Community Medicine

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    Hypertension and Obstructive Sleep Apnea are Associated with Abnormal Pressor Responses to Apnea
    (2015-03) Jouett, Noah; Mason, Ryan; Niv, Dorene; Watenpaugh, Don E.; Smith, Michael L.
    Background: Cardiovascular diseases are commonly associated with elevated sympathetic nerve activity (SNA). Previously, we have shown that the blood pressure response to a voluntary apnea is closely correlated with the SNA response in patients with sleep disordered breathing (SDB) and thus may serve as an index of SNA responsiveness. In the current study, we hypothesized that the pressor response to apnea is 1) reduced with effective treatment of SDB in SDB patients, and 2) that it is exaggerated in hypertensive patients (HTN) when compared to healthy control subjects. Methods: 22 OSA patients (14 treated and 8 untreated), 19 treated hypertensive patients and 23 healthy normotensive control subjects were recruited from the UNTHSC Primary Care Center and Sleep Consultants of Texas. Subjects completed a medical history questionnaire and Epworth Sleepiness survey. Blood pressure was measured by standard auscultatory assessment in the seated position. Baseline blood pressure was obtained in triplicate during quiet rest. Then after practicing a voluntary breath hold, subjects repeated three voluntary 20-second breath holds each beginning at end-expiration. Comparisons were made 1) between treated and untreated SDB patients, and 2) between HTN patients and healthy control subjects using a Student t test. Results:Importantly, as in prior studies the pressor response to apnea was not different from zero in the healthy control subjects (-1.0 ± 4.2 mmHg, p>0.05). In the SDB patients, the pressor response was significantly greater than zero in both treated (11.4 ± 3.9 mm Hg) and untreated (24.5 ± 9.8 mm Hg) SDB patients. Conclusions: These data support our hypotheses that the pressor response to voluntary apnea is exaggerated in both untreated SDB and treated HTN patients and that effective treatment of SDB reduces this response, but does not normalize the response. These data suggest that the pressor response to apnea may be a simple physiologic index of exaggerated sympathetic responsiveness.
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    Prevalence of Infant Bed-sharing in Breastfeeding Mothers
    (2015-03) Slaymaker, Kristen N.; Shah, Deep; Bowman, W. Paul; Raines-Milenkov, Amy
    Purpose: Research has shown that bed-sharing is a risk factor for SIDS and infant suffocation, two of the leading causes of infant mortality. Several studies have shown a strong relationship between breastfeeding and bed-sharing. Almost all mothers who continue to breastfeed for more than eight weeks incorporate bed-sharing into their nocturnal feeding and sleep routine early in infant’s life for minimal disruption of night-time breastfeeding. The intent of the research is to analyze infant care practices and parent beliefs. The information gained will help identify trends in breastfeeding, infant sleep location, and parents’ reasoning behind these practices. We are interested in finding out if breastfeeding is associated with a mother’s reasoning behind choosing her infant’s sleep location among Hispanic mothers. Methods: Study design consisted of surveying mothers ≥ 18 years who had an infant between ages of 2 weeks and 3 months visiting UNTHSC Pediatric Outpatient Clinic. Survey questionnaire inquired about demographics, breastfeeding and infant sleep routine. Results: Out of 103 mothers surveyed, 45% were of Hispanic origin. Among Hispanic mothers, 50% were currently breastfeeding or feeding pumped milk. Out of all Hispanic mothers responded, 44% reported baby sleeps in mother’s bed at some point in the night. When all breastfeeding mothers (55) were asked to select reason for choosing infant’s sleep location, 17 mothers selected that it was easier to feed their baby and 32 mothers selected it seems safer for baby. Conclusion: Results showed a significant association between breastfeeding and selecting sleep location due to ease of feeding (P-value < 0.05), but did not find an association between breastfeeding and sleeping in mother’s bed at night. Although Hispanic mothers were slightly less likely to breastfeed and slightly more likely to bed-share at night than non-Hispanic mothers, these relationships did not prove significant.
