General Public Health

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    Increasing Atmospheric Levels of 1,2,4-TMB in the DFW Metroplex from Natural Gas (Extraction) Processing from 2005 – 2015 and Asthma Rate
    (2017-03-14) Calderon, Ebony; Rich, Alisa; Hosseinzadehnaseri, Hadis
    Introduction: 1,2,4-Trimethylbenzene (1,2,4-TMB) is an industrial solvent used in 21 different hydraulic fracturing fluids. 1,2,4-TMB is found to contribute to the formation of photochemical smog in the presence of other VOCs, which is known to exacerbate respiratory conditions. 1,2,4-TMB contributes to formation of Peroxyacetyl nitrate (PAN), a component of photochemical smog reactive to sunlight and a factor in ozone production. The purpose of the study was to examine the overall trend in atmospheric 1,2,4-TMB, and the rate of Asthma over the same time period. Methods: Ambient concentrations of 1,2,4-TMB were collected from the Texas Commission on Environmental Quality (TCEQ) database, and the U. S. Environmental Protection Agency’s Urban Air Toxics Monitoring Programs (UATMP) report from 2005-2013. Asthma data was collected on children and adults from the 2015 United Way Tarrant County Community Assessment (UWTCCA). Results: Based on TCEQ data, the average amount of 1,2,4-TMB has increased during the past decade. The maximum observed level of 1,2,4-TMB increased by 437.5% from 2008 to 2010, and concentrations were 790% higher from 2008-2009, 2,119% higher in 2010, and 10,747% higher in 2011 (Rich & Orimoloye, 2015) when compared to UATMP. The 2015 UWTCCA indicates a higher asthma prevalence in North Texas. In 2010, lower respiratory disease was ranked as the 4th leading cause of death in Tarrant County. Asthma among Tarrant County adults is 9.6% higher and 17.6% higher for children compared to Texas. 1,2,4-TMB is capable of producing PAN, a powerful respiratory irritant present in photochemical smog. Increasing levels of 1,2,4-TMB in the DFW area due to natural gas extraction may be a contributing factor to the increasing rates of asthma. 1,2,4-TMB is also a factor in smog production, a respiratory irritant and exacerbator of asthma. Conclusions: Increased atmospheric levels of 1,2,4-TMB was found in areas of natural gas extraction and processing in the DFW area. 124-TMB is a factor in PAN production and ozone, which are respiratory irritants. Fort Worth has a high rate of asthma, which may be associated with increased levels in 1,2,4-TMB, PAN, photochemical smog, and ozone.
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    Characteristics of Physical Activity among African American women in the Better Me Within Program
    (2017-03-14) Taskin, Tanjila; Iqbal, Ahmed; Kitzman-Ulrich, Heather PhD; Dodgen, Leilani
    Background: African American (AA) women experience the highest rates of obesity at 57.2% compared to other groups in the United States (38.2% white women, 46.9% Hispanic women); and have the lowest levels of physical activity with only 30% of adult AA women meeting national aerobic guidelines compared to 44% of white women. Physical fitness is an important driver of health and may be even more critical than weight loss for improving health and longevity. A recent study demonstrated that individuals with good cardiorespiratory fitness, even with a BMI in the overweight or obese category (BMI [greater than] 25), had similar mortality rates to people whose BMI was in a healthy range (BMI Methods: Data were collected from participants in the BMW program (2013-2016). Variables were explored from five domains at baseline and 16 weeks to assess the relationship with physical activity (total weekly minutes) including: 1) Demographic characteristics (age, education, number of children, marital status, income, insurance); 2) Existing medical conditions (weight and height to calculate body mass index (BMI), cholesterol levels, waist circumference, blood pressure, hemoglobin A1C, and fasting glucose); 3) Health behaviors (smoking, drinking, sedentary time); 4) Mental conditions (body appreciation, physical activity and nutrition self-efficacy, confidence for exercise, mood, stress, and motivation for eating and exercise); and 5) Diet (fruit intake, vegetable intake, total calories, total fat, total carbohydrates, and total protein). Results: A total of 221 AA women were randomized to intervention or control (mean age=48.8+11.2; mean BMI=36.7+8.4; 52% technical or high school). There is a hypothesized positive effect expected between the intervention and physical activity between baseline and 16 week measures. Variables are being assessed through correlations and regressions to determine the effects on physical activity using SAS (version 9.4). The results will be expanded upon proper analysis. Conclusions: Increasing physical activity among AA women is critical to improving long term health and risk for chronic disease. This study will provide information to improve evidence-based lifestyle programs for AA women.
