Women's Health
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Item 365 DAYS OF INFANT MORTALITY USING PHOTOVOICE TO UNDERSTAND INFANT MORTALITY AS AN ISSUE FOR SOCIAL CHANGE(2014-03) Paul, Marcy; Eley, Lindsey; Miller, Jennifer M.; Espinoza, AnnaPurpose (a): African Americans have an infant mortality rate more than twice the rate of Whites; yet there is limited information about parents' experience of an infant death and their perceptions about the causes of racial disparity in infant mortality. Photovoice, a documentary photography technique, was used to give a voice to parents who experienced an infant loss, and to better understand the causes and effects of racial disparity in infant mortality. To date, no known Photovoice projects have focused solely on the perceptions of parents who suffered an infant death. Methods (b): North Texas parents who experienced an infant loss were recruited using convenience sampling techniques. Participants were provided digital cameras, and asked to photograph and journal about community resources which were helpful to them as they grieved, and community resources, or lack thereof, they felt may have contributed to the death of their baby. Participants were divided into two groups based on current residency (Fort Worth or Dallas, Texas). These groups met monthly, giving participants an opportunity to discuss their photos, journal entries, and experiences during the project. Photographs and journal entries will be on display at a local art gallery as an exhibit, "Eight Warrior Mamas: Survivors of Infant Mortality - Empty Arms, Broken Hearts, and Grieving Wombs." Results (c): African American women (n=6) and White women (n=2) participated in the project. From their photographs and group discussions three themes emerged. The first theme was poor post-partum care. Many of the mothers reported feeling that the health provider they visited after delivery was insensitive, and the post-partum examinations were uncomfortable. The second theme was loneliness and isolation. The mothers described finding it difficult to locate support groups and other resources to help them during the grieving process. The third theme was the poor/inappropriate response from health insurers and regulatory agencies such as Child Protective Services. The mothers expressed that they were treated in a cold and distant manner when communicating with different systems about their deceased child. Conclusions (d): This project is an innovative approach to identifying systemic issues that contribute to racial disparity in infant mortality. Through the exhibit parents who suffered an infant death have a platform to voice their loss and their concerns about needed social change. Additionally, the exhibit increases community awareness of the issue of infant mortality. These findings suggest the importance of continuing to raise awareness about infant mortality and the need to further assess institutional polices' effect on racial disparities in infant mortality.Item "IT HAPPENS OUT HERE" - THE VICTIMIZATION EXPERIENCES AND HEALTH CHALLENGES OF WOMEN WHO ARE HOMELESS(2014-03) Saks, Gabrianna E.; Spence-Almaguer, Emily; Chhetri, Shlesma; Crain, CindyThe Homeless Women’s Health and Victimization Study was a collaborative community-based research project that has filled a crucial gap in knowledge about the violence and abuse experienced by women utilizing emergency shelters in the East Lancaster area of Fort Worth, Texas. This study was also an invaluable learning experience for UNT Health Science Center graduate students. Participation in the study was offered as a service learning project and volunteer opportunity in the School of Public Health. Students were involved in every stage of the study and were able to experience lessons related to the practice of Behavioral and Community Health that simply cannot be taught in a classroom. Since the initial release of data to community stakeholders, there have been remarkable changes made by homeless service providers in response to our report. Presbyterian Night Shelter has made changes to their policies that allow more women to stay inside the shelter during the day. They have also made changes to the facility to provide more beds for women and keep the women’s area more secure. YWCA has reallocated their resources to increase their number of emergency beds in order to provide emergency shelter options outside of the East Lancaster area. The Fort Worth Police Department has also responded by implementing a night patrol and outreach program in the East Lancaster area. The findings of this study have also helped the Day Resource Center for the Homeless become the first homeless outreach program in Texas to receive funding from the Victims of Crime Act to address homeless women’s safety. This study has embodied what it means for a health science center to work together with our community to identify problems and find solutions. Purpose (a): The Homeless Women’s Health and Victimization Study was conducted in order to explore the unique experience of violence and victimization among homeless women and the effects these experiences have on physical and mental health. Methods (b): This study utilized non-random, purposive sampling of women utilizing emergency shelter services in the East Lancaster area of Fort Worth, Texas. A total of 150 face-to-face interviews were conducted with homeless women by trained volunteers