Browsing by Author "Raines-Milenkov, Amy"
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Item Addressing Substance Abuse During the Pregnancy and Postpartum Period(2020) Raines-Milenkov, Amy; Fadeyi, Oluwatosin; Davis, Ambriale; Ghosh, Shanalyn; Le, ChristinePurpose: The purpose of this study is to identify the best practices to combat substance abuse in both the pregnancy and postpartum period. Methods: The research was conducted using a web-based search of peer-reviewed journal articles and state reports. Results: Our results demonstrate that there is a need for increased drug abuse screening during both the antepartum and postpartum period. Because opioids are a major contributor to maternal death, providers need to administer a tailored plan of care for pain relief to ensure the necessity of prescription painkillers. The Wisconsin Drug Monitoring Program saw a 7% decrease in opioid prescriptions from cesarean delivery and 6% decrease from vaginal delivery through effective monitoring prior to discharge. From 2012 to 2015, drug overdose accounted for 17% of all maternal deaths between the time of delivery and one-year postpartum in Texas. Conclusion: Although many states have taken initiatives to combat the growing rate of maternal mortality, research and interventions that addresses the role of substance abuse is still minute. California's maternal mortality rate tremendously decreased as a result of healthcare recommendations from their Pregnancy-Associated Mortality Review, but drug overdose still ranks as the second leading cause of maternal deaths from pregnancy to one-year postpartum. This underscores the necessity for increased awareness of how substance abuse can affect mothers one-year past delivery in both outpatient and hospital-settings.Item Benefits of a Pediatric Home Visitation Program Involving TCOM Students(2017-03-14) Raines-Milenkov, Amy; Bowman, Paul; Shah, Deep; Calder, BrittanyBackground: Home visitation programs increase child development, access to healthcare, and attendance at well child visits as well as decrease accidental injuries. By focusing on maternal and child health, there is the opportunity to prevent disease development, improve overall health, and decrease infant mortality. Including medical students in home visitation has the potential to build relationships and understanding that increases quality of care and learning. The purpose of this project was to assess the feasibility and benefits of incorporating Texas College of Osteopathic Medical (TCOM) students into an existing UNT Health Science Center home visitation program. Methods: To assess the feasibility of this type of model at UNTHSC, a literature review of home visitation programs that involve medical students was conducted. Additionally, an interview and review of similar UNTHSC programs were conducted. Results: The literature revealed several benefits for student learning. For example, medical students found that many of their misconceptions about their patients and their care were corrected by visiting the patient's home. Additionally, students felt they could provide better care after seeing the environments where their patients lived. The experience also helped the students view the patient as a person not just their disease and increased humanism in their care. Conclusions: The literature suggests incorporating medical students into home visitation programs has benefits for the medical students and their future practice. UNTHSC has existing assets that could foster this type of educational experience. For example, the Healthy Start Program is a home visitation program with the intention of improving maternal and infant health. This program would be the backbone for a program involving medical students. Additionally, TCOM has a geriatric home visitation program whose logistics and curriculum could be used as a layout for a similar pediatric based program. A logic model detailing a sample pilot project will be presented. By building from established programs, instituting a pediatric home visitation program involving TCOM students could improve the quality of the medical students’ education while embracing the osteopathic model and providing service to the community. However, more research is needed to understand the program participant’s perspectives and acceptability of receiving services from medical students.Item Cervical Cancer Screening Among Refugee Populations in Tarrant County(2015-03) Liang, Lai Y.; Raines-Milenkov, Amy; Qualls-Hampton, Raquel Y.; Baker, EvaCervical cancer is the second most common cause of cancer mortality among women, with most cancer deaths among women of developing countries. It is also the most easily preventable cancer in women. This study evaluates cervical cancer screening practices among several refugee populations in Tarrant County: Burmese, Bhutanese, Somalian, and Congolese. Many factors influence participation in cervical cancer screening among refugee women. Such factors include knowledge about cervical cancer, cultural beliefs, financial concerns, access to health care, physician characteristics, and time in the United States. The study aimed to investigate the impact of time in the United States on cervical cancer screening. Data for this study were obtained from a project called the Building Bridges Initiative. As part of this program, trained refugee Lay Health Educators reached out to refugee women in their communities with education and assistance in receiving