Community Medicine

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    Plasma Biomarkers as Indicators for Neurocognitive Impairment in HIV+ Individuals
    (2019-03-05) Aryal, Subhash; Borgmann, Kathleen; Ghorpade, Anuja; Swanta, Naomi
    Purpose: Chronic inflammation in HIV patients correlates with the severity of HIV-associated neurocognitive disorders (HAND), suggesting that inflammatory mediators could be indicators for the progression of HIV-associated neurocognitive impairment. The current clinical evaluations for HAND are designed for diagnosis after the onset of the disorder, limiting avenues for intervention. Therefore, there is a need for prognostic biomarkers to determine the likelihood for HAND development. This study aims to identify inflammatory factors from blood plasma and peripheral blood mononuclear cell (PBMC) that correlate with neurocognitive performance to serve as prognostic markers of HIV-associated neurocognitive impairment. We hypothesize that these associations are dependent upon race and sex. Methods: A total of 121 HIV+ male and female African, Caucasian and Hispanic Americans were enrolled for two separate study visits. At each visit, participants underwent a drug screen, a blood draw and a computerized neurocognitive assessment in memory, psychomotor speed, reaction time, complex attention, cognitive flexibility, processing speed and executive function using the CNS Vital Signs software. Participant blood was processed to isolate plasma and in vivo PBMCs, PBMCs were further incubated in media for 24 hours. A panel of inflammatory factors were measured in the participant samples by ELISA and real-time PCR. A multivariate multiple linear regression model was utilized to identify inflammatory factors that significantly associate with neurocognitive scores. Results: Higher plasma levels of monocyte chemoattractant protein 2 or tissue inhibitor of metalloproteinases 1 significantly associated with lower neurocognitive scores in all domains tested except reaction time. In addition, higher plasma levels of chemokine c-c ligand 17, interleukin (IL) 10, and IL-23 significantly associated with lower neurocognitive scores in processing speed and executive functioning. Conclusion: Identified plasma markers of neurocognitive performance can be utilized as indicators of neurocognitive impairment in HIV patients. This suggests that the markers can predict neurocognitive decline at the second study visit. This study may provide an avenue for early therapeutic intervention.
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    Evaluation of Resources for Homeless Veterans in Tarrant County
    (2019-03-05) Saleen, Aaron; Colucci, Patricia; Lutz, Ashley; Le, Minh; Perez, Aaron; Bairuty, Dania
    Purpose: Our project aimed to gather and present information about the homeless veteran population of Tarrant County and the resources available to them. Three to six percent of homeless veterans in the United States reside in Texas and the majority of that population is in metropolitan areas such as Dallas-Fort Worth. This number is increasing with each passing year and access to information pertaining to services that can help them is limited and often difficult to find. The homeless veteran population faces many unique problems including mental illness, physical disability, and acquiring proper health care. Methods & Results: Research and analysis of resources offered for the homeless in Tarrant County yielded several assistance programs. Of those programs, several were aimed towards serving the veteran population including the VA hospital, Compensated Work Therapy, Veterans Justice Outreach Program, Presbyterian Night Shelter, and HUD-Veterans Affairs Supportive Housing (HUD-VASH). Each program had unique barriers to access but common themes were distance to service site and lack of funding. Conclusions: While there are numerous resources for homeless veterans to utilize, the barriers to accessing care and specific eligibility guidelines for each resource prevent them from benefiting from services to improve quality of life through housing and healthcare. There is a need for increased social awareness as well as minimizing barriers to access.