from December 2012 to May 2013. The interview consisted of closed and open ended questions covering recent victimization, service utilization, mental and physical health, healthcare utilization, prior abuse, transactional sex, and personal safety and health strategies. Quantitative data analysis was performed using statistical software and a grounded theory approach was used for qualitative data analysis. Results (c): The majority (60.1%) of participants reported at least one form of physical or sexual violence, stalking, threats, or verbal abuse in the last 12 months. One in 6 women (17.3%) reported experiences that meet the legal definition of rape in Texas, 46% were physically or sexually attacked, 20.7% reported intimate partner violence. These attacks have had significant health consequences, with 23% of women reporting injuries incurred as a result of their attacks. In addition, 78% of women reporting recent abuse and 88.5% of women reporting recent rape met the threshold for psychiatric distress. There was a clear relationship between prior victimization and recent violence. Among those reporting physical or sexual violence in the past 12 months, the majority were abused as a child (62.5%) or abused by an intimate partner (65%). Conclusions (d): Violence and victimization is a painful reality for many of the women experiencing homelessness in our community. The homeless services delivery system and community stakeholders must work together to identify solutions that will improve the safety of women on East Lancaster, as well as help women leave the East Lancaster region.Item SURVIVAL SEX ON THE STREETS: RESULTS FROM THE HOMELESS WOMEN'S HEALTH AND VICTIMIZATION STUDY(2014-03) Chhetri, Shlesma; Saks, Gabrianna E.; Spence-Almaguer, Emily; Crain, CindyIn order to meet the needs of homeless women in our community, we must first understand their experience. The Homeless Women’s Health and Victimization Study provides valuable insight about the frequency, types, correlates, and consequences of violence and victimization among homeless women in our community. Some of the most compelling results from this study were related to transactional sex. These findings contribute to an understanding of the role that “survival sex” plays in the complex experience of female homelessness. Survival sex can be defined simply as transactional sex acts that are performed to meet a person’s most basic and immediate needs. This behavior is an adaptation to survive in the hostile and predatory environment that many homeless women find themselves in. Some homeless women perceive survival sex as the “last resort”. Although these behaviors are often grossly underreported due to stigma, our study participants were graciously honest about their experiences. From their responses, it is clear that not only is survival sex happening in our homeless communities, but that it is happening at much higher rates than previously estimated. This finding is even more alarming when considered alongside the mental and physical health implications of these practices. Additionally this study highlights the correlation between survival sex and history of prior victimization among these women, broadening the conceptualization of transactional sex. This study has given a voice to women in our community that are often overlooked and these results highlight the significance of a practice that most would prefer to ignore. A problem cannot be addressed if nobody knows it exists. Purpose (a): The Homeless Women’s Health and Victimization Study was conducted in order to explore the unique experience of violence and victimization among homeless women and the effects these experiences have on physical and mental health. This poster will focus on the results related to transactional sex. Methods (b): This study utilized non-random, purposive sampling of women utilizing emergency shelter services in the East Lancaster area of Fort Worth, Texas. A total of 150 face-to-face interviews were conducted with homeless women by trained volunteers from December 2012 to May 2013. The interview consisted of closed and open ended questions covering recent victimization, service utilization, mental and physical health, healthcare utilization, prior abuse, and transactional sex. Quantitative data analysis was performed using statistical software and a grounded theory approach was used for qualitative data analysis. Results (c): One in every 4 participants reported that they had engaged in survival sex, or transactional sex acts intended to meet subsistence needs or substance dependencies. Many of those who had traded sex did so to meet their most basic needs. One in every 6 women had exchanged sex for a safe place to stay and 13% had traded sex for something to eat. Women who had engaged in survival sex activities were significantly more likely to report victimization in the past 12 months (p=.001), prior intimate partner violence (p=.03), and childhood physical and sexual abuse (p=.007). Sexual or physical victimization during childhood appeared to have an influential role: 75% of those who engaged in sex trade reported childhood victimization compared to 38% of women who reported no engagement in sex trade. Those engaged in survival sex were also significantly more likely to show signs of psychiatric distress (p=.004) and other health indicators. Conclusions (d): These findings contribute to a comprehensive understanding of the complex experience of homelessness and give new insight into the prevalence, context, and correlates of survival sex among women who are homeless. The results indicate that victimization may play a role as both a precursor and product of engaging in survival sex. The increased risk for psychiatric distress and other health conditions emphasize the serious health implications of transactional sex among homeless women.Item TESTOSTERONE REPLACEMENT THERAPY: ONE SIZE FITS ALL?