Medicine and Health Sciences Commons^™

A Multicenter Evaluation Of Pediatric Emergency Department Injury Visits During The Covid-19 Pandemic, Holly R Hanson, Margaret Formica, Danielle Laraque-Arena, Mark R Zonfrillo, Puja Desai, Joseph O O'Neil, Purnima Unni, Estell Lenita Johnson, Patricia Cobb, Maneesha Agarwal, Kristen Beckworth, Stephanie Schroter, Stephen Strotmeyer, Katie A Donnelly, Leah K Middelberg, Amber M Morse, James Dodington, Richard F Latuska, Brit Anderson, Karla A Lawson, Michael Valente, Michael N Levas, Andrew Waititu Kiragu, Kathy Monroe, Stephanie M Ruest, Lois K Lee, Tanya Charyk Stewart, Megan M Attridge, Maya Haasz, Mubeen Jafri, Alicia Mcintire, Steven C Rogers, Neil G Uspal, Ashley Blanchard, Max D Hazeltine, Teresa Riech, Charles Jennissen, Lynn Model, Quinney Fu, Lindsay D Clukies, David Juang, Michelle T Ruda, Jose M Prince, Stephanie Chao, Brian K Yorkgitis, Wendy J Pomerantz

Student and Faculty Publications

BACKGROUND: Injuries, the leading cause of death in children 1-17 years old, are often preventable. Injury patterns are impacted by changes in the child's environment, shifts in supervision, and caregiver stressors. The objective of this study was to evaluate the incidence and proportion of injuries, mechanisms, and severity seen in Pediatric Emergency Departments (PEDs) during the COVID-19 pandemic.

METHODS: This multicenter, cross-sectional study from January 2019 through December 2020 examined visits to 40 PEDs for children < 18 years old. Injury was defined by at least one International Classification of Disease-10th revision (ICD-10) code for bodily injury (S00-T78). The main study outcomes were total and proportion of PED injury-related visits compared to all visits in March through December 2020 and to the same months in 2019. Weekly injury visits as a percentage of total PED visits were calculated for all weeks between January 2019 and December 2020.

RESULTS: The study included 741,418 PED visits for injuries pre-COVID-19 pandemic (2019) and during the COVID-19 pandemic (2020). Overall PED visits from all causes …

Advanced Breast Cancer Care: The Current Situation And Global Disparities, Aruni Ghose, Susannah Stanway, Bhawna Sirohi, Miriam Mutebi, Sarah Adomah

General Surgery, East Africa

Objectives: Advanced breast cancer (ABC) is an incurable disease. The number of people living with ABC has increased globally. Disparities in ABC care exist at both individual and system levels. ABC cases in most low- and middle-income countries (LMICs) are underreported due to a lack of national cancer registries. Harmonized guidelines for resource stratification and capacity building in LMICs are under way.

Data sources: MEDLINE, Cochrane, and Google Scholar databases were used.

Conclusion: To improve ABC outcomes and resolve disparities, more robust health systems or pathways need to be developed across the cancer continuum in addition to social education.

Implications …

Addressing Cervical Cancer Disparities In Texas: Expansion Of A Community-Based Prevention Initiative For Medically Underserved Populations, Samantha H Batman, Melissa L Varon, Maria Daheri, Tony Ogburn, Saul D Rivas, Laura Guerra, Paul A Toscano, Monica Gasca, Lori Campos, Savanah Foster, Melissa Martin, Marian Yvette Williams-Brown, Yvette Poindexter, Belinda Reininger, Mila P Salcedo, Andrea Milbourne, Bryan Fellman, Maria E Fernandez, Ellen Baker, Rose Gowen, Susan Fisher-Hoch, Ana M Rodriguez, Jessica Milan, Monica Pippin, Ernest Hawk, Kathleen M Schmeler

Student and Faculty Publications

Although cervical cancer is preventable, significant disparities exist in access to screening and prevention services. In medically underserved areas (MUAs) of Texas, these rates are 55% higher compared to the remainder of the US. In 2019, we expanded a multicomponent, comprehensive program to improve cervical cancer prevention in partnership with 13 clinics and mobile vans in MUAs of Texas. Our multicomponent intervention program consists of community education and patient navigation coupled with a training/mentoring program for local medical providers to perform diagnostic procedures and treatment for patients with abnormal screening results. Hands-on training courses to learn these skills are coupled …