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    Assessing the Relationship Between Human Papilloma Virus Vaccine Health Literacy and Caregiver Primary Language
    (2019-03-05) Fernando, Shane PhD, MS, FRSPH; Nguyen, Katherine OMS-II
    Background: Although the Human Papilloma Virus (HPV) vaccine has shown to greatly reduce the incidence of cervical cancer and HPV infection rates, HPV vaccination rates remain low within the United States. Studies suggest that HPV health literacy is correlated with several social determinants, but the relationship between caregiver primary language and HPV health literacy is less well-established. Objectives: Determine whether the lack of physician-caregiver communication regarding the HPV vaccine is a barrier in increasing HPV vaccination rates in children whose caregivers do not speak English as their primary language at home. Hypothesis: Caregivers who do not speak English as their primary language (NE) have lower HPV health literacy than caregivers who speak English as the primary language (E). Methods: 165 caregivers completed a multiple-choice paper survey regarding their knowledge and perception of the HPV vaccine within the Pediatrics and Women’s Health department of the UNT Health Science Center. After completion of the survey, caregivers then engaged in a short education session and completed the same survey via phone or email 10-20 days after the initial encounter. Statistical analysis was performed using chi-square analysis. Results: NE caregivers were less likely to have heard of HPV (p Conclusions: NE caregivers have lower HPV health literacy rates and are less likely to give the HPV vaccine to their children. The variance between the two sets of parents indicate that the lack of physician-caregiver discussion regarding the HPV vaccine may be a cause of the low HPV vaccination rates within this population. A priori literature suggests NE caregivers are at a disadvantage in learning about the preventative benefits of vaccines. These results highlight the potential benefit that HPV health education by physicians and allied health professionals can provide in efforts to increase HPV vaccination rates among children of NE caregivers.
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    Health Literacy: Obstacles to Quality Healthcare in Tarrant County
    (2019-03-05) Cooksey, Luke; Ahn, Soongjin; Rose, Sushyreta; Hubbard, Daniel; Vo, Russell
    Purpose: To identify the primary barriers to health literacy and the resources available to community members to optimize health literacy. Background & Conclusion: Health literacy is defined as the degree to which individuals have the capacity to obtain, process, and understand basic health information and the services needed to make appropriate health decisions. According to the U.S. Department of Health & Human Services, only 12% of persons in the United States are classified as proficient, meanwhile more than 25% of persons ([greater than] 77 million people) in the United States experience difficulty with mundane health tasks like following the directions on a prescription label. There are a variety of influencing factors that determine a person’s overall health literacy including demographic factors, biological, and psychosocial factors. There are four main demographic factors that influence health literacy: poverty status, race/ethnicity, education level, and age. Patients that are below the poverty status line, have minority status, have achieved less than a high school education or its equivalent, and/or are above 65 years of age are at an increased risk of possessing less than proficient health literacy. The primary biological and psychosocial aspects that influence health literacy include a patient’s lifestyle and occupation, language competency, culture, and/or cognitive ability. In Tarrant County, there are a number of accessible and expedient resources available to healthcare professionals and members of the community to optimize health literacy and subsequently, health outcomes. The resources available include: United Way of Tarrant County Health Symposium, North Texas Area Community Health Centers, Tarrant County Diabetes Collaboration, Healthy Aging and Independent Living Initiative, Health Education and Literacy Project Consortium, UNT Health Science Center, and of course, your primary care provider.
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    A peek into Tarrant County’s declining Tobacco Usage
    (2019-03-05) Turnbow, Austin; Ali, Reiza; Lewis, Daeija; Arrigunaga, Jose; Wolstein, Austin
    Background Smoking is the leading cause of preventable death in the United States. It is estimated that nearly half a million premature deaths can be attributed to smoking per year. Tarrant County has shown a steady decline in adult smokers in the past decade. In 2015, Fort Worth showed an adult smoking rate of 15.80%, compared to 16.70% in the state of Texas. This number dropped to 14% by 2017. To better understand future health implications, the contributing factors to this decline are discussed. Methods Through the use of data collection from a variety of community resources, a compilation of the most noteworthy efforts made towards combating tobacco addiction are identified and thoroughly evaluated. These resources are identified through and the Tarrant Cares website. Results Many services use an evidence-based approach to reduce the likelihood of substance use through education, familial support, and acquiring the skills needed to live a tobacco free life. Setting goals, making good decisions, and developing a strong-willed mind set can help residents gain confidence and make healthy choices. Many of the substance abuse prevention services that are available include community coalition programs, youth prevention programs, partnership for success, and strategic prevention framework through prescriptions. Conclusions Based on the efficacy of the programs that were evaluated, it can be concluded that these resources have indeed led to a decrease in tobacco use amongst Tarrant County residents. With more widespread efforts towards combating tobacco use through various resources, Texas can become a healthier state as a whole. The resources available in Tarrant County are effective, and a tribute to local government leaders who have made it a priority to have these resources available to its residents. The returns on these investments should encourage expanded efforts, especially aimed at youth.
