Browsing by Subject "Medicine and Health"
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Item Access to Health and Social Services for Poverty Level Adults with Chronic Disease or Disability(2006-12-01) Reese, Sharon E.; Kristine Lykens; Sue Lurie; Richard ScotchReese, Sharon E., Access to Health and Social Services for Poverty Level Adults with Chronic Disease or Disability. Doctor of Public Health (Health Management and Policy), December, 2006, 79 pp., 7 tables, 51 references. This dissertation reports the results of research into the difficulties poverty level adults with disabilities have in accessing vital health and social services. Chapter one gives a background of the problem, a purpose of the research, the research question, limitations and constraints, and the importance of the study. Chapter two is a review of the literature concerning this population and access. Chapter three reviews the methodology used in the study, with chapters four and five presenting results, conclusions and recommendations. Qualitative methods using a focus group and individual interviews five major themes emerged: health issues, access or obtaining care, interactions with providers, obtaining medication, and transportation (table 6). A review of these themes and the particular responses of participants in these areas highlighted the need for policy change in the area of access to services for this special group. This dissertation also makes recommendations for policy changes and potential barriers to those changes.Item Advance Directives Planning Among Mexican-Americans in Dallas-Fort Worth(2005-05-01) Santiago, Carmen; Lurie, Sue; Gonzalez, Adela; Rene, AntonioSantiago, Carmen C., Advance Directives Planning Among Mexican-American in Dallas Fort Worth. Doctor of Public Health (Social and Behavioral Sciences), May 2005, 133 pp., bibliography, 33 titles. This qualitative study explored the knowledge base of advance directives planning among Mexican-Americans in the Dallas-Fort Worth area. In addition, the study explored areas that influenced their willingness to engage in advance directives and their preferences related to family collective decision-making. Two focus groups, representing two different populations were conducted. One focus group represented second generation Mexican-Americans, 65 years old and older, both men and women that were hospitalized or participated in home health care programs between January 2004 and January 2005. The second focus group consisted of Mexican-Americans, 18 years and older who were family members or caregivers of sick elders in the same time frame. Questions utilized to gather the knowledge and beliefs of the focus group participants, were based on a previous study by Dr. Morrison and Dr. Meir conducted in New York. Participant’s responses were analyzed using NVIVO software. Findings indicated a lack of knowledge of advance directives and confusion about state wills and living wills among Mexian-Americans in Dallas-Fort Worth. A majority of the focus group participants expressed a preference for their older children to make the decisions of their end of life care. This was due to a belief that their child is better educated and could make the right decision. Participants also revealed the importance of a family collective decision. This belief in family unity kept them from excluding members from the decision of end of life care. Another interesting finding from this study was a majority of the participants had already made funeral plans such as arranging for the lot to be buried in and funeral service pre-paid, but had not considered advance care directives. According to both groups of participants, arranging for their funeral service gave them a peace of mind and dignity since they had established where they will be interred. These findings suggested that the Mexican-American population needs to be informed about this legal process. Mexican-Americans need to be aware that the State provides ways to obtain this documentation at no cost. Health care providers should be involved in the education about advance directives and encourage their patients to learn more and consider obtaining one. Further research studying Mexican American knowledge and beliefs, at state level and a comparison among states should be explored. Keywords; advance directives, decision making, end of life, ethical issuesItem An Analysis of Texas Hospitals: Assessing the Association between Charity Care, Uncompensated Care, & Community Benefits(2007-05-01) Mitias, Marcus J.; Nuha Lackan; Jeff Talbert; Douglas MainsMitias, Marcus J. An Analysis of Texas Hospitals: Assessing