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Item A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas(2007-05-01) Miller, Thaddeus L.; Scott McNabb; Peter Hilsenrath; Jotam PasipanodyaMiller, Thaddeus L. A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas. Doctor of Public Health (Health Management and Policy), May 2007, 232 pp., 29 tables, 2 illustrations, bibliography, 274 titles. Tuberculosis cost has been incompletely described as the cost arising from acute illness and treatment. The societal cost of tuberculosis arises from infection, suspicion of infection, acute and preventive responses, the sequalae of illness (including acute morbidity, drug induced hepatitis, mortality, and disability), and the compounding effects of transmission. This societal cost in unknown however the variable portion of this cost is equivalent to the savings made possible by averting tuberculosis, This study measured the societal cost of tuberculosis in Tarrant County, Texas, for the year 2002. Societal costs were estimated as the sum of known or estimated expenditures and health losses related to tuberculosis and discounted at 3%. Current and future costs will accrue to an estimated net $33.9 2002 USD million for the year 2002 in Tarrant County, Texas. An average of 1.4 QALYs net of 3% social discount were lost per incident case. The greatest burdens of tuberculosis, when analyzed by either cost or health quality, can be averted only by case prevention. Forty-three and 44% of societal cost was generate by secondary transmission and chronic impairment associated with pulmonary tuberculosis. Neither factor is routinely considered in discussions of tuberculosis cost. Acute treatment, hospitalization and direct medical care account for only 2.4% of societal cost. Any intervention that prevents one tuberculosis case will prevent at least a net $295,182 (2002 USD) and individual health quality losses averaging 1.4 net QALYs.Item A Health Assessment of Refugee Children From Former Yugoslovia in Tarrant County(2001-12-01) Podgore, John K.; Marshall, Murial; Rene, Antonio; Sandhu, RaghbirThis study was conducted to provide an assessment of the health status and health care utilization of children from former Yugoslavia living in Tarrant County. Additionally an assessment of barriers and problems encountered by these families in obtaining health care for their children was presented. One hundred thirteen households of refugee families arriving in Tarrant County from 1998 through 2000 participated by answering a 79 item health information questionnaire. The results revealed that most of the refugee families had no regular health care provider to assure continuity of medical care. Lack of access to dental care and inappropriate utilization of hospital emergency facilities were also identified as problems. Insufficient understanding of health insurance issues and inability to access health information were additional problems. Addressing these problems by local and state health care agencies may help to improve health care delivery for these and future refugee children.Item A Path Analysis of Body Mass Index, Body Image, and Unhealthy Dietary Behavior as Contributors to Suicidal Behavior in Female Adolescents(2004-05-01) Rorie, Michele Taylor; Balcazar, Hector; Lurie, Sue; ReneRorie, Michele Taylor, A Path Analysis of Body Mass Index, Body Image and Unhealthy Dietary Behavior as Contributors to Suicidal Behavior in Female Adolescents. Doctor of Public Health (Social and Behavioral Sciences), May 2004, 120 pp., 17 tables, 6 illustrations, references, 106 titles. Objectives- This study examined the pattern and magnitude of relationships between body mass index, body image, unhealthy dietary behaviors, and suicidal behavior among a sample of White, African American, and Hispanic adolescent females. Methods-This study employed secondary analysis of the 2001 Youth Risk Behavior Survey public-use dataset to provide quantitative estimates of the causal connections between body mass index, body image, dietary behaviors, and suicidal behavior. A sample (n=5,218) of White, African American, and Hispanic adolescent females aged 14-17 were selected for analysis. This cross-sectional study involved public high school students in grades 9-12. The variables/constructs BMI, Body Image, and Dietary Behavior were examined using a path analysis to determine the magnitude of effects on Suicidal Behavior in adolescent females. Results- The path coefficients were obtained for the path model using multiple regression equations, which took direct and indirect effects into