General Public Health

Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/31264

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    PREDICTORS OF PROGRAM COMPLETION AND RECIDIVISM IN A JAIL-BASED TREATMENT PROGRAM
    (2013-04-12) Ebare, Kingsley
    Purpose: Substance abuse is a major contributing factor to incarceration and recidivism. Jail substance abuse treatment programs can be effective in decreasing incarceration and recidivism. Understanding the barriers and predictors of program completion, relapse and recidivism in substance abuse treatment programs can facilitate tailored interventions directed at more adversely affected subgroups to improve treatment outcomes. This evaluation study examines the relationship between program completion and socio-demographic factors in predicting recidivism in a jail-based substance abuse treatment program for probationers as they re-integrate into the community. Methods: This study is an outcome evaluation study to determine predictors of program completion and recidivism in a substance abuse treatment program. The program is designed in three phases. Phase 1 is the in-jail component of the intervention, while in phases 2 and 3, the probationer resides in the community, but is required to attend treatment in the supervised(phase 2) and unsupervised(phase 3) phase. We analyzed Data from 197 offenders who participated in the treatment program between June 2009 and December 2012. Variables included age at first arrest, monthly income, gang involvement, prior arrest, employment status, level of education, offense level, mental health status, offence category, and risk level Results: Program completers reported a statistically significant higher income (t=2.95, p=0.02), higher age at first arrest (t=1.94, p=0.03). We found no statistically significant association between program completion and prior arrest (p>0.05) or level of offense (p>0.05). However, recidivism was positively associated with prior arrest (p=0.001), offense level (p=0.048), and offense type (p=0.007). There was no significant association between recidivism and marital status, employment status or education. Logistics regression analysis revealed risk level (OR=0.263) income level (OR=1.001) as significant predictors of program completion while marital status (OR=7.396), prior arrest(OR=0.112) and age at prior arrest (OR=0.906) showed significant association with recidivism. Conclusions: Age at first arrest, Prior arrest and marital status are associated with recidivism while drug risk level and income level are associated with recidivism
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    BIOTERRORISM RESOURCES AND AWARENESS IN TARRANT COUNTY
    (2013-04-12) Pfeiffer, Catherine
    Purpose: This poster is a systematic review of the methods and algorithms available to health care professionals in Dallas and Fort Worth that minimize the impact of a possible bioterrorism attack. This includes background information on recognizing and classifying biological threats, as well as a discussion of ways such threats can affect public health and community function. Methods: We conducted a thorough search of electronically accessible resources, a listing of resources available to Tarrant County and surrounding areas, and condensed classifications of bioterror agents that may be encountered. We contacted the Tarrant County Public Health Department and utilized CDC publications as main sources, as well as other published literature, FEMA, and the Red Cross. Results: Dallas/Fort Worth's quarantine station is one of nineteen CDC quarantine stations in the United States and responds to threats in five states including Texas. Within the CDC's laboratory response network there is a single level II level laboratory in the state of Texas, with the ability to analyze select toxins and nerve agents. Among the available tools for reporting and responding to bioterrorism activities is the CDC's Early Aberration Reporting System, which may be utilized by the public for surveillance of bioterrorism-related cases at the local and state level. Some of the other resources with great potential to shorten response times and improve efficiency are the Readiness Plan Templates for healthcare facilities, response protocols and descriptions, and reporting outlets. Conclusions: Dallas/Fort Worth's quarantine station is one of nineteen CDC quarantine stations in the United States and responds to threats in five states including Texas. Within the CDC's laboratory response network there is a single level II level laboratory in the state of Texas, with the ability to analyze select toxins and nerve agents. Among the available tools for reporting and responding to bioterrorism activities is the CDC's Early Aberration Reporting System, which may be utilized by the public for surveillance of bioterrorism-related cases at the local and state level. Some of the other resources with great potential to shorten response times and improve efficiency are the Readiness Plan Templates for healthcare facilities, response protocols and descriptions, and reporting outlets.