the Association between Charity Care, Uncompensated Care, & Community Benefits. Master of Public Health (Health Management & Policy), May 2007, 47 pp., 5 tables, 11 illustrations, references, 45 titles. The question of whether not-for-profit hospitals are meeting their charitable obligations is once again starting to intensify. Congress is calling for increased scrutiny of not-for-profit hospitals. Similarly, pressure is mounting in Texas where the not-for-profit hospital sector struggles to justify the contributions they make to the community. This cross-sectional study examines the county level association between charity care, uncompensated care expenditures, and community benefits, and hospital structure, and the number of uninsured. Descriptive and multi-linear regression analyses are used to compare hospital charity care and uncompensated care expenditures in Texas. Results indicate the number of uninsured is significantly associated with charity care expenditures and uncompensated care expenditures.Item An Exploratory Study of the Influence of Language and Ethnic Concordance on Hispanic Patients' Trust in their Healthcare Providers in Tarrant County(2007-08-01) Macias, Isela; Holly E. Jacobson; Francisco Soto-Mas; Daisha CipherMacias, Isela. An Exploratory Study of the Influence of Language and Ethnic Concordance on Hispanic Patients’ Trust in Their Healthcare Providers in Tarrant County. Master of Public Health (Health Interpreting & Health Applied Linguistics), August 2007, 76 pp., 8 tables, references, 57 titles. There is a scare number of Spanish-speaking, Hispanic physicians to serve a growing Spanish-speaking Hispanic population. A survey and interview were conducted in a primary health clinic with fifty-two Spanish-speaking Hispanic patients. The Introduction (Chapter 1), included the problem and purpose; Literature Review (Chapter 2), analyzed supporting literature; Methodology (Chapter 3), described data process; Results (Chapter 4), reported the findings; and Conclusions and Recommendations (Chapter 5), included the decision. Spanish-speaking Hispanics in the study had more trust in Spanish-speaking Hispanic physicians than in non-Hispanic physicians who did not speak Spanish. More studies should include Spanish-speaking Hispanics and focus on differences in acculturation and the patient-physician relationship.Item Associations Between Socioeconomic Statuses and Behavioral Risk Factors and Self-Reported Health Status(2005-05-01) Wu, Gang; Daisha Cipher; Shande Chen; Sejong BaeWu, Gang, Association Between Socioeconomic Statuses and Behavioral Risk Factors and Self-Reported Health Status. Master of Public Health (Biostatistics), May 2005, 70pp., 5 figures, 4 tables, references, 58 titles. Socioeconomic statuses (SES) and behavioral risk factors determine more than 70% of overall health outcome of American population. The effects of SES and behavioral risk factors on self-reported health status (SRHS) were studied using binary logistic regression models. Age group, education level, ethnicity, physical activities, cholesterol intake, smoking status, and drinking status were identified as significant predictors (p [less than] 0.05) to SRHS based on overall model. Significant predictors for each ethnic group varied based on the same model separated by ethnicity: White (insurance coverage, physical activities, smoking status, and drinking status), Black (gender, vegetable intake, and Hispanic (cholesterol intake). Ethnic disparities in SES and behavioral risk factors were discussed. The findings may have potential importance in public health intervention.Item Automodification Reaction of PARP-1 Reversibly Regulates the DNA-Binding of NF-kB(2001-11-01) Chang, Woo-Jin; Alvarez, Rafael; Mathew, Porunelloor A.; Goldfarb, Ronald H.Chang, Woo-Jin, Automodification Reaction of PARP-1 Reversibly Regulates the DNA-Binding of NF-kB, Doctor of Philosophy (Microbiology and Immunology), November, 2001, 92 Pages, 20 figures, 3 schemes, and bibliography. Poly(ADP-ribose) polymerase (PARP-1, E.C. 2.4.2.30) is a constitutively expressed nuclear enzyme. It comprises about 1% of the total nuclear protein and in phylogenetically well conserved in most eukaryotes, with a notable exception in yeast. PARP-1 post transitionally modifies DNA-binding proteins by transferring the ADP-ribose moiety from BNAD+. Although the exact biological function of poly(ADP-ribosyl)ation has not been clearly elucidated, the process is thought to be involved in DNA repair, replication, and gene expression. Previous studies have indicated that PARP-1 participates in eukaryotic gene expression including