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Article: Patient Survey Regarding Non-Medical Burdens of Care at a Parental Fetal Care Center.

Gregory, Emily J / Abbasi, Aleeza H / Markham, Kara B

2024 Volume 11, Page(s) 23743735241231693

Abstract: Recognizing the paucity of literature describing the non-medical effects of care at a tertiary parental fetal care center upon families, the purpose of the study was to better examine the potential barriers that our patients face related to care in a ... ...

Abstract	Recognizing the paucity of literature describing the non-medical effects of care at a tertiary parental fetal care center upon families, the purpose of the study was to better examine the potential barriers that our patients face related to care in a parental fetal care center. An anonymous survey was sent via email to patients who received care from 2015 to 2021. The survey included questions regarding demographics, fetal diagnoses, non-medical expenses related to care, and the impact of care on patient relationships, employment, and other children. 453 patients (15.9%) responded out of the 2684 emails sent. 58.3% of patients traveled >100 miles to reach our referral center, with 20% traveling >300 miles. 42.6% of patients reported non-medical expenditures exceeding $1000, with nearly 1 in 10 reporting expenditures of >$5000 (8.6%). Overall, 38.2% of women reported moderate to severe financial burdens related to receiving care at the parental fetal care center. This study illuminates the financial and social burdens that care at a tertiary parental fetal care center imposes upon families. By acknowledging these barriers, we can strive to minimize them to best provide equitable access to high-quality fetal care services.
Language	English
Publishing date	2024-02-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	2857285-3
ISSN	2374-3743 ; 2374-3735
ISSN (online)	2374-3743
ISSN	2374-3735
DOI	10.1177/23743735241231693
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Article ; Online: Sequence Properties of An Intramolecular Interaction That Inhibits p53 DNA Binding.

Gregory, Emily / Daughdrill, Gary W

Biomolecules

2022 Volume 12, Issue 11

Abstract: An intramolecular interaction between the p53 transactivation and DNA binding domains inhibits DNA binding. To study this autoinhibition, we used a fragment of p53, referred to as ND WT, containing the N-terminal transactivation domains (TAD1 and TAD2), ... ...

Abstract	An intramolecular interaction between the p53 transactivation and DNA binding domains inhibits DNA binding. To study this autoinhibition, we used a fragment of p53, referred to as ND WT, containing the N-terminal transactivation domains (TAD1 and TAD2), a proline rich region (PRR), and the DNA binding domain (DBD). We mutated acidic, nonpolar, and aromatic amino acids in TAD2 to disrupt the interaction with DBD and measured the effects on DNA binding affinity at different ionic strengths using fluorescence anisotropy. We observed a large increase in DNA binding affinity for the mutants consistent with reduced autoinhibition. The ΔΔG between DBD and ND WT for binding a consensus DNA sequence is -3.0 kcal/mol at physiological ionic strength. ΔΔG increased to -1.03 kcal/mol when acidic residues in TAD2 were changed to alanine (ND DE) and to -1.13 kcal/mol when all the nonpolar residues, including W53/F54, were changed to alanine (ND NP). These results indicate there is some cooperation between acidic, nonpolar, and aromatic residues from TAD2 to inhibit DNA binding. The dependence of DNA binding affinity on ionic strength was used to predict excess counterion release for binding both consensus and scrambled DNA sequences, which was smaller for ND WT and ND NP with consensus DNA and smaller for scrambled DNA overall. Using size exclusion chromatography, we show that the ND mutants have similar Stokes radii to ND WT suggesting the mutants disrupt autoinhibition without changing the global structure.
MeSH term(s)	Tumor Suppressor Protein p53/metabolism ; Protein Binding ; Protein Domains ; DNA/chemistry ; Alanine/metabolism ; Binding Sites/genetics
Chemical Substances	Tumor Suppressor Protein p53 ; DNA (9007-49-2) ; Alanine (OF5P57N2ZX)
Language	English
Publishing date	2022-10-25
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2701262-1
ISSN	2218-273X ; 2218-273X
ISSN (online)	2218-273X
ISSN	2218-273X
DOI	10.3390/biom12111558
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Article ; Online: Family Leave and Maternal Mortality in the US-Reply.

Scott, Kristan / Gregory, Emily F / Burris, Heather H

JAMA

2023 Volume 330, Issue 14, Page(s) 1387–1388

MeSH term(s)	Family Leave ; Maternal Mortality ; United States/epidemiology ; Humans ; Female
Language	English
Publishing date	2023-10-09
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2023.14936
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Article ; Online: Addressing Maternal Mortality in the US-A Pediatrics Responsibility.