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    Nutritional Barriers in Geriatrics
    (2015-03) Forner, Elizabeth A.; Feezel, Ashlea; Irani, Ayesha; Hersh, Jessica; Joseph, Justin
    1. This research was performed to identify the community resources available to the geriatric patient population with specific regards to their nutrition. We have identified the specific obstacles that geriatric patients face in receiving proper nutrition and have sought out multiple programs within our community that address these issues. 2. We targeted the most significant and widespread problems that geriatric patients experience and then located programs that could best assist with these needs. We identified programs specific to Tarrant County and those that have a focus on the care of the elderly. 3. We found that the most significant problems encountered by this population are weight loss and malnutrition and have identified that these factors are directly correlated with and increased morbidity and mortality rate, increased risk for hospital admissions, decreased disability, and dependency. Some notable contributing factors include socioeconomic factors, psychological factors, and physiological factors including oral and dental health, gastrointestinal health, and the frequent presence of multiple disease processes. We have found that the Tarrant County Meals on Wheels program and Senior Citizen Services of Greater Tarrant County provide extensive support in these regards. 4. In conclusion, we have identified that Tarrant County provides this population with adequate and numerous resources to address their specific nutritional and medical needs as a whole.
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    Texas, Medicaid and the Coverage Gap
    (2015-03) Arismendez, Alan A.; Crowley, Patrick; Yoo, James
    Title: Texas, Medicaid and the Coverage Gap Purpose: Medicaid provides medical coverage to millions of Americans, and makes up a large part of the Texas state budget. Many medical students do not know what exactly Medicaid provides, who can register for it, and where indigent patients can go to register. Our presentation helps define the what, how, and who of Medicaid insurance Methods: We searched local, state, and federal government resources for Medicaid signup and what services are offered to whom. To improve relevance, we also searched popular and public websites for the impact of the Affordable Care Act (ACA) Results: There are a number of ways to sign up in the Tarrant county area, both directly and through connecting organizations. The ACA has affected Medicaid coverage in other areas more than Texas, but the number of uninsured has nonetheless declined. We found that the main population of Medicaid beneficiaries comprises children in impoverished families. Conclusions: Medicaid is a large part of many doctors’ practices, and there is little reason to believe this will change in the near future. We hope that resources listed here will encourage students and physicians to help connect their uninsured patients with coverage, and will enlighten students of the role government insurance plays in the modern medical environment.
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    Medicare and its Economical Solutions
    (2015-03) Garg, Tushar; Tan, Christopher; Ha, Christopher; Caughlin, Morgan; Chen, Zephan
    Purpose of the research: The purpose of this investigation was to analyze the historical development of Medicare and the progression to its current state with the intention of better understanding the problems that Medicare is facing today. With this, we hoped to draw current solutions from national and local perspectives. Our goal was to examine the basics of Medicare and identify national and community resources that assist Medicare enrollees and their families. Material/Methods: Our methodology consisted of examining reports produced from non-profit and governmental organizations like Kaiser Family Foundation, Centers for Medicare & Medicaid Services and Center for Disease Control and Prevention to elicit insight on cost, demographics, and trends. We also gathered information from the National Hospital Discharge Survey published by the Center for Disease Control. Summary: Medicare costs are increasing rapidly and the program is entering a period of growth faster than ever recorded before. As of 2010, Medicare accounts for $453 billion. To reduce future costs and help close loopholes, the Affordable Care Act (ACA) was introduced in 2010. ACA extended the Medicare budget by 12 years. In addition to these federal initiatives various local level organizations also help reduce the financial burden by preventing medical conditions in enrollees which lead to post acute care and hospice care which are two of the major burdens on the Medicare system. Conclusion: The rising costs of the Medicare system will be financially taxing in the future as enrollment increases over the next few decades. However, the ACA policies will lead to significant reductions in Medicare cost. Additionally, there are a variety of local community resources in Tarrant County that can help families and enrollees learn more about Medicare, mitigate their healthcare costs and participate in preventative care.