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    Screening for Adverse Childhood Experiences in the Fort Worth Pediatric Mobile Clinic - A Quality Improvement Initiative
    (2019-03-05) Robinson, Dr. Christina MD; Randall, Carly
    Purpose: Adverse Childhood Experiences, or ACEs, are stressful or traumatic events that can disrupt childhood cognitive, social, and emotional development and can increase the likelihood of adopting health-risk behaviors. ACEs have also shown strong correlations to the development of disease, disability, and asocial problems later in life. Low socioeconomic status, health disparities, low health literacy, and poor access to healthcare are factors that play an important role in poor health. Along with ACEs, prolonged adversity can cause a Toxic Stress Response, which can play an important role in negative health outcomes and poor well-being long-term. The Pediatric Mobile Clinic, or PMC, sees patients without insurance or who are on Medicaid. The goal of this project is to screen the patients of the PMC for ACEs and early symptoms associated with ACEs, determine if the patient population at the PMC has a higher prevalence, and develop an intervention about ACEs and poor health outcomes. Methods: Data was collected from 43 patients at the UNTHSC Pediatric Mobile Clinic. Patients were asked to complete two surveys about themselves regarding ACEs, life stressors, and associated symptoms. The surveys used were adapted from the Center for Youth Wellness ACE-Questionnaires. Data was interpreted by following the CYW ACE-Q Scoring Guidelines and the patients would be categorized as either a “refer to treatment” or not. Data was assessed using Microsoft Excel for the prevalence of ACEs and associated symptoms in the patients seen. Results: The number of PMC patients that fit into the category of “refer to treatment”, because their total ACE Q Score was between 1-3 with associated symptoms or over 4 with or without symptoms was 8 out of 43, or 19%. %. The average age for ”refer to treatment” was 7.5 years old for the younger age group, and 17.6 years old for the adolescent group. The average total ACE Q score was 3.25, and the average number of associated symptoms was 2.5. The most common associated symptoms reported by the PMC patients was weight gain or loss, unexplained somatic complaints, conflicts with friends and family, and developmental or speech delays. The data also showed a positive relationship between the ACE Score and the total number of relevant symptoms. Conclusions: There is a positive relationship to the total number of ACEs and life stressors and the total number of ACE associated symptoms. Routine screening for ACEs offers the ability to identify at-risk individuals, raise awareness of the importance of preventing additional exposure to ACEs, and the opportunity for intervention and treatment.With the current low sample size, the hypothesis was not supported by the data, with less than the majority of the PMC patients fitting the “refer to treatment” category. The study will continue to reach an appropriate sample size and the level of privacy the patient has while completing the questionnaires will be noted and taken into consideration for results. In the future, the PMC hopes to adopt a system of screening for ACEs and life stressors in their patients, educating the at-risk children and families about the role of ACEs on future negative health outcomes, and intervening when necessary.
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    HIV Prevalence and Resource Availability in Tarrant County
    (2019-03-05) Karnkowska, Barbara; Mebane, Nova; Norris, Ashton; Shawn, Samuel; Garcia, Laura
    Purpose: Human Immunodeficiency Virus (HIV) is a retrovirus that attacks the immune system and can progress to Acquired Immunodeficiency syndrome (AIDS) if not treated. HIV management has been improving since its discovery in the 1970’s. However, lack of knowledge regarding community resources is a limiting factor in the low-income population. The purpose of this review is to report HIV mechanism of infection, current infection rates and resources available in Tarrant County. Methods: We conducted a literature search to find resources specific to the Tarrant County area focusing on HIV education, transmission reduction, treatment as well as support groups. Results: Services provided at low cost that help prevent the spread of HIV are the most widely available. These are made available by the AOC (AIDS Outreach Center), HELP (Health Education and Learning Project), the Tarrant County Public Health Department, and the JPS Healing Wings HIV/AIDS Center. HIV education services are limited due to the constraint of appointments. The most comprehensive assistance programs are reserved for low-income individuals diagnosed with HIV/AIDS. These comprehensive programs assign a case manager to help individuals take advantage of the broad range of services offered, such as psychological counseling, nutritional guidance, support groups, cancer screenings, and pain management. Conclusion: Since the discovery of this disease, there has been a growing effort to help this subpopulation of people in the Fort Worth community. There are many programs that aid a HIV patient with important needs such as healthcare, medicine access, HIV education, or a supportive community to live in. Many of these resources discussed can be easily accessed through the internet, by telephone, or inquiring with their local community organization. However, there are still barriers that may exclude people from receiving the benefits of these resources such as income status and household size. It is evident through these programs that not just prevention of this disease should be a main focus, but also caring for those who are afflicted with this illness as well.