Scott, Kristan / Gregory, Emily F / Burris, Heather H

JAMA

2023 Volume 329, Issue 21, Page(s) 1819–1820

MeSH term(s)	Female ; Humans ; Attitude of Health Personnel ; Maternal Mortality/ethnology ; Maternal Mortality/trends ; Mothers/statistics & numerical data ; Pediatrics ; Social Responsibility ; United States/epidemiology
Language	English
Publishing date	2023-05-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2023.6234
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Article ; Online: Protein disorder and autoinhibition: The role of multivalency and effective concentration.

Fenton, Malissa / Gregory, Emily / Daughdrill, Gary

Current opinion in structural biology

2023 Volume 83, Page(s) 102705

Abstract: Regulation of protein binding through autoinhibition commonly occurs via interactions involving intrinsically disordered regions (IDRs). These intramolecular interactions can directly or allosterically inhibit intermolecular protein or DNA binding, ... ...

Abstract	Regulation of protein binding through autoinhibition commonly occurs via interactions involving intrinsically disordered regions (IDRs). These intramolecular interactions can directly or allosterically inhibit intermolecular protein or DNA binding, regulate enzymatic activity, and control the assembly of large macromolecular complexes. Autoinhibitory interactions mediated by protein disorder are inherently transient, making their identification and characterization challenging. In this review, we explore the structural and functional diversity of disorder-mediated autoinhibition for a variety of biological mechanisms, with a focus on the role of multivalency and effective concentration. We also discuss the evolution of disordered motifs that participate in autoinhibition using examples where sequence conservation varies from high to low. In some cases, identifiable motifs that are essential for autoinhibition remain intact within a rapidly evolving sequence, over long evolutionary distances. Finally, we examine the potential of AlphaFold2 to predict autoinhibitory intramolecular interactions involving IDRs.
MeSH term(s)	Proteins/metabolism ; Protein Binding ; Intrinsically Disordered Proteins/chemistry
Chemical Substances	Proteins ; Intrinsically Disordered Proteins
Language	English
Publishing date	2023-09-29
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1068353-7
ISSN	1879-033X ; 0959-440X
ISSN (online)	1879-033X
ISSN	0959-440X
DOI	10.1016/j.sbi.2023.102705
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Article ; Online: Comparison of Cardiovascular Health Between Parents and Non-Parents in NHANES 2011-2018.

Gregory, Emily F / Maddox, Adya I / Tindall, Alyssa / Ibarra, Jose L / Virudachalam, Senbagam

Family & community health

2024 Volume 47, Issue 3, Page(s) 231–238

Abstract: Background and objectives: We compared cardiovascular health for parents and non-parents using the American Heart Association's Life's Essential 8 (LE8).: Methods: This cross-sectional cohort analyzed 2011-2018 NHANES participants aged 20 to 54. The ... ...

Abstract	Background and objectives: We compared cardiovascular health for parents and non-parents using the American Heart Association's Life's Essential 8 (LE8). Methods: This cross-sectional cohort analyzed 2011-2018 NHANES participants aged 20 to 54. The exposure was parenting, defined as living with a child. Logistic regression assessed whether parenting was associated with odds of ideal LE8 total or sub-scores. Regression adjusted for age, sex, race and ethnicity, educational attainment, marital status, and income. Subgroups included female sex, male sex, income <150% federal poverty levels, and parents of younger children. Results: 6847 participants represented a weighted population of 79 120 285 (57% parents). Parenting was not associated with adjusted odds of ideal total LE8 (OR 0.91, 95% CI 0.76-1.09). Parenting was associated with decreased odds of ideal body mass index (BMI) (OR 0.81, 95% CI 0.72-0.91) and increased odds of smoking avoidance (OR 1.22, 95% CI 1.09-1.38). Associations varied by subgroup. Only the subgroup with lower incomes demonstrated reduced odds of ideal total LE8 for parents (OR 0.58, 95% CI 0.41-0.82). Conclusions: Parents and non-parents differed in smoking and BMI, though not in LE8 total. Families with low incomes may particularly benefit from dual generation cardiovascular risk reduction.
MeSH term(s)	Humans ; Female ; Male ; Cross-Sectional Studies ; Parents/psychology ; Adult ; Middle Aged ; Cardiovascular Diseases/epidemiology ; United States/epidemiology ; Nutrition Surveys ; Young Adult ; Parenting/psychology ; Body Mass Index
Language	English
Publishing date	2024-05-07
Publishing country	United States
Document type	Journal Article ; Comparative Study
ZDB-ID	449879-3
ISSN	1550-5057 ; 0160-6379
ISSN (online)	1550-5057
ISSN	0160-6379
DOI	10.1097/FCH.0000000000000403
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Article ; Online: Improving breastfeeding care & support in a large, urban, pediatric primary care practice.