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    Factors Predicting Completion of Daily Phone Assessments
    (2017-03-14) Walters, Scott; Nandy, Rajesh; Li, Tommy
    Objective: Participants in long-term studies often have varying rates of compliance with study activities, especially when those activities are required daily for extended periods of time. This study examined predictors of daily survey completion among a group of permanent supportive housing residents enrolled in m.Chat, a health coaching program. Methods: A subset of participants in the program received a prepaid cellphone with unlimited voice and text minutes, with the requirement that they complete a short automated assessment each morning. The phone recorded the number of days the participant was prompted to complete the assessment, the number of completed assessments, and the percentage completed each month. We examined age, sex, race, mental illnesses, reading ability, and alcohol use as predictors of percent completion. Results: Of the 109 participants who carried the phone for at least one month, three predictors impacted daily completion rate: a history of hallucinations, binge drinking, and baseline reading level. Of the three, having experienced hallucinations was the only statistically significant predictor. Subjects who had not experienced hallucinations in the past year had a completion rate approximately 10% higher than those who had experienced hallucinations. Conclusion: While some characteristics of a participant, namely their age, sex, race, and substance use, do not accurate predict the likelihood of completion rate of a daily assessment, other characteristics such as hallucinations may play a role. Additional research could help identify reliable predictors of compliance that would allow investigators to maximize response rates to long term assessment protocols. This may allow investigators to predict how reliable a participant will be when daily completion of an assessment is required on the phone.
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    Cooking Dinner at Home: Analysis of the National Health and Nutrition Examination Survey (NHANES) 2009-2010
    (2017-03-14) Rendon, Alexis; Agravat, Devang; Gaona Villarreal, Gabriela; Qureshi, Iram; Aryal, Subhash; Mallampati, Rajesh
    Purpose: The frequency of cooking dinner at home in American households has declined in recent decades. We determined the prevalence of cooking dinner at home among 2009-2010 NHANES respondents. Methods: Multinomial regression, poisson regression, and negative binomial regression models were used to predict increased odds of cooking dinner at home. Federal Poverty Level (FPL), level of education, age, gender, country of origin, and family structure were significant predictors. Results: Survey respondents who were below 350% FPL, had lower educational attainment, older age, foreign-born, and living with a partner or dependents were more likely to have increased rates of cooking dinner at home. In contrast, respondents who were younger, Black, and male were more likely to have decreased rates of cooking dinner at home. Conclusions: Further study is warranted to determine how healthier food preparation habits can be disseminated across diverse groups.
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    Does Smoking Status Differ by Veteran Status in Young Adult Males?
    (2017-03-14) Newman, Clare PA-S; Potter, Paige PA-S; Tompkins, Ava PA-S; Diver, Thomas MPAS, PA-C, DFAAPA; Hartos, Jessica; Hammond, Haley PA-S
    Introduction: Cigarette smoking is widespread among veterans, but few studies have assessed smoking behavior in younger veterans or between young veterans and non-veterans. Thus, the purpose of this study was to investigate whether veteran status is related to smoking status in young adult males. Methods: This cross-sectional analysis used 2014 BRFSS data for males ages 18-40 from Alabama, Arkansas, South Carolina, Tennessee, and Virginia. Multiple logistic regression analysis was used to assess the relationship between veteran status and smoking status, while controlling for age, ethnicity/race, education level, employment status, income level, mental health, and depression. Results: In all five states, the majority of young adult males reported current smoking (59-64%) and few were veterans (10-17%). After controlling for demographic and psychosocial factors, smoking status was not significantly related to veteran status but was significantly related to age and education level (moderate effect sizes) in three of the five states. Conclusions: Overall, smoking status is not significantly related to veteran status in general population samples of young adult males. Smoking remains prevalent in this age group but probably at a lower percentage than reported in this study. Limitations of the study include dichotomous variables and cross-sectional study design. Practitioners should screen young adult males for smoking status, educate patients on the relationship of tobacco use and health, and provide guidance and referrals for smoking cessation.
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    Details and Deadlines: What Predicts Health Goal Completion Among Residents of Permanent Supportive Housing?
