Women’s Health
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21699
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Item Threats to the Tradition and Practices of Breastfeeding in Refugees Following Resettlement in Tarrant County(2017-03-14) Raines-Milenkov, Amy; Baker, Eva; Durbin, Katherine; Kwentua, Victoria; Thein, Emelda; Mudey, Halimo; Subedi, Radhika; Rudasingwa, Laurette; Moreno, TanirBackground: Few studies have investigated breastfeeding in refugee populations resettled in the United States. Of those that exist, studies have found that refugees face many challenges to exclusively breastfeeding their children due to conflict between their traditions and the U.S. culture, economy, and health care system. However, there has been no research studying these difficulties among recently arrived populations of refugees, such as the Bhutanese and Karen. The purpose of this study is to identify factors that threaten to disrupt breastfeeding practices in recently arrived populations of refugees following resettlement in Tarrant County. Methods: Data for this study comes from previously collected focus group transcripts. Secondary data analysis was used from 5 focus groups from the Bhutanese, Karen, and Somali community. Thematic analysis was used to identify significant themes in the transcripts relating to the subject of the study. Analysis included reading of the text, coding the data, theme identification, and consolidating the information in order to identify the three primary threats to breastfeeding practices. Results: Three main themes emerged. These included the influence of health care providers, the perception of existing U.S. breastfeeding practices, and the interference of work duties or financial issues. These influences were consistently found to have a negative impact on the continuation of exclusive breastfeeding among each refugee population. Conclusions: Refugees are at a significant disadvantage of losing breastfeeding practices following resettlement and adjusting to a new culture in the U.S. However, the tradition and practice of exclusive breastfeeding should be a protected and promoted behavior. Cultural competence and consideration should be incorporated into the education of health care workers in order to promote breastfeeding and address, and when possible, remove threats to this positive maternal behavior.Item Association of Trauma on Chronic, Infectious, and Reproductive-related Disease Prevalence among Women in Substance Abuse Treatment(2017-03-14) Guardado, Annie; Dokpesi, Philip; Bakre, Sulaimon; Felini, Martha; Keck, ErinBackground: Previous literature demonstrates that individuals with co-occurring substance use disorders (SUDCs) often have comorbid conditions. Although SUDCs have been linked to higher use of medical management, there are few studies of the burden of disease types across and within high risk women in substance abuse treatment. The purpose of this cross-sectional study was to analyze the prevalence of chronic, infectious, and reproductive-related disease separately among women in substance abuse treatment and further explore whether prior trauma history was associated with disease prevalence. Methods: As part of a larger cancer prevention project conducted in Dallas from 2012-2016, 1076 women in treatment at the largest substance abuse treatment center in North Texas received education regarding cancer prevention, and were offered a well woman cancer screening exam. Data collected from a self-administered questionnaire included demographics, medical health history, reproductive history, substance use history, and trauma experience (physical, sexual, verbal/emotional) within the last 6 months. Participants were from 119 counties across Texas, including border counties. Descriptive and stratified analyses were performed to determine disease prevalence by trauma history. Results: Exposure to trauma was correlated with a higher prevalence of chronic disease (p Conclusions: Findings suggest comorbid disease and adverse reproductive outcomes are prevalent in this population. An exceptional window of opportunity exists to integrate preventive and preconception care interventions within treatment recovery centers, but the key challenge will be determining how it can be best delivered to women with significant trauma histories.Item Faculty, Resident, and Nursing Attitudes Regarding Transitions of Care of Antepartum, Postpartum, and Gynecology Patients in the County Hospital Setting(2017-03-14) Hoang, Christine; Jackson, Angalene; Marshall, Hayley; Kremer, TimothyPurpose: To evaluate attitudes about a transition of care system and identify opportunities to improve the safety and quality of care involving antepartum, postpartum, and gynecology patients. Background: Handoffs and transitions of care have been a central part of patient safety goals at John Peter Smith Hospital. With twice daily shift changes for physician and nurses, the Department of Obstetrics and Gynecology introduced a new interdisciplinary team transition of care system. Initial anecdotal feedback suggested that the handoff process was suboptimal and communication efforts could be improved. A survey was developed to evaluate opinions about the process and identify areas for improvement. Methods: An anonymous online survey was administered to physicians and nurses participating in the new handoff system. The results were analyzed to identify opportunities for improvement. Results: Responses were analyzed from 21 members of the interdisciplinary team. 47% of the respondents found the transition of care system helpful. 