account. The Female Adolescent Model (n= 5,218) yielded an R2 = .27. This meant that 27% of the variance in Suicidal Behavior was explained by BMI, Body Image, and Dietary Behavior. When race/ethnicity was analyzed separately, different values were observed. The White Adolescent Female Model (n=2,768) had an R2=.32. The Black or African American Model (n=1,206) had an R2=.23, and the Hispanic or Latino Model (n=1,224) had an R2=.27. Conclusion- The basic state of what is an actual fact about a person (i.e. weight) does not cause an increase of harmful or destructive behavior. The person’s beliefs drive intention as it was demonstrated through the immergence of significant indirect pathways from BMI through Body Image and Dietary Behavior to Suicidal Behavior. The path analyses for the three racial groups suggest that there are varying degrees of influence among BMI, Body Image, Dietary Behaviors, and Suicidal Behaviors.Item A Review of Dendritic Cell Vaccines in Cancer Treatment and a Managerial Focus on Issues Related to Subject Recruitment(2006-12-01) McFarlin, Tory; Arredondo, LaChelle; Gwirtz, Patricia A.; Oglesby, MichaelMcFarlin, Tory. A Review of Dendritic Cell Vaccines in Cancer Treatment and a Managerial Focus on Issues Related to Subject Recruitment. Master of Science (Clinical Research Management), December 2006, 97 pp., 5 tables, bibliography, 24 titles. Melanoma is form of skin cancer that can become deadly if the cancer progresses to a stage of metastasis. Five year survival rates as low as 10% may be noted in such patients. Decarbazine and Proleukin have been approved by the FDA for the treatment of metastatic melanoma; however both have response rates of approximately 20% or less. New treatment modalities including dendritic cell (DC) vaccines are currently being tested for treating metastatic melanoma with greater safety and efficacy profiles. DC vaccines are made by obtaining a subject’s DCs, priming them with melanoma antigen ex vivo and then injecting them into the patient to initiate an immune response against melanoma tumor cells in vivo. Investigational new treatments such has the DC vaccine must first be tested in clinical trials on research subjects. Subject enrollment issues regarding such a trial can cause delays in advances of the treatment. As an intern with a DC vaccine clinical trial, the author assisted in screening 45 patients and observed many hindrances involving enrollment of subjects. Such hindrances include: low rates of study personnel retention, small patient pools, and competing trials. Recommendations to improve enrollment include: more effective advertisement strategies and increased patient education.Item A Review of the Literature on Faith-Based Organization's HIV/AIDs Care and Prevention Efforts in Sub-Saharan Africa(2005-05-01) Rojas, Zeida G.; Lurie, Sue; Urrutia-Rojas, XimenaRojas, Zeida G., A Review of the Literature on Faith-Based Organization’s HIV/AIDS Care and Prevention in Sub-Saharan Africa. Master of Public Health (Community Health), May 2005, 83 pp., 20 diagrams, bibliography, 10 titles. The thesis assesses the role of faith-based organizations (FBOs) involved in HIV/AIDS related care and prevention activities in Sub-Saharan Africa. Do FBOs have the ability to address the multi-faceted syndrome that HIV/AIDS brings to an individual, their family and community? Can FBOs be effective partners to carry out prevention and care initiatives? Faith-based organizations are generally overlooked as potential partners and leaders in the fight against HIV/AIDS. FBOs are often the only genuine nongovernmental organizations in many rural parts of poor countries, or at a minimum, they are the strongest and most influential. Due to their organizational networks, FBOs are able to mobilize people and resources, and to reach rural or isolated areas. Evidence of current FBO efforts demonstrates that FBOs have the ability to address the multifaceted effects of HIV/AIDS and can become indispensable partners for government health agencies and NGOs.Item A Six-Year Analysis of the Distribution of Time to Death Among Colorectal Cancer Patients in the State of Texas(2000-05-01) Williams, Vanessa P.; Antonio A. Rene; Thomas J. Fairchild; Sally BlakleyWilliams, Vanessa P., A Six-Year Analysis of the Distribution of Time to Death Among Colorectal Cancer Patients in the State of Texas. Master of Public Health (Epidemiology), May 2000, 55 pp., 11 tables, 9 figures, references, 52 titles. The cancer experience of Texans differs substantially by race/ethnicity. Among Caucasian, African American, and Hispanic men and