cervical, breast, and Hepatitis B screenings. The Lay Health Educators consented and interviewed women who met the inclusion criteria during the baseline assessment. For the purposes of this study, the following baseline questions were examined: “Have you had a Pap test?” and “What was the date of your last Pap test?” in addition to demographic information and time of arrival in the United States. The association of arrival in the United States and screening, as well as qualitative data from comments shared during the group education sessions are presented to illustrate barriers to screening. Rates of cervical cancer screening among refugee populations are far below that of the recommended rate in the United States as outlined by Healthy People 2020. Therefore, refugee populations in the Unites States, especially when resettling from countries with a high incidence of cervical cancer, are in need of culturally and linguistically tailored cancer education prevention and intervention programs.Item Colorectal Cancer Knowledge and Screening Habits among Refugee Populations in DFW(2017-03-14) Raines-Milenkov, Amy; Baker, Eva; Subedi, Radhika; Thein, Emelda; Qureshi, Iram; Kwentua, VictoriaPurpose: Colorectal cancer (CRC) is the fourth most common cancer worldwide. Although resources are available to screen for and to treat CRC, refugees living in the United States report low levels of screening. Over the past several years, Texas has resettled the largest numbers of refugees, yet little research has investigated the need for colorectal cancer screening in refugee populations. This study aimed to assess local refugees’ current knowledge of and experience with colon/rectal cancer and screening. This information is needed to guide effective CRC education and screening efforts among this underserved population. Methods: Refugees, previously enrolled in a community-based refugee health program, the Building Bridges Initiative (BBI), were contacted by bilingual lay health educators to complete a 23-question phone interview on their familiarity with CRC. The survey was translated into Nepali and Karen by a professional translator, and included detailed descriptions of colon cancer and available screening methods. Descriptive statistics were compiled using statistical analysis software. Results: Twenty-nine of the 43 eligible participants (ages 50-75) agreed to participate. 72% of participants were unaware of colon cancer, and 97% wanted more education on the subject. Familiarity with the screening process and physician recommendation were strong motivators to complete a CRC screening. Conclusions: Local refugee populations are receptive to CRC screening. Programs such as BBI have the structure in place to provide culturally and linguistically appropriate education and tailored evidence-based interventions, which are necessary to reduce health disparities when it comes to CRC screening.Item Exploring how Age of Mothers Influence Maternal Practices among NICU Infants(2015-03) Gil, Maty; Shah, Deep; Raines-Milenkov, Amy; Bowman, W. PaulPurpose: Infants placed in the neonatal intensive care unit (NICU) after births have a greater risk of Sudden Infant Death Syndrome (SIDS), infections, and impaired cognitive skills compared to fully term infants. In the NICU, mothers are encouraged to practice safe sleep environments and breastfeed. Mother’s choice in adopting breastfeeding and safer sleep positions may be influenced by their level of brain maturity and infant’s health. At the age of 25, the brain fully matures, which promotes less risky behavior and more timely decisions. We are interested in learning how maternal practices such as breastfeeding and baby's sleep positions are influenced in two age groups of mothers (18-24 and 25-40) among NICU infants. Methods: In-person surveys were administered by research personnel to mothers 18 years or older with infants aged 2 weeks to 3 months during their UNTHSC-Pediatric Outpatient Clinic visits. The surveys asked questions about demographics, perinatal history, breastfeeding and other feeding practices, sleep position, and sleep locations, and exposure to smoking. IBM SPSS Statistics 21 software was used for double-data entry and statistical reporting. Results: Selected results reported here include factors related to breastfeeding and sleep position. Of all mothers (103) surveyed, 21 had infants placed in a NICU after birth. Among all NICU infants, 10 infants had younger mothers (18-24 years) and 11 had middle-aged (25-40) mothers. All of the mothers had breastfed or pumped breast milk for a short period of time, but currently only 60% of younger mothers and 64% of middle-aged mothers were breastfeeding. Among all, 7 out of 10 younger mothers and 9 out of 11 middle-aged mothers placed baby on back position to sleep. Conclusions: Compared to those under age 25, middle-aged mothers with a NICU infant did not show a significant increase in adopting healthy maternal practices such as breastfeeding and safe sleep position. The lower incidence of breastfeeding might related to the challenges that parents with preterm infants face such as milk productions, latching problems, etc. Understanding the reasons why mothers are not choosing to adopt more healthy maternal practices is very important. Clinicians and researchers need to examine the reasons mothers are discontinuing breastfeeding and implement new strategies to promote longer breastfeeding.Item Factors affecting awareness of Hepatitis B status among