IU Indianapolis ScholarWorks :: Browsing by Author "Nunge, Rebecca A"

Browsing by Author "Nunge, Rebecca A"

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Acknowledging Racial and Ethnic Health Disparities in Mass Incarceration
(Indiana State Medical Association, 2022-06-06) Brown, Lucy; Clark, Sydney; Nunge, Rebecca A; Fazle, Trilliah; Cooper, Siena; Robinson, Peyton; Darroca, Roberto
Whereas, the United States incarcerates more people per capita than any country in the world, where the U.S. comprises only 4% of the world’s population, yet is home to nearly 16% of all incarcerated people in the world; and Whereas, in Indiana, the total jail population increased by 526% between 1970 and 2015, while rates of pretrial detainees have increased by 72% in the state’s 48 rural counties, 43% in the state’s 21 small/medium counties, 40% in the state’s 22 suburban counties, and 268% in Marion County alone since 2000; and Whereas, in 2015 in Indiana, when including jail, prison, immigration detention, and juvenile facilities, the incarceration rate was 765 per 100,000 people, well above the rate of the United States as a whole, which was 665 per 100,000 people; and Whereas, Black residents make up 10% of Indiana’s population, but represent 24% of people in jail and 34% of people in prison; additionally, pretrial populations, disproportionately Black and Hispanic, more than doubled from 2002 to 2017; and Whereas, in 2019, Native people made up 2.1% of all federally incarcerated people, larger than their share of the total U.S. population, which was less than one percent; additionally, Native women are particularly overrepresented in the incarcerated population, making up 2.5% of women in prisons and jails and only 0.7% of the total U.S. female population; and Whereas, populations of color are more impacted by the use of money bail, where Black defendants often receive higher bail amounts, even when controlling for legal factors such as offense severity; and Whereas, Black and brown defendants are 10-25% more likely to be detained pretrial or to receive financial conditions of release; and Whereas, significant racial and ethnic disparities exist among policing, arrests, and incarceration rates, which further exacerbate disparate health outcomes for Black communities, including, but not limited to, Black individuals disproportionately being stopped by the police, experiencing use of force and repeated arrests, serving sentences of life and life without parole, being sent to solitary confinement, and receiving convictions that place them on death row; and Whereas, nearly one in three Black men will ever be imprisoned, and nearly half of Black women currently have a family member or extended family member who is in prison; and Whereas, ISMA (RESOLUTION 15-31) advocates for improved health care of incarcerated individuals; however, ISMA has no policy acknowledging the inequitable burden of incarceration and policing on minoritized individuals and communities of color; and Whereas, the AMA (H-65.954) recognizes police brutality as a manifestation of structural racism which disproportionately impacts Black, Indigenous, and other people of color; therefore, be it RESOLVED, that ISMA recognize that unjust and disproportionate racial and ethnic disparities exist in policing, sentencing, and mass incarceration among Black, indigenous, and other people of color (BIPOC) and have devastating impacts on BIPOC communities; and be it further, RESOLVED, that ISMA refer to the Committee on Diversity, Equity and Inclusion for study on what policies would be germane for ISMA to act on regarding racial and ethnic disparities in mass incarceration.