(2014-03) Nazarali, Rizwan; Cunningham, RebeccaTestosterone replacement therapy (TRT) has been used to improve libido and overall well-being in men. Recently, there has been a rise in off-label TRT to treat diminished libido in women. Current studies from our laboratory have shown that testosterone is linked with cognition and memory in aging men. However, the relationship is murkier when associating cognitive impairment with testosterone in aging women. A key component of aging is oxidative stress (OS). Previous studies by our laboratory have shown that OS and the male sex hormone, testosterone, have a significant impact on neuronal viability, and subsequently cognition. An analysis of plasma biomarker proteins for OS (homocysteine) and testosterone was conducted on 177 Mexican-American women, 185 Caucasian women, 117 Mexican-American men, and 116 Caucasian men with a mean age of 72 from the Texas Alzheimer’s Research and Care Consortium (TARCC) to determine their role on memory and cognitive impairment. Participants were stratified according to their OS status (Low OS 12 mol/L of homocysteine). Participants were diagnosed as cognitively intact, mild cognitive impairment, or Alzheimer’s disease. Our results show that OS was significantly higher in men relative to women. Under a low oxidative stress environment, testosterone did not have a significant impact on memory or cognitive impairment, regardless of ethnicity or gender. However, in a high OS environment, testosterone significantly improved memory function and decreased cognitive impairment in Mexican-American men. Further, testosterone had a negative impact in Caucasian men, in which testosterone increased cognitive impairment. Testosterone had no effect on memory or cognitive impairment in women, irrespective of ethnicity. Collectively, the data support the hypotheses that: 1) testosterone mediates cognitive impairment in Caucasian men with high OS, 2) TRT therapy may be a viable option for Mexican-American men and, 3) testosterone does not alter memory or cognitive impairment in women. Therefore, the use of TRT should be tailored to an individual with respect to ethnicity and gender. Purpose (a): Testosterone replacement therapy (TRT) has been used to improve libido and overall well-being in men. Recently, there has been a rise in off-label TRT to treat diminished libido in women. Current studies from our laboratory have shown that testosterone is linked with cognition and memory in aging men. However, the relationship is murkier when associating cognitive impairment with testosterone in aging women. A key component of aging is oxidative stress (OS). Previous studies by our laboratory have shown that OS and the male sex hormone, testosterone, have a significant impact on neuronal viability, and subsequently cognition. Methods (b): An analysis of plasma biomarker proteins for OS (homocysteine) and testosterone was conducted on 177 Mexican-American women, 185 Caucasian women, 117 Mexican-American men, and 116 Caucasian men with a mean age of 72 from the Texas Alzheimer’s Research and Care Consortium (TARCC) to determine their role on memory and cognitive impairment. Participants were stratified according to their OS status (Low OS < 12 mol/L and High OS >12 mol/L of homocysteine). Participants were diagnosed as cognitively intact, mild cognitive impairment, or Alzheimer’s disease. Results (c): Our results show that OS was significantly higher in men relative to women. Under a low oxidative stress environment, testosterone did not have a significant impact on memory or cognitive impairment, regardless of ethnicity or gender. However, in a high OS environment, testosterone significantly improved memory function and decreased cognitive impairment in Mexican-American men. Furthermore, testosterone had a negative impact in Caucasian men, in which testosterone increased cognitive impairment. Testosterone had no effect on memory or cognitive impairment in women, irrespective of ethnicity. Conclusions (d): Collectively, the data support the hypotheses that: 1) testosterone mediates cognitive impairment in Caucasian men with high OS, 2) TRT therapy may be a viable option for Mexican-American men and, 3) testosterone does not alter memory or cognitive impairment in women. Therefore, the use of TRT should be tailored to an individual with respect to ethnicity and gender.Item ACCEPTABILITY OF SELF-ADMINISTERED PAP SMEARS AMONG SUBSTANCE ABUSING POPULATIONS(2014-03) Bangara, Saritha; Shuler, Monique; Qualls-Hampton, Raquel Y.; Felini, Martha J.The objective of this study was to assess the acceptability of self-administered Pap tests among a high risk subset of women with substance abuse issues. Our findings have been used to develop a trauma-informed, culturally sensitive cervical cancer education program that can be integrated into substance abuse treatment centers as part of this project. Purpose (a): Prior studies have revealed high acceptability