Bhutanese, Karen, Somali, and Central African Refugee populations in Tarrant County: Building Bridges Initiative (BBI)(2016-03-23) Felini, Martha; Raines-Milenkov, Amy; Baker, Eva; Okaalet, JennyBackground: Hepatitis B Virus is reported to be the leading cause of liver cancer in the United States, and 90% are foreign born. The CDC recommends HBV screening for newly arrived refugees who have lived in countries with a high prevalence of chronic HBV infection. Nearly 14,000 refugees resettled in Texas in 2014. Currently, limited data is available on refugee awareness of HBV. This study aims to investigate what factors influence their awareness of HBV status. Methods: Four community health workers conducted outreach and baseline assessments in their respective communities (i.e. Bhutanese, Burmese, Somali and Central African). Means, t-tests, and chi-square tests evaluated the influence of time in the US, education, and group on awareness of self-reported Hepatitis B status at baseline. Results: Approximately 350 women have participated in BBI. 60% had heard of hepatitis B. Only 26% were aware of their Hepatitis B status. The bivariate analysis showed nearly half of the central African women were aware for their HBV status (47.3%) in comparison with Somali (30.8%), Burmese (18.7%), Bhutan (3.3%). On average, participants lived in the US for approximately 5 years. Education and region were not significantly associated with awareness of HBV status. Conclusion: Majority (74%) of refugees are unaware of their Hepatitis B status. Time in the U.S., nor formal education influence HBV status awareness. However, awareness between regions shows that the differences within ethnic groups (traditions, health care beliefs) need to be considered. Refugee populations remain in need of culturally and linguistically appropriate cancer prevention programs.Item Human Papillomavirus (HPV) and Oropharyngeal Cancer in the LGBT Population(2020) Raines-Milenkov, Amy; Bui, Priya; Fulda, Kimberly; Thompson, Erika; Fernando, Shane; Felini, Martha; Aziz, HadiaPurpose: In 2015, HPV-positive oropharyngeal squamous cell carcinoma (oropharyngeal SCC) became the most prevalent HPV-associated cancer in the United States. Oral HPV infection disproportionately affects gay and bisexual males, with men who have sex with men almost twice as likely to have a high-risk oral HPV infection than men with predominantly female sex partners. Despite the rise of HPV-positive oropharyngeal SCC, the rate of HPV vaccination among male adolescents in Texas lags behind the national rate of vaccine uptake. This review examines the barriers to vaccination uptake in gay and bisexual males. Methods: The databases used for this review were PubMed Central, UpToDate, and the Center for Disease Control. Key words searched included HPV rates in LGBT, HPV Oropharyngeal cancer, HPV vaccine barriers, and HPV vaccination rates in LGBT. Results: Three main barriers to vaccination were identified in the LGBT population. These barriers included lack of recommendation from a healthcare provider, lack of funding for new age of majority individuals, and outdated marketing strategies. Conclusion: The most important factor that determines whether a LGBT adolescent receives the HPV vaccine is a recommendation from a healthcare provider. Additionally, when the HPV vaccine is marketed as preventing anal, penile, and oral cancer in males versus just preventing genital warts, the intent of an LGBT patient to initiate the vaccination series is greater. Further research should be done to determine which educational methods and marketing materials used by a healthcare provider impact a patient's decision to vaccinate most significantly.Item Identifying Stigmatizing Language in Maternal Mortality Medical Health Records(2024-03-21) Gi, Ashley; Raines-Milenkov, AmyIssue: This presentation endeavors to comprehensively address the ever-growing issue of stigmatizing language within medical health records, particularly in regards to maternal mortality. Maternal mortality remains a pressing health concern, with stark disparities persisting among different demographic groups. There is a notable gap in the identification of bias and disparities within medical records, with stigmatizing language being one manifestation of this bias. Stigmatizing language in medical records perpetuates harmful stereotypes, undermines patient trust, exacerbates disparities, and hinders equitable care delivery. This review focuses on the Maternal Mortality Case Preparation process which involves a systematic review of maternal death cases to identify contributing factors in hopes of reducing maternal mortality rates. Setting: The objective is to equip maternal mortality abstractors with the necessary resources to identify and abstract stigmatizing language present in maternal death medical records, fostering a more accurate and unbiased documentation process. Project: Efforts were directed towards refining a specialized tool to primarily assist Maternal Mortality Case abstractors and MMMRC Reviewers in identifying bias and stigmatizing language within medical records. The tool helps abstractors and Reviewers identify instances of discrimination within medical records that may have contributed to maternal death, ensuring a comprehensive approach to mitigating biases and promoting equitable maternal healthcare. Additionally, an accompanying PowerPoint presentation was developed to raise awareness about the harmful impact of stigmatizing language and