Browsing by Author "Espinoza, Anna"
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Item 365 DAYS OF INFANT MORTALITY USING PHOTOVOICE TO UNDERSTAND INFANT MORTALITY AS AN ISSUE FOR SOCIAL CHANGE(2014-03) Paul, Marcy; Eley, Lindsey; Miller, Jennifer M.; Espinoza, AnnaPurpose (a): African Americans have an infant mortality rate more than twice the rate of Whites; yet there is limited information about parents' experience of an infant death and their perceptions about the causes of racial disparity in infant mortality. Photovoice, a documentary photography technique, was used to give a voice to parents who experienced an infant loss, and to better understand the causes and effects of racial disparity in infant mortality. To date, no known Photovoice projects have focused solely on the perceptions of parents who suffered an infant death. Methods (b): North Texas parents who experienced an infant loss were recruited using convenience sampling techniques. Participants were provided digital cameras, and asked to photograph and journal about community resources which were helpful to them as they grieved, and community resources, or lack thereof, they felt may have contributed to the death of their baby. Participants were divided into two groups based on current residency (Fort Worth or Dallas, Texas). These groups met monthly, giving participants an opportunity to discuss their photos, journal entries, and experiences during the project. Photographs and journal entries will be on display at a local art gallery as an exhibit, "Eight Warrior Mamas: Survivors of Infant Mortality - Empty Arms, Broken Hearts, and Grieving Wombs." Results (c): African American women (n=6) and White women (n=2) participated in the project. From their photographs and group discussions three themes emerged. The first theme was poor post-partum care. Many of the mothers reported feeling that the health provider they visited after delivery was insensitive, and the post-partum examinations were uncomfortable. The second theme was loneliness and isolation. The mothers described finding it difficult to locate support groups and other resources to help them during the grieving process. The third theme was the poor/inappropriate response from health insurers and regulatory agencies such as Child Protective Services. The mothers expressed that they were treated in a cold and distant manner when communicating with different systems about their deceased child. Conclusions (d): This project is an innovative approach to identifying systemic issues that contribute to racial disparity in infant mortality. Through the exhibit parents who suffered an infant death have a platform to voice their loss and their concerns about needed social change. Additionally, the exhibit increases community awareness of the issue of infant mortality. These findings suggest the importance of continuing to raise awareness about infant mortality and the need to further assess institutional polices' effect on racial disparities in infant mortality.Item Addressing Disparities in Treatment for Substance Use Disorder Among Individuals with Developmental Disabilities: Perspectives from Treatment Facility Employees(2024-03-21) Yip, Maggie; Phan, Cong-Bao; Espinoza, Anna; Walters, Scott; Barnett, Tracey E.; Bednar, Hannah; Garcia, Lizbeth; Taha, Suha; Miller, Jackson; Lopez, Cindy; Fulda, KimberlyPurpose Research on substance use disorder (SUD) among individuals with developmental disabilities (DD) is limited. The extant literature suggests that people with DD are less likely to use substances overall compared to people without a disability; however, they are more susceptible to SUD if they do use substances. Among facilities in the United States that provide aid for individuals with DD and treatment facilities for individuals with SUD, there are currently no interdisciplinary practice guidelines or training materials available for providers treating those with a co-diagnosis of DD and SUD. Our project aims to reduce the disparities between treatment guidelines and materials available for people with a co-diagnosis of both SUD and DD. The purpose of this analysis was to gauge overall awareness of providing treatment for individuals with SUD/DD co-diagnosis and reflect on current protocols regarding this population. Methods In this project, interviews were conducted with workers at facilities that primarily provide SUD services. Relevant facilities were identified and selected through systematic internet searches. In this study, 11 questions were asked to workers at facilities through 15-30 minute phone interviews. Questions that were used for this analysis revolved around themes of workers’ perspectives on the importance of integrating SUD/DD services, their current practices, and their future recommendations for integrating care for individuals with both SUD/DD. Results We conducted a total of 12 interviews. Responses came from the South and Midwest United States geographical regions. From these interviews, we found that most programs aim to individualize their approaches to treating this specific population. However, there is no standardized approach to how they individualize these cases. Furthermore, many programs expressed that they rarely refer individuals with a co-diagnosis