    (2017-03-14) Chhetri, Shlesma; Crayton, Leeshia; Walters, Scott; Spence-Almaguer, Emily; Ahmed, Hijab
    Background: Permanent Supportive Housing (PSH) is an intervention designed to solve chronic homelessness in the United States and includes supportive services to assist people with living independently. In Tarrant County, these services are augmented by, a health coaching program that is intended to improve the overall quality of life of PSH residents. Participants meet monthly with health coaches to establish health and wellness goals which are are documented using an online health coaching program. Purpose:This study examined the association between different “SMART” (Specific, Measurable, Attainable, Realistic and Time-limited) characteristics and goal completion among participants. Methods:There were 329 participants with 1057 recorded goals over the intervention period. We excluded inactive goals, and data from the first and last three months of the participant’s involvement. Each goal was coded based on SMART traits using a binary choice (0 and 1 for absence or presence of trait, respectively). The outcome of interest was goal completion status (completed vs. active). Results: Participants were almost equally divided between females (51%) and males (49%). The mean age was 52 years. Descriptive tests revealed that 73% of goals were specific and measurable and 21.5% of goals were time-limited. The characteristics of being attainable and realistic lacked variability and were not included in further analysis. At the participant’s most recent coaching visit, 30% of the goals were completed and 70% were still active. Out of active goals, 70.5% were specific and measurable and of the completed goals, 78.9% were specific and measurable (Chi square p=0.005). Likewise, of active goals, 19.3% goals were time-limited compared to 26.5% of completed goals that were time-limited (Chi square p=0.009). Logistic regression revealed that the odds of specific and measurable goals being completed was 46% higher than those not specific and measurable (p=0.023). Similarly, the odds of timely goals being completed was 39% higher compared to non-time limited (p=0.045). Conclusions: Successful health goals were more likely to be specific, measurable, and time-limited. Limitations of this study included difficulties in standard appraisal of attainability. Future studies could further establish a temporal link between SMART traits and goal completion.
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    Incarceration as a predictor of latent TB infection among homeless people in Tarrant County, Texas
    (2017-03-14) Mallampati, Rajesh; Miller, Thaddeus; Akkidas, James K.
    Background: Latent tuberculosis infection (LTBI), which affects an estimated 13.2 million people in the U.S., is a major impediment to TB elimination in the U.S. Testing and treatment of high-risk groups is a key focus of TB prevention efforts. Residence in shelters and correctional facilities are risk factors for LTBI, and both are more common among homeless people. We examined incarceration as a predictor of LTBI among homeless people in Tarrant County, Texas. Objective: To evaluate incarceration as a predictor of LTBI among homeless people in Tarrant County, Texas. Methods: We analyzed local data collected for the Tuberculosis Epidemiologic Studies Consortium, a 10-site study funded by the Centers for Disease Control and Prevention to assess sensitivity and specificity of three commercially-available tests for LTBI: the tuberculin skin test and two interferon-gamma release blood assays: QuantiFERON®-TB Gold In-Tube, and T-SPOT®.TB test. Analysis was confined to homeless persons who used night shelters in Tarrant County, enrolled from July 2012 to December 2016. LTBI was defined as a positive result from any test. Multiple logistic regression evaluated the relationship between LTBI and history of incarceration while controlling for drug or alcohol abuse, tobacco smoking, and other demographic and risk factors. Results: Among 1,030 shelter residents, history of incarceration was associated with increased likelihood of LTBI (adjusted odds ratio, 1.58; 95% confidence interval, 1.06 to 2.35). Conclusions: Among homeless shelter users in Tarrant County, Texas, LTBI was more common among those with a history of incarceration. This may be a useful indicator to prioritize LTBI screening.
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    How are Incentives Spent? A Look at Gift Card Purchases Among Low-Income Research Participants
    (2017-03-14) Walters, Scott; Rendon, Alexis
    Objective: Incentives are frequently used to motivate volunteers to participate in research studies. This study examined the kinds of things that low-income study participants purchased with their incentive gift cards. Methods: For participating in a health coaching program, study participants received a $25 or $35 Walmart gift card every 6 months. During follow-up phone assessments, we asked participants what kinds of items they purchased with their most recent gift card. Results: Among 259 respondents, the most commonly reported purchased items were food (30.5%), household items (14.2%), clothing (12.6%), and personal hygiene items (11.9%). Less common items included cigarettes (1.6%), gifts for others (2.6%), pet food (2.6%), and reporting the gift card as unspent (2.6%). Additionally, we found that 73.4% of reported purchased items would have qualified as wellness items that could have been purchased using the study participant’s monthly $60 allowance. Conclusions: Most study participants reported spending their incentive gift cards on items that were congruent with health improvement goals of the health coaching program. This information may be useful in tailoring incentives in a way that helps participants reach their health and wellness goals.
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    Microcephaly and Zika Virus: Exploring Possible Factors for the Increase Prevalence in Brazil
    (2017-03-14) Rich, Alisa; Nnaka, Tonychris; Dunnigan, Kayan
    Introduction: Recent studies have associated Zika virus with increased prevalence of microcephaly, abnormally small head circumference in newborns, among infants born in certain countries in South America. In the United States, data has shown that most states have maintained a high prevalence rate for microcephaly preceding the recent Zika outbreak. The question that has remained unanswered is whether the sudden increase in the prevalence of Zika virus in South American countries is truly attributed to bite of the female Aedes species of mosquito, or are other potential factors contributing to the increase. Several chemicals such as Pyrioxyfen, which was added to Brazilian drinking water for the first time in 2014 as a larvicide, is known to cause microcephaly. The use of such chemicals are controlled in the United States, but might not have similar regulations in other countries. Alcohol and drugs are teratogens that can cause microcephaly, the use of these substances are evident among certain ethnicities and countries (Mayo Clinic). Methods: Utilizing data on the prevalence of microcephaly in the United States a two-way ANOVA of the prevalence of microcephaly in certain racial groups by state shows a significant difference in the prevalence of microcephaly by race in each state analyzed. Results: The highest prevalence of microcephaly in the United States is in Alaska (19 per 10,000 live births), which does not have the Aedes species of mosquitos indicating that other factors are contributing to higher prevalence rates of microcephaly. Conclusions: Given that there several causes of microcephaly and the prevalence of microcephaly in the United States more research should be done to determine if chemicals such as Pyrioxyfen are the cause of the recent rise in the prevalence of microcephaly in South America.