Approach to Patients with an Adnexal Mass
(2022-08) Nunge, Rebecca A
Award Recognition for "Developing a Minimally Invasive Cell-Based Model to Predict Response to Major Trauma"
(2021-08) Gates, Kayla L; Nunge, Rebecca A; Adom, Jamila; Kaplan, Mark; McKinley, Todd
Background: The physiologic response to injury is heavily influenced by the immune system. The complexities of the immunologic response to injury are becoming increasingly understood as researchers have leveraged computational methods that allow temporal and spatial coordination of immune mediator orchestration to be quantified. Recently, early differences in immunologic orchestration have been shown to stratify individual tolerance to injury. Specifically, there are subsets of trauma patients that are either sensitive or tolerant to hemorrhage that demonstrated notably different early immunologic orchestration of mediators from clusters of cytokines that are primarily tissue protective or pro/anti-inflammatory. These differentiating networks of mediators formed and dissipated over the initial 72 hours after injury clearly demonstrating that the immunologic response to injury is an acute dynamic event that has pathomechanistic relevance to outcomes after injury. Additionally, it is distinctly possible that individualized differences in immune response may determine tolerance/sensitivity to injury. The differential immunologic response to trauma represents an opportunity to discover specific factors that may be predictive of a patients’ response to traumatic injury and subsequent hemorrhagic shock. Accordingly, we have embarked on a line of experimentation to explore potential precision approaches based on individual immunologic response to injury. Here we report our initial experimental findings in conceptual model development with the ultimate goal of developing minimally invasive/non-injurious testing that will accurately identify individual tolerance to hemorrhage and injury. In this experiment, an in-vitro cell-based assay was designed to mimic traumatic injury. Specifically, we tested the immunologic response in murine splenocytes to a simulated hypoxic injury, a simulated mechanical injury and a simulated open wounding injury. The development of a reliable cell-based model will allow investigation to determine correspondence and relevance between cell-based responses to non-traumatic injury and in vivo immunologic response to trauma, with the overall goal of developing a reliable test to predict response to traumatic injury in humans. Methods: In-vitro cellular responses of murine splenocytes are reflective of peripheral blood cell responses and were used for pilot experiments. Splenocytes from C57BL/6 (B6) BALB/c or CH3/ HeJ strains mice were used with stimuli that mimic traumatic injury using chemical (hypoxia or sepsis) or mechanical (shear stress) stimuli that might from an open wounding type of injury. Hypoxia was simulated by subjecting cell cultures to hydrogen peroxide. Sepsis was simulated by subjecting cells to lipopolysaccharide (LPS). Some culture conditions included several individual cytokines associated with acute inflammation and external pathogens (interleukin (IL)-6, IL-1β, IL- 33), the damage molecule high mobility group box protein (HMGB)-1, or combinations of LPS and the cytokines. Following treatment, cDNA was prepared and used for qPCR amplification of TNFα, HIF1α, and BAX to assess inflammation, hypoxia, and apoptosis, respectively. Multiplex analysis of IL-21, IL-4, IL-22, IL-5, and IL-10 expression was performed from culture supernatant collected at 24 hours after stimulation. Flow cytometry was performed to assess proliferation of immune cells following treatment. ELISA was conducted to quantify production of the cytokine IL-9 that occurred following splenocyte stimulation. Results: Analysis of C57BL/6 splenocyte viability show that any combination of cytokines or LPS did not impact cell survival, while hydrogen peroxide reduced survival significantly in each treatment group. From the qPCR data, LPS generated a 4x increase in TNFα expression relative to control, while cytokine treatment yielded no expression changes. Treatment with LPS + cytokines closely resembled the LPS treatment group. LPS treatment reduced expression of HIF1α, while hydrogen peroxide increased expression of HIF1α. The addition of cytokines reduced expression of HIF1α in groups that were treated with both hydrogen peroxide and cytokines. ELISA analysis of the proinflammatory cytokine IL-9 indicated increased production of IL-9 following treatment with LPS + cytokines. In the second experiment, the model was applied to three different strains of mice in order to gauge differences in the immune response to the same cellular stress. Multiplex analysis showed no significant changes in IL-4 or IL-21 expression in any of the strains. C3H mice showed no response to LPS, which was expected due to LPS resistance in these strains. In the B6 and BALB mice, IL-10 was induced by LPS treatment. BALB mice also showed increased expression of IL-5 and IL-22 in response to mechanical stress, while the other strains showed no response. IL-10 expression was not induced by mechanical injury in any strain. Flow cytometry analysis was used to assess immune cell response to stimuli. Both B6 and C3H mice showed increased percentages of CD4 and CD8 cells in response to mechanical stimulus, LPS, and LPS + cytokine treatment relative to control. Macrophage levels were more elevated in B6 mice in response to mechanical stimulus, whereas levels decreased in the C3H mice. Discussion: The overall goal of this line of investigation is to develop minimally invasive and non-injurious testing that can be used to determine individual tolerance/sensitivity to trauma and hemorrhage. These pilot studies were used to determine how immune cells can be isolated and stimulated to mimic injury. Splenocytes were used as they encompass a broad cross-section of white blood cells. Clear inter-strain differences were evident between the B6, BALB and C3H mice. Hypoxia stimuli consistently resulted in roughly a 50% loss of cell viability and accordingly may not be a viable strategy. The greatest effects were encountered with LPS +/- addition of stimulating cytokines. We measured changes in five of six cytokines in B6 mice and four of six BALB mice involving reparative cytokines (IL-21 and 22), anti-inflammatory cytokines (IL-10) and in type 2 cytokines (IL-4 and IL-5). Accordingly, these strains and stimulation methods will be expanded to determine effects on production on a broader panel of cytokines. In addition, computational methods will be leveraged on the next experiment to determine in-vitro effects on immunologic mediator orchestration to account for time-dependent mediator networks and spatial networks of mediators. Moving forward, these experiments will be repeated to reproduce our findings and improve our ability to distinguish between varying immune responses. Results will then be paired with studies examining the responses to traumatic injury among these and other strains. The overall goal of this project is to accurately predict the response to an in-vivo injury using an in-vitro non traumatic stimulus. Findings from this project will enable the development of a clinical test that accurately predicts immunologic response to trauma and stratify individual tolerance to hemorrhage and injury.