Kawan, Meg / Gregory, Emily F / Spatz, Diane L

Journal of pediatric nursing

2022 Volume 70, Page(s) e3–e8

Abstract: Background and specific aims: Human milk/breastfeeding is the gold standard for infant nutrition. Interventions in pediatric primary care could improve breastfeeding exclusivity and duration. Our specific aims were two-fold: 1) Accurately measure ... ...

Abstract	Background and specific aims: Human milk/breastfeeding is the gold standard for infant nutrition. Interventions in pediatric primary care could improve breastfeeding exclusivity and duration. Our specific aims were two-fold: 1) Accurately measure breastfeeding indicators and 2) Implement AAP Breastfeeding-Friendly Pediatric Office Practice Recommendations. Materials and methods: In 2018, a single, urban, large primary care pediatric practice initiated a Quality Improvement project to improve breastfeeding outcomes. Stakeholders met to discuss metrics of interest, develop documentation templates, review data capture, and plan interventions to support breastfeeding. Practice based interventions to improve measurement included: piloting documentation templates, incorporation of default templates office-wide, and developing tracking tools for both use of templates and breastfeeding outcomes. Interventions to support breastfeeding occurred simultaneously and included workflow redesign to increase nurse-provided breastfeeding education, partnering with community-based lactation consultants for outpatient support, staff education, and National Breastfeeding Month activities. Results: Since initiation of the data analytic tool, breastfeeding data has been analyzed from over 30,000 visits (86% Medicaid-insured, 82% Black race). Currently, 80% of providers use default templates that allow standardized data capture. At first newborn visit, 74% of infants were breastfed. At six months, 36% of infants were breastfed; 23% exclusively. Standardized documentation of infant feeding status improved and has remained consistent. Breastfeeding duration did not significantly improve despite practice interventions. Conclusions: Pediatric primary care measurement tools are feasible and critical to understand breastfeeding continuation. Increased resources and interventions to support breastfeeding in Primary Care are necessary to improve outcomes.
MeSH term(s)	Infant ; Infant, Newborn ; Female ; Pregnancy ; Child ; Humans ; Breast Feeding ; Milk, Human ; Nursing Care ; Postnatal Care ; Primary Health Care
Language	English
Publishing date	2022-11-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	632731-x
ISSN	1532-8449 ; 0882-5963
ISSN (online)	1532-8449
ISSN	0882-5963
DOI	10.1016/j.pedn.2022.10.007
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Article ; Online: Prevalence and Predictors of Integrated Care Among Teen Mothers and Their Infants.

Larsen, Alexandra L / Lorch, Scott A / Passarella, Molly / Gregory, Emily F

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

2022 Volume 71, Issue 4, Page(s) 474–479

Abstract: Purpose: Integrated models of primary care for parenting teens, in which teens and infants are cared for by the same clinical team on the same day, are associated with reduced repeated pregnancies and increased uptake of contraception and immunization. ... ...