women, colon cancer is either the second or third leading type of cancers among Texans. The distribution of time to death over a six-year period were assessed from a cohort of African American, Hispanic, and Caucasian men and women diagnosed with colon cancer in 1992. The purpose of this study is to determine if there is a difference in the overall death time distribution and tumor histology among African Americans, Hispanics, and Caucasian men and women who were diagnosed with colon cancer in 1992 in the state of Texas. Analysis results indicated that Hispanic females (65.59%) and Caucasian males (65.52%) had higher survival times among the race/ethnic groups. African American males (53.85%) and females (56.40%) experienced lower survival time for the cohort. For overall distribution of time to death among deceased subjects, African American males and Hispanic females experienced the lowest distribution times among the subjects. The overall distribution of time to death for all histology types were the same for each type.Item A Study of Disparities in the Receipt of Anti-Retroviral Drugs, Health Status, and Insurance Coverage Among a Sample of HIV-Positive Adults(2006-12-01) Wittenmyer, Brian F.; Kristine Lykens; Jeffrey Talbert; Tim StrawdermanWittenmyer, Brian F., A Study of Disparities in the Receipt of Anti-Retroviral Drugs, Health Status, and Insurance Coverage among a Sample of HIV-Positive Adults. Master of Public Health (Health Management and Policy), December 2006, 88 pp., 8 tables, references, 32 titles. Anti-retroviral medications (ARV) are effective at treating HIV/AIDS. Medicare, Medicaid, and ADAP are public programs that supply ARVs to needy patients in the U.S. Studies have documented dispartities in AIDS incidence/prevalence, insurance, and ARV-use. The study described demographic, clinical, and insurance characteristics of a sample of HIV+ persons. The study explored relationships between AIDS diagnosis, health status, and ARV-receipt and demographic, insurance, and clinical variables. Disparities in ARV-receipt, AIDS diagnosis, and health-status were found for gender, age, race, geographic region, and SES. Policy recommendations included: shortening the disability waiting-period for Medicare-eligibility, and relaxing Medicaid’s income-eligibility requirements.Item A Study of Hepatitis A Seropositivity in Dallas County, 1998-1999(2001-05-01) Fulda, Kimberly G.; Antonio Rene; John Licciardone; Sally BlakelyFulda, Kimberly G., A Study of Hepatitis A Seropositivity in Dallas County, 1998 – 1999. Master of Public Health (Epidemiology), May 2001, 39 pp., 4 tables, 9 figures, references, 28 titles. The purpose of this study was to determine incidence rates per 100,000 population of hepatits A (HAV) in Dallas County for 1998 and 1999. Individuals who tested seropositive for hepatitis A between January 1, 1998 and December 31, 1999 were included. The variables of interest were sex, race, age, Zone Improvement Plan (ZIP code), and date of occurrence. Rates for 1998 were 1.9 times higher in Dallas County than the United States. In 1999, the Dallas County rate increased over 1.6 times. Rates were significantly higher in males for both years, and rates were highest among Hispanics and lowest among Blacks. Differences in age distribution varied between years by increasing in ages 50 and older in 1999. Several ZIP codes exceeded rates of 20 per 100,000 for both 1998 and 1999. Dallas County met the Advisory Committee on Immunization Practices guidelines for routine vaccination of all children in 1999.Item A Study to Determine Improved Compliance of Biophosphonate Treatment in Subjects with Osteoporosis(2005-02-01) Enard, April T.; Gwirtz, Patricia A.; Jimenez-Williams, Cynthia; Rubin, BernardEnard, April T. A Study to Determine Improved Compliance of Bisphosphonate Treatment in Subjects with Osteoporosis. Master of Science, February 11, 2005. The ability of patients to adhere to treatment regimens is very poor and continues to impede optimal therapy of osteoporosis. The shortcomings in treating osteoporosis are: a) noncompliance and/or lack of continued persistence of therapy, b) efficacy of therapy on bone turnover marker levels and fracture prevalence, and c) tolerability of therapy to patients. Studies have shown that interventions such as education and awareness of bone mineral density promote patient usage compliance. The slightest improvement in compliance allows further understanding of accurate efficacy of medication therapy to fractures, bone marker levels, and overall improvement of bone mass. Increased compliance/persistence allows