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    ASSESSING TREATMENT ELIGIBILITY AND REARREST STATUS IN STREET SEX WORKERS CONTACTED THROUGH THE DALLAS POLICE DEPARTMENT S PROSTITUTE DIVERSION INITIATIVE
    (2013-04-12) Talari, Deepika
    Purpose: To assess eligibility for immediate diversion into treatment among prostitutes contacted through the PDI and evaluate recidivism based on their final disposition (jail, residential treatment, released with referral to outpatient treatment) from October 2007 through September 2012. Methods: Eligibility for immediate diversion is defined on the basis of charge classification. Prostitutes committing misdemeanor C offense were eligible for immediate diversion to treatment services. Persons committing prostitution offenses with higher charges (MA, MB, and SJF) were ineligible for immediate diversion, but provided another opportunity to participate in treatment at pre-trial release. Eligibility was determined from the DPD's booking form. Data for follow-up of women diverted to residential treatment was provided by the Nexus Recovery Center. The number of days in jail for PDI participants placed in custody was provided by the Dallas County Pre-Trial Release Division. Results: Eight hundred and sixty sex workers were contacted by the PDI at the end of five years. The majority of sex workers contacted were by arrest (n=807). Fifty-three voluntarily walked onto the street staging site for services. Four hundred and seventy-four contacts were eligible for immediate diversion to treatment. Of those eligible for treatment, 59% opted to enter treatment. Three hundred and eighty-nine participants ineligible for immediate diversion were transported to jail. Of the 177 contacts entering in-patient treatment services, 61 successfully completed the initial treatment program. More than half of the treatment completers were not subsequently rearrested when compared to the contacts that went to jail (35%). Conclusions: Ineligibility for immediate diversion because of higher arrest charge may be a potential barrier to women who want to enter treatment but are not able to do so. Sex workers that went to jail had higher proportion of rearrests compared to those that chose treatment services suggesting that immediate diversion for ineligibles sent to jail may be a worthwhile legislative effort. Further analysis is required to identify key factors which influence recidivism among street sex workers.
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    AWARENESS OF AED SAFETY AMONG EMPLOYEES AT UNTHSC
    (2013-04-12) Adamson, Aaron
    Purpose: Cardiovascular Disease is the number cause of death in America and is the leading cause of death in adults over the age of forty. Cardiac arrest is the primary cause of sudden death in individuals who are not admitted into the hospital, and the majority of these deaths are due to Ventricular fibrillation (VF). Automated External Defibrillators (AEDs) are portable machines typically located in public areas that diagnose VF and treat with defibrillation. The American Heart Association introduced AEDs through community public access defibrillator programs and helped pass laws throughout the United States to ensure that AEDs are available in public facilities. In the past year, the campus of UNTHSC has increased 1) the awareness of AED safety and use, and 2) the implementation of CPR and AED training. Methods: A survey was conducted to evaluate awareness on the safety of AED use and the presence of AEDs on campus among non-clinical employees. Results: The increased training was accompanied by a small increase in knowledge of the "location of the nearest AED" (45% to 52%), and the "fear of misuse" decreased from 56% to 47%. Moreover, the "fear of a lawsuit" was reduced from 47% to 29%. Conclusions: Although these findings suggest that the general awareness has improved, the data suggest that a greater effort is needed to better inform the general public of the safety of AED use.
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    THE GOODNEWS (GENES, NUTRITION, EXERCISE, WELLNESS AND SPIRITUALITY) TRIAL: FINDINGS FROM A HEALTH PROMOTION INVENTION ON THE BELIEFS OF AFRICAN AMERICAN ADULTS IN SOUTH DALLAS ON CARDIOVASCULAR DISEASE RISK FACTORS
    (2013-04-12) Ola, Olatunde
    Purpose: Significant disparities persist in the prevalence, morbidity, and mortality associated with cardiovascular diseases (CVD) and major risk factors based on race and ethnicity; the NIH supports risk factor reduction as the most desirable strategy for reducing CVD morbidity and mortality in high-risk populations. Methods: The GoodNEWS Program is a community-based participatory research (CBPR) project among twenty - eight (28) African-American congregations in Dallas, Texas. The partnership has existed for more than ten (10) years with significant community input and engagement. We recently completed a randomized National Institutes of Health (NIH) study, testing the effectiveness of our CBPR partnership on changing health beliefs, eating behavior and increasing physical activity. Results: Baseline data from October 2008 (N=392) indicate that most GoodNEWS participants are overweight (18.7%) or obese (67.3%), and almost one-half (48.3%) have metabolic syndrome. Participants have substantially higher levels of diagnosed disease compared to CDC national averages for African-American adults: heart disease (9.3% vs. 6.1%), diabetes (15.3% vs. 11.8%), high cholesterol (36.3% vs. 14.5%), and high blood pressure (47.5% vs. 31.6%). At the 18-month post-intervention follow-up in April 2010, the intervention group had significant reductions in food energy intake (kcal) (p=.01). However, beliefs about the effects of diet on health outcomes only changed in the control group and not the intervention group. Control participants increased their belief that diet is related to high blood pressure (p=.04), that cholesterol is related to weight gain (p=.017), and that salt intake contributes to high blood pressure (p= .015). Conclusions: The GoodNEWS program demonstrates that a strong community partnership can contribute to reducing CVD risk through food energy intake among African-American adults in the community-congregation setting. However, although intervention participants reduced caloric intake, this was not accompanied by changes in the beliefs of intervention program participants regarding diet and disease outcomes. Indeed, only the control group participants improved their understanding of this relationship. The study did not control for individual-level factors which may have mediated the relationship between the treatment variable and individuals' health beliefs.
