Browsing by Subject "Social and Behavioral Sciences"
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Item A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas(2007-05-01) Miller, Thaddeus L.; McNabb, Scott; Hilsenrath, Peter; Pasipanodya, JotamMiller, 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 Critical Review of the One Hour and the Eight Hour Standards for Ozone with an Overview of the Proceedings that Led to the Implementation of The New Standard for Ozone(2004-05-01) Palla, Amruth A.Palla, Amruth R., A Critical Review of the One Hour and the Eight Hour Standards for Ozone with an Overview of the Proceedings that Led to the Implementation of The New Standard for Ozone; Master of Public Health (Environmental and Occupational Health), May 2004, 58 pp, 3 tables, 2 illustrations, 35 titles. With the increasing concern for human health and the recognition of the major role played by environment in the multi-factorial disease etiology, the various parameters established for maintaining the environmental constituents in the proportions desired for achieving a normal health status are taking an important position in the present day world. In 1997, during its review process the EPA found the exiting one-hour standards, for ozone to be insufficient to achieve the health friendly concentrations, and therefore proposed a new eight hour standard for this pollutant. The new standards proposed by the EPA were challenged by various other organizations and several proceedings have happened since then. The purpose of my thesis is to do a critical analysis of the advantages and the drawbacks of the two standards and to do an overview of the proceedings that have led to the implementation of the new standards.Item A Faith Based Approached to Cervical Cancer Screening in Latina and Vietnamese Women: Outcome Analysis(2005-05-01) Perez, Robin Z.; Gonzalez, Adela; Lykens, Kristine; Galvan, RobertPerez, Robin Z., A Faith Based Approach to Cervical Cancer Screening in Latina and Vietnamese Women: Outcome Analysis. Master of Public Health (Health Management and Policy), May 2005, 34pp., 4 tables, 3 illustrations, bibliography, 6 titles. A secondary data analysis study of the cervical cancer screening collaboration hosted by the St. Joseph Health Care Trust through six area Catholic churches was conducted to describe a program that has been recognized as a best practice for serving minority communities in Texas. The objectives of the study were to list demographic characteristics associated with the screening participants; to review culturally sensitive programming and approaches to serving both Latina and Vietnamese women. The results of this study will assist in implementation of similar interventions. The conclusions demonstrate that interventions that are tailored to specific communities may influence program participants and increase screening turnout.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 Novel Approach to Inquiry-Based Learning Models in the Sciences: Utilization of Case Presentations and Patient Encounter Workshops in High School Life Science Classrooms(2004-07-01) Whitaker, Lekeisha R.; Rustin E. Reeves; Victoria Rudick; Rouel RoqueA Novel Approach to Inquiry-Based Learning Models in the Sciences: Utilization of Case Presentations and Patient Encounter Workshops in High School Life Science Classrooms. Lekeisha R. Whitaker. Abstract. A novel approach to inquiry-based learning models is needed in a curriculum that reflects changing demographics, societal demands, and diverse cultural background. The proposed module which is designed to teach the urinary system to Fort Worth Independent District high school biology students as outlined in the Texas Essential Knowledge and Skills (TEKS) guide, represents application of this novel tool in the classroom. It is designed to be implemented in inquiry-based learning classrooms that function to encourage the natural process of inquiry throughout grade levels. The proposed module takes advantage of media resources, introductory case reports, and patient encounter workshops that outline diet, disease, and health disparities as a way to capture student interest in content relevant material, engage students in the daily lessons, and invoke long-term retention of basic life science concepts. Through future research and testing of module design and effectiveness in the classroom, the proposed approach to inquiry-based learning may serve to optimize student understanding of fundamental science concepts and diet and disease as it relates to normal body function, with implications that may affect change in lifestyle. Furthermore, the proposed learning module, if effective, may also serve as a template to be used to teach other life science subjects.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; Rene, Antonio A.Rorie, 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 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.; Lykens, Kristine; Talbert, Jeffrey; Strawderman, TimWittenmyer, 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.; Rene, Antonio; Licciardone, John C.; Blakely, SallyFulda, 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 Access to Care and Hospitalizations for Diabetes Complications Among Elderly Hispanics and African Americans in Texas(2005-08-01) Chaudhary, Prateek; Lykens, Kristine; Borejdo, Julian; Rene, Antonio A.Chaudhary, Prateek. Access to Care and Hospitalizations for Diabetes Complications Among Elderly Hispanics and African Americans in Texas. Master of Public Health, August 2005, 52 pp, 6 tables, bibliography. The mismanagement of diabetes care, due to disparities in access, deficiencies in health insurance, or poor quality of primary care, can lead to preventable microvascular complications which force diabetics to utilize hospital