of SUD/DD outside of their agency and feel inadequately prepared to treat individuals with SUD/DD co-diagnosis, which further emphasizes the need for accessible standardized guidelines. Overall, many workers expressed a need for improved access to screenings, assessment tools, specific guidelines, knowledge, training, and specialized programs for the variety of specific types of DDs. Conclusions People with DD that experience SUD are a vulnerable population with few resources. To meet the needs of this vulnerable population, standardized guidelines and training materials should be developed to address the specific needs of this patient population and equip healthcare providers and stakeholders with the tools necessary to ensure this population has proper and equitable access to treatment.Item Exploring the Role of Protective Factors on Depressive Symptoms among Mexican American Children.(2016-03-23) Jaime Hinojosa, Etienne; Aguilar, Alejandra; Franks, Susan; Fulda, Kimberly; Espinoza, Anna; Espinoza, AlexPurpose: National Health and Nutrition Examination Survey (NHANES) 2009–2012 dataset revealed that 7.6% of Americans aged 12 and over had depression. Youth, ages 12-17, had a depression rate of 5.7%. Research shows that ethnic disparities in mild, moderate, and severe depressive symptoms exist in Hispanics, compared to Non-Hispanic whites. The objective of this project is to explore the association between protective factors at the individual, relationship, and community level with depressive symptoms among Mexican American children. Materials and Methods: Variables were selected based on the social ecological model. A cross-sectional sample of 144 children, ages 10-14, and their legal guardian were used to examine exposure to seven protective factors: 1) acculturation 2) self-worth 3) positive physical development 4) family meals together 5) parent attendance of child events 6) neighborhood safety and 7) presence of recreation centers. The total number of protective factor exposures was categorized into four levels: 1, 2, 3, ≥ 4 exposures and run in a logistic regression model as the exposure of interest with depressive symptoms as the outcome. Depressive symptoms were evaluated using the Total Score yielded from the CDI 2: Self-Report (Short) version (CDI 2: SR[S]). Depressive symptoms were dichotomized as not having depressive symptoms (Average/Lower Level) and having depressive symptoms (High Average, Elevated, and Very Elevated Levels). Results: Of the boys (51% of sample), 10 (7%) had depressive symptoms, compared to 20 (14%) girls. Logistic regression adjusting for gender shows a relationship between protective factor exposures and depressive symptoms. Poverty, parent income, and BMI were not significantly associated with depressive symptoms and were not included as confounders. The model shows that for each increasing level of protective factor exposure there is a 0.168 (CI: 0.058, 0.490) odds for depressive symptoms. Conclusions: As the number of exposures to protective factors increase in a Mexican American child, the child has reduced odds of having depressive symptoms. Future studies should investigate not only the total number of protective factor exposures, but which type (e.g. individual, relationship, or community level) most impact the etiology of depressive symptoms in Mexican American children.Item Getting Lost in Translation: The Dangers in Literal Translation(2008-04-18) Pena, Itzel; Gwirtz, Patricia A.; Gladue, Brian; Espinoza, AnnaCurrently 16 million Hispanics in the U.S. do not speak any English making the need for Spanish translation apparent. Within the clinical research realm, accurate translation is important for complete comprehension of the informed consent process, as it is the application of the ethical principle of respect for persons (autonomy). This study found that literal translations might not always be the best form of translation. Instead, non-literal translations may offer better comprehension of the consent process. However, the effect of being bilingual and attaining high education levels are significant factors influencing the comprehension of the informed consent document. Additionally these factors may actually facilitate the understanding of the consent form more than the literal and non-literal translation. Lastly, the perception and meaning behind different translations can affect comprehension of consent concepts. Subjects preferred to be called participants showing that the two different translations can hold different meanings.Item Hyperemesis Cannabinoid Syndrome Chart Review(2023) Patterson, Tyler; Porter, Cardon; Birky, Jaxton; Judd, Dallin; Zhang, Fan; Espinoza, Anna; Galke, Curtis; Petersen, JamesPurpose: The purpose of this research study is to determine if the combination of Compazine and Benadryl is a superior method of treatment for patients who present with nausea and vomiting symptoms due to a diagnosis of Hyperemesis Cannabinoid Syndrome. Based on patient charts from a regional hospital emergency department in Oklahoma, an analysis was performed to determine if this combination of medications is more effective in quickly reducing the nausea, vomiting, and other symptoms associated with cannabis use.Methods: An agreement was created between a