Search

Background: While the Texas infant mortality rate (IMR) is below the Healthy People 2020 objective (5.7 per 1,000 live births), stark differences in IMR are seen across Texas communities. Health indicators for the state suggest important missed opportunities for improving maternal and infant outcomes. The Healthy Families initiative was a collaboration between a Texas state agency, community partners, and academic institutions to understand how evidence based interventions could be identified, adapted, and implemented to address community priorities and reduce disparities in pregnancy outcomes. Method: The Healthy Families initiative included two Texas counties, one with low utilization of prenatal care and one with persistent disparities in infant mortality. The model served to (1) identify community factors influencing IMR and maternal morbidity through stakeholder engagement and secondary data, (2) build community capacity to link pregnant women with existing and newly developed services, and (3) develop partnerships within the community and clinics to improve access to and sustainability of services. Results: A community-based participatory approach focused on stakeholder engagement was used to identify, design, and adapt strategies to address community-identified priorities. Conclusions: The Healthy Families initiative is a unique state-community-academic partnership aimed at improving pregnancy outcomes in vulnerable communities, with a focus on promotion of capacity building, maintenance, and sustainability of maternal and infant health programs

Background/Aims: The nontuberculous mycobacterial lung disease (NTM), caused by Mycobacterium avium complex (MAC) is an increasing health problem in the USA and worldwide. The NTM disease is prevalent in Caucasian women with a current diagnosis or history of breast cancer (BCa), posing a significant challenge towards treatment. We hypothesize that NTM affected women with considerable therapeutic resistance may harbor pathogenic microbes other than nontuberculous mycobacterium, aiding in disease progression and therapeutic resistance. Methods: We assessed microbiome diversity in sputa from healthy women, women with nontuberculous mycobacterial lung disease (NTM) and women with both nontuberculous mycobacterial lung disease and breast cancer (NTM-BCa). First, we collected sputa and isolated DNA from sputa of these healthy women and women with NTM and NTM-BCa. We also isolated DNA from sera derived extracellular vesicles from women with NTM-BCa. To identify diverse pathogenic microbes in various groups of subjects, we then performed 16S rDNA sequencing. Data analysis was performed utilizing the analytical pipelines at the Center for Metagenomic and Microbiome Research (CMMR), Baylor College of Medicine. Results: A large community of resident microbes, including bacteria, virus, Archeas and Fungi live in the human body are being increasingly recognized as the key components of human health and disease. We identified a diverse microbiome community in the sputa and the extracellular vesicles dominated by Streptococcus, Haemophillus, Veillonella, Neisseria, Prevotella, Fusobacterium, Bacteroides, Allistipes, Faecalibacterium and Staphylococcus in women with nontuberculous mycobacterial lung disease as well as women with both nontuberculous mycobacterial lung disease and breast cancer. Some of these genera, including Fusobacterium, Bacteroides, and Allistipes have estrobolome activity and associated with breast and other neoplasms. Conclusion: This work confirms the presence of a distinct pathogenic microbiome other than nontuberculous mycobacteria in the sputa and the circulating extracellular vesicles of these patients. This information could be useful for better therapeutic design to treat the NTM patients. [ABSTRACT FROM AUTHOR]

In response to the pandemic due to COVID-19, we developed online interactive dashboards to track and visualize the reported cases in real-time in certain geographical areas in Texas. In collaboration with local public health departments, we established an automated process of data collection/processing and then developed dashboards with more detailed tracking and analysis results. The dashboards aimed to provide Texans in those areas with health disparities with clear and detailed in-time tracking and analysis results of COVID-19 data and to help the public understand the in-time status of COVID-19 in their areas. Evaluation of the dashboards was conducted by surveying our collaborators in those areas and deemed highly effective and useful. We believe that the framework used in developing the dashboards and the data processing pipeline presented in this work could be used in tracking emerging infectious diseases and planning for the emergency management in the future. [ABSTRACT FROM AUTHOR]

Objectives. We evaluated a strategy for preventing tuberculosis (TB) in communities most affected by it. Methods. In 1996, we mapped reported TB cases (1985-1995) and positive tuberculin skin test (TST) reactors (1993-1995) in Smith County, Texas. We delineated the 2 largest, densest clusters, identifying 2 highest-incidence neighborhoods (180 square blocks, 3153 residents). After extensive community preparation, trained health care workers went door-to-door offering TST to all residents unless contraindicated. TST-positive individuals were escorted to a mobile clinic for radiography, clinical evaluation, and isoniazid preventive treatment (IPT) as indicated. To assess long-term impact, we mapped all TB cases in Smith County during the equivalent time period after the project. Results. Of 2258 eligible individuals, 1291 (57.1%) were tested, 229 (17.7%) were TST positive, and 147 were treated. From 1996 to 2006, there were no TB cases in either project neighborhood, in contrast with the preintervention decade and the continued occurrence of TB in the rest of Smith County. Conclusions. Targeting high-incidence neighborhoods for active, community-based screening and IPT may hasten TB elimination in the United States. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is the third most commonly diagnosed cancer in the United States and disproportionately higher in primarily rural Northeast Texas. In order to alleviate barriers to care common in rural areas such as distance to care, patients often complete a fecal immunochemical test at home, only needing a colonoscopy if the test yields positive results. However, many patients fail to follow-up with a colonoscopy following a positive fecal immunochemical test. Methods: This study sought to examine the role of medical and sociodemographic factors in predicting nonadherence to colonoscopy following a positive fecal immunochemical test result. Participants with a positive fecal immunochemical test result (n =241) were followed for up to 1 year to examine whether they underwent a colonoscopy at an academic institution located in Smith County, TX. Results: Age, gender, race/ethnicity, insurance status, and having a previous screening did not predict the likelihood of following-up a positive fecal immunochemical test result with a colonoscopy. Individuals living within Smith County (who travel shorter distances) compared to individuals living outside of Smith County (longer travel distances) (p = .005) were 88% more likely to have a follow-up colonoscopy. Individuals living within Smith County followedup after 177.08 days (SE = 23.89), while those not living in Smith County followed-up after 231.11 days (SE = 11.22). Finally, those witha family history of colon cancer were 75% more likely (p = .030) to have a follow-up colonoscopy. Those with a family history of colon cancer followed-up after 126.89 days (SE = 28.52), while those without a history followed-up after 203.04 days (SE = 12.27). Discussion: Among primarily rural populations, the distance one travels to receive care and a family history of colorectal cancer are better predictors of receiving a colonoscopy after a positive fecal immunochemical test that other variables. [ABSTRACT FROM AUTHOR]