emergency departments (ED). This study uses 2002 hospital discharge data from the Texas Health Care Information Collection to determine whether diabetic and elderly (65+) African Americans and Hispanics from Texas counties with a low ratio of physicians per, 1,000 population (PPR) are more likely to be admitted through the ED with complications from diabetes. Findings indicate that while Hispanic ethnicity is significantly associated with ED use as a source of admission, diabetics from counties with higher PPR are more likely to be admitted through the ED for diabetes complications than diabetics from counties with a lower PPR.Item Access to Health and Social Services for Poverty Level Adults with Chronic Disease or Disability(2006-12-01) Reese, Sharon E.; Lykens, Kristine; Lurie, Sue; Scotch, RichardReese, 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 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 Application of the Theory of Reasoned Action to Female Adolescent Sexual Behavior(2000-05-01) Gilbert-Cronen, Vanessa S.; Rene, Antonio; Goldfarb, Ronald H.; Urrutia-Rojas, XimenaGilbert-Cronen, Vanessa S., Application of the Theory of Reasoned Action to Female Adolescent Sexual Behavior. Doctor of Philosophy (Biomedical Sciences), May, 2000, 143pp., 25 tables, 8 illustrations, references, 170 titles. Objectives. This study evaluated the Theory of Reasoned Actions for its effectiveness in the prediction of the sexual intercourse intentions of a group of female high school adolescents. An expanded model which included a self-esteem measure was also assessed for its contribution to the model. Additionally, six-month follow up data was used to determine whether sexual intercourse intention predicted reported sexual behavior at follow-up. Methods. Data from the National Urban Adolescent Pregnancy Prevention Program (NUAPPP), a longitudinal study conducted in 1997 and 1998 was used for this study. Tenth grade adolescent high school females (n=235) from two sites in Texas were selected to conduct a partial test of the Theory of Reasoned Action. The TRA model constructs attitudes and subjective norm were operationalized so that beliefs about sexual intercourse, attitudes towards pregnancy, perceived sexual beliefs about friends and parental communication beliefs were evaluated for their individual and combined effectiveness in the prediction of sexual intercourse intention. Results. Logistic analysis of individual model components showed significant associations between sexual beliefs (OR=5.75; 95% CI = 2.75, 11.98), pregnancy attitudes (OR=3.14; 95% CI=1.53, 6.44) perceived friend’s beliefs (OR=3.97; 95% CI = 1.57, 10.04) and sexual intercourse intention. When combined as a model, only sexual beliefs remained a significant predictor of intention (OR=4.02; 95% CI=1.79, 9.04). Evaluation of external variables showed past behavior to be a significant predictor of sexual intercourse intention (OR=32.59; 95% CI=12.56, 84.53). Conclusions. This study found the Theory of Reasoned Action to be inadequate in the prediction of adolescent female sexual intercourse intentions. The facts that individual constructs were significant predictors indicates a need for further research to understand the relationships between attitudes, beliefs, intention and behavior.Item Are Patients Satisfied with Care in the Veterans Health Administration System?(2007-10-01) Budzi, Dorothy F.; Lurie, Sue; Singh, Karan; Stimpson, JimBudzi, Dorothy F., Are Patients Satisfied with Care in the Veterans Health Administration System? Doctor or Public Health (Social and Behavioral Sciences), October 2007, 152 pp, 9 tables, 66 figures, 107 reference, 45 titles. Over 5 million men and women of the U.S. armed forces receive care from the Veterans Affairs healthcare system. The Veterans Health Administration (VHA) is the largest healthcare system and the single largest employer of physician assistants (PAs) and nurse practitioners (NPs) in the United States. Research question: This study asks the question whether the utilization of PAs and NPs in the VHA is a satisfying experience for the patients. Methods: The study analyzed outpatient Survey of Healthcare Experiences of Patients (SHEP), a monthly survey that measures patient satisfaction with the VA healthcare system. Returned surveys of patients who completed their visits at VHA outpatient clinics, acute care centers, and primary care centers across the nation in 2002-2006 were analyzed to explain patients’ satisfaction with PAs, NPs, and physicians. Samplings: Of the 2,164,559 questionnaires that were mailed to patients, 1,601,828 were returned (response rate= 64%, P-value=.05, confidence interval=95%, margin of error +/-2.2). A difference of four or more points is statistically greater than could be caused by sampling error. Secondary data on primary care patient satisfaction scores per Veterans Integrated Network Service (VISN) and facility was analyzed, and compared with provider type ratio per VISN and per facility. Results: the study found that the utilization of non-physician clinicians such as PAs and NPs in the VHA system was a satisfying experience for patients. In certain VISNs, patient satisfaction scores increased by 5% when the number of non-physician clinicians (NPC) was increased compared to 1.8% when the number of physicians was increased. Physician to PA/NP ratio was 7:3, and majority of the primary care providers were male while most of the NPs were female. The dominant age group of the providers was 45-54 years of age. Considering veteran status, PA veteran and non-veteran were 50:50, NP veterans approximately 65%, NP non-veterans 45%, and physician veterans 20% to 80% non-veterans. The information gained from this research may permit the administrators to develop plans and adjustments that foster quality healthcare services.Item Are the Disaster Preparedness Plans in the Largest Cities in the States Adequate for Disabled & Elderly Populations?