provide guidance on alternative language usage to promote inclusivity and sensitivity in medical documentation. Results: Through a comprehensive literature review, common forms of stigmatizing language prevalent in medical health records have been identified. These include the use of quotations, which may inadvertently portray certain patient attributes or conditions in a derogatory manner. Moreover, language that utilizes doubt markers and judgemental language indicates a lack of trust or skepticism towards the patient's reported experiences or medical history. Lastly, blaming patients by using disapproving language not only perpetuates negative stereotypes but also undermines patient autonomy and dignity. By recognizing and categorizing these common forms of stigmatizing language, healthcare professionals can become more aware of their inadvertent biases and strive towards promoting more respectful and patient-centered communication within medical documentation. Conclusion: The development and refinement of this tool and educational resource represent significant progress in addressing stigmatizing language within medical health records. By raising awareness on the harmful implications of stigmatizing language, we can work towards improving the quality of care provided and reducing disparities in maternal health outcomes. Furthermore, the lessons learned from this initiative emphasize the broader significance for promoting equity and inclusivity within healthcare systems, underscoring the importance of addressing bias and discrimination in medical documentation across all healthcare specialties. Through continued research, education, and advocacy efforts, we can strive towards a healthcare system that is truly inclusive, equitable, and respectful of all patients' diverse backgrounds and experiences.Item Postnatal Education through a Health Literacy Lens(2020) Wagner, Teresa; Thompson, Erika; Raines-Milenkov, Amy; Stark, Marie; Bush, Kim; Gadson, AmberPurpose: Globally, approximately 830 women die every day from preventable causes related to pregnancy and childbirth. Few studies have looked at the effect of health literacy on maternal morbidity and mortality. The purpose of this study was to examine health literacy of postpartum education from the perspective of new moms using the Integrated Model of Health Literacy (Sorensen, 2012). Methods: This study assessed readability, understandability and cultural sensitivity of postnatal information. We measured the ability of postpartum mothers to access, understand, appraise and apply postnatal care instructions at home through semi-structured, one-on-one interviews analyzed using qualitative methods. Results: Gaps were identified in the Access domain due to a lack of consistency and comprehensiveness of the information provided to new moms. Gaps represented reports of too much information, lack of time to read and lack of cultural sensitivity of postnatal education particularly in regard to postpartum depression. Conclusion: Findings suggest a need for standardized, concise, health literate and culturally sensitive postpartum education and materials to assist new moms in identifying postpartum warning-signs, take appropriate action and help reduce maternal morbidity and mortality.Item Pregnancy Outcomes Among Women in Substance Abuse Treatment(2015-03) Felini, Martha; Raines-Milenkov, Amy; Alexander, Brian; Ukpaka, Kelechi; Bangara, Saritha; Igenoza, Oluwatosin; Jegede, Opeyemi; Anderson, Ralph; Qualls-Hampton, RaquelPurpose Pregnancy outcomes are powerfully influenced by what occurs long before pregnancy begins. Providing preconception care is a critical component to decreasing rates of adverse pregnancy and birth outcomes, as reflected in the Healthy People 2020 objectives. To help promote progress on these objectives, improvements in birth outcomes must be made in our highest risk and most disparate populations. Using self-reported reproductive history data from an ongoing cervical cancer prevention services project delivered to substance abusing women in treatment, we examined the reproductive history and frequency of pregnancy outcomes. Further analysis explored whether previous trauma and risky sexual activity were associated with adverse pregnancy outcomes. Methods Study participants included women aged ≥18 years attending our cancer prevention education seminars at Nexus Recovery Center – the largest female only substance abuse recovery center in DFW. Demographics, past trauma, risky sexual activity, and birth histories (preterm births, miscarriages, abortions, number of children) were collected using self-administered questionnaires. Chi-square tests were used to assess differences between birth outcomes, trauma, and risky sexual activity. Results A total of 286 women with a median age of 32 years were included in this study. The majority of women were white (68%). Two-thirds reported histories of physical abuse, 50% reported sexual abuse, and 42% sold sex for drugs. Nearly nine out of 10 women reported previously being pregnant. A total of 809 pregnancies were observed among 237 pregnant women. Among pregnancies reported, 506 (63%) ended with childbirth (437 full term delivery, 69 preterm delivery), 123 (15%) with miscarriage, 148 (18%) with abortion, while the outcome was unknown for 32 (4%). Pre-term births were higher among women with histories of physical abuse (p=0.02) and more miscarriages were reported among victims of sexual abuse (p=0.02). No differences in