regional hospital in Duncan Oklahoma and The University of North Texas Health Science Center which allowed students at the Texas College of Osteopathic Medicine to review and analyze a total of 75 patients’ charts from the regional hospital. IRB approval was obtained for this project. The chart review process consisted of evaluating the patient's age, chief complaint, abnormal lab values, history of present illness (HPI), and medications administered in the emergency department. The important variables that assisted in this study were drug screening values, and the medications administered. The main outcome for which statistical efficacy of drug treatment was measured by duration of stay in the emergency department and whether or not an additional dose of medication was given. Results: This chart review showed that the 12 patients that used the Benadryl and Compazine combination had a decreased time spent in the emergency department by an average of 56 minutes when compared to 38 patients who received alternative medications. The average time spent in the emergency department for those who received Benadryl and Compazine was 127 minutes vs the average time spent for those using an alternative medication was 183 minutes. The typical dose was 50 mg of Benadryl and 10 mg of Compazine. While using an ANOVA statistical analysis these doses showed a significantly statistical relationship by decreasing provider-to-discharge time with a p value of 0.012. It was also found while using a logistic regression analysis that those patients who received this combination as their initial dose were less likely to receive a second dose. This relationship also was statistically significant with a p value of 0.005. It was also noted in the logistic analysis that females were more likely to receive a second dose when compared to men. This relationship also showed a relationship with significance and a p value of 0.037. Conclusions:The findings from this study recommend and encourage providers who are in a setting where Hyperemesis Cannabinoid Syndrome is prevalent to consider the medication combination of 50 mg of Benadryl and 10 mg of Compazine when providing treatment. There may be multiple ways to alleviate the discomfort and symptoms that patients may present with, however the combination stated above appears most effective to reduce provider-to-discharge time 56 minutes and eliminate second doses of medication based off of the data reviewed from the charts provided.Item Identifying Provider and Patient Barriers to the Implementation of (MeTree) Family Health History Clinical Decision Support (FHH CDS) Tools(2016-03-23) Cross, Deanna; Fulda, Kimberly; Espinoza, Anna; Zhang, Julia; Mallaiah, JanhaviObjective: The purpose of this study was to determine healthcare provider and patient barriers in the implementation of a FHH CDS tool. Background: The University of North Texas Health Science Center (UNTHSC) in collaboration with Duke University and other sites around the country is currently conducting an implementation-effectiveness study to investigate MeTree implementation. MeTree, a Family Health History Clinical Decision Support (FHH CDS) tool is a patient facing tool that provides disease risk-stratification to both patients and providers. In previous studies, several perceived barriers for the use of this type of tool were identified including limited time during a patient visit and a lack of patient knowledge to provide family health history. This is especially true in regard to primary care clinics that cater to underserved populations. Methods: Family Medicine providers from three primary care clinics were identified and recruited. Eligible patients of consented providers were invited to participate in the study via recruitment letters. Registration information was obtained from interested patients, and unique study IDs were assigned by study coordinators at UNT Health Science Center. Registered patients received an email link to e-consent and complete the family health history online using the MeTree software. A printed copy of the risk report generated on completion of MeTree was delivered to the primary care provider to be reviewed at their next clinical appointment. Results: To date, patients of two Family Medicine providers were invited to participate in the study. Of the 2711 who were invited, 92 patients registered (response rate 3.39%) and 11 patients completed MeTree (completion rate 11.9%). Qualitative information collected through in-person discussions with providers indicated a preference of integration of the risk stratification report into the electronic medical record (EMR) system versus a printed copy of the report. Patient barriers included lack of access to a computer and internet. Conclusion: Provider engagement in implementation of new clinical decision support tools is imperative for identifying barriers as well as providing potential solutions for these barriers.Item The impact of the COVID-19 pandemic on the access to care for Type 2 Diabetic Patients(2023) Matthews, Hillary; Fulda, Kimberly; Blair, Somer; White, Annesha; Pitts, Samantha; Young, Richard; Hendrix, Noah; Espinoza, Anna; Xiao, YanBackground: Type 2 diabetic hemoglobin (HbA1c) A1c testing decreased substantially during the coronavirus (COVID-19) pandemic, resulting in gaps in care. Low socioeconomic populations may be affected in care received during the COVID-19 pandemic. The pandemic may have further amplified health disparities, such as inadequate HbA1c testing, and decreased resource availability, ultimately leading to potential health decline. The purpose of this study was to identify race/ethnicity predictors of gaps in care for HbA1c testing during the COVID-19 pandemic among patients with type 2 diabetes (T2DM). Methods: This study included analysis of electronic health records from patients with T2DM at two healthcare systems (John Peter Smith Health Network and UNT Health). Times between HbA1c testing were compared pre COVID (March 1, 2019 – March 1, 2020) and during COVID (March 2, 2020 – March 1, 2021). Established patients (with two or more visits) at the two systems during the pre COVID period and at least one visit during the COVID period were included for analysis. Variables for analysis were selected using the Anderson Social Behavioral Model to assess the impact predisposing, enabling, and need factors had on gaps in HbA1c testing among different racial/ethnic groups during COVID-19. Data were analyzed using multilevel clustered survival models. Analyses were stratified by race/ethnicity (non-Hispanic White, non-Hispanic Black American, Hispanic, and other). Age, sex, BMI, visit modality (telemedicine or in-person), taking insulin (yes, no), at least one HbA1c above 8%, hypertension (yes, no), anxiety (yes, no), lipid metabolism disorder (yes, no), and private insurance (yes, no) were included in the models. Comparisons were made using multilevel clustered survival models to assess trends that occurred and the impact variables had in care gaps in type 2 diabetic patients during the COVID-19 pandemic. Results: A total of 2,951 patients were included. Patients with HbA1c >8% pre-COVID had larger HbA1c testing gap times during COVID-19 for all race/ethnicities, compared with those with HbA1c <=8%. Larger testing gaps among patients with diabetic medications (oral and injectables) during COVID-19 were identified in Non-Hispanic Black Americans (p=0.02) and Hispanics (p=0.01), compared to those without diabetic medications. Men experienced larger gap times in HbA1c assessments compared to females among non-Hispanic Black Americans. Having at least one telemedicine appointment was associated with a decreased gap time among Hispanics. Conclusions: Research demonstrates a reduction in access to care for underrepresented populations due to COVID. Patients with diabetic medications (excluding insulin) experienced decreased HbA1c assessments, potentially resulting in worsened health. Inconsistent chronic disease management is associated with increased risk of all-cause mortality. Implementation of telemedicine and increased HbA1c testing is known to correlate with positive health overall.Item PARENT'S PERCEPTIONS OF NEIGHBORHOOD SAFETY AND RISK OF TYPE 2 DIABETES IN MEXICAN AMERICAN CHILDREN AND ADOLESCENTS(2014-03) Ramirez, Roberto C.; Fulda, Kimberly; Lee, Michelle; Proffitt Leyva, Randi; Franks, Susan; Espinoza, AnnaWe conducted a study with Mexican American children and their parents and found that having playgrounds in the child's neighborhood lowers the risk of having type 2 diabetes. Purpose (a): The number of people suffering from type 2 diabetes (2 DM) has increased drastically over the last 30 years, especially in children under the age of 18. Specifically, Mexican American children have been diagnosed at alarming rates. Inactivity in children has contributed to these high rates of diabetes, but there is not sufficient information on factors that contribute to this inactivity. The purpose of this study was to explore parent’s perceptions of the features in their neighborhoods and its safety as it relates to their child being at risk of developing 2 DM. Methods (b): 144 Mexican American participants, ages 10-14 were enrolled in this study which included one visit that lasted approximately two hours. The primary caregiver was asked via a survey to assess the features and safety of the neighborhood in which the child participant lives. A set of measurements and family history were taken on each participant. “High-risk” status was assigned if participants had ≥3 of the following risk factors: BMI ≥95 percentile, high blood glucose, presence of Acanthosis Nigricans, family history of 2 DM in a 1st or 2nd degree relative, and history of hypertension or blood pressure ≥95th percentile. Simple and multiple logistic regressions were performed with high risk status for 2 DM as the outcome variable and neighborhood safety, presence of sidewalks and playgrounds in neighborhoods as the primary predictors. The adjusted model controlled for child’s age, gender, highest education level of household and household income. Results (c): Adjusted analyses illustrate that the presence of playgrounds in the respondent’s neighborhoods presented a 76% decreased odds of being at risk for 2 DM [OR: 0.24; 95% CI (0.06-0.86)]. The parent’s perceptions of neighborhood safety and the presence of sidewalks were not significant findings. In secondary findings, participants who responded that Spanish was the primary language spoken in the home had 79% decreased