Racial Disparities Among Predicted Bronchopulmonary Dysplasia Risk Outcomes In Premature Infants Born <30 Weeks Gestation, Priyanka Patel, Andrew Ellefson, David A. Paul

Department of Pediatrics Faculty Papers

Background and Objective: There is extensive literature to support eliminating race-based risk stratification. The National Institute of Child Health and Human Development (NICHD) calculator, used to predict risk of bronchopulmonary dysplasia (BPD), includes race as a variable. We sought to investigate how utilizing race in determination of risk for BPD may lead to inequitable care.

Methods: The study included a retrospective cohort of infants born <30 weeks gestation between January 2016 and February 2022. The primary outcome was the difference in predictive risk of BPD for non-Hispanic Black compared to non-Hispanic White infants. The secondary outcome was the disparity in theoretical administration of post-natal corticosteroids when the calculator was applied to the cohort. Analysis included paired T-tests and Chi-Square.

Results: Of the 273 infants studied, 154 were non-Hispanic Black (56%). There was no difference between the groups in gestation or respiratory support on day of life (DOL) 14 or 28. …

Multidisciplinary Care For Women With Aortic Disease: The Way To Improve Disparities, Rana O Afifi

Faculty and Staff Publications

No abstract provided.

Ten-Year Review Of Antihypertensive Prescribing Practices After Stroke And The Associated Disparities From The Florida Stroke Registry, Gillian Gordon Perue, Hao Ying, Antonio Bustillo, Lili Zhou, Carolina M Gutierrez, Hannah E Gardener, Judith Krigman, Angus Jameson, Chuanhui Dong, Tatjana Rundek, David Z Rose, Jose G Romano, Ayham Alkhachroum, Ralph L Sacco, Negar Asdaghi, Sebastian Koch

Student and Faculty Publications

BACKGROUND: Guideline-based hypertension management is integral to the prevention of stroke. We examine trends in antihypertensive medications prescribed after stroke and assess how well a prescriber's blood pressure (BP) medication choice adheres to clinical practice guidelines (BP-guideline adherence).

METHODS AND RESULTS: The FSR (Florida Stroke Registry) uses statewide data prospectively collected for all acute stroke admissions. Based on established guidelines, we defined optimal BP-guideline adherence using the following hierarchy of rules: (1) use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker as first-line antihypertensive among diabetics; (2) use of thiazide-type diuretics or calcium channel blockers among Black patients; (3) …

Addressing Cervical Cancer Disparities In Texas: Expansion Of A Community-Based Prevention Initiative For Medically Underserved Populations, Samantha H. Batman, Melissa L. Varon, Maria Daheri, Tony Ogburn, Saul D. Rivas, Laura Guerra, Paul Toscano, Monica Gasca, Lori Campos, Savanah Foster

School of Medicine Publications and Presentations

Although cervical cancer is preventable, significant disparities exist in access to screening and prevention services. In medically underserved areas (MUAs) of Texas, these rates are 55% higher compared to the remainder of the US. In 2019, we expanded a multicomponent, comprehensive program to improve cervical cancer prevention in partnership with 13 clinics and mobile vans in MUAs of Texas. Our multicomponent intervention program consists of community education and patient navigation coupled with a training/mentoring program for local medical providers to perform diagnostic procedures and treatment for patients with abnormal screening results. Hands-on training courses to learn these skills are coupled …

Expanding Health Professional Education In The Rio Grande Valley During The Covid-19 Pandemic, Sabrina R. Orta, Samantha G. Alvarado, Shuchita Jhaveri

Research Symposium

Purpose: The COVID-19 Pandemic has prompted innovation in health professional education, such that learners are able to recognize and mitigate healthcare disparities in the outcomes of vulnerable populations. The objective of our project was to increase education on preventing, preparing for, and responding to COVID-19 and other locally prevalent infectious diseases that disproportionately affect RGV communities.