poor birth outcomes were observed with high risk sexual activity. Conclusion Our findings suggest adverse pregnancy outcomes are high for substance abusing women in treatment compared to the general population. An exceptional window of opportunity exists to integrate preconception care interventions within treatment recovery centers, but the key challenge will be determining the best delivery mechanism within the context of significant trauma histories.Item Prevalence of Infant Bed-sharing in Breastfeeding Mothers(2015-03) Slaymaker, Kristen N.; Shah, Deep; Bowman, W. Paul; Raines-Milenkov, AmyPurpose: Research has shown that bed-sharing is a risk factor for SIDS and infant suffocation, two of the leading causes of infant mortality. Several studies have shown a strong relationship between breastfeeding and bed-sharing. Almost all mothers who continue to breastfeed for more than eight weeks incorporate bed-sharing into their nocturnal feeding and sleep routine early in infant’s life for minimal disruption of night-time breastfeeding. The intent of the research is to analyze infant care practices and parent beliefs. The information gained will help identify trends in breastfeeding, infant sleep location, and parents’ reasoning behind these practices. We are interested in finding out if breastfeeding is associated with a mother’s reasoning behind choosing her infant’s sleep location among Hispanic mothers. Methods: Study design consisted of surveying mothers ≥ 18 years who had an infant between ages of 2 weeks and 3 months visiting UNTHSC Pediatric Outpatient Clinic. Survey questionnaire inquired about demographics, breastfeeding and infant sleep routine. Results: Out of 103 mothers surveyed, 45% were of Hispanic origin. Among Hispanic mothers, 50% were currently breastfeeding or feeding pumped milk. Out of all Hispanic mothers responded, 44% reported baby sleeps in mother’s bed at some point in the night. When all breastfeeding mothers (55) were asked to select reason for choosing infant’s sleep location, 17 mothers selected that it was easier to feed their baby and 32 mothers selected it seems safer for baby. Conclusion: Results showed a significant association between breastfeeding and selecting sleep location due to ease of feeding (P-value < 0.05), but did not find an association between breastfeeding and sleeping in mother’s bed at night. Although Hispanic mothers were slightly less likely to breastfeed and slightly more likely to bed-share at night than non-Hispanic mothers, these relationships did not prove significant.Item Preventative Health Screenings in the Cambodian Community(2019-03-05) Raines-Milenkov, Amy; Chor, HolyPurpose: This research explores the knowledge and receipt of preventive health screenings among Cambodian immigrants in the United States. Cambodians entered the United States as refugees after a group of Communists named Khmer Rouge proceeded to rule the country with extraordinary brutality. An estimated 1.7 million Cambodian people died from executions, hunger, disease, injuries, and coerced labor, and exposure to elements. Cambodian immigrants face poverty, limited education, and health disparities in cardiovascular disease, diabetes, related risk factors, and mental health, including post-traumatic stress disorder and depression, which influence their ability to practice prevention and obtain treatment. Identification of the preventative health practices of this community may help healthcare providers better understand the needs of Cambodian immigrant and refugee populations in the United States. Methods: Surveys that assessed demographic, health insurance, health seeking behaviors, trauma, tobacco and smoking, alcohol use, cancer screening history and vaccinations, health education interest, and women’s health were collected from Cambodian men and women who are the age 21 and above. 49 surveys were completed from participants at faith-based gatherings, and other community events within the Dallas-Fort Worth area. Results: Along with other data, the results revealed that about 67% of individuals have had frightening experiences in their lives during which their personal safety or someone else’s safety was threatened, 32% of participants did not know their Hepatitis B status, and 6% have a positive Hepatitis B status. Moreover, 92% of participants indicated interest in participating in a program offered in Khmer that educates them about preventative health screenings. Limitations do exist because this focus group has a small sample size and is not representative of all Cambodian immigrant and refugee communities in the United States. However, themes have matched existing literature. Conclusions: Screening rates in this population near or exceed Healthy People 2020 Goals for screening (HP 2020: Colonoscopy 70.5%, Pap test 93%, mammogram 81.1%). However, Hepatitis B vaccination and knowledge could be improved. Providing culturally tailored education on Hepatitis B, vaccinations, and mental health could lead to increased cancer screening uptake, vaccination completion, and mental health awareness among this population.Item Preventive Health Screenings in High Risk Populations: The Case of a HIV Positive Refugee Woman(2016-03-23) Raines-Milenkov, Amy; Lopez, Tania; Wurie, Neneh; Anderson, Ralph; Okaalet, JennyBackground: Women infected with HIV are 5.4 times more likely to be diagnosed with cervical cancer than women without HIV. It is recommended that women with HIV have a pap test at the time of HIV