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    UNDERSTANDING FOOD INSECURITY IN NORTH TEXAS: EXISTING FOOD NEEDS ASSETS, AND RECOMMENDATIONS
    (2013-04-12) Tantravahi, Pratyusha
    Purpose: Food insecurity is defined as having limited availability or ability to gain access to safe and nutritionally sustainable food as a consequence of limited financial resources. For many low income families living in Dallas County, food insecurity is heightened as a result of living in food desert areas. Living in a food desert reduces access to affordable nutritious food options. Many residents are forced to rely on convenience stores and fast food restaurants that provide affordable but unhealthy alternatives low in nutrition.The goal of this research project was to 1) identify existing assets in North Texas capable of meeting the nutritional needs of low-income Americans, 2) find long-term solutions and possible next steps in helping to address the issue of food insecurity in North Texas, and 3) present a case study analyzing the Nashville Mobile Market (NMM) model as a potential solution to addressing food insecurity in North Texas Methods: Site visit and personal conversation was used to gather information for the case study. Results: Results from the case study analyzing NMM model showed that the mobile food market increased access to healthy foods while cutting down on time and money spent on transportation to a grocery store for residents living in food deserts. Also, the operating model of the NMM is set up in such a way to allow all the mobile markets to be self-sustainable though grocery sales after the initial start up period. Working with local community leaders and organizations allowed the mobile markets to function at an optimal level with the most benefit to the community members. Conclusions: Although there are many individual food pantries and organizations already in place to help narrow the gap leading to food insecurity, increased collaboration and dialogue among these organizations can lead to a more organized and effective method of reaching out to residents facing food insecurity. Due to their inherently diverse structure, food policy councils are in an excellent position to address the issue of increased collaboration among food pantries. Bringing in healthy fruits and vegetables into food deserts via the use of Mobile Markets has been shown to increase intake of healthy foods and decrease travel time and distance for food desert residents. Development of a mobile market system in collaboration with community members, local businesses, and academia is one innovative solution to narrowing the food insecurity gap among low-income communities in North Texas.
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    INCIDENTAL CLINICAL FINDINGS THROUGH RESEARCH PARTICIPATION IN THE NORTH TEXAS HEALTHY HEART STUDY
    (2013-04-12) Malone, Kendra
    Purpose: There is little literature that explores the benefits and implications of the use of Computed Tomography (CT) scans for research purposes. The purpose of this study was to examine incidental findings resulting from CT scans by participating in a behavioral research study that investigated disparities in cardiovascular health outcomes. Methods: A total of 571 asymptomatic adult participants were recruited in the North Texas Healthy Heart Study. All participants completed a one-hour in person interview, body measurements, lab analysis and a 16-slice CT scan of the heart and abdomen used to assess for Coronary Calcium Score and Visceral Adipose Tissue. Radiology reports were reviewed and all findings were categorized as having "clinical" or "unknown" significance. Three years of follow-up documentation were reviewed for status of radiology report findings. Study procedures where IRB approved by the UNTHSC (IRB # 2006-006, 2007-058). Results: There were at least four cases in the present study that resulted in a significant clinical intervention out of the 510 participants who completed CT scans, equivalent to one life saved per 127.5 scans. Of the 510 participants who completed a CT scan, 169 participants had a total of 246 clinically significant findings and 310 participants had a total of 467 findings of unknown significance. 145 participants had a CAC score of greater than 0, and of those, 19 participants had a CAC of greater than 500. Conclusions: The use of CT scans to test for coronary calcium is not clinically recommended in asymptomatic persons, and can result in unnecessary exposure to radiation. However, CT scans used during the course of study procedures can result in clinically significant findings that may otherwise have not been identified and constitutes an often unspoken benefit to participants. The consent process in research settings plays an important role in conveying the risks and benefits of clinical tests provided during the course of study procedures, particularly in addressing the difference between participating in research and testing provided for clinical care purposes.
