The Rider (2019-04-08)

https://scholarworks.utrgv.edu/rider/1111/thumbnail.jp

Focal Spot, Spring 1976

https://digitalcommons.wustl.edu/focal_spot_archives/1014/thumbnail.jp

Making a difference with home visiting : studies of an intervention in multicultural, disadvantaged settings in Sweden

Introduction: Inequalities in health, including child health, occur even in welfare countries like Sweden because of unequal distribution of the social determinants of health. Children’s health is poorer in multicultural and disadvantaged neighborhoods in Stockholm, compared with the Stockholm County average. Poorer child health can be related to parents’ lower social position in society, which is associated both with poorer health and lower health literacy (HL). Parents’ low HL relates to poorer knowledge and competencies in healthrelated issues and has negative consequences on children’s health. However, parents’ HL can be improved, and the well-established Swedish Child Health Care (CHC) program reaches all families with children from 0–5 years. Furthermore, an extended postnatal home visiting program for first-time parents, provided as a supplement to the CHC program was initiated in 2013 in Rinkeby, one of the multicultural and disadvantaged Stockholm neighborhoods to address obvious disparities in child health outcomes. The intervention consists of six joint extended home visits, conducted by CHC nurses and parental advisors from preventive social services during the child’s first 15 months of life. Postnatal home visiting is an evidencebased method in improving families and children’s psychosocial conditions among vulnerable families across the globe. This thesis includes four studies exploring the impacts of the extended postnatal home visiting program on parents and children. Aims: The overall aim of this thesis was to increase knowledge about the possible effects of an extended postnatal home visiting program within Swedish Child Health Care regarding parental experiences, parents’ health literacy, and child health, in multicultural, socioeconomically disadvantaged settings. Methods: This thesis used a multi-method approach consisting of one qualitative and three quantitative studies. All studies were conducted through CHC centers in multicultural, disadvantaged settings in northwest Stockholm from 2015 to 2020. The qualitative in-depth interview study with nine migrant fathers explored their perspectives on participating in the extended postnatal home visiting program and analyses used constructivist grounded theory. Data for the cross-sectional quantitative study (N=193) was collected through face-to face and phone interviews with first-time parents of newborn children, through structured questionnaires including the HLS-EU-Q16 tool (Swedish version), designed to measure comprehensive HL (CHL) in general populations. Psychometric properties of HLS-EU-Q16 that were evaluated through statistical methods, including exploratory factor analyses were: internal consistency, reliability, construct validity, floor and ceiling effects, reproducibility, ease of scoring, time to administer, and content validity. Face-to-face and phone interviews with first-time parents through structured questionnaires, including HLS-EU-Q16, were also used to collect data for the two quasi-experimental studies with pre-and post-measures. Pre-measures were conducted when first-time parents’ children were newborns and post-measures were conducted when children turned 15–18 months old (N=151). Additional data from the medical records of participants’ children and earlier published findings about measles, mumps, rubella (MMR) immunization coverage in the intervention area were used. Both quasi-experimental studies explored change in parents’ CHL from pre-to post-measures. One of the studies made comparisons of the change of parents’ CHL within and between the intervention group that attended the extended postnatal home visiting program vs. the comparison group that attended the ordinary Swedish CHC program. Data analyses used descriptive statistics, parametric/non-parametric tests, and general linear regression models. The other quasi-experimental study explored differences in children’s health outcomes (breastfeeding, MMR immunization, children’s exposure to smoke, language development and children’s healthcare utilization) and the associations between parents’ CHL and the children’s health outcomes (N=127) after participation in the intervention vs. the ordinary CHC program. Data analyses used descriptive statistics, nonparametric tests, and linear and logistic regression analyses. Results: Migrant fathers described their improved child-related knowledge and parental confidence during the in-depth interviews, as well as access to available societal resources that came about due to the extended postnatal home visiting program. One factor solution of exploratory factor analyses for HLS-EU-Q16 (Swedish version) explained 37.7% of the total variance of the tool when evaluating psychometric properties. Migrant background, educational level, and access to support from social networks had significant effects on CHL. Challenges related to comprehension of the HLS-EU-Q16 questions were found among participants with migrant backgrounds but were also expressed by Swedish-born participants. Significantly improved CHL after the extended home visiting program was only found in a sub-group of parents who needed an interpreter within the intervention group (F=11.429, p<0.001), and when compared with the corresponding sub-group of parents who attended the ordinary CHC program (F=5.025, p=0.027). A significantly reduced number of additional visits to the CHC center was observed in the intervention group (Kruskal-Wallis=10.063, p=0.002) but the rate of children’s normal language development at the age of 18 months was significantly lower in the intervention group, at 0.363 (95%CI [0.141,0.932]. MMR immunization coverage in the intervention site was higher after the program implementation in comparison with before (Chi2 =3.988, p=0.046). Changes in parents’ CHL after the home visits were not related to children’s health outcomes. Conclusions: This thesis indicates some positive impacts of the extended postnatal home visiting program on migrant fathers, parents’ CHL, and child health. The findings show the importance of including migrant fathers in home visiting programs, as it is beneficial to them in their parental role. When exploring parents’ CHL more specifically as an outcome of the extended postnatal home visiting program, despite HLS-EU-Q16 tools’ acceptable psychometric properties, the use of additional methods to measure parents’ HL is suggested in similar settings, as the questionnaire may not cover relevant aspects of HL. Even if parents’ comprehensive HL was measured to be improved in a sub-group of parents, HLSEU- Q16 is not measuring parents’ child-related HL, specifically. Further research is proposed to explore the extended home visiting program’s positive impacts on additional child health outcomes and their relationship to parental child-related HL in similar settings, as the research field remains relatively unexplored