Description: This project had 3 goals: (1) provide learners with virtual patient-interaction simulations (2) provide interactive training modules on the identification, prevention, and treatment of infectious diseases affecting South TX and strategies to increase child vaccinations, and (3) provide learners an opportunity to coordinate …

Maternal, Child, And Parenting Factors Associated With Obesity Among Pre-Kindergarten Children In Mississippi, Jerome R. Kolbo

Journal of Public Health in the Deep South

Background: Obesity among children and youth has been consistently assessed among public school students in Mississippi since 2005. Significant declines in the prevalence of obesity among elementary students over the past decade suggest that changes may be occurring prior to entry into public school. Purpose: The purpose was to collect anthropometric data on a weighted, representative sample of children ages 3 to 5 years in licensed childcare facilities across Mississippi, and to correlate maternal, child, and parenting characteristics to obesity. Methods: The Body Mass Index was calculated using measured height and weight data. Results: A total of 14.12% of the …

Racial/Ethnic Disparities In Prostate Cancer 5-Year Survival: The Role Of Health-Care Access And Disease Severity, Christiane J. El Khoury, Sean A.P. Clouston

Department of Medical Oncology Faculty Papers

Introduction: Prostate cancer (PCa) exhibits one of the widest racial and socioeconomic disparities. PCa disparities have also been widely linked to location, as living in more deprived regions was associated with lower healthcare access and worse outcomes. This study aims to examine PCa survival across various USA counties in function of different socioeconomic profiles and discuss the role of potential intermediary factors. Methods: The SEER database linked to county-level SES was utilized. Five-year PCa-specific survival using the Kaplan–Meier method was performed for five racial/ethnic categories in function of SES quintiles. Multilevel Cox proportional hazards regression was performed to assess the …

Pediatric Firearm Injury Epidemiology At A Level 1 Trauma Center From 2019 To 2021: Including Time Of The Covid-19 Pandemic, Cynthia Orantes, Hei Kit Chan, Daniel Walter, Summer Chavez, Irma T Ugalde

Student and Faculty Publications

BACKGROUND: Firearms are a leading cause of death in children. The demand for firearms increased following COVID-19 "stay-at home orders" in March 2020, resulting in record-breaking firearm sales and background checks. We aim to describe the changes in pediatric firearm-related injuries, demographics, and associated risk factors at a Level 1 trauma center in Houston before and during the COVID 19 pandemic.

RESULTS: The total number of pediatric firearm-related injury cases increased during March 15th to December 31st, 2020 and 2021 compared to the same time period in 2019 (104 verses 89 verses 78). The demographic group most affected across years …

Clinical And Demographic Attributes Of Patients With Diabetes Associated With The Utilization Of Telemedicine In An Urban Medically Underserved Population Area, Lisa Ariellah Ward, Gulzar H. Shah, Kristie C. Waterfield

Department of Health Policy and Community Health Faculty Publications

Marginalized populations often experience health disparities due to the significant obstacles to care associated with social, economic, and environmental inequities. When compared with advantaged social groups, these populations frequently experience increased risks, poorer health outcomes, and reduced quality of life (QoL). This research examines the clinical and demographic characteristics—age, gender, and race—related to patients with varying stages of type 2 diabetes mellitus (T2DM), comparing the utilization of telemedicine (TM) with traditional healthcare face-to-face (F2F) appointments in an urban medically underserved population area (UMUPA). A logistic regression model, was used to analyze retrospective electronic patient health records (EHRs) from 1 January …

African American Males Have More Distress During Cancer Treatment Than White Males, Stephanie Kjelstrom, Charis Wynn, Sharon Larson

College of Population Health Faculty Papers

African American (AA) males have a higher incidence and mortality rate for some cancers than other races and sexes, which could be associated with distress during treatment, medical mistrust, and health disparities. We hypothesize distress in AA males during treatment is higher than in other races and sexes. We assessed effect modification of moderate to severe (≥ 4) distress scores during cancer treatment by race and sex, age, and socioeconomic status (SES). National Comprehensive Cancer Network's distress thermometer (scale 0-10) and characteristics for 770 cancer patients were collected from a Philadelphia hospital. Variables included age, sex, race, smoking status, marital …

Diabetes Prevalence And Monitoring In Nonmetropolitan And Metropolitan Areas Within A Commercially Insured U.S. Population, Lindsey R. Hammerslag, Jeffery Talbert

