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Background Immigrants in the United States (US) today are facing a dynamic policy landscape. The Trump administration has threatened or curtailed access to basic services for 10.5 million undocumented immigrants currently in the US. We sought to examine the historical effects that punitive laws have had on health outcomes in US immigrant communities. Methods In this systematic review, we searched the following databases from inception–May 2020 for original research articles with no language restrictions: Ovid MEDLINE, Ovid EMBASE, Cochrane Library (Wiley), Web of Science Core Collection (Clarivate), CINAHL (EBSCO), and Social Work Abstracts (Ovid). This study is registered with PROSPERO, CRD42019138817. Articles with cohort sizes >10 that directly evaluated the health-related effects of a punitive immigrant law or policy within the US were included. Findings 6,357 studies were screened for eligibility. Of these, 32 studies were selected for inclusion and qualitatively synthesized based upon four themes that appeared throughout our analysis: (1) impact on healthcare utilization, (2) impact on women’s and children’s health, (3) impact on mental health services, and (4) impact on public health. The impact of each law, policy, mandate, and directive since 1990 is briefly discussed, as are the limitations and risk of bias of each study. Interpretation Many punitive immigrant policies have decreased immigrant access to and utilization of basic healthcare services, while instilling fear, confusion, and anxiety in these communities. The federal government should preserve and expand access for undocumented individuals without threat of deportation to improve health outcomes for US citizens and noncitizens.

In-hospital neonatal falls are increasingly recognized as a postpartum safety risk, with maternal fatigue contributing to these events. Recommendations to support rooming-in may increase success with breastfeeding; however, this practice may also be associated with maternal fatigue. We report a cluster of in-hospital neonatal falls associated with a hospital program to improve breastfeeding, which included rooming-in practices. Metrics related to breastfeeding were prospectively collected by chart audit or patient survey while ongoing efforts to improve breastfeeding occurred (September 2015–August 2017). Falls were identified through the hospital adverse event reporting system from January 2011 to February 2018. Medical records were reviewed to determine factors associated with the falls, including time of event, pain medication administration, hours of life at fall, method of delivery, or other notable factors that may have contributed to the fall event. Three fall events occurred within 1 year of commencing improvement efforts as process and outcome metrics associated with breastfeeding improved. All events were associated with mothers falling asleep while feeding their infant, and all occurred between midnight and 6 am. Falls occurred from 38.0 to 75.7 hours after birth. No sedating pain medications were administered within 4 hours of any event. In 2 of 3 cases, mothers experienced notable ongoing social stressors. Rooming-in was the most significant change involved in our health care delivery during the programmatic effort to improve breastfeeding. Monitoring for in-hospital neonatal falls may be needed during projects aimed at improving breastfeeding, particularly if rooming-in practices are involved.

Objective This study aims to characterize the top-ranked departments in otolaryngology to provide an indicator of the state of diversity within otolaryngology and to draw a comparison with other medical and surgical fields. Study Design This cross-sectional study examined the 20 highest-ranked otolaryngology programs according to the US News & World Report ranking of best hospitals for ear, nose and throat. Setting Academic otolaryngology departments in the United States. Methods Faculty demographic and biographical data were collected from departmental websites. The Web of Science h-index was used as a surrogate for academic productivity. Descriptive statistics and chi-square analysis were used to characterize the cohort and compare otolaryngology with other fields. Results Of 562 otolaryngologists on faculty at the 20 highest-ranked programs, 413 (73.5%) were men and 149 (26.5%) were women. Among the faculty in the cohort, 174 (31.0%) were professors, 145 (25.8%) were associate professors, and 183 (32.6%) were assistant professors. Across faculty appointments, the proportion of women grew smaller as academic rank increased. When compared with all faculty across US medical schools, the departments in this study had significantly lower proportions of female professors ( P = .0047), associate professors ( P = .0009), and assistant professors ( P = .0005). Male faculty members had higher h-indices than their female counterparts among professors ( P = .004), associate professors ( P = .008), assistant professors ( P = .0002), and clinical assistant professors ( P = .0009). Conclusion Women are underrepresented across all academic ranks in top-ranked otolaryngology programs. The current state of diversity in otolaryngology yields many opportunities to advance representation for women in the field.

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