the genes under the control of nuclear factor-kB (NF-kB). It has been demonstrated that PARP-1 deficient mice are more resistant to lipopolysaccharide-induced endotoxic shock than isogenic wild-type mice due to the inactivation of NP-kB in the mutants. In order to further analyze the interactions between PARP-1, NF-kB, and its consensus DNA in a cell-free system, we co-incubated recombinant PARP-1 protein and the p50-subunit of NF-kB (NF-kB-p50) in the absence of DNA strand-breaks. Electrophoretic mobility shift assays (EMSA) showed that sequence-specific DNA-binding of NF-kB-p50 was dependent on autopoly(ADP-ribosyl)ation of PARP-1. The NF-kB-p50 DNA-binding was inhibitied when PARP-1 was not auto-poly(ADP-ribosyl)ated either in the absence of BNAD+ or in the presence of 3-aminobenzamide, an enzymatic inhibitor of PARP-1. Coimmunoprecipation and immunoblot analysis demonstrated that NF-kB-p50 formed a heterodimer with PARP-1 when PARP-1 was not auto-poly(ADP-ribosyl)ated. In addition, poly(ADP-ribosyl)ation assays showed that NF-kB-p50 protein was not susceptible to poly(ADP-ribosyl)ation under normal incubation conditions. Those in vitro observations described above were confirmed by experiments utilizing HeLa nuclear extracts. EMSA showed that NF-kB DNA-binding was inhibited in 3-AB-pre-treated HeLa cells. To our knowledge, this is the first report demonstrating that auto-poly(ADP-ribosyl)ation reaction by PARP-1 reversibly regulates the function of a transcription factor by inhibiting the formation of heterodimer between PARP-1 and a transcription factor.Item Barriers to Women's Cardiovascular Risk Knowledge: A Tarrant County Study(2004-05-01) Liewer, Linda J.; Kristine LykensLiewer, Linda J., Barriers to Women’s Cardiovascular Risk Knowledge: A Tarrant County Study. Master of Public Health (Health Management and Policy), May 2004, 71 pp., 19 tables, 6 illustrations, 36 references, 17 titles. Women’s death rate from cardiovascular disease is greater than the death rate from all cancers. Awareness and knowledge of a disease are key to dealing with it, yet many women are still unaware of their CVD risk. The purpose of this study is to identify the barriers to knowledge about cardiovascular disease risk in women in Tarrant County. Interviews with administrative personnel in 10 community organizations confirmed the lack of awareness of CVD. Barriers included: women in caregiver roles advocate effectively for their family members, but less effectively for themselves; physician communication with women regarding CVD is often suboptimal; women fear breast cancer far more than CVD; a program deficiency exists in Tarrant County; lack of a visible woman champion and heart disease is still seen as a man’s disease.Item Disciplining Physicians: Factors that Influence Severity of Punishment by a State Board: An Investigation fo the Texas State Board of Medical Examiners, 1989-1998(2001-05-01) Gustowski, Sharon; Sharon ClarkPhysician conduct and competence is increasingly debated in today’s health care environment, an environment that is influenced by managed care, medical malpractice, and a more informed consumer population demanding a higher quality of medical care. Revocation of physician licenses has increased, and it has been noted that physicians older than 40 years received more disciplinary actions that their younger counterparts. Studies of disciplined physicians have been done in California, Rhode Island, Ohio, and New York. Additional studies have also been done investigating inappropriate prescribing practices and sex-related offenses committed by physicians. None of these studies identified risk factors that influenced the severity of punishment given by a state board. Additionally, data concerning osteopathic physicians was scant and not included. An important issue regarding physician conduct and competence is the comparability between osteopathic (DO) and allopathic (MD) physicians. Moreover, it is also important to know which, if any, factors influence the decision for a severe punishment (such as revocation or suspension of a license). In Texas, both DOs and MDs are licensed to practice medicine and, when warranted, disciplined by the Texas State Board of Medical Examiners (TSBME). The TSBME is the agency authorized to license and discipline physicians and other health care professionals as mandated by the Medical Practice Act. The current TSBME is composed of 9 MDs, 3 Dos, and 3 public representatives and all members are appointed by the governor for 6-year terms. Data obtained from the TSBME shows for each year from 1989 to 1998, Dos were more likely to be