diagnosis and every three years after 3 consecutive Pap tests are normal. This case study will describe the chronology of key events from resettlement in the U.S. to a high grade abnormal PAP test result in an HIV positive refugee woman. Building Bridges Initiative (BBI) is a cancer education and screening program for refugee women at the UNT Health Science Center and CPRIT. The program trains and employs lay health educators from refugee communities to provide culturally and linguistically appropriate outreach, education and navigation services. Methods: A review of existing medical records, BBI case files, and medical case management (MCM) files explored multilevel factors associated with missed opportunities for pap screenings and education. Data was collected on cancer knowledge and PAP test awareness from self-reported baseline assessments. Results: Our case study is an HIV positive refugee from Africa who reported to have become HIV positive as a result of rape in 2007. The patient reported a previous PAP test in January 2014 prior to arrival in the U.S. (February, 2014). At BBI enrollment (February, 2015), she specifically expressed interest in a follow-up PAP exam. Upon completion of cancer education classes (3/24/2015), a Well woman/PAP test appointment was scheduled and completed on 6/26/2015 at UNTHSC-OBGYN clinic. Patient was informed of high grade abnormal results and referred (7/6/2015) to MCM for follow-up. She subsequently underwent a colposcopy and cold knife cone biopsy. Patient was receiving treatment for her HIV status since March of 2014. Although a PAP referral was noted in her records (12/8/2014) she did not receive a PAP exam in that system, but received one through the BBI 6 months later. Patients are required to make the PAP appointment themselves. Conclusion: Records indicate that the BBI participant kept all appointments for her medical management of HIV. Failure to receive a PAP exam in the same medical system may be due to the requirement that patients make their own appointments. Language and cultural barriers may have prevented her from doing so. Refugee women face trauma, such as rape and the possibility of HPV, HIV and other infectious diseases. Given their vulnerability and high risk, it may be prudent to provide PAP exams upon arrival.Item PROMOTING HEALTHY PREGNANCY BEHAVIORS AMONG KAREN BURMESE REFUGEES(2014-03) Board, Amy; Raines-Milenkov, Amy; Thein, Emelda; Anderson, RalphPurpose (a): To identify baseline understanding of healthy pregnancy behaviors as well as gaps in knowledge and access to pregnancy-related care for Karen Burmese refugee women in Fort Worth. Methods (b): Focus groups were designed to identify the baseline level of pregnancy knowledge and access to care. Discussion with key players in the Karen community led to the selection a natural leader within the population to conduct the focus groups, which were held on two different days and times in the apartment complex where the majority of the population resides. Results (c): Respondents shared both positive and negative reactions regarding delivering a baby in the U.S based upon their personal experiences or stories they had heard from friends and relatives who had given birth. Positive responses included the ability to receive an epidural to relieve labor pain, access to prenatal vitamins, vaccines, and medicines, and the sentiment that in America, doctors are able to use tests and technology to make sure the baby receives good care. Negative responses included a lack of proper or culturally sensitive interpretation at provider visits, lack of proper information sharing by staff about the purposes of and alternatives for medical procedures, and long wait times at the hospital before receiving care. Barriers cited to receiving proper care include transportation, lack of insurance coverage, limited English proficiency, and anxiety about not being able to navigate the health system. Conclusions (d): Karen Burmese women in Fort Worth view the American health care system with a mixture of gratitude and trepidation. Full integration and use of this system for early access to prenatal care will involve outreach and education efforts among the Karen as well as greater understanding and flexibility on the part of health care providers.Item Refugee Women’s Breastfeeding Practices and Experiences Following Resettlement in Tarrant County(2016-03-23) Raines-Milenkov, Amy; Baker, Eva; Kwentua, Victoria; Thein, Emelda; Mudey, Halimo; Subedi, Radhika; Rudasingwa, Laurette; Durbin, KatherinePurpose Exclusive breastfeeding for the first 6 months of life ensures that infants obtain adequate nutrients needed to support healthy growth and development. While there is robust literature on factors influencing breastfeeding initiation and duration among sub-populations of women, there is little known about the breastfeeding practices of refugee women resettled in the United States. The limited studies and anecdotal reports suggest, however, that breastfeeding practices change following resettlement. This qualitative study aims to explore refugee women’s infant feeding experiences and practices to better inform culturally appropriate education, support, and maternity care for women resettled in Tarrant County, Texas. Methods Refugee women between the ages of 18 and 50, who had given birth to at least one live infant were recruited into the study. Participants completed a demographic survey and participated in a focus group discussion about their