Asylum seekers' perspectives on vaccination and screening policies after their arrival in Greece and The Netherlands

INTRODUCTION: Europe has been dealing with an increasing number of refugees during the past 5 years. The timing of screening and vaccination of refugees is debated by many professionals, however refugees' perspectives on health issues are infrequently taken into account. In this study, we aimed to investigate asylum seekers' perspectives on infectious diseases screening and vaccination policies. MATERIALS AND METHODS: Interviews were conducted in Greece and the Netherlands. Asylum seekers and recently arrived refugees were approached and informed with the help of interpreters; consent forms were acquired. The survey focused on demographic data, vaccination status, screening policies and prevention of infectious diseases. RESULTS: A total of 61 (43 male, 70.5%) refugees (30 Afghanis, 16 Syrian, 7 Erithrean) were interviewed. Mean age was 35.2 years (SD 13.5) and 50% had received primary or secondary education, while 24.6% received none. Median time after arrival in Greece and the Netherlands was 24 months (IQR 8.5-28). 44 out of 61 (72.1) participants were willing to be vaccinated after arrival in Europe, 26 preferred vaccination and screening to be performed at the point of entry. The need for screening and vaccination was perceived higher amongst participants in Greece (100% vs 43.3%) due to living conditions leading to increased risk of outbreaks. CONCLUSION: Participants were willing to communicate their perspectives and concerns. Screening and vaccination programs could be more effective when implemented shortly after arrival and by involving asylum seekers and refugees when developing screening and vaccination interventions

Improving immunization uptake rates among Gypsies, Roma and Travellers: a qualitative study of the views of service providers

BACKGROUND: Gypsies, Roma and Travellers are at risk of low uptake of routine immunizations. Interventions to improve uptake in these communities are seldom evaluated. As part of a qualitative study exploring barriers and facilitators to immunization uptake in Travellers, we report service provider (SP) perspectives. METHODS: We interviewed immunization SPs working with six Traveller communities across four UK cities. Participants included frontline staff and those with strategic or commissioning roles. Semi-structured interviews explored perceived attitudes of Travellers to vaccinations, local service delivery, and opportunities and challenges to improving uptake. Audio-recordings were transcribed, analyzed thematically and mapped to a socio-ecological model of health. RESULTS: 39 SPs participated. Four overarching themes were identified: building trusting relationships between SPs and Travellers; facilitating attendance at appointments; improving record keeping and monitoring and responding to local and national policy change. Travellers were perceived as largely supportive of immunizations, though system and organizational processes were recognized barriers to accessing services. CONCLUSIONS: Findings were broadly consistent across Traveller groups and settings. The barriers identified could often be addressed within existing infrastructure, though require system or policy change. Development of a culturally competent system appears important to enable equity in access to immunizations for Travellers

Health of Special Immigrant Visa holders from Iraq and Afghanistan after arrival into the United States using Domestic Medical Examination data, 2014-2016: A cross-sectional analysis.