disciplined than MDs (figure 1). Whether or not this represents a truly great risk for Dos to be disciplined by the TSBME is unknown. Therefore, it is important to know whether the same standard of care is applied to Dos and MDs and given a compromise of that standard, whether Dos and MDs are treated equally and fairly. The purpose of this study is to determine which factors, including the type of degree a physician holds, influenced the severity of punishment given to physicians by the TSBME from 1989-1998.Item Epidemiology of Cholera in Malawi, 2002-2003(2004-08-01) Nkhoma, Ella; Sejong Bae; Antonio Rene; Raghbir SandhuNkhoma, Ella, Epidemiology of Cholera in Malawi, 2002-2003. Master of Public Health (Epidemiology), August 2004, 33pp., 4 tables, 3 figures, bibliography, 24 titles. The objective of the present study was to characterize epidemic cholera in Malawi from 2002-2003. National and district-level surveillance records were used for the analyses in this study. The study employed Poisson regression, log-linear analysis, epidemic curve analysis, curve-fitting procedures and epidemic model simulations. District-level determinants of cholera mortality included various sociodemographic indicators. Significant two-way interactions were observed for age and district, with the oldest age group (65+) experiencing the highest risk of symptomatic cholera and residents of Nkhatabay districts also experiencing the most increased risk. Temporal analysis revealed the existence of secondary outbreaks and demonstrated the contribution of preexisting immunity to epidemic dynamics.Item Humanitarian and Technical Assistance to the Palestinian Health Sector: Donors' Policy and Behavior Analysis(2004-12-01) Hamarna, Rami A.Hamarna, Rami A., Humanitarian and Technical Assistance to the Palestinian Health Sector: Donors’ Policy and Behavior Analysis. Master of Public Health (Health Management and Policy), December 2004, 170pp, 19 Tables, 41 Illustrations, bibliography, 104 titles. International assistance to the Palestinian health sector is reviewed in this thesis. Assistance to the health sector has been the major force towards developing a sound health infrastructure in the Palestinian territories. I argue that Palestinians are much like other recipients of aid for the health sector. This thesis explores the high aid dependence of Palestinians and the great influence of donors. I highlight that donors used aid conditionally, in its different forms, to intrusively interfere in Palestinian national planning and reform. Palestinians are no exception and they, like other countries, have been subject to relatively similar kinds of conditions. However, they were exceptional in the timing, in the great need for aid, and in the political context, which has impacted the effectiveness of the aid.Item Income Inequality and Racial Disparities in Infant Mortality in Texas Counties(2004-05-01) Jesmin, Syeda S.; Susan Eve; Kristine Lykens; Erma LawsonJesmin, Syeda S., Income Inequality and Racial Disparities in Infant Mortality in Texas Counties. Master of Public Health (Health Services Research), May, 2004, 63 pp., 7 tables, 2 figures, references, 74 titles. This study provides an initial examination of predictors of differences of infant mortality between African-Americans and Whites. Guided by Wilkinson’s theory, it was hypothesized that income inequality among the population is a significant predictor of infant mortality disparities. A number of socioeconomic and health services variables were used in this study to control for the effects of income inequality on the dependent variable. Findings suggest that income inequality of a county is not a direct predictor of higher infant mortality of African-Americans than Whites. However, the association of inequality and IMR gap varies based on the metropolitan status of the county. Insurance status was found to have a negative effect on IMR gap, which implies the importance of including variables other than related to access (such as, quality of care) in future research.Item Is an Enviormental Health Educational Intervention Sufficient to Change Behavior?: Perceptions from an Indigenous Lake Community in Guatemala(2006-12-01) Pezzia, Carla; Terrance Gratton; Sue Lurie; Norman TrieffPezzia, Carla. Is an environmental health educational intervention sufficient to change behavior?: Perceptions from an indigenous lake community in Guatemala. Master of Public Health (Environmental Health), December 2006, 46 pp., 6 tables, 1 illustration, references, 18 titles. Traditional environmental health practices focus on education and exposure prevention, but the