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    Public Health of Birth and Loss: Rituals from Around the World.
    (2017-03-14) Paul, Marcy; Iyioriobhe, Emanehi
    Background: Across the world, cultures differ in their approach to childbirth or loss after pregnancy. This review examines possible connections between the socio-ecologic model (SEM) and rituals surrounding childbirth or child loss. Methods: A literature review addressed birth and loss practices around the world. Databases searched included PubMed, Scopus, Academic Search Complete, and Global Health from 2006 to 2016. Inclusion criteria were birth rituals, birth practices, infant death, and post-partum practices. Exclusion criteria were practices after miscarriages and childbirth or death after three years. Forty articles were selected and reviewed as full texts. The identified rituals were further grouped together into rituals based on modern medical practices, rituals based on culture and societal traditions, postpartum rituals, and religious rituals. Connections between the SEM behind the rituals were examined. Results: North America, Western, and Eastern Europe had macro-level factors such as national, state, and local laws that contributed to activities practiced during childbirth or loss after pregnancy. Organizational factors and community relationships played a role in the birth activities practiced in parts of Asia and South America. Religious factors, interpersonal and individual factors were identified in Africa. Conclusions: Birth rituals connected with influences such as societal factors and policies were seen in westernized countries, as compared to influences such as community norms, interpersonal relationships, and individual attitudes and beliefs which are seen in other parts of the world.
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    For General Health, Does Alcohol Affect Sleep Patterns In Males Ages 45-80?
    (2017-03-14) Bennett, Kaitlin; Hartos, Jessica; Waxali, Aleah; Zafar, Sophia; Oropeza, Jenna
    Introduction: More than 60 million Americans experience long-term sleep problems. Although alcohol use is related to sleep issues, little is known about the relationship between alcohol and sleep in middle aged to elderly males. The purpose of this study was to evaluate the relationship between adequate sleep and alcohol use in males ages 45-80 years old. Methods: This cross sectional analysis used 2014 BRFSS data for males ages 45-80 from Ohio, Montana, Wisconsin, and Wyoming. Multiple logistic regression analysis was used to assess the relationship between alcohol use and adequate sleep, which controlled for age, ethnicity, children at home, employment status, exercise, marital status, and tobacco use (chew and smoke). Results: The majority of males ages 45-50 years old reported that they averaged at least 7 hours of sleep in the past 30 days (64-72%), and few reported that they binge drink (14-23%). After controlling for various factors, sleep was not related to binge drinking in any of the four states but was related to exercise habits (moderate effect sizes) in all four states. Conclusions: Overall, alcohol use was not related to sleep in males ages 45-80 years old in any states, but exercise was related (moderate effect sizes) in all states. The results of this study may generalize to primary care practice patients, but not to other clinical populations. This cross-sectional study did not assess sleep “patterns” or quality of sleep. Although alcohol was not found to be related to sleep, it is standard practice to screen all patients for alcohol use and adequate sleep. It’s indicated to screen for exercise habits in those who have inadequate sleep.