rates for using self-administered Pap smears as an alternative in populations where barriers may prevent access to conventional in-office cervical screening examinations. However, few studies to date have examined whether this self-screening tool would be an option among indigent women engaging in high-risk behaviors. The objective of this study was to assess the acceptability of self-administered Pap smears among women in treatment for substance abuse and co-occurring disorders at the Nexus Recovery Center, Dallas's largest female substance abuse treatment center. Methods (b): Six focus groups (N=48 women) were conducted among women participating in treatment at the Nexus Recovery Center. A separate focus group was conducted among members of our project advisory board (medical professionals, social workers, and recovering addicts) who guided the research. A mixed methods approach was used to analyze the data and identify themes from participants' responses. Results (c): In assessing the participants' utilization of cervical cancer screenings, 30 (63%) had a Pap smear in the last two years. Preliminary analysis suggests that the acceptability of self-administered Pap smears in our study population is low. Conclusions (d): The low acceptability of self-administered Pap tests in our study population is due to a perceived lack of trust in the effectiveness of this tool. This finding will be considered when developing a trauma-informed, culturally sensitive cervical cancer education program that can be integrated into substance abuse treatment centers as part of this project.Item PROMOTING HEALTHY PREGNANCY BEHAVIORS AMONG KAREN BURMESE REFUGEES(2014-03) Board, Amy; Raines-Milenkov, Amy; Thein, Emelda; Anderson, RalphPurpose (a): To identify baseline understanding of healthy pregnancy behaviors as well as gaps in knowledge and access to pregnancy-related care for Karen Burmese refugee women in Fort Worth. Methods (b): Focus groups were designed to identify the baseline level of pregnancy knowledge and access to care. Discussion with key players in the Karen community led to the selection a natural leader within the population to conduct the focus groups, which were held on two different days and times in the apartment complex where the majority of the population resides. Results (c): Respondents shared both positive and negative reactions regarding delivering a baby in the U.S based upon their personal experiences or stories they had heard from friends and relatives who had given birth. Positive responses included the ability to receive an epidural to relieve labor pain, access to prenatal vitamins, vaccines, and medicines, and the sentiment that in America, doctors are able to use tests and technology to make sure the baby receives good care. Negative responses included a lack of proper or culturally sensitive interpretation at provider visits, lack of proper information sharing by staff about the purposes of and alternatives for medical procedures, and long wait times at the hospital before receiving care. Barriers cited to receiving proper care include transportation, lack of insurance coverage, limited English proficiency, and anxiety about not being able to navigate the health system. Conclusions (d): Karen Burmese women in Fort Worth view the American health care system with a mixture of gratitude and trepidation. Full integration and use of this system for early access to prenatal care will involve outreach and education efforts among the Karen as well as greater understanding and flexibility on the part of health care providers.Item WHAT ARE THE BARRIERS TO BREAST CANCER SCREENING/MAMMOGRAPHY IN FREDERICKSBURG, TX?(2014-03) Baker, Laura; Patel, Pinal; Chiapa-Scifres, Ana; Bowling, JohnBreast cancer screening via mammography has been shown to catch cancer at earlier stages than would otherwise be caught. There are multiple reasons that women do not get mammograms and these reasons tend to differ in rural versus urban populations. This survey was distributed to female patients age 40 and over at Fredericksburg clinic in Fredericksburg, TX. Purpose (a): There are many barriers to breast cancer screening. Research has shown that lack of information about mammography, lower socioeconomic status, lower education level, lack of insurance, and travel burden are barriers to breast cancer screening. A lot of these barriers tend to exist in different proportions in a rural community versus an urban city. These barriers exist in Fredericksburg, but to varying degrees than other areas. The aim of this study was to determine what the barriers to breast cancer screening are in Fredericksburg, TX. Methods (b): Surveys were distributed to female patients over the age of 40 in Fredericksburg Clinic. The study sample included 36 surveys collected from January to March of 2013. The survey included demographic information, medical history, and factors related to breast cancer screening. Results (c): Average age of surveyed patients was 61.4 years. About 70% of respondents said that travel was not a burden to getting an annual mammogram out of the 91.2% that were screened. Out of 77.1% surveyed who thought that travelling was not a burden to getting an annual mammogram, 60% would need to drive less than 20 miles for a mammogram. The relationship between doctor recommendation of a mammogram and insurance coverage was investigated using Pearson product-moment correlation