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    Depression and Perception of Exercise as Treatment in Rural Texas
    (2015-03) Duong, Karen T.; Gupta, Pratik; Luz Chiapa-Scifres, Ana; Bowling, John
    Purpose: There is a lack of research about depression treatment specific to rural communities. There have been positive correlations with physical activity and mood disorders. The purpose of this study was to assess rural community patient’s views on validity of exercise as a treatment in depression. Methods: A survey collected patient information about demographics, participation in exercise, and perception about exercise as a valid depression treatment. Questions pertaining to exercise included how many days a week engaged in exercise, minutes per session, and type of exercise. Logistic regression was used to analyze data obtained from the survey. Results: Group 1 (18-39 years) was 0.570 times [0.117-2.767] less likely and Group 2 (40-59 years) was 1.6 times [0.257-10.662] more likely than group 3 (60+ years) to perceive exercise as valid treatment for depression. Based on ethnicity, Whites were 0.945 times [0.210 – 4.264] less likely and Blacks are 0.179 times [0.008-3.809] less likely than Hispanics to perceive exercise as valid treatment. We identified a correlation between exercise performed (independent variable) and perception of exercise as a valid or adjunct treatment approach for depression (dependent variable). Results indicate that participants who exercised for 0-30 minutes on an average day are 1.683 times [0.3-9.425] more likely and participants who exercised for 30-60 minutes are 2.347 times [0.339-22.748] more likely to perceive exercise as valid treatment for depression than participants who exercised for more than 60 minutes. Conclusions: Participants between age group of 40-59 years and participants of Hispanic ethnicity independently are most likely to perceive exercise as a valid treatment for depression. This is important because these findings can help healthcare providers tailor treatment of depression to specific age and ethnic groups. No correlation was observed between exercise time on a typical average day and their perception of exercise as a valid or adjunct treatment approach for depression.
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    Tarrant County Community Resources for Ovarian Cancer Treatment
    (2015-03) Hsu, Jennifer C.; Hoang, Steven; Nguyen, Stephanie; Tan, Henry; McMahon, Conrad
    Background Ovarian cancer accounts for 3% of reproductive system cancers among women, but it causes more deaths than any other form of reproductive cancer1. An analysis of 5 year cancer data revealed that between 2008 and 2012, 484 women in Tarrant County were diagnosed with ovarian cancer, and 303 women died with a mortality rate of 63%, the third highest of all cancers in the county2. Our research focuses on identifying community resources within Tarrant County that can guide and assist patients in coping with this difficult illness. Epidemiology The high mortality rate of ovarian cancer is due to its deep location within the pelvis, often leading to no symptoms until an advanced stage. Risk factors include women of middle age or older, family history, BRCA1/2 mutation, endometriosis, taking estrogen supplements alone and having never given birth3. To reduce risk, women are advised to use birth control pills, have ovaries removed, giving birth and breastfeeding3. Incidence rates vary by ethnicity with Caucasians having the highest rate followed by Hispanics and Blacks3. Subsequently, death rates are highest for Caucasians3. Tarrant County Resources The level of care available in Tarrant County can vary greatly depending on the patient’s ability to pay and health insurance status. While health insurance enrollment numbers have grown since the passage of the Affordable Care Act, many still do not have insurance. Community centers such as JPS help those with low income or lack of insurance find the guidance and support that they need. Additional resources include Texas Oncology, the Gynecological Cancer Navigational Program, Moncrief Cancer Resources from UT Southwestern, and the University of North Texas Health Science Center. With early detection and aggressive treatment, the 5 year survival rates of women with invasive stage I ovarian cancer can be as high as 90% compared to only 17% in stage IV.1Thus, it is imperative that women gain access to the care that they need as early as possible to ensure the best possible outcome. 1American Cancer Society 2Texas Cancer Registry 3Centers for Disease Control
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    Geriatric Fall Prevention in Tarrant County
    (2015-03) Weiser, Brent L.; Glogowski, Sarah B.; Rabbani, Tebyan A.; Fichuk, Sarah E.; Horn, Chelsea M.