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    Association of Sedentary Behavior with Salivary Estradiol Level Among African-american Women Who Are Overweight
    (2017-03-14) Kitzman-Ulrich, Heather; Dodgen, Leilani; Mandapati, Surendra; Gant, Kisa; Eke, Ikechukwu; Mamun, Md Abdullah
    Purpose: Recent studies have reported that sedentary behavior may have multiple adverse health outcomes in adults, and is related to elevated levels of estradiol that are associated with breast cancer, ovarian cancer, and endometrial cancer. A growing body of research has assessed the association of sedentary behavior with estradiol levels, however, few studies have been in African-American (AA) overweight women who are disproportionally diagnosed with cancer. The objective of this study was to assess the association of self-reported sedentary behavior of AA overweight women with salivary estradiol level. Methods: We recruited 263 AA overweight (BMI [greater than] 25, mean BMI 36.8 (SD 8.5), mean age 49.4 (SD 11.6) years) women from a faith-based weight reduction program from 2014-2016 in Dallas, Texas. Approximately 4mL of saliva was collected over four consecutive weeks. Saliva was stored in a sub 800C freezer and sent to a lab to assay. Weekly sedentary behavior was collected with a valid and reliable survey for weekdays and weekends that included hours of sitting to watch television, working on the computer, riding in a car, bus, or train, and other sitting practices. We used Pearson’s-correlation and linear models to estimate the unadjusted and adjusted association of sedentary behavior with estradiol level. Results: Average weekly sedentary time was 40.6 hours (SD = 17.5). The range of estradiol level was 0.50 pg/mL to 3.50 pg/mL with mean 1.13 pg/mL (SD = 0.55). Sedentary time was positively associated with estradiol level (correlation coefficient = 0.18, p2= 8.4%, p Conclusions: Self-reported sedentary hours for AA overweight women were less than the national average (5.8 hours in this study vs. 7.7 hours nationally, per day). We found that sedentary time was a predictive factor for estradiol level, and higher sedentary time was associated with elevated estradiol levels. Future research should further explore how sedentary behavior and elevated estradiol levels influence cancer risk in AA women.
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    Using Big Data to Examine Healthcare Quality and Outcomes: Claims Data Illuminate Association Between Behavioral Health and Preventable Hospitalization in Diabetic Patients
    (2017-03-14) Polcar, Leah; Miller, Thaddeus; Stockbridge, Erica L.
    Objective: High quality outpatient care for individuals with diabetes reduces the likelihood of acute diabetes-related complications and associated potentially preventable hospitalization (PPH). Comorbid behavioral health (BH) conditions can be a barrier to high quality outpatient diabetes care and may contribute to PPHs, but the association between BH comorbidities and PPHs has not been well-studied. We sought to determine if comorbid BH conditions are associated with an increased likelihood of diabetes-related PPHs. Study Design: We used a multivariable negative binomial-logit hurdle regression model to determine whether BH conditions were associated with diabetes-related PPHs as defined by the Agency for Healthcare Research and Quality. Covariates included sociodemographic and other comorbid medical condition variables. Materials: A national sample of medical and pharmacy claims data from the Optum Impact Research Database representing commercial insurer-covered healthcare received between 2011 and 2013 for 4,000,000 people. A total of 229,039 individuals met inclusion criteria (diagnosed/treated diabetes, aged 20-64, and complete data) and were included in analysis. Results: Claims effectively identified increased risk for PPH among diabetic patients with BH comorbidities. 20.7% had ≥1 BH condition and the risk for multiple PPHs increased as individuals’ counts of BH conditions increased. Schizophrenia, mood disorders, alcohol use disorders, and substance use disorders were each independently associated with increased risk of ≥1 PPH and an increasing number of PPHs. Conclusions: People with diabetes and comorbid BH conditions have a higher likelihood of and volume of PPHs. The results suggest that enhanced treatment approaches or improved care quality may be useful to improve health and other outcomes for this population. Claims data provide an accessible and effective approach to evaluation. Implications: Targeted interventions including case management, home health services, pharmacy management, or other structural enhancements may reduce hospitalizations in persons with comorbid diabetes and BH conditions. Given the significant proportion of diabetic patients with ≥1 diagnosed BH comorbidity, integrating diabetes care into BH treatment may drive improved health outcomes and cost savings. Evaluations of quality improvement activities focused on this population should consider using PPHs as outcome measures and claims as a data source.
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    Bullying and Sexual Victimization as Predictors for Substance Abuse and Physical Fighting Among High School Students
    (2017-03-14) De Hoyos, Jessica; Fulda, Kimberly; Qureshi, Aliya
    Purpose: Bullying and sexual violence have both been associated with negative health behavior outcomes in adolescent and youth populations. Traditionally, these topics have been researched separately, however, studies suggest that polyvictimization may increase the risk of experiencing negative health outcomes and behaviors. The objective of this study is to explore the association between having experienced both bullying and sexual victimization with substance abuse and physical fighting among American high school students. Materials and Methods: The data from the 2015 Youth Risk Behavior Surveillance System (YRBSS) for high school students will be used. Explanatory variables will be chosen based on indication of bullying and sexual victimization. Bullying will include either experiencing electronic bullying or traditional bullying, and sexual victimization will include ever being physically forced to do sexual acts, physically forced to do sexual acts by someone you are dating or going out with, or physically hurt by someone you are dating or going out with. Dependent variables will include substance abuse and physical fighting. Logistic regression will be used to examine the association of experiencing both bullying and sexual victimization with substance abuse and physical fighting. Results: 15,624 students’ questionnaires were obtained. Weighted percentages show that 48.7% were females and 51.3% were males. In addition, 27.2% students were in 9th grade, 25.7% in 10th grade, 23.9% in 11th grade, and 23.1% in 12th grade. 15.5% of students reported being electronically bullied and 20.2% reported being bullied at school. 6.7% of students reported ever being physically forced to have sexual intercourse. Results from logistic regression are pending. The study predicts to find association between polyvictimization of experiencing both bullying and sexual victimization with substance abuse and physical fighting. Conclusions: Studies suggest that polyvictimization resulting from experiencing both bullying and sexual victimization may be associated with negative and violence-related behaviors in high school populations. When investigating the association between victimization and these behaviors, overestimation of a single form of victimization may occur if multiple forms of victimization are not accounted for since the behavior may be explained by other or multiple forms of victimization.