division between the biophysico-chemical and social environment keeps them from always being sufficient; human ecology seeks to bridge this division. The second leading cause of mortality in Guatemala is gastrointestinal infections, and San Pedro, Guatemala, provides an opportunity to study these infections utilizing a human ecological approach. Morbidity data were collected from the local health center, observations noted systematically, and both residents and tourists were interviewed regarding their perceptions of the community’s environmental health. Results found that residents who had no contact with tourists stated that, for gastrointestinal infections due to refuse in the streets, education alone would not be sufficient to reduce this problem; most felt some type of government intervention would be necessary. It is recommended that public health specialists enjoy a human ecological approach and refer to the community when designing an appropriate intervention.Item Measurement of Health Care Professional Concordance with the National Asthma Education and Prevention Program Guidelines for the Management of Asthma(2007-05-01) Oshitoye, Jeannette AdetokunboAsthma is a widely prevalent chronic disease affecting children in the United States. Prior studies show that blacks are more likely to die from asthma than other racial groups. Despite this fact, blacks are less likely to receive the recommended medication to appropriately treat their asthma. Because of the disparity in treatment, this study was conducted to determine if minorities were receiving information recommended by the NAEPP Guidelines. Logistic regression was used to determine the receipt of instructional information. Results show that males are less likely; and those below the age of 17 are more likely to receive the information.Item The Effects of a School-Based Intervention on the Physical Activity Behaviors of Latino High School Students(2004-05-01) Pena, Eva; Balcazar, Hector; Lurie, Sue; Morrow, James R.Pena, Eva, The Effects of a School-Based Intervention on the Physical Activity Behaviors of Latino High School Students. Master of Public Health (Community Health), May 2004, 66 pp., 5 tables, 2 illustrations, 6 titles. The study was to determine if a culturally appropriate school-based intervention increases self-reported levels of physical activity (PA) in 9th grade Latinos. A culturally appropriate intervention could help Latino youth adopt and maintain PA. Students from two primarily Latino schools served as subjects. Experimental students received a modified form of Salud Para Su Corazon, a Latino community-based cardiovascular health initiative. Questions from CDC’s YRBSS were used to measure PA changes. A 3-way mixed model ANOVA was used investigate the effect of pre-post, treatment, and gender on self-reported days of participation in moderate (M) and vigorous (V) PA. Students reported increased M and V PA at the post-test compared to the pre-test. The experimental students tended to report greater increases in V PA following intervention compared to controls. Males reported higher levels of V PA than females. Results suggest some potential effect on student PA behaviors as a result of the intervention.Item The Impact of Race, Ethnicity, and Income on Dental Utilization(2004-05-01) Maresh, Kyeung Oak; Sejong Bae; Shande Chen; Karan SinghKyeung, Oak Maresh. The Impact of Race, Ethnicity, and Income on Dental Utilization Master of Public Health (Biostatics), May 2004, 29 pp., 5 tables, 43 references. Objective To determine if there is a difference in access to dental care services among the difference race/ethnic groups, to ascertain if dental care access differs according to income levels, and to look at the utilization patterns of dental care services. Methods The study data is public use data provided by the Medical Expenditure Panel Survey. The data for this study consisted of the 1999 Full Year Consolidated (Medical Expenditure Panel Survey) household component and the 1999 dental visits (HC-033B). Chi-square tests were performed to determine if there was a significant association (p [less than] 0.05) between each variable and the probability of dental care visits. Multiple logistic stepwise regression was performed to identify each predictor associated with dental care service. Results This study confirmed that minority ethnic groups access fewer dental care services than do non-Hispanic Whites. It also confirmed the second hypothesis that there is a positive relationship between income levels and access to dental care services. Conclusion The result of this study furthers our understanding