accurate comparison of bisphosphonates to one another for effectiveness on osteoporosis patients and allows improvement opportunity in treatment modalities that can positively influence the course of osteoporosis. This phase IV study targets compliancy/persistence in bisphosphonate therapy in treatment of osteoporosis.Item A Sun Awareness Pilot Project(2002-05-01) Franklin, Gillian A.; Claudia Coggin; Kristine A. Lykens; Doug A. MainsFranklin, Gillian A., A Sun Awareness Pilot Project. Masters of Public Health (Health Management and Policy), May 2002, 53 pp., 7 tables, bibliography, 48 titles. The most common cancer in the United States today is skin cancer; it is also the most preventable. At least 90% of all skin cancers is caused by sun exposure. Americans have a one in six lifetime risk of developing skin cancer and in Texas the rate is one in three. The purpose of this pilot project was to increase the level of sun protection knowledge and awareness in parents who brought their children in for a six-month immunization visit. The project was modeled after the Australian Cancer Council’s “Slip! Slop! Slap!” campaign. Data was collected from five pediatric clinics in this pretest/posttest design study. Multiple variables regarding demographics, skin type, knowledge, beliefs, sun-protective practices, and attitudes were included. Overall, parental sun protective knowledge and awareness increased. The information obtained from this pilot project may influence future public health decisions regarding education and prevention of skin cancers.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 Acculturation and Psychological Distress in Mexican-American Health Fair Participants(2004-12-01) Bereolos, Nicole M.; Coggin, Claudia; Franks, Susan; Simpkins, JamesBereolos, Nicole M., Acculturation and psychological distress in Mexican-American health fair participants. Master in Public Health (Health Behaviors), December 2004, 20 pp., 3 tables, 23 titles. Immigrants who have integrated into their host culture along with maintaining their cultural identity have better psychological well-being. Greater degrees of psychological distress in less acculturated immigrants may occur due to stressors associated with the transition. This isolation has prevented providers from addressing their mental health needs. This project studied psychological well-being as its relates to acculturation. Self-report questionnaires were offered at the Hispanic Health Fair in Fort Worth, Texas. Psychological distress was significantly higher for the low acculturated (LA) than the moderately acculturated (MA). Specifically, a higher degree of anxiety for the LA group was found compared to the MA. The difference in depression was not significant, however results suggest that mild psychological distress is likely prevalent in the LA. Results underscore the importance of gaining knowledge about the needs of Mexican-Americans that are rarely seen within traditional health service.Item Adult Women and Coronary Heart Disease: Studies on Surgical Procedures and Perception(2010-12-01) Schlorke, Patricia; Bae, Sejong; Biswas, Swati; Chen, OliveSchlorke, Patricia J., Adult Women and Coronary Heart Disease: Studies on Surgical Procedures and Perception. Doctor of Public Health (Biostatistics), December 2010, 124 pp., 12 tables, 3 figures, bibliography, 95 titles. Coronary heart disease (CHD) was the number one cause of death in the United States. The main CHD symptom was a heart attack. The most common form of a heart attack was chest pain and shortness of breath, which occurred in men. However, women did not usually have chest pain, but other symptoms such as abdominal pain or indigestion. This could lead women to perceive or believe that they would not have heart disease or heart attacks. This thought could lead women to not obtaining health care, such as surgical procedures, for CHD. Health professionals knew the signs and symptoms of CHD in men, but they may be uncertain in their diagnosis in women. This could lead to women not asking their health care professional about heart attacks or other symptoms. The purpose of this dissertation analyzed CHD in two areas in all women 18 years and older. These two areas were: (a) comparing hospital length of stay between men and women who had either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA); and (b) women’s perceptions about CHD. Data for the surgical procedures study came from the 2006 National Hospital Discharge Survey (NHDS) and for the perception study came from the 2007 Behavioral Risk Factor Surveillance System (BRFSS). The