Abstract	Purpose: Integrated models of primary care for parenting teens, in which teens and infants are cared for by the same clinical team on the same day, are associated with reduced repeated pregnancies and increased uptake of contraception and immunization. Our purpose was to determine how frequently teen-infant dyads receive integrated care. Methods: This study used Medicaid Analytic eXtract data to create a retrospective cohort of mothers aged 12-17 linked with infants born from 2007-2012 in 12 states. Teen-infant dyads were enrolled in Medicaid throughout the year after birth. The primary outcome was integrated care in the year after birth, defined as ≥ 1 instance when teen and infant had visits on the same day, billed to the same clinician identifier. Logistic regression assessed the relationship between integrated care and maternal demographics, dyad health, clinician specialty, and community factors. Results: Of 20,203 dyads, 3,371 (16.7%) had integrated care in the year after birth. Dyads with integrated care had a mean of 1.2 (SD 1.3) integrated visits. Dyads with integrated care had more visits (14.9, SD 10.6 vs. 11.7, SD 8.3), including more preventive visits for teens and more acute visits for both teens and infants. In regression, integrated care was associated with maternal factors (younger age, non-Latinx white race, and maternal health risks), residence in rural or high-poverty areas, and ever visiting Family Medicine clinicians. Discussion: Though uncommon, integrated care was associated with greater engagement in health care. Implementation of integrated care may support increased preventive care for parenting teens.
MeSH term(s)	Adolescent ; Adolescent Mothers ; Delivery of Health Care, Integrated ; Female ; Humans ; Infant ; Mothers ; Pregnancy ; Pregnancy in Adolescence/prevention & control ; Prevalence ; Retrospective Studies ; United States
Language	English
Publishing date	2022-06-29
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	1063374-1
ISSN	1879-1972 ; 1054-139X
ISSN (online)	1879-1972
ISSN	1054-139X
DOI	10.1016/j.jadohealth.2022.04.018
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Article ; Online: Interconception Preventive Care and Recurrence of Pregnancy Complications for Medicaid-Insured Women.

Gregory, Emily F / Passarella, Molly / Levine, Lisa D / Lorch, Scott A

Journal of women's health (2002)

2022 Volume 31, Issue 6, Page(s) 826–833

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Adult ; Female ; Humans ; Hypertension ; Infant ; Infant, Newborn ; Medicaid ; Pregnancy ; Pregnancy Complications/epidemiology ; Pregnancy Complications/prevention & control ; Premature Birth/epidemiology ; Retrospective Studies ; United States/epidemiology ; Young Adult
Language	English
Publishing date	2022-02-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S. ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	1139774-3
ISSN	1931-843X ; 1059-7115 ; 1540-9996
ISSN (online)	1931-843X
ISSN	1059-7115 ; 1540-9996
DOI	10.1089/jwh.2021.0355
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Article ; Online: Preconception and Interconception Pediatric Primary Care Utilization of Pregnant and Parenting Teens.

Gregory, Emily F / Henry, Drisana / Akers, Aletha Y

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

2021 Volume 69, Issue 2, Page(s) 315–320

Abstract: Purpose: Gaps in preventive care may contribute to adverse outcomes among pregnant teens. This study quantified teen preventive care utilization before and after pregnancy.: Methods: A continuous retrospective cohort identified 150 teens with a ... ...

Abstract	Purpose: Gaps in preventive care may contribute to adverse outcomes among pregnant teens. This study quantified teen preventive care utilization before and after pregnancy. Methods: A continuous retrospective cohort identified 150 teens with a positive pregnancy test (July 2015 to May 2017) at two pediatric primary care sites. Chart review assessed office visits for 18 months before and after the pregnancy test. We also assessed contraceptive counseling, pregnancy outcomes (live birth, miscarriage, termination), and continuity with a single clinician. Demographic factors included age, race, ethnicity, primary insurance, and residential zip code. Logistic regression identified factors associated with visits after pregnancy. Separately, for a cohort of 47 parenting teens who received primary care at the same site as their infants, we assessed teen-infant care after birth. Results: Teens were predominantly non-Latina black (91%) and Medicaid insured (71%). Before pregnancy, most teens had preventive visits (66%) and reported contraceptive use (65%). After pregnancy, 52% discussed pregnancy decisions within a month, 55% reported contraceptive use, and 64% had any primary care visit. Postpregnancy visits were associated with teen age (<18 vs. ≥18 years odds ratio 2.84, 95% confidence interval 1.17-6.90) and pregnancy outcome (termination vs. live birth odds ratio 4.02, 95% confidence interval 1.47-11.01). Among parenting teens, there were more infant visits than teen visits, and continuity was higher for infants. Conclusion: In a primary care cohort of pregnant teens, gaps persisted in pediatric clinical follow-up after pregnancy. Particularly in situations where pregnancy led to a birth, pregnancy frequently prompted a transition away from pediatric care.
MeSH term(s)	Adolescent ; African Americans ; Child ; Female ; Humans ; Infant ; Parenting ; Pregnancy ; Pregnancy Outcome ; Pregnancy in Adolescence/prevention & control ; Primary Health Care ; Retrospective Studies ; United States
Language	English
Publishing date	2021-01-19
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1063374-1
ISSN	1879-1972 ; 1054-139X
ISSN (online)	1879-1972
ISSN	1054-139X
DOI	10.1016/j.jadohealth.2020.12.132
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