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    Impacts of Methicillin-resistant Staphylococcus aureus on Length-of-stay among Texas hospital inpatients Using ICD10CM Codes
    (2017-03-14) O'Neill, Liam Ph.D.; Park, Saehwan
    Objective: Patients who contract Methicillin-resistant Staphylococcus aureus (MRSA) during their hospital stay will have a significantly longer length of stay, resulting in increased costs and worse outcomes. In practice, however, it may be difficult to estimate the additional health care costs that can be attributed to a MRSA infection. Moreover, it is ethically impossible to conduct a randomized controlled trials (RCT) with a sufficiently large sample. The endogenous nature of hospital acquired infections (HAI) and limitations of ICD-9-CM administrative data have also posed challenges to researchers. The purpose of this study is to examine the effects of different categories of MRSA infections on length of stay among hospitalized patients in Texas, using ICD10CM data which have recently become available. Design: We used Texas Health Care Information Collection (THCIC) inpatient database for the fourth quarter in 2015. We only included hospitalized patients whose length of stay exceeded one day. The final sample included 654,074 discharges. The dependent variable was each patient’s length of stay (LOS). Explanatory variables included five different MRSA types (MRSA sepsis, MRSA pneumonia, MRSA unspecified sites, other MRSA infections, and MRSA colonization), recommended by ICD-10-CM guidelines. In order to properly assess MRSA effects, we controlled patients’ medical status using major diagnosis categories and Charlson comorbidity index. Other patient-level confounders were adjusted as well, including age, gender, race and ethnicity, admission sources, and admission types. Negative binomial models were used for our analysis. In additions, we used propensity-score matching (PSM) to reduce the bias due to confounders and to reasonably infer causality. Findings: The mean LOS among MRSA patients varied across different types of MRSA, ranging from 8.9 days (MRSA colonization) to 20.6 days (MRSA pneumonia), while average LOS among non-MRSA patients was 6.0 days. Our multivariate model indicated that MRSA infections significantly increased the length of stay and the effects by 52% up to 131% depending on MRSA types. Matched comparison revealed endogeneity, showing that the effect of MRSA infections reduced to 28%-77%, but were still significant, except MRSA colonization (p=0.119). The differences in days of LOS were 8.6 days for MRSA pneumonia (IRR=1.768; p Conclusions: While most types of MRSA increased LOS significantly, our study also confirmed endogenous relationship between length of stay and MRSA infection, potentially because developed MRSA may prolong hospitalization, which may itself increase the risk of exposure to other pathogens. This bi-directional relationship is likely to result in over-estimations, causing exaggerated benefit predictions. Nevertheless, our results verified that MRSA accounted for 4-8 days (32-77%) of unnecessary hospitalization. The use of ICD10CM data overcomes some of the limitations of previous studies, i.e., those based on ICD9CM, as it includes five sub-categories of MRSA infections. Implications: Economic analyses for interventions, programs, and structural investments which consider prevention of HAIs can use our results to estimate expected benefits of reduced MRSAs. Hospital managers and health care professionals can better manage various MRSAs by understanding different risks and impacts. A perennial difficulty in studying MRSA infections is the lack of accurate and reliable data. The use of ICD10CM combined with public-reporting of MRSA infections shows great promise toward improving patient safety.
