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1.
Health Aff (Millwood) ; 40(7): 1117-1125, 2021 07.
Article in English | MEDLINE | ID: covidwho-1302018

ABSTRACT

Puerto Rico is a US territory and a popular destination for Latino immigrants in the Caribbean. Even with few language and cultural barriers, however, many Latino immigrants in Puerto Rico are uninsured. Using data from the 2014-19 Puerto Rico Community Survey, we examined inequities in health insurance coverage for non-Puerto Rican Latinos ages 18-64 living in Puerto Rico according to citizenship status and Latino subgroup (Dominican, Cuban, Mexican, and other Latino). After controlling for potential confounders, we found that noncitizen Dominicans had a significantly lower probability of having any health insurance (57.2 percent) and having any private insurance (31.5 percent). Regardless of similarities in culture and language, Latino immigrants on the island, particularly Dominicans, experience major health insurance coverage inequities. Considering that Puerto Rico's immigration system is regulated by US federal statute, both federal and local policy makers should acknowledge and focus on reducing these immigrant disparities in health insurance coverage.


Subject(s)
Emigrants and Immigrants , Adolescent , Adult , Humans , Insurance Coverage , Insurance, Health , Medically Uninsured , Middle Aged , Puerto Rico , United States , Young Adult
2.
Pediatr Pulmonol ; 55(2): 360-368, 2020 02.
Article in English | MEDLINE | ID: covidwho-1064413

ABSTRACT

BACKGROUND: The use of medications to treat respiratory conditions of extreme prematurity is often based upon studies of adults or children over 2 years of age. Little is known about the spectrum of medications used or dosing ranges. To inform the design of future studies, we conducted a prospective analysis of respiratory medication exposure among 832 extremely low gestational age neonates. METHODS: The prematurity and respiratory outcomes program (PROP) enrolled neonates less than 29-week gestation from 6 centers incorporating 13 clinical sites. We collected recorded daily "respiratory" medications given along with dosing information through 40-week postmenstrual age or neonatal intensive care unit discharge if earlier. RESULTS: PROP participants were exposed to a wide range of respiratory medications, often at doses beyond published recommendations. Nearly 50% received caffeine and furosemide beyond published recommendations for cumulative dose. Those who developed bronchopulmonary dysplasia were more likely to receive treatment with respiratory medications. However, more than 30% of PROP subjects that did not develop bronchopulmonary dysplasia also were treated with diuretics, systemic steroids, and other respiratory medications. CONCLUSION: Extremely preterm neonates in PROP were exposed to high doses of medications at levels known to generate significant adverse effects. With limited evidence for efficacy, there is an urgent need for controlled trials in this vulnerable patient population.


Subject(s)
Infant, Premature , Intensive Care Units, Neonatal , Bronchopulmonary Dysplasia/drug therapy , Child , Child, Preschool , Female , Gestational Age , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature, Diseases/drug therapy , Male , Patient Discharge , Prospective Studies , Respiratory Tract Diseases/drug therapy , Steroids/therapeutic use
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