odds of being at risk for 2 DM [OR: 0.21; 95% CI (0.11-1.35)]. Conclusions (d): Potential policy implications resulting from the analysis of the study point to an increase in potential support for the establishment of playgrounds in areas that are deprived of such elements.Item Parent’s Perception of Adolescents Health in Association with Child Reported Depression among Mexican American Children 10-14 Years of Age(2018-03-14) Espinoza, Anna; Fulda, Kimberly; Franks, Susan; Muzaffar, OmairPurpose: Depression in children is frequent and represents a challenge to be recognized by both the family and the primary care physician. Many parents are unaware of their child’s depression and may not recognize the symptoms, and primary care physicians do not routinely screen for depression in children. Providing a connection between the family, physician, and child to recognize depression is important. The purpose of this study was to examine the association between parent’s perception of their child’s health and child reported depression among Mexican American children 10-14 years of age. Methods: One hundred and forty-four Mexican American children ages 10-14 and a parent/legal guardian participated in a cross-sectional study. Child participants completed depression screening using the child report Children’s Depression Inventory (CDI 2: Self-Report Short Version). Regression analyses were performed. Unadjusted and adjusted odds ratios and 95% confidence intervals were computed. The dependent variable was child report depression screening (average/lower and high average/elevated/very elevated), and the primary independent variable was parent reported perception of the child’s health (fair/poor or good/very good/excellent). The adjusted model controlled for family income, marital status of primary care giver, highest grade completed by anyone in the household, child age, and child gender. Results: There were 74 (51.4%) male children, and the mean age was 11.97 (sd=1.45). Thirty (20.80%) of children screened high for depression, and parents reported fair/poor health for 11 (7.6%) of children. Children were more likely to screen high for depression if their parents reported their health as fair/poor [OR=11.85, (95% CI:2.65-53.05)] or if they were female [OR=3.58, (95% CI:1.37-9.35)] in the adjusted model. Conclusion: Parents perception of their child’s health is associated with child self screening high for depression. Including a simple question about how a parent rates their child’s health could provide clinical utility for primary care physicians.Item Patient Perspectives Unveiled: An Analysis of Common Questions and Concerns to Empower Informed Healthcare Dialogues with Elderly Patients Taking Multiple Medications(2024-03-21) Schneider, Clara; Lal, Kevin; Espinoza, Anna; Xiao, Yan; Hendrix, Noah; Young, Richard; Fulda, KimberlyPurpose: Health literacy is often a barrier to patient understanding and effective communication with healthcare providers. Patients are often unaware of what questions to ask during their visits and leave their provider offices without fully understanding their conditions or medication regimens. Past studies have shown that facilitating patient dialogue through structured questions during the encounter results in fewer patient callbacks and improved comprehension. The goal of this study was to identify the most common questions and concerns that patients 50 years and older who are on five or more medications would like to discuss with their physicians about their medications. Such data could help physicians anticipate and educate patients with information most valuable to them during office visits. Methods: We designed a 20-question survey to better understand what patients desired from their primary care visit including questions to ask, concerns to tell, and positive behaviors to report to their provider. We focused on the ask and tell sections which involved presenting questions or concerns that were pertinent to the patient's conditions or medications. Participants included patients at family medicine clinics from a county hospital system (240) and a private practice (211) in Fort Worth who were 50 years of age or older and taking five or more medications. Surveys were administered at a clinical visit by the medical assistant before the physician/patient encounter. Descriptive statistics are provided. Results: Out of 451 surveys completed, the questions that patients were most interested in talking with their physician included: 1) What should I eat, and what should I not eat for my condition? (20.4%) 2) Can I take fewer medicines than I am taking? (15.3%) 3)How do I learn more about my condition? (14.6%) The least common questions were 1) Why do I need several medications for my condition? (8.2%) 2) Other questions: (8.6%) 3) How can I stop my blood sugar, heart rate, or blood pressure from getting too low? (9.1%) The most common concerns about their medications were: 1) I stopped or skipped these medicines, due to: cost, side effects, or other reasons (11.1%) 2) I have new medicines from other doctors (offices, hospitals or emergency rooms) (8%) 3) I have concerns with my medicines (examples: cost, hard to read, not helping much) (5.7%) Conclusions: It is evident that patients are