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    EFFECTS OF NUTRITION AND WEIGHT PERCEPTIONS ON DIETARY PATTERNS IN HISPANIC YOUTH
    (2013-04-12) Waverka, Rachael
    Purpose: Increasing obesity rates continue to be a prevalent problem among Hispanic youth. This study applies Theory of Planned Behavior (TPB) constructs to evaluate how weight perceptions and nutritional beliefs are associated with dietary behaviors in Hispanic youth. Understanding dietary behaviors from a TPB perspective can guide obesity prevention efforts in this high-need population. Methods: FIT for Health is an 8 week, on-going medical and graduate student run obesity prevention program for Hispanic families with an overweight (BMI% > 85th) child (ages 8 - 10 years). Baseline data was collected on 55 children (45% female; 45.5% > 95th BMI%; mean age = 9.18 ? 1.36, 58.2 % Hispanic) that included the SPAN self-report questionnaire which measured youth's nutrition behavior and attitudes. Results: Correlational analyses found that perception of weight status was significantly associated with consuming less unhealthy foods (r = 0.35; p = 0.01), and not associated with consuming healthy foods (r = .16; p = .24). Nutrition attitudes were not significantly associated with healthy (r = 0.10; p = 0.54) or unhealthy (r = -0.04; p = 0.80) dietary patterns. Conclusions: These findings indicate that in Hispanic youth, a perception of being overweight is associated with dietary behaviors to reduce unhealthy food consumption. Attitudes towards weight status may provide potential intervention strategies for obesity prevention programs in minority youth.
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    HEALTHY MOMS- HEALTHY BABIES- HEALTHY COMMUNITY INITIATIVE: CONCEPT MAPPING AND COMMUNITY MEMBERS BELIEFS ON THE IMPACT OF RACISM ON INFANT MORTALITY
    (2013-04-12) Malone, Kendra
    Purpose: Tarrant County has among the highest rates of infant mortality in Texas. Despite national efforts to eliminate racial disparities in infant mortality, the rate of infant mortality among African Americans significantly exceeds the rate of white, Mexican and Native Americans with similar socio-demographic factors. Research shows racism, mediated through stress, accounts for this disproportionality in infant mortality. Through participation in a Kellogg Foundation Action Learning Collaborative, the Healthy Moms - Healthy Babies - Healthy Community Initiative aims to reduce infant mortality through community engagement, focusing specifically on the impact of racism. The Texas Department of State Health Services funded this concept mapping project. Methods: Concept mapping is a multi-pronged, community-based process that includes brainstorming one issue, rating responses, sorting into themes, and computer-based spatial grouping. Community members from areas of Fort Worth with the highest rates of infant mortality were invited to generate ideas of how the community could decrease racial disparities in infant mortality. Ideas were rated on participation, impact, and time to implement change. Results: Seventy-two community members produced 289 statements for review, with 133 statements used for rating. Twelve actionable themes emerged: 1) connect people to resources 2) healthy environments from birth to old age 3) create partnerships among existing programs or new community programs 4) raise socioeconomic opportunities through educational incentives 5) build relationships within and outside the community 6) increase access to life skills education 7) increase parenting education 8) renew community structures 9) improve access to healthy foods 10) focus on strengths and reduce weaknesses within the community 11) empower the community to set and keep standards 12) break the cycle of race-connected social stigmas. Results were presented to community members for feedback and consensus. Conclusions: Concept mapping identified the community's priorities for reducing percieved racial impacts on infant mortality. The H3 team is currently looking for more avenues to connect community members to new and existing resources. Other findings emerging from the concept mapping project will be used to implement interventions to decrease racial disparities in infant mortality.
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    EFFECTIVENESS OF EDUCATIONAL AND BEHAVIORAL INTERVENTIONS TO REDUCE ISOCYANATE EXPOSURE IN THE AUTO BODY REPAIR AND REFINISHING INDUSTRY: A CLUSTER-RANDOMIZED CONTROLLED TRIAL
    (2013-04-12) Liu, Youcheng
    Purpose: To better control isocyanate exposure and prevent occupational asthma in the auto body repair and refinishing industry, improved exposure control strategies are needed. We conducted a cluster-randomized controlled trial in this industry. The main objectives were to assess the effectiveness of educational and behavioral interventions on worker knowledge, attitudes, and self-reported and observed behaviors with regard to isocyanate exposures. Methods: 103 workers from 14 auto body shops were selected and randomly assigned into the intervention and control groups. The intervention group received both educational training and behavioral feedback process throughout the first 6 months. Original surveys of exposure-related knowledge and attitudes and self-reported behavior were administered and actual behaviors were observed at baseline, 6, and 12 months. Data were analyzed using the Chi-square test and linear modeling, and statistical significance was set at P < 0.05. Results: Worker knowledge and attitudes improved significantly (p Conclusions: Educational training and behavioral feedback improve knowledge, attitudes, and self reported and observed behaviors in auto body workers exposed to isocyanates. Knowledge and attitude survey is a potentially useful tool to characterize auto body worker exposure risk and readiness for behavior change. In this setting training with behavioral feedback did add more benefit beyond the educational intervention. This study identified effective intervention components in improving worker safety knowledge, attitudes and self-reported behaviors in the auto body repair and refinishing industry. The findings can help increase use of safe work practices.