coefficient. There was a positive correlation between the two variables, r=.46, n=36,p=0.005. Conclusions (d): A statistically significant association was found between travel distance and whether they thought travel was a burden. Most patients will travel in order to get a once yearly mammogram but it can be considered to be a burden. Efforts to decrease the distance that some patients have to drive for a mammogram would increase the rates of women that get recommended screenings. Patients that had health insurance were more likely to see a doctor regularly and be recommended further health screenings. With an increase of healthcare coverage, doctors should be able to better recommend preventative health practices to patients.Item A LIFE-THREATENING CASE OF SEXUAL ASSAULT(2014-03) Miller, Brighton R.; Hinkle, KollierThe case presents a victim of sexual assault who suffered a stab wound which required life-saving surgical intervention to repair a laceration to the myocardium. The case report analyzes the appropriate protocol for a sexual assault victim with life threatening injuries. It summarizes the operative note for the surgical repair and uses medical references to comment on the method of treatment used. While immediate evaluation of trauma remains the primary focus in the emergency room, it is important to arrange follow up and psychological counseling for complete recovery. Purpose (a): Once reported to police, cases of sexual assault must be assessed by appropriate hospital staff who are trained in gathering biologic evidence of the sexual encounter and examining the patient for possible injuries. According to the Bureau of Justice Statistics, "Seventeen percent of the 135,550 completed or attempted sexual assaults annually against females ages 12 or older resulted in injury"5. Victims of sexual assault who are injured are more likely to receive medical treatment if reported to police. The case presented exemplifies the importance of seeking medical attention after sexual assault because it involved life-threatening injuries. Methods (b): Assessment - A 28-year-old woman who had suffered sexual assault presented to the emergency department with a total of nineteen stab-wounds to the face, neck, anterior chest, upper abdomen, back, both upper extremities and lower extremities. A primary and secondary survey of the patient was completed and the patient presented hemodynamically stable. A Sexual Assault Nurse Examiner completed a thorough medical forensics exam, collected evidence of assault and treated patient prophylactically for possible infection and pregnancy. A Computed Tomography was completed which showed concern for a hemopneuothorax. The patient remained in stable condition in the emergency department for three hours. Treatment - A right tube thoracostomy was placed for the patient's hemopneumothorax. Next, a diagnostic laparoscopy was performed. Exploration of the abdomen was initiated and a laceration to the diaphragm was noted through which the patients beating heart could be seen. A decision was made to convert to an open exploratory laparotomy. A pericardial window was made in the preperitoneal space below the xiphoid. A 1.5 to 2 cm laceration in the apex of the heart was seen. The laceration was repaired. The laceration to the diaphragm was repaired. All stab wounds were thoroughly irrigated and closed with staples. Finally, a flexible esophagoscopy and sigmoidoscopy was performed to screen for any other possible injuries. Results (c): Literature Review - The assessment and treatment of the present case proved to be effective in identifying an underlying heart laceration. The necessary steps were taken to evaluate a hemodynamically stable stab wound patient. Berardoni et al, explain, "Although it is widely accepted that patients demonstrating signs of hemodynamic instability, peritonitis or evisceration should undergo timely exploratory laparotomy, the proper conservative evaluation in hemodynamically stable patients with AASWs remain indefinable despite the multitude of proposed clinical pathways"1. Another study by Paydar et al, comparing the use of conservative management versus exploratory laparotomy found that "of the patients in the CM group, 11% needed delayed laparotomy"4. When an anterior abdominal stab wound patient is hemodynamically stable, it can be difficult to determine the proper course of management for that patient as shown by the statistical evidence of these studies. The conversion to exploratory laparotomy in this case was therapeutic in providing surgical intervention for a myocardial stab wound. Conclusions (d): In conclusion, it is important to fully evaluate victims of violent sexual assault both surgically and psychologically. A study by Koss et al. stated, "Findings indicated that severely victimized women, compared with nonvictims, reported more distress and less well-being, made physician visits twice as frequently in the index year, and had outpatient costs that were 2.5 times greater…long-term deleterious effects suggest that criminally victimized women's needs for medical treatment transcend the traditional focus on emergency care and forensic evaluation."3. After a victim of rape recovers physically, the need for emotional, spiritual and psychological healing is indicated. it is important to treat the whole patient; keeping in mind that complete healing occurs when all aspects of human disease are treated.