breastfeeding practices and experiences. The demographic survey addressed participant age, ethnicity, time and experience breastfeeding, etc., and descriptive statistics were complied to assess the characteristics/demographics of the study population. Bilingual research personnel conducted focus groups in their respective language using a semi-structured interview guide exploring infant feeding practices, experiences, sources of information, etc. The group discussions were audio-recorded, translated and transcribed. Systematic procedures of qualitative data analysis included intensive reading of the text and group discussion of full transcripts, followed by coding, displaying, reducing, and interpreting information. Results Refugee women representing different ethnic groups participated in the demographic surveys and focus groups. Conclusions Results of the focus groups suggest multiple influences on infant feeding practices of refugee women following resettlement in the United States. A culturally and linguistically multi-level approach to providing education and support services to refugee women is necessary to protect their breastfeeding practices. Findings from this study have implications for health providers, resettlement agencies, public health and others involved in serving this population.Item Sickle Cell Disease Awareness, Willingness to be Tested and Willingness to Participate in Genetic Counseling Among African Immigrants of the Democratic Republic of Congo in North Texas(2020-05) Njesada, Ndolembai S.; Nandy, Karabi; Sterling, David; Raines-Milenkov, Amy; Young, RichardThe aim of this exploratory cross-sectional research was to assess the awareness of Sickle Cell Disease (SCD), the willingness to be screened for SCD, and the willingness to participate in genetic counseling among African immigrants from the Democratic Republic of Congo who resided in North Texas through in-person surveys. A structure questionnaire containing 36 SCD questions was administered to DRC immigrants residing in Dallas-Fort-Worth-Denton-Arlington metroplex of North Texas between August and November 2019. One hundred and eighty-six were successfully interviewed. SCD awareness was very high among participants (97%); however, only about 65% agreed to participate in SCD testing and 72% to genetic counseling. Statistical significance in the levels of awareness, willingness to be screened and to participate in genetic counseling was noted between males and females. Education was negatively associated with awareness of SCD. Those who had less than high school education had higher odds of being aware of sickle cell compared to those who had more than high school education. However, those who had refugee immigration status had seven times higher odds of being willing to participate in SCD testing compared to permanent resident status. There is a need for SCD education among immigrants from endemic countries like DRC, given that almost half of the participants were not willing to participate in SCD educational programs. The need of mix methods studies to understand the various patterns of association related to all the factors associated with sickle cell disease is warranted.Item The Impact of the Lay Health Educator (LHE) Model on Hepatitis B Screening among the Refugee Population(2020) Acharya, Rushil; Raines-Milenkov, Amy; Felini, Martha; Baker, Eva; Akpan, Idara N.Purpose: Hepatitis B (HBV) is a viral infection affecting the liver which may lead to acute and chronic diseases such as cirrhosis and liver cancer. Although refugees are required to screen for hepatitis B at the time of arrival in the U.S., many of them are not aware of their hepatitis B results and there are gaps in follow-up care for individuals who test positive. The Building Bridges program responds to this unmet need through hepatitis B education, screening and navigation to follow-up clinical care. This study aims to evaluate the impact of Building Bridges lay health educator (LHE) model as an approach to increase hepatitis B screening among the refugee population. Methods: A cross-sectional analysis of HBV screening was conducted among the refugee population enrolled in the Building Bridges program from 2014 to 2020. Statistical analysis was performed using Microsoft Excel and Statistical Analysis System (SAS). Hepatitis B screening completion rates were calculated. Results: 1053 female and male enrolled refugees were asked about previous hepatitis B screening. 717 participants were eligible, of those, 680 participants were never screened. At post enrollment, 303 participants received hepatitis B screening. Conclusions: The LHE model helped to increase Hepatitis B screening. Lay health educators play significant roles in facilitating access to health care. There is need for more research on the impact of the LHE model in motivating the need for preventive health screening. More research is needed to understand why some participants did not choose to be screened.Item The Potential of a Medical Legal Partnership to Improve the Health of a 17 year old Patient with Undiagnosed Intellectual Disability(2021) Jethro, Sarah; Raines-Milenkov, AmyBackground: Medical legal partnerships (MLP) foster equity and addresses Social Determinants of Health through legal advocacy and expertise. MLPs educate medical professionals on the legal rights of individuals with intellectual disabilities concerning medical services. Implementation of an MLP program in the pediatric setting could address