(2007-05-01) Hall, Stephanie K.Hall, Stephanie K, Are the Disaster Preparedness Plans in the Largest Cities in the Unites States Adequate for Disabled & Elderly Populations? Master of Public Health (Community Health), May 2007, 36 pp., 10 tables, 1 map, reference, 15 titles. This study seeks to compare urban disaster plans in the 25 largest U.S. cities. The focus of this study involves two populations that are often neglected or dealt with last: elderly and disabled. Therefore, the largest US cities should have a comprehensive disaster preparedness plan that includes evacuation & transportation; sheltering and health services; and legal considerations for both the disabled & elderly populations. The data reported in this study was gathered from each city Office of Emergency Management website. The data was analyzed to determine which cities have disaster preparedness plans that consider the disabled and again populations. Results indicate many cities are not prepared.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 Barriers to Medicaid Enrollment: A Study of the Texas Healthy Kids Corporation(2000-12-01) Barlow, Daphne J.; Mains, Doug A.; Blakley, SallyBarlow, Daphne J., Barriers to Medicaid Enrollment: A Study of the Texas Healthy Kids Corporation. Masters of Public Health (Health Administration), December, 2000, 38 pp., 18 tables, References, 13 titles. Recently Medicaid eligibility was expanded to include more children than ever before in Texas. However, many Medicaid eligible families have not obtained benefits. This study concerns potentially Medicaid eligible families who applied to the Texas Health Kids Corporation. A random telephone survey of these applicants examined the outcome of Medicaid eligibility notification. Data was analyzed to determine the predictors of attempting or completing an application. No significant sensitivity to profilers such as primary language, race/ethnicity, education level or age was detected. Instead, having prior knowledge of Medicaid eligibility and being female were predictive factors to consider when engineering outreach programs. While these results indicated a statistical significance, further study of repeat notification and gender in order to conclusively recommend policy change. These results have implicated for the Texas CHIP program.Item Barriers to Women's Cardiovascular Risk Knowledge: A Tarrant County Study(2004-05-01) Liewer, Linda J.; Lykens, KristineLiewer, 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 Behavioral Disturbances, Chronic Pain, and Cognitive Impairment in Long-Term Care Centers(2004-07-01) Ambavaram, Sukanya; Cipher, Daisha J.; Bayona, Manuel; Coggin, ClaudiaAmbavaram, Sukanya. Behavioral Disturbances, Chronic Pain, and Cognitive Impairment in Long-Term Care. Master of Public Health, July 2004, 45 pp., 8 tables, references. Background- There is increasing interest in finding the relationship between pain, depression, behavioral disturbances and cognitive impairment in patients living in long-term care centers and predicting behavioral disturbances using chronic pain, depression and cognitive impairment as predictors. To date this is the first study identifying the relationship between pain and behavioral problems. Methods- The study population consisted of 412 residents living in 16 long-term care centers in Dallas, TX. Pearson product-moment Correlation was done to find the association between behavioral disturbances and pain, depression and cognitive factors. Multiple regression analysis was performed to obtain best predictors of behavioral disturbances and forward selection procedure to find out best fit model. Conclusion- Statistically significant correlation was achieved between behavioral excess and overall pain. The correlation was statistically significant between behavioral deficit and overall pain, activity interference and depression. Overall pain, activity interference and depression are significantly inter-correlated with each other. Over all pain and activity interference were found to be statistically significant predictors of behavioral excess. Overall pain was found to be statistically significant predictor of behavioral deficit.Item Characteristics of Primary Care Physicians Serving in Texas Medically Underserved Areas(2006-08-01) Lancaster, Scott Bradley; Lykens, Kristine; Gamber, Russell; Talbert, JeffreyLancaster, Scott Bradley, Characteristics of Primary Care Physicians Serving in Texas Medically Underserved Areas, 2005. Master of Public Health (Health Management and Policy), May 2006, 63 pp., 13 tables, bibliography, 59 titles. Primary care physician demographics were examined to determine if subgroups differed in choice of practice location in urban and rural Medically Underserved Areas (MUAs) in Texas. Compared with the overall proportion of physicians practicing in rural MUAs (8.8%), subgroups that significantly differed were Dos (13.5%), males (10.6%), general practitioners (19.4%), family physicians (12.4%), and graduates of medical school prior to or during 1960 (18.8%) and from 1961-1970 (11.2%). Compared with the overall proportion of physicians practicing in urban MUAs (23.2%), subgroups that significantly differed were females (25%), Blacks (29.7%), and Latinos (38.7). Binary logistic regression showed that Asian ethnicity, general practice specialty, and graduate year of 1961-1970 predicted MUA practice location. The statistically significant differences observed underscore the importance of further study to examine potential differences between rural and urban MUAs. Public policy that provides incentives for more equitable physician distribution should be based on sound research.