Breast Cancer Diagnosed During Pregnancy
(2021-03) Yep, Fiorella; Nunge, Rebecca A; Shepler, Christine; Ludwig, Kandice
Background: Pregnancy-associated breast cancers are cancers diagnosed during pregnancy or within 1 year of delivery. It is rare, occurring in 2.5-7.5/100,000, but these numbers continue to rise as maternal age increases. As a result, prospective studies evaluating diagnosis and treatment are limited. Case Description: Patient is a P1G0 35 yo woman who presented with a new breast mass at 26 wga. Diagnostic workup including core biopsy revealed invasive ductal carcinoma, ER 70%, PR 40%, her-2 negative. After multidisciplinary discussion with the breast team and the patient’s obstetrician, the patient underwent mastectomy with sentinel node biopsy at 28 wga. Pathology showed a 1.9 cm tumor with 5 negative sentinel nodes. Genomic evaluation of her tumor using 21-gene recurrence score revealed significant risk of distant recurrence without chemotherapy. Patient will initiate chemotherapy after delivery. Conclusion: The treatment regimen should be as close to standard of care as possible for a non-pregnant woman with the same cancer. Diagnostic workup should include ultrasound and possible mammogram with shielding of the fetus. Core biopsy can provide definitive diagnosis. Surgery is the mainstay of treatment during pregnancy, and decisions regarding breast conservation are dependent on gestational age at presentation. Adjuvant treatments can be performed with modifications and avoidance of radiotherapy during pregnancy. Decisions regarding treatment require multidisciplinary input between the oncology and obstetric teams to provide effective care with minimal toxicity to the fetus. Clinical Significance: Physiological changes of the breast during pregnancy make diagnosis of new breast cancer difficult. Furthermore, lack of diagnostic suspicion delays diagnosis. Further research is needed to determine the best diagnostic and therapeutic methods to ensure the best prognosis for mother and baby as the prevalence of breast cancer during pregnancy continues to rise.
Developing a Minimally Invasive Cell-Based Model to Predict Response to Major Trauma
(2020-07-31) Nunge, Rebecca A; Gates, Kayla L; Adom, Jamila; Kaplan, Mark; McKinley, Todd
Background. Physical trauma results in a systemic inflammatory response. Preliminary research in orthopedic trauma patients suggests that patients with similar demographics and severity of injury vary in their response to traumatic injury. Analysis of the immunological response post-injury showed a sustained pro-inflammatory response with delayed reparative cytokine expression in trauma sensitive patients, while the trauma tolerant patients had an early inflammatory expression with resolution by 72 hours post-injury. Thus, we hypothesize that differential response to non-traumatic injury might serve as a predictive tool for the identification of trauma tolerant and sensitive patients prior to injury. The goal of this research is to test whether immunological changes to inflammatory stimuli can predict tolerance or sensitivity to trauma using an-vitro cell-based assay. Methods. Splenocytes were isolated from naive C57BL/6 mice and subjected to biological trauma in vitro using LPS (100 ng/mL) or hypoxic trauma using hydrogen peroxide (50 µM, 100 µM, and 200 µM) with or without proinflammatory cytokines, IL-1β (1 ng/mL) , IL-6 (200 ng/mL), and IL-33 (150 ng/mL). Inflammation and hypoxia were assessed using IL-6 and HIF-1ɑ expression respectively via qPCR 24 hours post-treatment. Cell death and pro-inflammatory cytokine production using multiplex analysis were used to measure outcomes. Results. Both types of treatments showed increased cell death compared to the control group. qPCR data is pending. Conclusion. With these studies as a core of the experimental approach, this in vitro cell-based assay will be used to assess immunologic response to inflammatory stimuli across the genetic variation of mouse strains. Findings from this project could enable the development of a clinical test that accurately predicts immunologic response to trauma and related-complications based on patients’ sensitivity to pre-traumatic injury.