of race/ethnicity and socioeconomic status in relation to dental care access. They may also help to raise consciousness of dental care utilization and provide basic information to set up efficient prevention strategies increasing dental care utilization among minority racial/ethnic groups and those of low socioeconomic status.Item Unmet Health Care Needs Stratified by Socioeconomic Status: Results of the National Survey of Children with Special Health Care Needs(2006-12-01) Fulda, Kimberly G.; Kristine Lykens; Karan Singh; Sejong BaeFulda, Kimberly G., Unmet Health Care Needs Stratified by Socioeconomic Status: Results of the National Survey of Children with Special Health Care Needs. Doctor of Public Health (Clinical Research), December 2006, 200 pp., 15 tables, 4 figures, references, 73 titles. The purpose of this research study was to identify factors that affect unmet health care needs for children with special health care needs (CSHCN) and to identify how these factors vary by socioeconomic status. Data were obtained from an already existing publicly available database from the National Survey of Children with Special Health Care Needs, 2000-2002, available through the Centers for Disease Control and Prevention. Approximately 750 CSHCN from each of the 50 states and the District of Columbia were included. Survey data represented parent responses on health care and health care needs for CSHCN. Responses for 38,866 CSHCN up to 17 years of age were included in the analysis. Four hypotheses were tested: having received all needed routine, preventive care; having received all needed care from a specialist; having received all needed mental health care or counseling; and having received comprehensive, coordinated care in a medical home. Within each of the four hypotheses, four models were presented for socioeconomic status (SES): [less than] 133% of the federal poverty level (FPL); 133-199% of the FPL, 200-299$ of the FPL, and ≥ 300% of the FPL. Age, severity of the CSHCN’s condition, sex, race, ethnicity, maternal education, insurance status / type, geographical region of the household, relationship of the respondent to the CSHCN, the total number of adults in the household, and the total number of kids in the household were all significant predictors of having received all needed care in at least one SES stratum for the four hypotheses. Analyses revealed there are disparities among SES strata for unmet health care needs for CSHCN.Item Urbanicity and Mammography Utilization: How Living in an Urban or Rural Area Affects Mammography Screening Utilization Among Women in the United States(2008-05-01) Ylitalo, Kelly R.; Kathryn Cardarelli; Fang Fang Zhang; Nuha LackanYlitalo, Kelly R., Urbanicity and Mammography Utilization: How Living in an Urban or Rural Area Affects Mammography Screening Utilization among Women in the United States. Master of Public Health (Epidemiology), May 2008, 67 pp., 7 tables, 1 figure, references. Mammography is a widely used screening tool that can help prevent breast cancer mortality, yet utilization is not consistent. We utilized the 2006 Behavioral Risk Factor Surveillance System data to evaluate differences in mammography screening practices by urbanicity (urban vs. rural residence). Chi-square analyses, logistic regression, and propensity score matching were utilized to determine the association between urbanicity and mammography compared to women who lived in rural areas, even after controlling for individual variables. Geographic access to health care as represented by individual urban or rural residence may contribute to mammography screening practices in the United States.Item Variation in Hospital Utilization for Cardiovascular Surgical Procedures in Texas(2007-12-01) Kunte, Parag S.; Sejong Bae; Nuha Lackan; Karan SinghKunte Parag S., Variation in Hospital Utilization for Cardiovascular Surgical Procedures in Texas. Master of Public Health (Clinical Research), December 2007, 45 pp., 5 tables, references, 39 titles. Racial and ethnic differences in hospital utilization for cardiovascular surgeries have been studied for many years, but most of this research is limited to the Medicare or veteran population. The present study extends to the wider Tecas population including all insurance types, and includes non-Hispanic whites, non-Hispanic blacks, Hispanics, and others. This retrospective cross-sectional study examines racial/ethnic differences in the utilization of cardiac procedures. Results suggest that racial and ethnic differences in the utilization of cardiac procedures exist in Texas and are observed across all types of insurance.