    Purpose: According to the U.S. Centers for Disease Control and Prevention, falls are the leading cause of both fatal and non-fatal injuries amongst geriatrics, afflicting one out of three adults aged 65 and older.Due to falls, it is estimated that direct health care costs will increase from approximately 30 billion dollars in 2010 to 55 billion dollars by 2020. In addition to the physical impact, falls can also greatly affect the quality of life by increasing the fear of falling. This can diminish partaking in physical and social activities, further exacerbating feelings such as depression, helplessness, and social isolation. In Tarrant County, the geriatric mortality and hospitalization rates, due to fall-related injuries, exceed the Texas state average. These statistics demonstrate the need for increased community awareness and action on fall prevention. Methods: Our team consulted with local geriatricians regarding the clinical applications of fall prevention. We accessed a variety of national and local resources to compile data regarding falls as well as prevention programs within Tarrant County. In addition, we contacted community organizations for more information about the services their programs provide. Results: Through our research, we compiled a wide variety of local, free programs available for senior citizens in Tarrant County. These programs are directed at utilizing CDC suggested intervention methods such as patient education, strength and balance improvement, as well as preventative home modifications. The community resources identified include an in home fall risk assessment, group exercise classes, minor home repairs, and regular health screenings. Conclusions: There are a multitude of national and local organizations dedicated to fall prevention and identification of high-risk individuals. These services help senior citizens maintain their active and independent lifestyles, while minimizing the morbidity and mortality associated with falls.
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    Exploring how Age of Mothers Influence Maternal Practices among NICU Infants
    (2015-03) Gil, Maty; Shah, Deep; Raines-Milenkov, Amy; Bowman, W. Paul
    Purpose: Infants placed in the neonatal intensive care unit (NICU) after births have a greater risk of Sudden Infant Death Syndrome (SIDS), infections, and impaired cognitive skills compared to fully term infants. In the NICU, mothers are encouraged to practice safe sleep environments and breastfeed. Mother’s choice in adopting breastfeeding and safer sleep positions may be influenced by their level of brain maturity and infant’s health. At the age of 25, the brain fully matures, which promotes less risky behavior and more timely decisions. We are interested in learning how maternal practices such as breastfeeding and baby's sleep positions are influenced in two age groups of mothers (18-24 and 25-40) among NICU infants. Methods: In-person surveys were administered by research personnel to mothers 18 years or older with infants aged 2 weeks to 3 months during their UNTHSC-Pediatric Outpatient Clinic visits. The surveys asked questions about demographics, perinatal history, breastfeeding and other feeding practices, sleep position, and sleep locations, and exposure to smoking. IBM SPSS Statistics 21 software was used for double-data entry and statistical reporting. Results: Selected results reported here include factors related to breastfeeding and sleep position. Of all mothers (103) surveyed, 21 had infants placed in a NICU after birth. Among all NICU infants, 10 infants had younger mothers (18-24 years) and 11 had middle-aged (25-40) mothers. All of the mothers had breastfed or pumped breast milk for a short period of time, but currently only 60% of younger mothers and 64% of middle-aged mothers were breastfeeding. Among all, 7 out of 10 younger mothers and 9 out of 11 middle-aged mothers placed baby on back position to sleep. Conclusions: Compared to those under age 25, middle-aged mothers with a NICU infant did not show a significant increase in adopting healthy maternal practices such as breastfeeding and safe sleep position. The lower incidence of breastfeeding might related to the challenges that parents with preterm infants face such as milk productions, latching problems, etc. Understanding the reasons why mothers are not choosing to adopt more healthy maternal practices is very important. Clinicians and researchers need to examine the reasons mothers are discontinuing breastfeeding and implement new strategies to promote longer breastfeeding.