55% felt their goals for handoffs were accomplished. All respondents reported importance in addressing updates on patient plans of care and anticipated discharge dates. Content of handoffs should focus on the acute and critically ill patients. The attending physician, chief resident, and nursing team leaders should participate in the handoff process. Conclusions: Differences in goals and content focus between nurses and physician contributed to suboptimal communication and handoffs. Identifying the deficits allow opportunities for improvement in transitioning care and ultimately the safe and quality of care provided to patients. Participation in the process should include faculty physicians, chief residents, and nursing leaders.Item Perspectives on Cancer and Cancer Screenings Among Refugee Immigrants(2017-03-14) Milenkov, Amy; Thein, Emelda; Mudey, Halimo; Rudasingwa, Laurette; Subedi, Radhika; Qureshi, IramPurpose: The United States Preventive Services Task Force advises women to receive timely cervical, breast, and colorectal cancer screenings, however, studies show refugee women are less likely to receive these screenings. The purpose of this study is to identify cancer knowledge and barriers to recommended cancer screenings from the perspective of refugee women. Materials and Methods: Female Lay Health educators from four refugee communities provided cancer education to women enrolled in the Building Bridges Imitative. Qualitative statements from participants were collected at the education sessions and post intervention assessments and grouped into themes Results: The data collected showed that cancer screening practices were low and many cultural misconceptions on screening practices exist in refugee communities. Refugee women had limited knowledge on the cause of cancer and its ability to be treated. Conclusions: Understanding more about the barriers to cancer screenings from the perspective of refugee women can help create or refine interventions. Culturally tailored cancer education interventions can be beneficial in correcting cancer and cancer screening myths among refugee populationsItem The Impact of Environment on Hormone Replacement Therapy(2017-03-14) Duong, Phong; Cunningham, Rebecca; McCuiston, ClaytonPurpose: Women that have undergone long-term menopause exhibit elevated oxidative stress. Prior studies have found equivocal effects of hormone replacement therapy for women in menopause. It has been proposed that hormone replacement therapy is adverse for women 10 years post-menopause. Furthermore, post-menopausal women have a higher risk for Parkinson’s disease than pre-menopausal women. Therefore, we propose that hormone replacement therapy is additive to oxidative stress, resulting in dopaminergic neuronal loss, a hallmark for Parkinson’s disease. Methods: In this study we used dopaminergic 27 cell line that originated from fetal female rats. Cells were exposed to an oxidative stressor, hydrogen peroxide (H2O2), to induce 20% cell death. Following H2O2, cells were treated with either testosterone (100 nM) or 17beta-estradiol (10 nM) to model hormone replacement therapy. Cell viability was assayed using the MTT protocol. Results: H2O2 treatment decreased cell viability approximately 20%. Testosterone treatment further increased H2O2 cell loss by 60%. Although not as potent as testosterone, estradiol did exacerbate H202 induced cell loss by 40%. Neither testosterone nor 17beta-estradiol were damaging to cells in the absence of an oxidative stressor. Conclusions: Depending on the cellular environment, both androgenic and estrogenic steroid hormones can negatively affect neuronal function.Item Osteonecrosis Following Radiation and Osteoporosis(2017-03-14) Anderson, Ralph; Miroshnichenko, Gennady; Keck, Erin; Zimmerman, Leah; Mello, LeahObjective: This case report describes osteonecrosis of the pelvis, two and half years after receiving radiation therapy for a leiomyosarcoma of the vagina in a 40 year old female. Methods: The patient presented with a vaginal mass measuring 8 cm which on biopsy showed a leiomyosarcoma (20 mitotic figures / 10 high power fields). She had a resection of the tumor followed by radiotherapy to the pelvis and 6 months of Doxil chemotherapy finishing in March of 2013. Three years later she presented with pelvic pain and instability of walking. A combination of radiologic imaging including a CT scan of her pelvis, a bone scan and a MRI scan of her lumbosacral spine revealed necrotic lesions in the pelvic ischium and bilateral pelvic insufficiency fractures in the sacrum. Biopsy of the tissues showed necrotic tissue but no cancer. A DEXA scan was performed which showed diagnostic T scores as L spine -0.6, femoral neck -3.1, total hip -3.1, giving a WHO classification of osteoporosis. Results: Her treatment for osteonecrosis and osteoporosis includes calcium, vitamin E, oyster shell, weight bearing exercises and Fosamax 70 milligrams daily. Her pain has improved and she no longer requires utilizing a walker. Conclusions: In women who present with pelvic pain after pelvic radiotherapy, bony destruction and fractures can be indicative of a late radiation effect rather than osseous metastases. Patients with osteoporosis are at a much higher risk for developing post-radiotherapy osteonecrosis and fractures. Conservative treatment together with Fosamax have begun to show improvement in the clinical condition of the patient. Radiological imaging will be utilized as appropriate to determine improvement in the status of the pelvic bone.Item Outcomes Associated with a Trial of Labor After Cesarean Section (2017)(2017-03-14) Anderson, Ralph; Felini, Martha; Baker, Austin; Papa, Tracy; Benson, Meagan; Flood-Shaffer, Kellie; Zimmerman, Leah; Westbrook, BrettObjective: To examine the outcomes of women attempting a trial of labor after cesarean section (TOLAC). Methods: A retrospective chart review was performed on all patients who attempted a TOLAC from June 2012 to May 2016 at John Peter Smith Hospital (JPS). Delivery characteristics and prevalence of adverse delivery outcomes were assessed and then compared to a previous TOLAC study at JPS (2004-2008). Stratified analysis was performed and statistical significance was calculated with χ2 and fishers exact statistics (α Results: 660 patients attempted a trial of labor during the study period. This was 2% of the total births at the hospital during the time period. 