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Enrollees living in nonmetropolitan areas had 22% higher likelihood of having diabetes, even after controlling for factors like age and region.
• The prevalence of diabetes in 2019-2020 was 7.9% in nonmetropolitan areas and 6.2% in metropolitan areas.
• Annual hemoglobin A1c (HbA1c) testing occurred for 85.1% of nonmetropolitan and 85.7% of metropolitan enrollees with diabetes. After controlling for other factors, we found significantly lower testing for those in nonmetropolitan areas.
• For diabetic enrollees, having an HbA1c test in 2019 was associated with an 8% decrease in the likelihood of non-cardiovascular complications related to diabetes and a 6% …

Learning Through Doing: Comprehensive Programming For A Training Program In Cancer Disparities, Kayce D Solari Williams, Kamisha Hamilton Escoto, Crystal Roberson, Kathy Le, Lorraine R Reitzel, Lorna H Mcneill, Shine Chang

Student and Faculty Publications

In the United States, preparing researchers and practitioners for careers in cancer requires multiple components for success. In this reflection article, we discuss our approach to designing a comprehensive research training program in cancer disparities. We focused on elements that provide students and early career scientists a deep understanding of disparities through first-hand experiences and skills training necessary to build a research career in the area. Our Educational Program sits within the framework of an NCI P20 program, "UHAND (University of Houston/MD Anderson Cancer Center)", jointly established by an NCI-designated comprehensive cancer center and a minority-serving university as a collaborative …

Is There Really A Difference In Outcomes Between Men And Women With Hepatocellular Cancer?, Andrea Fa, Denise M. Danos, Lauren Maniscalco, Yong Yi, Xiao Cheng Wu, Mary A. Maluccio, Quyen D. Chu, John M. Lyons

School of Public Health Faculty Publications

Hepatocellular carcinoma (HCC) is a male-dominated disease. Currently, gender differences remain incompletely defined. Data from the state tumor registry were used to investigate differences in demographics, comorbidities, treatment patterns, and cancer-specific survival (HSS) among HCC patients according to gender. Additional analyses were performed to evaluate racial differences among women with HCC. 2627 patients with HCC were included; 498 (19%) were women. Women were mostly white (58%) or African American (39%)—only 3.8% were of another or unknown race. Women were older (65.1 vs. 61.3 years), more obese (33.7% vs. 24.2%), and diagnosed at an earlier stage (31.7% vs. 28.4%) than men. …

Health Disparities Within Rural Communities In The Southern Region Of The United States, D’Angelo Stokes, Jordan Howard, Terrence Mchugh, Nicholas Bohannon, Emeka Ikeakanam, Evan Curry, Jason Walker

Research Day

Intro:

Historical studies have shown that health disparities exist between urban and rural communities, however additional disparities are also known to exist within rural communities as well. These include health disparities between races, ethnicities, and socioeconomic statuses, among others. While the disparities between urban and rural communities have been researched and described more extensively, there is a paucity of information available about the disparities that exist within rural communities. Our goal in this research initiative was to characterize the disparities that exist within rural communities by examining the findings of several publications that sought to describe this phenomenon in the …

Impact Of Personal, Familial, And Socioeconomic Factors On The Return Of Remotely Collected Samples For Genetic Testing, Jordan Zeiger

Dissertations & Theses (Open Access)

There are a multitude of barriers known to impact access to medical care in the United States. COVID-19 has changed and compounded these barriers and led to a shift in the setting of the genetic counseling (GC) appointment, and in sample types used for genetic testing, specifically with use of telemedicine and remotely collected saliva kits. Previous studies have described lack of patient follow-through in returning these kits. Though the understanding of barriers to medical care, including access to genetics services, is well described, there is little in the literature for how these barriers impact the return of remotely collected …

Removing Barriers To Tecovirimat For Mpox-Infected Individuals Via Novel Models Of Care Delivery, Michael Mccarthy, Ba, Joe Glowacki, Do, Ms, Rostislav Livinsky, Pa, Daniel Taupin, Md, Mhqs, Dagan Coppock, Md. Msce

Division of Infectious Diseases and Environmental Medicine Posters

Problem Statement

During the 2022 mpox outbreak, the CDC’s expanded access Investigational New Drug (IND) protocol created a practical barrier to the outpatient provision of tecovirimat. We rapidly implemented a tecovirimat prescription program for individuals infected with mpox to improves access to care.

