021-02829-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Healthcare organizations are increasingly screening and addressing food insecurity (FI); yet, limited data exists from clinic-based settings on how FI rates change over time. The objective of this study was to evaluate household FI trends over a two-year period at a clinic that implemented a FI screening and referral program. METHODS In this retrospective cohort study, data were extracted for all visits at one academic primary care clinic for all children aged 0-18 years whose parents/guardians had been screened for FI at least once between February 1, 2018 to February 28, 2019 (Year 1) and screened at least once between March 1, 2019 to February 28, 2020 (Year 2). Bivariate analyses tested for differences in FI and demographics using chi-square tests. Mixed effects logistic regression was used to assess change in FI between Years 1 and 2 with random intercept for participants controlling for covariates. The interaction between year and all covariates was evaluated to determine differences in FI change by demographics. RESULTS Of 6182 patients seen in Year 1, 3691 (59.7%) were seen at least once in Year 2 and included in this study. In Year 1, 19.6% of participants reported household FI, compared to 14.1% in Year 2. Of those with FI in Year 1, 40% had FI in Year 2. Of those with food security in Year 1, 92.3% continued with food security in Year 2. Compared to Hispanic/Latinx participants, African American/Black (OR: 3.53, 95% CI: 2.33, 5.34; p < 0.001) and White (OR: 1.88, 95% CI: 1.06, 3.36; p = 0.03) participants had higher odds of reporting FI. African American/Black participants had the largest decrease in FI between Years 1 and 2 (- 7.9, 95% CI: - 11.7, - 4.1%; p < 0.0001). CONCLUSIONS Because FI is transitional, particularly for racial/ethnic minorities, screening repeatedly can identify families situationally experiencing FI.
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Affiliation(s)
- Kimberly Montez
- Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
| | - Callie L. Brown
- Departments of Pediatrics and Epidemiology and Prevention, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA 01655 USA
| | - Scott D. Rhodes
- Department of Social Sciences and Health Policy, Wake Forest University Health Sciences, Winston-Salem, NC 27101 USA
| | - Eunyoung Y. Song
- Department of Social Sciences and Health Policy, Wake Forest University Health Sciences, Winston-Salem, NC 27101 USA
- Health Quality Partners, Doyleston, PA USA
| | - Alysha J. Taxter
- Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
| | - Joseph A. Skelton
- Departments of Pediatrics and Epidemiology and Prevention, Wake Forest University Health Sciences, Winston-Salem, NC 27101 USA
| | - Laurie W. Albertini
- Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
| | - Deepak Palakshappa
- Departments of Pediatrics and Internal Medicine, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
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McLaurin-Jiang S, Cohen GM, Brown CL, Edwards P, Albertini LW. Integrated Mental Health Training Relates to Pediatric Residents' Confidence with Child Mental Health Disorders. Acad Psychiatry 2020; 44:299-304. [PMID: 31965516 DOI: 10.1007/s40596-020-01182-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/05/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The primary aim of this study was to determine the association of an integrated mental health training model on pediatric residents' use of (1) secondary screens, (2) mental health referrals, (3) psychotropic medications, and (4) follow-up appointments for mental health concerns. The secondary aim was to determine resident confidence managing mental health conditions. METHODS Visits of children ages 6-18 years old with either a positive primary mental health screen or a mental health diagnosis in pre- and post-intervention years (N = 113 and N = 251, respectively) at a single-site continuity clinic were included. Authors also surveyed alumni from pre- and post- intervention years (N = 46) about their confidence with managing mental health disorders. The authors used chi-squared and t-tests to compare visit characteristics between years and multivariable logistic regression to determine correlates of mental health management. RESULTS Post-intervention residents more often used secondary screening tools (adjusted odds ratio 5.61, 95% confidence interval 2.08-15.17). There were no differences in referrals, prescribing psychotropic medications, or follow-up visits. Post-intervention graduates reported higher confidence with diagnosis, screening, medication management, and follow-up for mental health disorders. CONCLUSIONS After transitioning to an integrated mental health model, residents were more likely to use secondary screens and post-intervention graduates reported higher confidence with managing mental health disorders.
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Affiliation(s)
- Skyler McLaurin-Jiang
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Gail M Cohen
- 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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Affiliation(s)
- Gail M Cohen
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
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