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    Looking Beyond the Injuries: Identifying the complex healthcare needs among survivors of interpersonal violence
    (2017-03-14) Andrews, Alita; Spence-almaguer, Emily; Grace, Jessica; Carlson, Erin; Chhetri, Shlesma
    Background: More than 1 in 3 women in America (35.6%) experience some form of interpersonal violence (IPV) during their lifetime (Black et al, 2011). The long-term negative impact on the physical and mental health of women experiencing violence has been well documented in the literature. There is evidence that IPV survivors have complex health needs and high health care utilization patterns (Rivara et al., 2007). However, a gap exists in the alignment of the nature of services provided versus the needs of IPV survivors. Services offered by IPV organizations are often geared towards meeting immediate needs for housing, financial assistance, and other forms of tangible support, particularly for individuals using emergency shelter services. Furthermore, these crisis periods are also aggravated by an increased risk for physical violence and stalking, and/or involvement in the criminal justice system. The purpose of this study was to understand the complex and holistic health needs of survivors who are utilizing IPV services. Methods: This study utilized data collected during a needs assessment conducted among 99 women residing in Tarrant County. Participants were recruited from three service providers actively providing services to IPV survivors. The survey tool incorporated questions regarding victimization history, healthcare utilization, and Self-Regulation Questionnaires (SRQ-20) to capture the distress symptoms demonstrated by IPV survivors. Results: The majority (80%) of participants reported at least one chronic health condition, yet 30% of the women mentioned not going to the doctor for routine healthcare. One-third of participants reported utilizing the ER for non-emergency reasons. While 70% of the sample reported having a place to go when sick and injured, 43% identified that place to be the ER. Among the participants, 53% reported experiencing 7 or more psychosomatic distress symptoms, meeting the WHO threshold for psychiatric distress. Conclusions: This study illustrated that the needs of IPV survivors are complex and extend beyond physical injuries. It is imperative to look beyond the crisis indicators and address the stress and strains resulting from the violence that not only becomes burdensome for survivors but also results in greater health care utilization. Currently, the Technology Enhanced Screening and Supportive Assistance (TESSA) project is using this data to support the integration of IPV and healthcare services in the community.
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    Association between Self-Reported Diabetes Mellitus and Latent Tuberculosis Infection in a U.S.-Born Homeless Population
    (2017-03-14) Mallampati, Rajesh; Board, Amy; Miller, Thaddeus; Taskin, Tanjila
    Background: Latent TB infection (LTBI) is disproportionately prevalent among certain US populations, including homeless persons.Diabetes mellitus (DM) is also more common among those with LTBI and suggests higher risk for development of TB disease.A significant association between LTBI and self-reported DM in homeless populations would support self-report as potentially useful to ascertain this important risk. Objectives: To evaluate associations between self-reported DM and LTBI among persons using night shelters in an urban Texas county. Methods: We analyzed data from U.S.-born persons using night shelters in Tarrant County, Texas during January 2013 to December 2016. Study data are a local subset of data collected by the Tuberculosis Epidemiologic Studies Consortium, a 10-site study funded by the Centers for Disease Control and Prevention to assess sensitivity and specificity of three commercially-available tests for LTBI: the tuberculin skin test and two interferon-gamma release blood assays: QuantiFERON®-TB Gold In-Tube, and T-SPOT®.TB test. We defined LTBI as a positive result on any test. Multiple logistic regression was used to evaluate relationships between LTBI and self-reported DM while controlling demographic and other factors. Results: Among 1,030 shelter users, we found no association between self-reported DM and LTBI (Odds ratio, 1.22; 95% confidence interval, 0.68 to 2.20). Conclusions: Diabetes is an important TB-related risk factor and its ascertainment can help prioritize targeted screening and intervention. We found self-reported DM did not effectively predict LTBI in our sample, suggesting it is an insufficiently reliable measurement for homeless screenings.
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    Environmental Factors of Climate, Air Quality and Altitude in Sickle Cell Pain Events: Defining the Paradigm
    (2017-03-14) Rcih, Alisa; Njesada, Ndolembai
    Objective: The purpose of this present review is to give a general overview of research concerning the role of environmental factors on sickle cell disease and determine whether these factors are consistently associated with Sickle Cell Disease (SCD). Materials and Methods: Evidence suggests that the recurrent pain episodes experienced by SCD patients are associated with the polymerization of the deoxygenated hemoglobin (HbS), and this process is dependent on hypoxia, PH, temperature and the hydration of red blood cells which could be influenced by environmental factors. Sickle cell disease (SCD), a hereditary red blood disorder, is a global health problem, and more than 100,000 babies are born with it annually. There are more than 300 million carriers of the sickle cell trait worldwide. In the USA, the average lifetime cost of sickle cell disease per patient is $460,151with higher mortality rates among adults. There were 96 articles identified from the online databases (PubMed, Google Scholar, Medline (National Library of Science), Web of Science, Scopus and Science Direct) based on the following words: “Environment”, “sickle cell disease”, “environmental factors”, “environmental determinants”, “risk factors”, “sickle cell anemia”, “air quality”, “climate”, “altitude”, “infection”, “housing”, and “socioeconomic status”. 38 studies met the inclusion criteria of peer reviewed, conducted among human subjects and written in English. Most of the studies were associated with the impact of environmental factors on SCD crises. Results: Climate has been strongly implicated as a trigger for pain crises in sickle cell. 3 studies linked wind speed to pain crises. 2 Studies associated low temperature with SCD crises while 12 other studies linked high temperature to the same crises. Additionally, 3 studies found no relationship between pain and high temperature. 5 studies associated pressures to pain (4 at high pressure and 1 at low pressure). 3 studies associated humidity to pain (1 high, 1 low humidity) and 3 others found no association. For rain, 3 found associations while 3 others found no association. Conclusions: The following conclusion can be drawn: although some results are contradictory, climate determines the complication rates among SCD patients, and there is need for further research to establish a causal relationship.