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    Evaluating services provided to the homeless population of Fort Worth
    (2019-03-05) Mahan, Jedidiah; Shultz, Matthew; Kway, Kristi; Adams, Ana; Chilakamarri, Sandeep; Aziz, Hadia
    Purpose: This study identifies and evaluates services provided to the homeless population in Fort Worth, Texas by local and state organizations. Methods: Six organizations serving the homeless population of Fort Worth were identified and evaluated for eligibility, location, services provided, and barriers to access. These organizations include True Worth Place, Presbyterian Night Shelter, Union Gospel Mission, Section 8 Project Rental Assistance (PRA) Program, LegUp Program, and The Net. Results/Conclusions: Interventions employed by local and state organizations address the physiological, psychological, and/or social components of homelessness. Common services include shelter (emergency, transitional, and long-term), medical care, life skills coaching, social support, and basic needs provision. These organizations either provide these services outright or by implementing a system where persons may earn the services after completing certain tasks such as attending a certain number of meetings and workshops. Frequent eligibility criteria required by the local and state organizations include valid U.S. identification and proof of low-income or homeless status. The most prominent barriers to access were identified to be insufficient transportation, community uprooting, and time constraints.
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    Preventative Health Screenings in the Cambodian Community
    (2019-03-05) Raines-Milenkov, Amy; Chor, Holy
    Purpose: This research explores the knowledge and receipt of preventive health screenings among Cambodian immigrants in the United States. Cambodians entered the United States as refugees after a group of Communists named Khmer Rouge proceeded to rule the country with extraordinary brutality. An estimated 1.7 million Cambodian people died from executions, hunger, disease, injuries, and coerced labor, and exposure to elements. Cambodian immigrants face poverty, limited education, and health disparities in cardiovascular disease, diabetes, related risk factors, and mental health, including post-traumatic stress disorder and depression, which influence their ability to practice prevention and obtain treatment. Identification of the preventative health practices of this community may help healthcare providers better understand the needs of Cambodian immigrant and refugee populations in the United States. Methods: Surveys that assessed demographic, health insurance, health seeking behaviors, trauma, tobacco and smoking, alcohol use, cancer screening history and vaccinations, health education interest, and women’s health were collected from Cambodian men and women who are the age 21 and above. 49 surveys were completed from participants at faith-based gatherings, and other community events within the Dallas-Fort Worth area. Results: Along with other data, the results revealed that about 67% of individuals have had frightening experiences in their lives during which their personal safety or someone else’s safety was threatened, 32% of participants did not know their Hepatitis B status, and 6% have a positive Hepatitis B status. Moreover, 92% of participants indicated interest in participating in a program offered in Khmer that educates them about preventative health screenings. Limitations do exist because this focus group has a small sample size and is not representative of all Cambodian immigrant and refugee communities in the United States. However, themes have matched existing literature. Conclusions: Screening rates in this population near or exceed Healthy People 2020 Goals for screening (HP 2020: Colonoscopy 70.5%, Pap test 93%, mammogram 81.1%). However, Hepatitis B vaccination and knowledge could be improved. Providing culturally tailored education on Hepatitis B, vaccinations, and mental health could lead to increased cancer screening uptake, vaccination completion, and mental health awareness among this population.