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    QUANTIFYING ISOCYANATES FROM MEDICAL DEVICES AND PRODUCTS: A PILOT STUDY
    (2013-04-12) Liu, Youcheng
    Purpose: Isocyanates can cause asthma. This study was conducted to identify and quantify methylene diphenyl diisocyanate (MDI) species in medical devices and products used in the neonatal intensive care setting. Methods: Thirteen medical devices and products were tested. Foams and suspected isocyanate-containing parts of the test items were separated from the rest of the devices. Two small pieces (~0.5 g) from each device or product were sampled and pre-weighed, and then extracted following a standardized protocol. The foam-type materials were placed into a glass syringe and infused with 10 mL of the 2E-4M 1-(9-anthraceny lmethyl)piperazine in toluene solution for one minute and then extracted from the syringe through a filter. The procedure was repeated ten times. A second extraction using a new aliquot of 10 mL solution (same procedure) was performed. The solution was evaporated to dryness, reconstituted to 1 mL in acetonitrile and analyzed for extractable MDI species with 2 injections. Chemical analysis for isomers of MDI (4,4'-, 2,4'-, and 2,2'-), MDI trimer, tetramer and pentamer was accomplished using a hyphenated liquid chromatography/mass spectrometry (LC-UV-MS/MS) analytical method. The limit of detection was 25 pg/mL for 4,4'-MDI, 5 pg/mL for 2,4'-MDI and ~1 ng/mL for trimer. In statistical analysis, quantities (ng) of MDI isomers from 2 injections were averaged. Quantities from two extractions were added together and divided by the sample weight (mg) to derive the concentration for the replicate. Two replicate concentrations were then averaged to calculate the mean for each device or product. Results: Mean (? standard deviation: SD) concentration (ng/mg) of 4,4'-MDI ranged from 0.0005 (? 0.0001) for the forehead pad to 0.1401 (? 0.1972) for a diaper, and 2,4'-MDI ranged from 0.00001 for a diaper, foam-based arm board, neonatal SpO2 adhesive sensor (sensor portion), forehead pad to 0.0045 for neonatal SpO2 adhesive sensor (foam portion). Mean concentrations of both 4,4'- and 2,4'-MDI for other devices and products were in between the ranges. No 2,2'-MDI, and MDI trimer, tetramer and pentamer were detected. Conclusions: 4,4'- and 2,4'-MDI species were detectable in all medical devices and products tested, but concentrations were low. Although MDI species were detectable, it is not clear whether low levels identified will be absorbed through the skin and have a potential clinical or long-term adverse effect. Further studies are needed to evaluate these implications.
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    EVALUATING PRECEPTIONS OF DISASTER PREPAREDNESS IN A RURAL COMMUNITY
    (2013-04-12) Mitchell, Robert
    Purpose: Liberty County, located in Southeast Texas between Houston and Beaumont, has been on the receiving end of two hurricanes that mandated evacuation in 2005 and 2008. The purpose of this project was to explore the perceptions of and preparations for disasters among the population of Liberty County. Methods: A survey was given to patients in a Family Medicine clinic in Liberty County. The survey asked participants about their preparations for future disasters. Data was then compared to the same survey given nationally. Results: The results showed that participants were well prepared. 55.2% of them had a three day supply of water, 24.0% a written evacuation plan, 85.4% working battery radios, 95.8% working battery flashlights, and 94.8% had experience with disasters. Conclusions: These results showed that residents of Liberty County are more prepared for disasters than most of America.
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    STUDENT RUN COMMUNITY-BASED OBESITY PROGRAM FOR HISPANIC FAMILIES
    (2013-04-12) Momoh, Jane
    Purpose: Hispanic children and adults have experienced significant rates of weight gain and associated health disparities. Although there are numerous effective weight loss programs for children, less is known about programs for low-income, ethnic minorities. This study examined the effects of an on-going student run program to improve weight in primarily Hispanic families with an overweight child (Body Mass Index (BMI) % > 85th; ages 7 - 10 years). A student-run advisory board managed recruitment, data collection, and facilitated an 8-week group program that focused on diet and physical activity delivered in both English and Spanish. The aim of this research is to examine the difference post-intervention in nutrition, physical activity, and BMI among children engaged in the FIT for Health program. Methods: Self-report questionnaires were collected at baseline and post-intervention to evaluate changes in diet and physical activity behaviors. Also, height and weight measures were collected at baseline and post-intervention to calculate child's BMI percentile. The study variables included eating behavior, BMI percentile, knowledge on nutrition, and physical activity. Univariate analysis was used for descriptive statistics and a dependent (paired) t-test was used to estimate the mean difference between baseline and post-intervention. Results: Baseline and 12-week post-intervention data were collected on 55 children (52% male; mean BMI = 26.6 ? 4.6; 73% > 95th BMI%; mean age = 9.2 ? 1.37, 74% Hispanic) and parents (79% females; mean age = 22 ? 7.4; 26% had a high school education or some college/technical education). Results showed a difference in unhealthy (p < 0.01) and healthy eating behavior (p < 0.01) between baseline and post-intervention. No difference was observed in BMI percentile or physical activity. Conclusions: Findings from this study provide preliminary support for a student-run family-based weight management program for improving dietary behaviors in overweight children. Also, results from this study suggests that a collaborated effort between medical and public health graduate students is a promising strategy for developing sustainable weight management program for underserved children.