Developing a Minimally Invasive Cell-Based Model to Predict Response to Major Trauma
(2020-07-31) Nunge, Rebecca A; Gates, Kayla L; Adom, Jamila; McKinley, Todd
Background. Physical trauma results in a systemic inflammatory response. Preliminary research in orthopedic trauma patients suggests that patients with similar demographics and severity of injury vary in their response to traumatic injury. Analysis of the immunological response post-injury showed a sustained pro-inflammatory response with delayed reparative cytokine expression in trauma sensitive patients, while the trauma tolerant patients had an early inflammatory expression with resolution by 72 hours post-injury. Thus, we hypothesize that differential response to non-traumatic injury might serve as a predictive tool for the identification of trauma tolerant and sensitive patients prior to injury. The goal of this research is to test whether immunological changes to inflammatory stimuli can predict tolerance or sensitivity to trauma using an-vitro cell-based assay. Methods. Splenocytes were isolated from naive C57BL/6 mice and subjected to biological trauma in vitro using LPS (100 ng/mL) or hypoxic trauma using hydrogen peroxide (50 µM, 100 µM, and 200 µM) with or without proinflammatory cytokines, IL-1β (1 ng/mL) , IL-6 (200 ng/mL), and IL-33 (150 ng/mL). Inflammation and hypoxia were assessed using IL-6 and HIF-1ɑ expression respectively via qPCR 24 hours post-treatment. Cell death and pro-inflammatory cytokine production using multiplex analysis were used to measure outcomes. Results. Both types of treatments showed increased cell death compared to the control group. qPCR data is pending. Conclusion. With these studies as a core of the experimental approach, this in vitro cell-based assay will be used to assess immunologic response to inflammatory stimuli across the genetic variation of mouse strains. Findings from this project could enable the development of a clinical test that accurately predicts immunologic response to trauma and related-complications based on patients’ sensitivity to pre-traumatic injury.
Fatty acid metabolism disorder not found on prenatal testing
(2022-03) Nunge, Rebecca A; Grismore, Myranda; Ganapaneni, Sruthi; Waters, Hallie; Rouse, Caroline E
Case Description: A 26 year old G3P2001 presented for amniocentesis due to a family history of carnitine palmitoyltransferase 2 (CPTII) deficiency. Her first child developed seizures and passed away soon after birth; CPTII deficiency was diagnosed on the newborn screen. Both parents were confirmed to be carriers. For her second pregnancy, she opted against invasive testing. The newborn was treated proactively. Testing confirmed the child was not affected, and treatment was halted. In the current pregnancy, she opted for amniocentesis, which revealed an affected male. Background: CPT II deficiency is a rare autosomal recessive disease caused by a mutation in a gene encoding carnitine palmitoyltransferase 2, an essential enzyme in fatty acid oxidation. Affected patients are at risk for hypoketotic hypoglycemia, seizures, hepatomegaly, cardiomyopathy, arrhythmias, and other downstream issues. A postnatal diagnosis via the newborn screen does not confer the benefit of advanced awareness of the disease and allow for preemptive treatment. CPT II deficiency can be confirmed prenatally with diagnostic testing. Amniocentesis is an invasive test associated with a low but present risk of pregnancy loss, so some may opt against the test. Conclusion: Carriers of CPT II mutations are counseled that future pregnancies confer a 25% risk of having an affected child. Prenatal diagnostic testing is recommended for prenatal diagnosis, which allows for planning of immediate treatment in the NICU. However, opting to forgo invasive testing and preemptively treat potentially affected child until newborn screening results return, as occurred in this patient’s second pregnancy, is also an option. Clinical Significance: CPT II deficiency is a rare disease that can have devastating effects in newborns without a known diagnosis. Parents with known carrier status must be extensively counseled on their options regarding prenatal and postnatal screening as well as immediate newborn care.