interested in learning about their conditions and making appropriate lifestyle changes. The most commonly raised concerns were related to medication access, polypharmacy, and efficacy. These data show some of the potential topics patients want to discuss with their providers. The most common topics from this study can be implemented into a question prompt lists (QPL [https://onlinelibrary.wiley.com/doi/abs/10.1111/ecc.12489?casa_token=kGVvFBSWANEAAAAA:NOhQ46f92KtdNp9XgslcAiwEoB6MI0N4K1vOA2P7FyFQ_BBgv0BycKPBy4sLKk_e9Cki971trjdfoL1k]) specific to medications and chronic disease management. Providers could give lists to patients to review while waiting for care. Having these topics beforehand would help the patients be prepared when presented with “what questions do you have?”; thus, revealing the patient's perspective and helping to increase their health literacy.Item Preconception Care and Reproductive Life Planning: Engaging Primary Care Providers(2016-03-23) Fulda, Kimberly; Raines-Milenkov, Amy DrPH; Lee, Michelle; Wilder, Misty; Zhang, Julia; Salyer-Caldwell, Ann; Espinoza, AnnaPurpose: In the United States, about 51% of pregnancies are unplanned (Guttmacher Institute, 2015). Preconception care (PCC) provides patients with the resources and knowledge to prepare for pregnancy and improve birth outcomes. By utilizing PCC, physicians can advise patients on numerous behavioral and lifestyle changes to help prevent complications from occurring. The usage of preconception care is a strong candidate to decrease the amount of unplanned pregnancies for women in their child bearing years. The objective of this project is to identify primary care providers educational and behavioral needs in preconception care screening practice. Materials and Methods: Participants were recruited from NorTex members “by-invitation only” recruitment. The preconception care surveys were administered on-line via email to clinicians, including primary care providers, pediatricians, OB-GYNs, nurse practitioners, and physician assistants to assess the essential role of clinicians in reproductive life planning. The survey contains approximately 12 questions and takes approximately 10 minutes to complete. The on-line responses were exported in a database and analyzed using Excel. Results: Of the 500 expected surveys, 149 have been completed of by family practice physicians (28%), OB/GYNs (10%), pediatricians (2%), physician assistants (5%), nurse practitioners (22%), and nurses (33%). Survey results revealed providers’ obstacles to providing reproductive life planning in their practice included factors such as lack of time with patients (37%) and inadequate/ insufficient information (brochures, posters, flyers, etc.) to provide to the patient (31%). Additionally, providers indicated the need of educational materials on Reproductive Life Planning (57%) and believed inclusion of Reproductive Life Planning questions into the EMR (47%) would help implement Reproductive Life Planning in their practice. Of the participating providers, 83% were unaware of the Texas Department of State Health Services “Someday Starts Now” public awareness campaign. Conclusions: Integrating preconception health into routine primary care encounters with patients of reproductive age should be a significant driver in the reduction of infant mortality rates and increase in healthy families. Future studies should investigate PCC’s integration into providers’ care with the most effect tool, educational material or inclusion of Reproductive Life Planning questions into the EMR.Item Sleep Duration and Social Determinants of Health Predict Osteoporosis in Adults 50 Years of Age and Older After Controlling for Vitamin D, Demographic Characteristics, and Physical Activity.(2023) Campbell, Blake; Fulda, Kimberly; Zhang, Fan; Webb, Brian; Espinoza, Anna; Navid, DanielPurpose: Osteoporosis is a bone disease that develops when bone density and mass decreases, or when the quality or structure of bone changes. There are many causes of osteoporosis, with some etiologies being more understood than others. Prevention is critical in the treatment of osteoporosis, due to its serious complications, including life altering hip and spine fractures. Despite prevention and treatment, osteoporosis in most cases is inevitable, but the onset and severity is what can be helped. Finding other ways to slow or even prevent osteoporosis is an active area of study, with sleep being one of the many variables of interest due to its role in homeostasis. The literature demonstrates contradictory findings for the relationship between sleep and osteoporosis. Many of the studies lack a recent and/or big enough sample size, and there is a need for further research on the subject. Additionally, recent literature has not included variables representative of social determinants of health, such as income and education. The purpose of this study was to further investigate the association that between sleep and osteoporosis in individuals 50 and older using the NHANES Database while controlling for potential covariates such as social determinants of health. Methods: Data from the National Health and Nutrition Examination Survey (NHANES), 2017-2020 were analyzed to determine the association between sleep duration and