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    ASSESSMENT OF PROTECTIVE FACTORS FOR CHILD MALTREATMENT AND THE DEVELOPMENT OF A CHILD MALTREATMENT PREVENTION PROGRAM IN UNDER-SERVED COUNTIES IN NORTH TEXAS
    (2013-04-12) Akinbola, Ebunoluwa E.
    Purpose: The objective of the study was to measure the protective factors, risk factors, and predictive factors of child maltreatment in two counties underserved by public health programs. Methods: A local community children's health coalition in conjunction with the Cook Children's Hospital developed and conducted a child maltreatment survey among 803 randomly selected parents of children from ages 0 to 14 years from two underserved counties in North Texas. We used SAS and SPSS software to analyze the survey data. We estimated and compared the predictive, protective and risk factor scores for child maltreatment to national norms. Results: The overall prevalence for past experience of child abuse is 15.3% (n=123). Possible substance abuse is indicated in 6.4% (n=51) of the respondents. The protective factor baseline scores are similar between the counties. The overall scores for each county ranges are between 5.8 and 6.0. The overall average protective factor score tends to increase as the number of children per household increases from one child to two children, however further increase in family size decreases the mean for the protective factor score. Concrete support scores (which encompass housing and financial support) were higher among parents who had at least some familiarity with parenting education programs, parent support services, or social support services. Conclusions: Although the counties have strong scores for most of the protective factors against child maltreatment, concrete support is lacking. The study indicates that many respondents in both counties are unfamiliar with services that offer education and support to parents. Comparison between current protective factor scores and scores after the introduction of community interventions that promote parenting support services may provide more clarity on these relationships.
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    ISOCYANATES IN MEDICAL DEVICES AND PRODUCTS: A QUALITATIVE ASSESSMENT
    (2013-04-12) Franklin, Gillian
    Purpose: It is hypothesized that direct contact of newborn infants with medical devices and products that have polyurethane and polyurethane foam components will result in skin exposure to isocyanates and subsequent immune response or sensitization. This sensitization may lead to asthma later in their lives. This study was conducted to qualitatively evaluate residual isocyanate content on medical devices and products used in a neonatal intensive care unit (NICU), as the initial step to assess neonatal infants' isocyanate skin exposures. Methods: Thirty-seven commonly used medical devices and products were selected and qualitatively tested. Test items were laid on the laboratory bench. Aromatic and aliphatic isocyanate Surface SWYPE" pads were used with 5 drops of acetone on the pads to wipe the surfaces of tested items using three fingers and moderate pressure; then the pads were placed on them with close contact. After 3 minutes, 60 minutes, and 24 hours the pads and medical devices were observed for an orange to red color change that indicates the presence of a specific type of isocyanate. Result was rated as positive if a color change was observed within 24 hours and negative if no color change occurred. Results: Twenty-seven percent (10 of 37) medical devices and products tested showed a color change, either on the wipe pad or/and on the product surfaces indicating the presence of either/or both free and bound isocyanate functional groups. Most colors indicated aromatic isocyanates except for one medical device, the z-flo fluidized positioned cushion that indicated aliphatic isocyanates. Conclusions: This study demonstrated that some medical devices and products used in NICU setting contain polyurethane or polyurethane foam components. Further studies to evaluate additional devices and products qualitatively are needed. These medical devices and products that were identified as containing isocyanates have been further tested to identify and quantify isocyanate species. The results are presented in a companion abstract. The potential transfer of isocyanates onto the surfaces of neonatal infants also needs to be assessed.