The Importance of Newborn Screening in the Detection of Congenital Hypothyroidism in Females
(2019-11) Husain, Mahera; Nunge, Rebecca A; Rose, Maggie; Bittar, Julie; Zimmerman, Michelle K
Title: The importance of the newborn screen in detection of congenital hypothyroidism in females Authors: Mahera Husain, Rebecca Nunge, Maggie Rose, Julie Bittar. Michelle Zimmerman, MD Case: A nine-day-old female infant presented to the pediatric endocrinology clinic to establish care for congenital hypothyroidism. She was born vaginally at 36 weeks and 6 days, without complications to a 15-year-old mother with no past medical history or family history of chronic illnesses, including thyroid disease. At birth, she weighed 5 lb 10 oz, and was 19" long. Newborn screen showed TSH >1000 mcU/mL (reference 0.72-4.77) and free T4 of 0.3 ng/dL (reference 0.9-1.7). Exam revealed slightly indented anterior fontanelle, overriding sutures and a palpable posterior fontanelle. She had no palpable thyroid. Thyroid ultrasound showed no thyroid tissue in the neck. She was started on 37.5 mcg (16 mcg/kg) daily of levothyroxine. At two-month follow-up, TSH had decreased to 17 mcU/mL and free T4 1.1 ng/dL. Accordingly, her levothyroxine dose was increased. Two months later, her TSH was 25 mcU/mL and free T4 1.2 ng/dL. She will require lifelong thyroid supplementation and close follow-up. Conclusions: Newborn screening for thyroid defects is crucial to detect congenital hypothyroidism and prevent lifelong neurocognitive deficits and developmental delay. Clinical Significance: Congenital hypothyroidism has an incidence of 1:2000 in the United States. Females are twice as likely to be diagnosed with congenital hypothyroidism. Thyroid hormones are necessary for physical and neurological development, especially brain development. The prognosis for congenital hypothyroidism is excellent as long as medication is started early (as in this patient’s case). The severity of neurodevelopmental defects is related to the severity of the case, as well as how long the hypothyroidism is left untreated. The longer an infant goes without treatment, the more severe the deficit is, as demonstrated by lower IQ values. This case illustrates the need for comprehensive newborn screening for thyroid deficits. Newborn screening is a public health program whose recommendations vary by state, region, and country.
Improving Conditions for Incarcerated Individuals
(2022-06-06) Clark, Sydney; Cooper, Siena; Brown, Lucy; Nunge, Rebecca A; Fazle, Trilliah; Robinson, Peyton; Darroca, Roberto
Whereas, in 2019, the United States’ incarceration rate was estimated to be 629 per 100,000 people, which is the highest rate globally and over 8% higher than the closest country; and Whereas, in Indiana, the total jail population has increased 526% from 1970 to 2015 and the total prison population has increased 224% from 1983 to 2018, with our incarceration rates being fourth highest nationally; and Whereas, in 2015, Indiana had the second highest rate of pretrial detainees in the nation at a rate of 272 per 100,000 people; and Whereas, since 2000, the rate of pretrial detainees has increased 72% among Indiana’s 48 rural counties, 43% in 21 small/medium counties, 40% in 22 suburban counties, and 268% in Marion county alone; and Whereas, in the United States, the rate of recidivism is 70% within 5 years of release with few resources to assist reentering individuals find housing, gain employment, or access social services; and Whereas, when connected with employment opportunities, financial planning services, stable housing, and physical and mental health services, rates of recidivism decrease significantly, over 60% amongst those who complete programs, among reentering individuals; and Whereas, incarcerated individuals have higher rates of mental illness than the general population, with approximately 14.5% of men and 31% of women in jails having at least one mental illness as compared to 3.2% and 4.9% respectively amongst the general population; and Whereas, nationally, the number of suicides has increased by 85% in state prisons, 61% in federal prisons, and 13% in local jails from 2001 to 2019, with suicide being the leading cause of death in jails; and Whereas, the risk of suicide in recently released individuals is nearly 6.8 times higher than that of the general population, with most occurring within 28 days of release; and Whereas, in a study of 80 jails by Scheyett et al., 68 reported having no mental health staff who provided care within the jail, 15 reported taking, on average, 5 days or longer to retrieve inmates’ medications and none were utilizing evidence-based screenings to assess for serious mental illnesses, highlighting a concerning disconnect between jail staff and mental health providers; and Whereas, re-entering individuals are unlikely to connect with primary care upon release and very rarely seek mental health services in the months following release; and Whereas, inarcerated individuals are often restricted from accessing rehabilitative social services such as the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), and Medicaid either through a lack of meeting eligibility requirements or personally held beliefs by incarcerated individuals surrounding eligibility and accessing resources; and Whereas, when provided assistance and access to expedited Medicaid enrollment, reentering individuals were more likely to access health services and receive prescriptions; and 263 Whereas, ISMA (RESOLUTION 15-31) advocates for improved health care of incarcerated individuals; therefore, be it RESOLVED, that ISMA support legislation that improves access to comprehensive physical and behavioral health care services for juveniles and adults throughout the incarceration process from intake to re-entry into the community; and be it further RESOLVED, that ISMA support legislation that removes barriers and increases access to social services and benefits apropos to the respective situations of incarcerated individuals and re-entering individuals, such as: (a) food subsidies; (b) healthcare, including Medicare and/or Medicaid; and (c) housing; and be it further RESOLVED, that ISMA work with relevant stakeholders to create discharge planning and programs that connect reentering individuals with primary care providers and medical homes within the community.