osteoporosis in adults 50 and older. Multivariate logistic regression was performed controlling for race/ethnicity, age (≥50 years), gender, highest household education, physical activity, poverty, vitamin D, and BMI. Analyses were considered statistically significant at p<0.05. Results: Analyses included 4963 adults over the age of 50, with 51% (2507) being female. A total of 12.3% (611) of the cohort had a diagnosis of osteoporosis, with 87% of the osteoporotic group being female (530). Mean age was 65.2 years (sd=9.3) for the total sample, 64.5 (sd=9.2) for non-osteoporotic individuals, and 70.0 (sd=8.8) for osteoporotic individuals. In the adjusted analyses, we found no statistically significant association between sleep duration and osteoporosis. There is a statistically significant association between family monthly poverty level and osteoporosis ([OR:0.93; 95%CI(0.87-0.99) p=0.047]. BMI, Age, and Gender were also significantly associated with osteoporosis. Other social determinants of health such as race, physical activity, and education were not statistically significant. Vitamin D was also not associated with osteoporosis. Conclusion: The purpose of this study was to further investigate the association between sleep and osteoporosis in individuals 50 and older while controlling for covariates, particularly social determinants of health. We looked at specifically sleep duration, and a previous diagnosis of osteoporosis. We theorized that lower sleep durations may have an association with osteoporosis; however, our results did not support this. The association between family poverty index and osteoporosis highlights the importance of exploring socioeconomic differences in sleep and osteoporosis research in the future, respectively. Finally, this study is limited by a lack of a quantitative measure of osteoporosis. Future work with additional socioeconomic variables and more consistent data collecting modalities should shed more light on the subjectItem The association between prescribing patterns and type of primary care visit among older adults with polypharmacy: a cross-sectional study(2022) Villanueva, Elias Arellano; Xiao, Yan; Espinoza, Anna; Muzaffar, Omair; Hendrix, NoahBackground: Primary health care has been vitally disrupted by the COVID-19 crisis. Changes in primary care delivery in COVID-19 present an opportunity to study how patients and primary care professionals have adapted to the crisis. With the wide adoption of telehealth modalities, understanding changes in prescribing practices among elderly patients could serve to reduce adverse drug events. With the ongoing adoption of telehealth services, there are concerns about the potential of inappropriate prescribing practices. Moreover, older adults who take more medications and require more monitoring than all other age groups could be disproportionately impacted by policies enacted to limit the spread of SARS-Cov-2. The complex care requirements of elderly patients with multimorbidity's heightened health care strains due to COVID-19, and medication errors can have significant negative health consequences on elderly patients. In this cross-sectional study, we looked for associations between prescribing practices and visit modality for adults with polypharmacy within primary care. Methods: Through post-visit surveys, we interviewed a total of 64 low-acuity patients ≥ 50 who were on more than 5 medications and were attended by a provider within the Family Medicine Clinic at HSC Health Clinic between June 2021 and August 2021. Of the 64 patients, that were interviewed, 32 had an in-person visit and 32 had telehealth visits with their providers. The providers were also asked to complete a survey about their visit with the patient and the types of changes that were made during the consult. We looked for an association between the visit modality type and prescription changes through the following question: "Did the total number of medicines or supplements change as a result of this visit" from the surveys provided by the providers. Logistic regression was used to look at the association between prescription changes & visit modality while controlling for age and gender. Results: Of the 64 patients that completed the survey, age (M = 66.66 years, SD = 9.57 years), gender included Female (n=50) and Male (n=14). Data for this study included adults who self-reported as White (n=43), Black or African American (n=19), Prefer not to Answer (n=1) and Unknown or not Listed (n=1). The association between prescription changes and visit modality was found to be non-significant (odds ratio [OR] .1.140; 95% confidence interval [CI] .417-3.115). This finding did not change even while adjusting for gender and age (adjusted odds ratio [OR] .820; 95% confidence interval [CI] .384-3.35). Conclusions: Prescription changes were similar between in-person visits and telehealth visits for adults ≥ 50 years who were on ≥ 5 medications while adjusting for gender and age. If differences between visit modality and prescribing changes were to be found other factors should be investigated. Given the need to reduce medication errors among older adults, providers can provide accessibility options through different visit modalities while ensuring consistency in medication changes.