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    DESCRIPTIVE ANALYSIS OF MORTALITY DATA IN TEXAS STATE CORRECTIONAL FACILITIES
    (2013-04-12) Hall, Lauren
    Purpose: Inadequate prisoner healthcare in Texas is a significant problem. The Federal Constitution requires Texas to provide basic medical care for prisoners' serious medical conditions. Federal courts have had to monitor Texas for failing to meet the basic requirements of prisoner medical care. This study analyzed data on prison deaths in the state of Texas in order to determine trends in causes of death and identify points of advocacy to improve prisoner healthcare. Methods: This study used data on Texas prisoner deaths found in custodial death reports and made publicly accessible in a dataset via request to the Texas Attorney General's office. The dataset contained information for deaths reported between February 7, 2006 and October 12, 2011. Descriptive analyses were performed on demographics, death types, and medical conditions which were further stratified by gender. Overall mortality rates were calculated per year, and further stratified by prison type. Results: Texas female and male prisoners primarily died due to natural causes/illness (48%), followed by suicide (20%). The main medical cause of death due to natural causes was cardiovascular disease (24%), followed by infection in males (11.2%) and respiratory disease in females (16.9%). Overall, mortality rates in Texas prisons have decreased each year from 81.3 per 100,000 in 2006 to 67.7 per 100,000 in 2011. Higher mortality rates were observed in the smaller, low capacity Texas Department of Criminal Justice prison units. Conclusions: Mortality rates appear to be decreasing across prison facilities (both penitentiaries and county jails) in the state of Texas from 2006 to 2011. A more comprehensive and uniform database would be beneficial to future analyses on Texas prisoner deaths and healthcare. Further data is needed for a more robust interpretation of the data analyzed.
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    COLORECTAL CANCER SCREENING IN EASTLAND & LIMESTONE, TEXAS: PATIENT AWARENESS
    (2013-04-12) McKenzie, Laura
    Purpose: The U.S. Preventive Services Task Force (USPSTF) has designated colorectal cancer screening as a Grade "A" recommendation. Despite such strong recommendations, recent studies indicate that rural populations are being screened less successfully than urban populations. The studies show that colorectal cancer screening detects more advanced disease in rural populations than in urban populations. Previous studies have also identified different factors affecting colorectal cancer screening, one of them being knowledge about colorectal cancer and screening guidelines. The purpose of this study was to assess the relationship between knowledge of colorectal cancer and knowledge of colorectal cancer screening with actual screening by colonoscopy in a patient population in Eastland and Limestone Counties. Methods: A cross-sectional study was conducted by administering a survey to assess citizen's public knowledge concerning colorectal cancer and screening. The survey consisted of questions related to colorectal cancer screening knowledge and behaviors. Questions were taken from the Behavioral Risk Factor Surveillance System Survey, as well as other published literature regarding knowledge of colorectal cancer. The survey also contained demographic information. Participants age 18 and older were recruited in primary care clinics in Eastland and Limestone Counties. Descriptive statistics were performed for demographic variables (gender, age). A knowledge of colorectal carcinoma (CRC) score and a knowledge of CRC Screening were calculated. Logistic regression was performed to analyze the relationship between both types of knowledge and being screened by colonoscopy. Results: Of the 109 respondents, 68.8% ( n= 75) were 50 years or older and 72.5% (n=79) were female while 25.7% (n=28) were male. In this study 58.5% scored the survey maximum score of 3 for Knowledge of CRC and 19.8% the maximum score of 5 for knowledge of CRC screening. The odds of being screened by either colonoscopy or sigmoidoscopy in those 50 years or older significantly increased (OR = 1.82; 95% Confidence Interval [CI], 1.08 to 3.05) when combined knowledge score of respondents increased by one unit. The odds for screening is also increased significantly (OR = 11.9; 95% CI, 1.06 to 132.7) in those employed compared to those not employed. Conclusions: The results show that colorectal screening was higher in respondents with greater knowledge about CRC and CRC screening.
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    TEXAS DEPARTMENT OF STATE HEALTH SERVICES NUTRITION, PHYSICAL ACTIVITY, AND OBESITY PROGRAM EVALUATION
    (2013-04-12) Cardarelli, Kathryn
    Purpose: The purpose of this project is to develop an implementation and evaluation plan for the "Strategic Plan for Obesity Prevention in Texas, 2012-2021." This includes an assessment of current partnerships between the Texas Department of State Health Services (DSHS) and organizations, coalitions, and community groups involved in obesity prevention in Texas. Methods: A database of current stakeholders by public health region and stakeholder type will be created and new partners will be sought out based on gaps in representation. An online survey will be administered, assessing obesity prevention strategic areas of focus among partners, prior partnership with the DSHS, and types of obesity prevention activities organizations would be willing to partner on with DSHS. Results: A database with 527 potential partners representing 218 organizations involved in obesity prevention in Texas has been compiled. A survey instrument has been developed and is in the process of being pilot tested. Conclusions: The development of an implementation and evaluation plan for obesity prevention efforts in Texas will lead to modification and improvement of DSHS activities related to obesity prevention and lead to the establishment of new partnerships and collaborative work to reduce the prevalence of obesity and associated chronic diseases in Texas.