Improving Health in Incarcerated Women
(Indiana State Medical Association, 2022-06-06) Nunge, Rebecca A; Brown, Lucy; Clark, Sydney; Fazle, Trilliah; Cooper, Siena; Darroca, Robert
Whereas, research often uses gendered language such as “women” or “woman” to describe patients; however, the authors of this resolution recognize that individuals of all gender identities can become pregnant; and Whereas, between 1980 and 2020, the number of incarcerated women in federal and state prisons and county jails has increased by more than 475%; and Whereas, though more men are incarcerated than women, the rate of growth for incarceration of women has been twice that of men since 1980; and Whereas, the imprisonment rate for Black women was 1.7 times the rate of imprisonment for White women, and the rate of imprisonment for Latinx women was 1.3 times the rate of White women in 2020; and Whereas, in 2020, Indiana had the 12th highest female imprisonment rate nationally, at 64 per 100,000, while the national average was 42 per 100,000; and Whereas, the number of women incarcerated in Indiana’s jails has increased more than 25-fold from 1970 to 2015, while the number of women in Indiana prisons has increased more than 19-fold from 1978 to 2017; and Whereas, a 1999 report by the Federal Bureau of Justice Statistics, which is the most recent report to study abuse prior to incarceration, found that 57% of women in state facilities had experienced sexual or physical abuse prior to their incarceration; and Whereas, the link between domestic violence and incarceration of women is evidenced by the fact that the crimes for which women are incarcerated are often directly related to domestic abuse; and Whereas, a 2008 report from the Bureau of Justice found 4% of state and 3% of federal inmates to be pregnant at the time of admission, while only 54% received some type of prenatal care; and Whereas, Indiana does not provide screening and treatment for high-risk pregnancies and only recently passed legislation to limit the use of restraints; and Whereas, a 2016-2017 survey conducted by the Pregnancy in Prison Statistics Project found 3.8% of newly admitted women and 0.6% of all women were pregnant in December 2016, with 92% of these pregnancies resulting in live births, meaning that policymakers and public health practitioners can optimize outcomes for incarcerated pregnant women and their newborns; and Whereas, a 2008 report from the Bureau of Justice found a statistically significant difference between reported specific medical problems among females (57% in state prisons, 52% in federal prisons) compared to their male counterparts (43% in state prisons, 36% in federal prisons), with arthritis, asthma, and hypertension being the most commonly reported problems; and Whereas, three fourths of incarcerated women are of childbearing age (18-44 years old), and therefore are still menstruating but must pay for their own feminine hygiene products if they do not have the means to afford necessary hygiene products; and Whereas, the AMA (H-525.974) recognizes the financial burden of feminine hygiene products, classifies them as medical necessities, and advocates they be provided free of charge to all incarcerated women; and Whereas, women have specific health needs, including reproductive, gynecologic, and prenatal care, trauma- informed mental health care, and substance abuse care; and Whereas, prisons remain ill-equipped to provide adequate mental and physical healthcare for women inmates; and Whereas, ISMA (RESOLUTION 15-31) advocates for improved health care of incarcerated individuals; therefore, be it 78 RESOLVED, that ISMA seek and support legislation that improves access to comprehensive reproductive and physical health care services to women throughout their incarceration from intake to re-entry into the community; and be it further, RESOLVED, that ISMA seek and support legislation that increases allocation of healthcare for women’s prisons within the Indiana Department of Corrections and local county jails in Indiana; and be it further, RESOLVED, that the ISMA adopt AMA H-525.974, as amended, as follows: AMA ISMA: (1) recognizes encourages the Internal Revenue Service to classify feminine hygiene products as medical necessities; (2) will work with federal, local, state, and specialty medical societies, and other relevant stakeholders to advocate for the removal of barriers to feminine hygiene products in state and local prisons and correctional institutions to ensure incarcerated women be provided free of charge, the appropriate type and quantity of feminine hygiene products including tampons for their needs; and (3) encourages the American National Standards Institute, the Occupational Safety and Health Administration, and other advocates and seeks legislation for the state to provide access to free, readily-available feminine hygiene products to all incarcerated women. relevant stakeholders to establish and enforce a standard of practice for providing free, readily available menstrual care products to meet the needs of workers.

Browsing by Author "Nunge, Rebecca A"

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