444/660 delivered vaginally (67%). Successful VBAC was significantly more likely when the patient presented in spontaneous labor versus when the patient was induced (74% vs 49%, p= Conclusions: The overall success rate of 67% is within the expected range based on public data. However, the success rate at JPS Hospital had decreased from the previous study. This decrease in success coincides with an increase in the rate of induction of labor. Indeed, the success rates for patients who are induced is lower than the patients who present in spontaneous labor. Based on this data, we will reevaluate our practice of induction of labor in trial of labor candidates.Item Is Maternal Depression a major Predictor of Language Development in low income families?(2017-03-14) Suzuki, Sumihiro; Rich, Alisa; Uche, Uloma I.Purpose: The purpose of the study is to analyze what impact maternal depression has on language development of children in low income families. Methods: Using the national Early Head Start Research and Evaluation (EHSRE)14 program, data was retrieved on maternal depression and child language development (birth to 3 years). Maternal depression was measured at time of recruitment (baseline) and 14 months (post-recruitment). Child language development measured at 14 and 24 months. A logistic regression was conducted to determine the association between maternal depression and child development while controlling for socioeconomic status, education, birth weight, early birth, maternal occupation, child gender and child age. Results: 52% of eligible responding mothers at baseline had CES-D scale scores >16, the cut off score for depressive symptoms while at 14 months, 36% of biological mothers had CES-D scores >16. Depression was reported greater in African Americans withschool, neither employed nor in school/training, and household incomes Conclusions: Maternal depression in this low income population is not associated with child language development. This may be attributed to the fact that early exposures to biological and environmental risk factors have been identified to be associated with some developmental disabilities in children and studies have suggested that the consequences of these risk factors can be more severe for children in low income families. This, therefore, suggests that the impact of maternal depression on language development may not be a major predictor of language development for children in the low income families.Item The Relationship Between Food Tracking And Attendance in a Weight Management Intervention in African American Women(2017-03-14) Mandapati, Surendra; Dodgen, Leilani; Kitzman-Ulrich, Heather PhD; Gant, KisaBackground: Approximately eighty percent of African American are overweight or obese. Interventions show less weight loss and shorter periods of maintenance overtime compared to Caucasians. Current interventions with AA women show less weight loss overall, and lower maintenance over time compared to other populations. Literature has shown that food tracking is one of the most effective ways to aid in weight loss. However, this behavior is difficult to adopt and sustain. A recent study found that there was a 3% adherence to “actively” documenting their food intake. Barriers that have been identified are: the process is tedious, makes one feel guilty at times, and not being able to correctly identify what to enter when making home cooked meals. These barriers are suspected to influence program attendance among participants. The Better Me Within (BMW) program is a faith-enhanced Diabetes Prevention Program (DPP) for women in African American churches. This study examines food tracking patterns over time compared to attendance during a 16 week behavioral intervention. Methods: African American women from 11 churches in Dallas/Fort Worth attended weekly classes over 16 weeks in the BMW program. Participants were asked to track dietary intake each week through paper food logs or online food tracking programs. Health coaches at each church collected food logs, weight and attendance during class and reported this information to research staff. Attendance rates and frequency of food tracking were calculated from research logs. Descriptive statistics, and independent t-tests were conducted to examine the relationship between attendance and frequency of food tracking. 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). The mean attendance was significantly higher among the group who submitted more than four or more food logs (u = 14.14, SD = 1.77) than the group who submitted less than four food logs (u = 8.8, SD = 4.9), p Conclusions: Participants who engaged in higher levels of food tracking attended nearly twice as many sessions as women who completed less tracking. Both behaviors, self-monitoring through food tracking, and program attendance, have been associated with better health outcomes such as reduced weight and associated chronic disease risk factors. Future studies should evaluate what factors influence these behaviors such as self-efficacy, motivation, or barriers.