the unmet need for a school evaluation. A related model, medical legal psychological partnerships (MLPP) add the benefit of psychological expertise to address school-related mental health needs. Here we apply the MLP and MLPP model to a single case. Case: The case is a 17-year-old girl who was admitted to a children's hospital for pain control and hydration post-tonsillectomy. She had a clinical suspicion of Autism and Bipolar disorder. This was believed to contribute to a three-year delay in her formal school education. The patient and her mother presented with multiple gaps in her care related to social determinants of health and health literacy. These included difficulties communicating pain level, comprehending therapy goals, and inappropriate expectations of recovery. Conclusions: If the patient presented in this case had access to an MLP or an MLPP she would have been able to access testing and treatment services resulting in an individualized education plan, receive medical and psychological treatment, as well as school-based behavior plan. MLP can be effective in removing barriers to care by addressing structural problems at the root of health inequities. MLPP's are effective at addressing complex needs with the goal of achieving equity.Item Threats to the Tradition and Practices of Breastfeeding in Refugees Following Resettlement in Tarrant County(2017-03-14) Raines-Milenkov, Amy; Baker, Eva; Durbin, Katherine; Kwentua, Victoria; Thein, Emelda; Mudey, Halimo; Subedi, Radhika; Rudasingwa, Laurette; Moreno, TanirBackground: Few studies have investigated breastfeeding in refugee populations resettled in the United States. Of those that exist, studies have found that refugees face many challenges to exclusively breastfeeding their children due to conflict between their traditions and the U.S. culture, economy, and health care system. However, there has been no research studying these difficulties among recently arrived populations of refugees, such as the Bhutanese and Karen. The purpose of this study is to identify factors that threaten to disrupt breastfeeding practices in recently arrived populations of refugees following resettlement in Tarrant County. Methods: Data for this study comes from previously collected focus group transcripts. Secondary data analysis was used from 5 focus groups from the Bhutanese, Karen, and Somali community. Thematic analysis was used to identify significant themes in the transcripts relating to the subject of the study. Analysis included reading of the text, coding the data, theme identification, and consolidating the information in order to identify the three primary threats to breastfeeding practices. Results: Three main themes emerged. These included the influence of health care providers, the perception of existing U.S. breastfeeding practices, and the interference of work duties or financial issues. These influences were consistently found to have a negative impact on the continuation of exclusive breastfeeding among each refugee population. Conclusions: Refugees are at a significant disadvantage of losing breastfeeding practices following resettlement and adjusting to a new culture in the U.S. However, the tradition and practice of exclusive breastfeeding should be a protected and promoted behavior. Cultural competence and consideration should be incorporated into the education of health care workers in order to promote breastfeeding and address, and when possible, remove threats to this positive maternal behavior.Item Trauma-Informed Care for Refugee Populations(2016-03-23) Raines-Milenkov, Amy; Baker, Eva; Thein, Emelda; Mudey, Halimo; Rudasingwa, Laurette; Subedi, Radhika; Qureshi, IramBackground: With the growing number of refugees resettled in the United States after fleeing war torn countries devastated by genocides, mass violence, and human rights abuses, it is increasingly likely that a healthcare provider will treat a patient who has experienced one or more traumatic events. When trauma is unaddressed, healthcare providers may unknowingly trigger re-traumatization, preventing refugees from seeking or receiving healthcare services. Refugee trauma survivors require a sensitive system of care. Western medicine is unfamiliar to many refugee groups, and some services, such as cervical cancer screening, may remind them of prior trauma. Trauma-informed care is an approach for assisting trauma survivors with evidence of benefit to vulnerable populations. Objectives: Introduce the trauma-informed care framework and key principles, provide examples of traumas experienced by refugees, and demonstrate how previous trauma can influence preventive health care utilization among women enrolled in the Building Bridges program. Methods: A literature review of trauma-informed care and trauma among refugees resettled in the United States was conducted. Additionally, qualitative data collected by Building Bridges Lay Health Educators as part of their education and navigation services was analyzed and grouped into themes. Results: Recurring themes of rape, torture and distrust towards healthcare providers was found in literature on refugee trauma. Similarly, Building Bridges data confirms rape and violence experienced by refugee women inhibit them from seeking preventive health services. Conclusions: This calls for more attention to the mental health needs of resettled refugees. Refugees need a linguistically and culturally appropriate form of care incorporating the trauma-informed framework.