Project AIM

Primary aim: describe how we rapidly implemented a program for increasing tecovirimat distribution in a metropolitan area.

Secondary aims: describe the patient population who received tecovirimat as treatment for mpox at our clinic and analyze several clinically relevant time intervals along the continuum of care delivery.

Lesbian, Gay, Bisexual, Transgender, Queer (Lgbtqia+) Health Disparities In Sexual Health And Sexual Education, Cole T. Mcbride

Curriculum and Instruction Undergraduate Honors Theses

Background: Comprehensive sex education instills knowledge and promotes the health of all youth, however, most sex education remains heteronormative. School-based programs in the United States (US) emphasize monogamous, heterosexual relationships. In 2021, only 7.4% of students received sex education that included positive representations of both LGB and transgender people and nonbinary topics, while 72% of programs across the US omit LGBTQ+ topics. Most new HIV diagnoses occur in gay and bisexual men aged 13-34, but the sex education environment for this group is increasingly hostile as more states prohibit addressing these topics in public schools.

Purpose: The purpose …

Mental Health In Sexual And Ethnic Minorities, Aaliyah Bailey, Ashlyn Bowers, Ashley Clark, Cassidy Paquette, Garrett Bassham

Epsilon Sigma at-Large Research Conference

Evidence Based Health Promotion Scientific Abstract

Introduction & Background:

Mental Health resources are scarce in rural areas. In 2020, suicide was the third leading cause of death for African Americans ages 15 to 24; this is only one example of the mental health disparities experienced by minority groups.

Purpose Statement and Research Question:

We saught to answer: “Are there greater mental health disparities among sexual and ethnic minorities, such as LGBTQ+ groups or Middle Eastern women, compared to their heterosexual, majority counterparts; if so, is there anything we can do about the issue as nurses?”

Literature Review:

To match the …

Mental Health Disparities In Minorities And Their Relation To Nursing Practice, Aaliyah Bailey, Ashley Clark, Ashlyn Bowers, Cassidy Paquette, Garrett Bassham

Epsilon Sigma at-Large Research Conference

Evidence Based Health Promotion Scientific Abstract

Introduction & Background:

Mental Health resources are scarce in rural areas. In 2020, suicide was the third leading cause of death for African Americans ages 15 to 24; this is only one example of the mental health disparities experienced by minority groups.

Purpose Statement and Research Question:

We saught to answer: “Are there greater mental health disparities among sexual and ethnic minorities, such as LGBTQ+ groups or Middle Eastern women, compared to their heterosexual, majority counterparts; if so, is there anything we can do about the issue as nurses?”

Literature Review:

To match the …

Racial And Ethnic Disparities In Alcohol-Attributed Deaths In The United States, 1999–2020, Ibraheem M. Karaye, Nasim Maleki, Ismaeel Yunusa Ph.D.

Faculty Publications

The disparities in alcohol-attributed death rates among different racial and ethnic groups in the United States (US) have received limited research attention. Our study aimed to examine the burden and trends in alcohol-attributed mortality rates in the US by race and ethnicity from 1999 to 2020. We used national mortality data from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database and employed the ICD-10 coding system to identify alcohol-related deaths. Disparity rate ratios were calculated using the Taylor series, and Joinpoint regression was used to analyze temporal trends and calculate annual and …

Promoting Equity For Women In Medical Journal Editing, Allison Chamberlain Miller, Diane Powers Dirette

The Open Journal of Occupational Therapy

No abstract provided.

Colon Cancer Screening And The Association With Colon Cancer Incidence And Mortality Rates In Ethnic Minority Groups, Jovonne Smith

Student Scholar Showcase

Colorectal cancer (CRC) continues to be a public health burden and is the second leading cause of American cancer deaths. Strides have been made in the medical community, and there has been an overall decrease in CRC rates. This decrease is primarily due to a cumulative decline in late-onset colorectal cancer diagnosis (LOCRC), defined as CRC cancer in adults over the age of 50 years. CRC continues to burden American Indians and Alaska Natives (AIAN) and Non-Hispanic Black individuals (NHB) disproportionately. The incidence and mortality rates remain disproportionately higher than other ethnic groups, and the survival rate is lower than …

Management Of Stage I And Stage Ii Labor Arrest Disorder To Reduce Primary Cesarean Section Birth Rate For African American Women, Ariam Yitbarek Mha, Bsn, Rn, Nea-Bc

Doctor of Nursing Practice Projects

Background: Cesarean section delivery rate in the United States has reached an alarming rate of over 30%. African American women experience a higher cesarean birth rate compared to Caucasian Women. The repeat c-section rate for all patients is greater than 80%. These findings underscore the need for intervention to reduce primary cesarean section deliveries in African American Women.