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    POPULATION-BASED RATES AND CORRELATES OF SELF-REPORTED FREQUENT MENTAL DISTRESS IN DIFFERENT SOCIO-GEOGRAPHIC ENVIRONMENTS IN TEXAS
    (2013-04-12) Akinboro, Oladimeji
    Purpose: Background: Frequent mental distress (FMD) is an indicator of poor mental health used in health-related quality of life surveillance. FMD is defined as reporting at least 14 days of mental ill-health in the prior 30-day period. Objectives: 1. To examine FMD rates in different sociogeographical populations in Texas 2. To evaluate the population-based correlates of FMD 3. To assess the use of medication for mental health problems among individuals with FMD Methods: At least 385 adults each from six counties in Texas (N=2,330), selected using probability-based dual-frame random digit dialing, were surveyed via computer-assisted telephone interviews between September and November 2012. The sampled counties were Hale (rural northwest); Lubbock (urban northwest); McLennan (urban central); Jim Wells (rural south); Willacy (rural south); and Webb (urban south). A forward stepwise procedure (entry criterion: p Results: FMD prevalence ranged from 4.5% (95% CI: 2.35, 6.57) in Lubbock county to 11.1% (95% CI: 5.36, 16.90) in McLennan. Lower odds of FMD were seen in Hispanics (vs.) non-Hispanic whites (OR=0.31, 95% CI: 0.15, 0.62); the elderly (e65 years) vs. 18-44 year-olds (OR=0.34, 95% CI: 0.15, 0.77); and males vs. females (OR=0.50, 95% CI: 0.27, 0.93). Higher odds of FMD were seen with inability to work vs. employed (OR=8.38; 95% CI=4.03, 17.43); and rarely/never having social support vs. most times/always (OR=4.59, 95% CI: 2.22, 9.51). 41.2% (95% CI: 27.40%, 55.00%) of those with FMD were on medication for mental health or emotional problems. Conclusions: FMD rates may vary across sociogeographic environments in Texas. Strengthening the social support systems for those with FMD holds promise for addressing the burden of poor mental health if the nature of association between social support and FMD can be clearly elucidated. A low medication usage rate among those with FMD suggests a need for increased clinical surveillance, and treatment for mental and emotional problems.
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    DO PRESCRIPTION PICTOGRAMS IMPROVE UNDERSTANDING OF MEDICATION DIRECTIONS FOR SPANISH SPEAKING PATIENTS?
    (2013-04-12) Scifres, Timothy
    Purpose: Language barriers exist in the US between Spanish-speaking patients and English- speaking healthcare providers, especially in terms of explaining and understanding proper medication use. This study aimed to measure the understanding of prescription instructions within the Spanish speaking population by using pictograms. The study also aimed to determine if medication instruction comprehension was increased with prescription instructions in Spanish compared to English instructions customarily included. Methods: The investigators constructed a survey to measure the participants' prescription instruction comprehension and utilized a cross-sectional study design to conduct study analyses. The survey included participant demographics, Prescription Instruction Comprehension (PIC) scores, and participant reflections. The survey was conducted throughout the Dallas/Fort Worth Metroplex from June 2012 to August 2012. Participants were recruited from the Bob Mann Medical Clinic in Arlington, TX as well as other locations in the Dallas/Fort Worth Metroplex area. A paired sample T-test was performed to compare the means of participants' Prescription Instruction Comprehension (PIC) scores with the pictogram versus without pictograms as well using prescription instructions written in Spanish versus English. Results: A total of 128 surveys were conducted for this study. There was statistically significant difference between mean PIC score with pictograms (M = 89.76, SD = 16.17), and mean PIC score without pictograms (M = 82.94, SD 20.48), t (114) = 7.56, p < .0005 (2-tailed). A statistically significant difference was found between PIC scores of Spanish instructions (M = 89.76, SD = 16.17) and PIC scores of English instructions (M = 77.97, SD = 22.24), t (114) = 7.98, p < .0005. When participants were asked if pictograms increased their confidence in understanding prescriptions, 84.8% responded "yes." More than half of participants (64.8%) responded "yes" to "would like pictograms included with all of your prescriptions", and 27.2% of the participants responded "yes but with better pictures." Conclusions: Adding pictograms to prescription instructions improved overall understanding for Spanish-speaking participants. This study also found that including prescription instructions in Spanish, the participants' native language, increased correct interpretation of how to take prescription medications. Pictograms also increased participants' confidence for understanding their medication directions.