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    Reproductive Health of Women in Tarrant County: A Review of Resources and Services
    (2019-03-05) Bhatnagar, Shweta; Cocanougher, Ellen; Geis, Sharyn; Moorhead, Ava; Dhume, Mahima
    Purpose: The landscape for female reproductive health in Texas is appalling. Texas has the highest uninsured rate, the highest rate of cervical cancer, and the highest repeat teen birth rate in the United States. Additionally, Texas has the worst maternal mortality rate (MMR) of any state. Texas established the Texas Maternal Mortality and Morbidity Task Force in 2013 to investigate a shocking spike in the maternal deaths reported. While the task force concluded the data was erroneous, it is still universally acknowledged that there has been an alarming increase in MMR in the last decade. Furthermore, the MMR within Tarrant County is much higher than the statewide rate, and is comparable to many developing countries. Maternal mortality disproportionately affects African American women with an MMR 1.5-2.5 times greater than those of other racial groups. Methods: This study is a review of resources available locally, and attempts to highlight the services offered by four prominent institutions in Tarrant County: Planned Parenthood, John Peter Smith Hospital, Tarrant County Public Health Department, and Healthy Texas Women. Results: While this issue is multifactorial, Tarrant County has numerous resources set-up to assist all women ranging from healthy teens to pregnant women to new mothers. Conclusion: Although there is a broad range of services offered locally, we believe there is still a great scope for improvements to tackle the rising MMR from a policy perspective, as well as services targeted at assisting African American women who suffer disproportionately.
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    Establishing a Critical Incident Medical Response System on a Texas University Campus: Stop the Bleed Campaign
    (2019-03-05) Fogelberg, Katherine; Lara, Brandi; Mott, Jeffrey
    Purpose: The ever increasing incidence of non-accidental mass casualty incidents on educational institutions has commanded the attention of emergency management and medical trainers nationwide. The chaos at these scenes often presents numerous barriers to access for traditional Emergency Medical Services; thus, there is a need for faculty and student bystanders to be trained and properly equipped to effectively provide life sustaining medical care until law enforcement can secure the perimeter. Non medical personnel providing life sustaining medical treatment to the wounded has been a concept used on the modern battlefield for many years. Every Soldier deploying to combat for over a decade receives point of injury medical training and immediate access to life saving equipment. Such medical equipment is carried on their person, stored in nearby vehicles and mounted on the walls of high traffic areas such as dining facilities and gymnasiums. The purpose of this translational research project was to adopt the US military’s Tactical Combat Casualty Care (TCCC) guidelines,1,3which are currently considered to be the standard of care for military prehospital medicine, to a state University in Texas by implementing the White House endorsed Stop the Bleed Campaign. Methods: The TCCC guidelines were adopted and successfully used by the US military for use during the Global War on Terrorism. These guidelines were later adapted to civilian law enforcement by the Committee on Tactical Emergency Casualty Care2,4and the National Association of Emergency Medical Technicians by way of the Prehospital Trauma Life Support manual2. The success of these programs in the civilian community provided a Segway for the Obama administration’s White House endorsement of the Stop the Bleed Campaign. Such an endorsement has created the opportunity for grants providing funds for training and medical equipment to support the campaign. Through a grant provided to the University of North Texas Health Science Center (UNTHSC) by The North Central Texas Trauma Regional Advisory Council (NCTTRAC), UNTHSC has been able to purchase and preposition medical supplies throughout the university. Training on the medical equipment was initiated by former military veterans of the UNTHSC faculty and student body. Results: The UNTHSC established a pilot program to train student and campus employees (faculty, staff & law enforcement) in tactical prehospital medical care on the most common preventable causes of death. The program consists of multiple components to include a three tiered medical supply system similar to the successful military model used for over 20 years. These include 1) Tourniquets per police officer and select students (Physician Assistant program), 2) Medical equipment bags for all campus police vehicles, and 3) Twenty Life Station®medical kits prepositioned in high traffic areas of the campus. Training to date has included 60% of the PA student body and 50% of the campus police officers. Conclusion: The principles of medical care in the military tactical care environment are similar to those in the civilian tactical care environment. These military lessons learned on the modern battlefield have met with a welcomed reception in the community nationwide at local, state and federal levels. The White House Stop the Bleed Campaign has been gaining notoriety nationwide. By implementing the program on the University of North Texas Health Science Center, it has paved the way for other Texas campuses to follow the established model.