Objective: This quality improvement project aimed to implement caregiver education on the ACOG/SMFM definition of the first and second-stage labor arrest disorder to reduce primary cesarean section birth for African American women.

Method: This pre-and post-intervention quality improvement project was conducted on …

Disparities In Access To Cancer Diagnostics In Asean Member Countries, Nicole Rose I. Alberto, Isabelle Rose I. Alberto, Corinna Victoria M. Puyat, Maria Alexandra R. Antonio, Frances Dominique V. Ho, Edward Christopher Dee, Brandon A. Mahal, Michelle Ann B. Eala

Ateneo School of Medicine and Public Health Publications

Diagnostics, including laboratory tests, medical and nuclear imaging, and molecular testing, are essential in the diagnosis and management of cancer to optimize clinical outcomes. With the continuous rise in cancer mortality and morbidity in the Association of Southeast Asian Nations (ASEAN), there exists a critical need to evaluate the accessibility of cancer diagnostics in the region so as to direct multifaceted interventions that will address regional inequities and inadequacies in cancer care. This paper identifies existing gaps in service delivery, health workforce, health information systems, leadership and governance, and financing and how these contribute to disparities in access to cancer …

Health Disparities Experienced By Hispanic Americans With Multiple Myeloma: A Systematic Review, Andrea Anampa-Guzmán, Sara Taveras Alam, Inas Abuali, Samer Al Hadidi

Faculty and Staff Publications

Health disparities in multiple myeloma (MM) disproportionately affect minorities. Characterization of health disparities encountered by Hispanic Americans with MM is necessary to identify gaps and inform future strategies to eliminate them. We performed a systematic review of publications that described health disparities relevant to Hispanic Americans with MM through December 2021. We included all original studies which compared incidence, treatment, and/or outcomes of Hispanic Americans with other ethnic groups. Eight hundred and sixty-eight articles were identified of which 22 original study articles were included in our systematic review. The number of publications varied over time with the highest number of …

Experiences Of Covid-19-Related Racism And Impact On Depression Trajectories Among Racially/Ethnically Minoritized Adolescents, Sabrina R. Liu, Elysia Poggi Davis, Anton M. Palma, Hal S. Stern, Curt A. Sandman, Laura M. Glynn

Psychology Faculty Articles and Research

Purpose

In 2020, racially/ethnically minoritized (REMD) youth faced the “dual pandemics” of COVID-19 and racism, both significant stressors with potential for adverse mental health effects. The current study tested whether short- and long-term trajectories of depressive symptoms from before to during the COVID-19 pandemic differed between REMD adolescents who did and did not endorse exposure to COVID-19-era-related racism (i.e., racism stemming from conditions created or exacerbated by the COVID-19 pandemic).

Methods

A community sample of 100 REMD adolescents enrolled in an ongoing longitudinal study of mental health was assessed before and during the COVID-19 pandemic. Participants were 51% girls, mean …

Vaccination Inequities Among Children 12-23 Months In India: An Analysis Of Inter-State Differences, Octavia K. Goodman, Abram L. Wagner, Dakota Riopelle, Joseph L. Mathew, Matthew L. Boulton

Community & Environmental Health Faculty Publications

Background

Previous research has shown that socioeconomic and demographic risk factors in children are additive and lead to increasingly negative impacts on vaccination coverage. The goal of this study is to examine if different combinations of four risk factors (infant sex, birth order, maternal education level, and family wealth status) vary by state among children 12-23 months in India and to determine the impact of ≥ 1 risk factor on differences in state vaccination rates.

Methods

Using data from the National Family Health Survey (NFHS) conducted in India between 2005 and 2006 (NFHS-3) and 2015-2016 (NFHS-4), full vaccination of children …