results showed for the surgical procedures men and women had increased hospital days of care (DOC) for all surgical procedures. The results for the perception study showed women varied by age, race-ethnicity, education, income, and other factors in heart attack symptom knowledge. These two studies had the following conclusions. The results for increased hospital DOC had implications, such as increased health utilization, for present and future hospitalizations. The results for heart attack symptom knowledge showed a need for more awareness and communication of heart attack symptoms among all women across the United States.Item An Analysis of Osteoporosis-Related Hip Fractures, Using Hospital Discharge Data(2001-12-01) Rubin, Bernard; Antonio A. Rene; Douglas Mains; Muriel MarshallThe purpose of this study is to assess whether a current physician practice may inadequately diagnose osteoporosis in a high risk population of postmenopausal women who have sustained a hip fracture. A review of all patients discharged from Texas hospitals during calendar year 1999 was analyzed, using the Public Use Data File provided through the Texas Health Care Information Council. A total of 13,628 women over the age of 55 were admitted to hospital with a fractured hip. Only 2,233, or 16.3%, of women were also coded with the diagnosis of osteoporosis (P [less than] 0.001). Forty to fifty percent of postmenopausal women have osteoporosis. Therefore, women presenting with a fragility fracture form an even more at-risk subset of the population, such that one would expect a majority of these women to carry a diagnosis of osteoporosis. Percentages of Caucasian, non-Hispanic women in each group were comparable. The age distribution in each group was comparable, implying that the coded diagnosis of osteoporosis was not related to the age of the women when admitted to the hospital. In conclusion, physicians practicing in Texas during calendar year 1999 inadequately diagnosed osteoporosis in a high risk population of postmenopausal women who were admitted to hospital with fractured hip. Future analysis of subsequent analysis databases will be able to identify whether or not continuing medical education efforts will cause physicians to diagnose osteoporosis in this high risk population more frequently.Item 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 Analytical Study of the Perceptions, Prevention Strategies, Treatment and Economic Impact of Equine West Nile Virus(2004-06-01) Galvan, Robert; Lurie, Sue; Singh, Karan; Gonzalez, AdelaGalvan, Robert, M.P.H., M.S. An Analytical Study of the Perceptions, Prevention Strategies, Treatment and Economic Impact of Equine West Nile Virus. Doctor of Public Health, Social and Behavioral Sciences, June 2004, 109 pp., 16 Tables, 15 Figures, 47 Titles. Since the introduction of the West Nile Virus (WNV) in the United State in 1999, WNV has been the cause of disease and deaths in humans, wild birds, zoo birds, and horses. In 2002, more than 15,000 equines in 40 states were diagnosed with illness associated with WNV. Approximately one third of those horses died or were euthanized (Campbell et al, 2002). Horses are infected with the WNV more often than humans or any other mammal. It is becoming on e of the fastest growing health threats to horses nationwide. Texas responded to the discovery of WNV by expanding their surveillance systems in the eastern counties of the state (Texas Department of Health, 2003). Positive reports for WNV were announced in 2002, which prompted an increase in public education and equine vaccination recommendations. Although much has been reported on the economic impact WNV has on human health and hospital care facilities, documentation is lacking on these issues in the equine population. Understanding the biology, epidemiology, economic impact, and how WNV affects the equine industry are important aspects to public health programs and prevention activities. The objectives of this study are to: (1) examine WNV cases in the equine population in Texas in order to better understand the distribution of clinical disease, signs, treatments and outcomes; (2) to provide information regarding the perceptions, knowledge, concerns, and treatment of the WNV by Texas veterinarians; and (3) to determine the economic impact of the WNV on the equine population in the state. A 14 question survey was mailed to licensed veterinarians in Texas in an effort to gather information about their perceptions and beliefs of the WNV, recommended treatment preferences, and the estimated cost of treatment. Outcomes included case fatality