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    Comparison of Atmospheric Volatile Organic Compounds (VOCs) in Unconventional Shale Gas Extraction and Production Areas and the 2008/09 and 2010 U.S EPA Urban Air Monitoring Program (UATMP)
    (2017-03-14) Negedu, Grace; Rich, Alisa; Uche, Uloma I.
    Purpose: This study analyzed if VOC levels in the atmosphere were elevated in areas of energy E&P. Results were compared to ambient air sampling data from U.S. EPA Urban Air Toxic Monitoring Program (UATMP) using 2008/2009 and 2010 data. The UATMP is the most comprehensive air monitoring program in the U.S. Methods: Ambient air sampling occurred in 6 counties in the Dallas/Fort Worth (DFW) Metroplex from 2008 – 2010 using certified sterilized evacuated stainless steel 6 liter summa canisters. Air samples were analyzed by GC/MS (Gas Chromatography Mass Spectrometry) following U.S. EPA Compendium Method Toxic Organics (T0-14A). Results: Ambient air sampling confirmed the presence of 106 VOCs however, 37 chemicals were comparable between the Barnett Shale study and UATMP. For 2008/09, 25 out of 37 compounds were elevated in the Barnett Shale over UATMP. Significantly elevated compounds include hexachlorobutadiene (+1429.41%), 1,2,4-trichlorobenzene (+2268.42%), m&p – xylene (3284.38%), benzene (+5432.71%), 3-methylhexane (+6000.80%), ethylbenzene (+6707.23%), 1,1,2,2- tetrachloroethane (+20,500%). For 2010, 30 out of 37 compounds were elevated in the Barnett Shale over UATMP. Significantly elevated compounds included dichlorotetrafluoroethane/F114 (+1036.36), toluene/methylbenzene (+1115.86%), tetrachloroethene/PCE (+1121.11%), ethylbenzene (+1458.62%), 1,2-dichloroethane/EDC (+1539.34%), trichloroethylene/TCE (+3302.23%), 1,3,5–trimethylbenzene (+5520.86%) hexachlorobutadiene (+7778.79%), m&P- xylene (+8085.19%), 1,2,4-trimethylbenzene (+10,647.33%), 1,1,2,2-tetrachloroethane (+17,066.67%), 1,2,4-trichlorobenzene (+20,049.25%), benzene (+21,745%). Conclusions: This study confirms energy extraction and production contributes to elevated levels of VOCs in the atmosphere impacting ozone levels. VOCs found in this study are considered to be hazardous air pollutants (HAPs), primarily for the impact to human health. Exposure to HAPs have been associated with elevated incidence in birth defects, cancers, immune and nervous system disorders.
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    Health Literacy: Assessing the “Health Literacy Assessment Using Talking Touchscreen Technology” Survey in HIV Participants
    (2017-03-14) Silva, Homero; Uberu, Jerome Jr; Clay, Patrick
    Purpose: Health literacy is “the ability to obtain, process, and understand health information needed to make informed health decisions”. Limited health literacy is related to poorer health and outcomes due to deficiencies in understanding basic health information. To address literacy needs, a baseline assessment is needed. The purpose of the survey is to assess the health literacy level of HIV patients in North Texas using a validated, online tool that can be used even in resource limited environments. Methods: Participants at 4 distinct urban locations (an HIV specialty clinic, pharmacy, housing unit, and peer support group) gave verbal consent to complete the anonymous, online, audio-driven, validated “Health Literacy Assessment Using Talking Touchscreen Technology” (Health LiTT) survey. Questions assess ability to recall disease and medication understanding, read prescription labels and recall information after a simulated physician consultation. Results: A total of 78 participants completed the survey (approx. 80% response rate). The average respondent was male (73%), non-White (28%), 43 years old (+/- 3.2 yr), completed high school (90%) and resided in an urban setting (93%). In interpretation of prescription labels, respondents performed better when figures were presented, with 94% (Take With Food) and 69% (Take With Water) correctly selected when prompted whereas questions on actions to take regarding label directions without images provided only 19% (Take on empty stomach) answered correctly. In disease state knowledge comprehension, 90% of respondents correctly understood both why medications were being used and consequences of incorrect administration. While 63% were able to correctly recall how the drug worked and less than half of respondents could recall the likelihood of side effects (44%) after a simulated physician counseling session. Conclusions: Respondents performed better regarding general medication knowledge and following directions when images were provided, but performed worse when recalling specific drug information based on a pre-recorded simulation. HealthLiTT may improve patient education efforts by facilitating targeting of patient specific knowledge gaps in resource limited settings.