rate, descriptive data, veterinarians’ knowledge of WNV, veterinarians’ beliefs/perceptions of WNV, and the economic impact of WNV. Descriptive analyses were performed by using SPSS version 11. The methods used for analysis of WNV data were primarily simple descriptive statistics including summations and frequencies. A cross-tabulation was performed between the results of Questions 1, 2, and 3 and a variable created to approximate the number of veterinarians that actually treated cases of WNV (treat). A cross-tabulation and Chi-square analysis was performed between the treatment variables (treat) and derived variables of Questions 1, 2, and 3 to examine differing beliefs and knowledge between veterinarians who had treated WNV and those who had not. Seven hundred of 4,177 surveys returned yielded a response rate of 16.8 percent. Among the veterinarians, 73.4% (514/691) believed that they are receiving or received enough training and/or education concerning WNV. The vaccination regimen is believed to be effective and reliable by 56.1% (393/691) of the respondents. There were 1,256 cases of equine WNV reported confirmed via laboratory testing. There were also 766 cases reported that were not confirmed via laboratory testing. Among the 2,022 diagnosed cases, 257 were vaccinated against WNV prior to illness; and, 159 cases were vaccinated after signs of illness. A total of 441 horses died as either a direct cause of the disease or by owner or veterinarian elected euthanasia. The most common criteria used to decide euthanasia in these horses was prolonged recumbency as reported by 44.2% (87/197) or the veterinarians. Fifty-two percent (233/488) of the veterinarians did not recommend prevention strategies to equine owners. The cost of vaccination regimen was reported by 63% (269/434) of the veterinarians to be $25 or less. The results of the survey suggest that there could be a need for WVN education among veterinarians in areas of prevention, control, and treatment. Future studies should be conducted to examine owner perceptions, knowledge and beliefs of WNV vaccinations and prevention strategies. Values for lost horses were not solicited in the survey, thus, a total economic impact could not be completely estimated. However, a formula to approximate the aggregate economic impact of the WNV on the Texas equine industry was employed.Item An Assessment of Treatment Outcomes and Perceptions of Care Amongst a Female Dual Diagnosis Population in Texas(2005-05-21) Garza, Monica J.; Doug A. Mains; T.J. Fairchild; Kristine LykensGarza, Monica J., An Assessment of Treatment Outcomes and Perceptions of Care Amongst a Female Dual Diagnosis Population in Texas. Master of Public Health (Management and Policy), May 2005, 109 pp., 42 Figures, 62 bibliography titles. The purpose of this study was to examine substance abuse services for the female population in Texas to ascertain whether a relationship existed between treatment settings, the severity of specified populations, and reported attitudes/perceptions of care. The study assessed sixty-four variables using an IRB-approved four-page survey instrument completed by 239 women receiving substance abuse treatment at outpatient and residential treatment settings. Statistical analyses included independent sample t-tests, correlations, and descriptive findings. The study found that the outpatient population of women surveyed a greater level of treatment satisfaction. Both study hypotheses were rejected. These evaluations will help Texas policy analysts, acknowledge a greater need for substance abuse trend studies.Item An Evaluation of Acanthosis Nigricans School Screening Results in Richardson Independent School District to Determine the Association of Acanthosis Nigricans and Other Factors for Type 2 Diabetes Mellitus(2005-05-01) Gardner, Janet E.; Urrutia-Rojas, Ximena; McConathy, Walter J.; Cipher, Daisha J.Gardner, Janet E., An Evaluation of Acanthosis Nigricans School Screening Results in Richardson Independent School District to Determine the Association of Acanthosis Nigricans and Other Risk Factors for Type 2 Diabetes Mellitus. Master of Public Health (Community Health), May 2005, 65 pp., 11 tables, reference list, 47 titles. Cases of Type 2 diabetes mellitus (T2DM) have been increasing at alarming rates in Texas. Identifying underlying factors, such as acanthosis nigricans (AN), elevated body mass index and hypertension, which might contribute to the development for type 2 diabetes, is critical. This study analyzed the relationship of AN with these risk factors of T2DM. Richardson Independent School District screening results for 2003-2004 were analyzed. This study concluded that calculated BMI values yielded the highest association with grades of AN. BMI-for-age percentiles greater than or equal to the 95th percentile and elevated diastolic and/or systolic blood pressures were strongly associated with AN grades.Item An Evaluation of the Impact of Continuity of Care on Cost of Services in New and Renewing CHIP Enrollees(2001-01-01) Montague, Brian; Kristine Lykens; Muriel Marshall; Karan SinghObjective. To assess the impact of continuity of care as measured by enrollment history on the cost of services in Colorado’s state insurance program for children in low-income families, the Child Health Plan Plus. Design. A retrospective cohort study using data extracted from the eligibility/enrollment system and the claims payment system for inpatient and specialty services. All children enrolled in the program for at least 90 days and managed under the state managed-care network from its inception to April 1st of 2000 were included in the analysis (n-11841). Enrollees were separated into three enrollment groups: new members, renewing members, and members transition from a prior outpatient services group. The odds by enrollment groups: new members, renewing members, and members transition from a prior outpatient services program. The odds by enrollment group an average monthly claims greater than the 75th percentile amongst those with claims (n-2661) and the odds of presence of any claim in the full data set were compared means of a logistic regression model. In order to permit inferences regarding the total cost of care, all models included age group as a cofactor. Presence of chronic or congenital disease, ethnicity, primary language, urban residence, and the presence of multiple parents or caretakers were tested using univariate chi-square analysis and significant factors (p [less than] 0.1) were included as effects in the models. Results. All cofactors with the exception of ethnicity were significant in both models. Chronic disease status was associated with an increased risk of all claims. (OR=4.961, p [less than] 0.0001) and high claims (OR=9.639, p [less than] 0.0001). Renewal status was associated with a decreased risk of any claim (OR=0.921, p [less than] 0.0936) while rollover status was associated with both an increased risk of any claim (OR=1.157, p=0.0034) and a decreased risk of high claims (OR=0.731, p=0.0033). Residence in rural counties increased the risk of any claim (OR=0.0428, p [less than] 0.0001) and an increased risk of high claims (OR=1.472, p=0.0376). Conclusions. Enrollment history had a modest, though significant, effect on the presence of any claim and the specific presence of high claims. Rollover status was protective increasing utilization of the system overall but reducing the risk of high claims whereas renewal status only reduced the risk of utilization overall. The absence of multiple adults in the household showed a pattern consistent with episodic use of the system. Relative to urban residents, residents of rural counties were more likely to have used any service and less likely to have incurred high claims. This effect may be attributable to the transition of patients to HMO networks in urban counties. Linguistic or cultural barriers as reflected in primary language strongly decreased utilization, suggesting that these may be important barriers to address in outreach and member education.Item Analysis of a Particulate Count Loading in a Water-Damaged Hospital(2007-12-01) Hill, Elizabeth G.; Larranaga, Michael; Gratton, Terry; Bae, Sae-JongHill, Elizabeth G., Analysis of a particulate count loading in a water-damaged hospital. Master of Public Health (Environmental Health), December 2007, 44 pp., 8 tables, 12 figures, bibliography, 38 titles. The purpose of this study was to determine whether data from particle counters placed on the ceiling in hospital rooms are comparable to data from particle counters placed on the wall in the same room. A baseline particulate concentration was also determined. An extensive literature review of the subject was performed as well as a statistical analysis of the data. The Spearman’s Rank Correlation showed that particulate concentrations from the ceiling and wall in the 0.3-5 μm size range were significantly correlated, while the particulate concentrations from the ceiling and the wall in the 5+ μm size range were not significantly correlated. The baseline concentrations were then found based on the descriptive statistics of the particulate concentrations taken from the ceiling.