BACKGROUND: Since 2008, the United States has issued between 2,000 and 19,000 Special Immigrant Visas (SIV) annually, with the majority issued to applicants from Iraq and Afghanistan. SIV holders (SIVH) are applicants who were employed by, or on behalf of, the US government or the US military. There is limited information about health conditions in SIV populations to help guide US clinicians caring for SIVH. Thus, we sought to describe health characteristics of recently arrived SIVH from Iraq and Afghanistan who were seen for domestic medical examinations. METHODS AND FINDINGS: This cross-sectional analysis included data from Iraqi and Afghan SIVH who received a domestic medical examination from January 2014 to December 2016. Data were gathered from state refugee health programs in seven states (California, Colorado, Illinois, Kentucky, Minnesota, New York, and Texas), one county, and one academic medical center and included 6,124 adults and 4,814 children. Data were collected for communicable diseases commonly screened for during the exam, including tuberculosis (TB), hepatitis B, hepatitis C, malaria, strongyloidiasis, schistosomiasis, other intestinal parasites, syphilis, gonorrhea, chlamydia, and human immunodeficiency virus, as well as elevated blood lead levels (EBLL). We investigated the frequency and proportion of diseases and whether there were any differences in selected disease prevalence in SIVH from Iraq compared to SIVH from Afghanistan. A majority of SIV adults were male (Iraqi 54.0%, Afghan 58.6%) and aged 18-44 (Iraqi 86.0%, Afghan 97.7%). More SIV children were male (Iraqi 56.2%, Afghan 52.2%) and aged 6-17 (Iraqi 50.2%, Afghan 40.7%). The average age of adults was 29.7 years, and the average age for children was 5.6 years. Among SIV adults, 14.4% were diagnosed with latent tuberculosis infection (LTBI), 63.5% were susceptible to hepatitis B virus (HBV) infection, and 31.0% had at least one intestinal parasite. Afghan adults were more likely to have LTBI (prevalence ratio [PR]: 2.0; 95% confidence interval [CI] 1.5-2.7) and to be infected with HBV (PR: 4.6; 95% CI 3.6-6.0) than Iraqi adults. Among SIV children, 26.7% were susceptible to HBV infection, 22.1% had at least one intestinal parasite, and 50.1% had EBLL (≥5 mcg/dL). Afghan children were more likely to have a pathogenic intestinal parasite (PR: 2.7; 95% CI 2.4-3.2) and EBLL (PR: 2.0; 95% CI 1.5-2.5) than Iraqi children. Limitations of the analysis included lack of uniform health screening data collection across all nine sites and possible misclassification by clinicians of Iraqi and Afghan SIVH as Iraqi and Afghan refugees, respectively. CONCLUSION: In this analysis, we observed that 14% of SIV adults had LTBI, 27% of SIVH had at least one intestinal parasite, and about half of SIV children had EBLL. Most adults were susceptible to HBV. In general, prevalence of infection was higher for most conditions among Afghan SIVH compared to Iraqi SIVH. The Centers for Disease Control and Prevention (CDC) Guidelines for the US Domestic Medical Examination for Newly Arriving Refugees can assist state public health departments and clinicians in the care of SIVH during the domestic medical examination. Future analyses can explore other aspects of health among resettled SIV populations, including noncommunicable diseases and vaccination coverage

Shared memory parallel computing procedures for nonlinear dynamic analysis of super high rise buildings

The proposed parallel state transformation procedures (PSTP) of fiber beam-column elements and multi-layered shell elements, combined with the parallel factorization of Jacobian (PF), are incorporated into a finite element program. In PSTP, elements are classified into different levels of workload prior to state determination in order to balance workload among different threads. In PF, the multi-threaded version of OpenBLAS is adopted to compute super-nodes. A case study on four super high-rise buildings, i.e. S1~S4, has demonstrated that the combination of PSTP and PF does not have any observable influence on computational accuracy. As number of elements and DOFs increases, the ratio of time consumed in the formation of the Jacobian to that consumed in the solution of algebraic equations tends to decrease. The introduction of parallel solver can yield a substantial reduction in computational cost. Combination of PSTP and PF can give rise to a further significant reduction. The acceleration ratios associated with PSTP do not exhibit a significant decrease as PGA level increases. Even PGA level is equal to 2.0g, PSTP still can result in acceleration ratios of 2.56 and 1.92 for S1 and S4, respectively. It is verified that it is more effective to accelerate analysis by reducing the time spent in solving algebraic equations rather than reducing that spent in the formation of the Jacobian for super high-rise buildings

Evaluation of a Community Health Worker Intervention on Rates of Measles, Mumps and Rubella Immunization in a Somali Population in Lexington, Nebraska

Measles is a highly contagious viral disease. It remains an important cause of death among young children globally, despite the availability of a safe and effective vaccine. There have been increasing outbreaks of measles to waning immunization. This study sought to evaluate rates of Measles, Mumps and Rubella (MMR) immunization in a Somali population living in Lexington, Nebraska and to evaluate a community health worker intervention to improve immunization rates. NESIIS data for Lexington Regional Health Center (LRHC) was queried to assess MMR trends for all clinic patients between 15 and 72 months both before and after implementation of the community health worker intervention. During the pre-intervention LRHC had an overall initial MMR vaccination rate of 67%. There was a significant lower rate of MMR immunization in the Somali population (29%) compared to the Hispanic population (72%, p\u3c0.0001) and the Non-Somali, Non-Hispanic population (75%, p\u3c0.0001). Interestingly, this vaccine hesitancy was unique to MMR vaccination with rates of varicella vaccination significantly higher at 75% versus 29% for MMR (p\u3c0.0001). During the intervention period LRHC had an overall initial MMR vaccination rate of 37% which was significantly lower than previous. There was a significant increase in rate of MMR immunization in the Somali population (52%) compared to the pre-intervention rate of 29% (p\u3c0.0001). The rate of varicella immunization among the Somali population did not significantly change between the two time periods (p=0.2302). Rates of MMR and varicella immunization significantly decreased in the Hispanic population (MMR 37% p\u3c0.0001, Varicella 61% p\u3c0.0001) and the Other population (MMR 32%, p\u3c0.0001, Varicella 51%, p\u3c0.0001). In conclusion, there is MMR vaccine specific hesitancy within the Somali population in Lexington, Nebraska that puts the community at risk for a measles outbreak. Using a community health worker intervention can help to improve MMR immunization rates within this population

Control and Characterization of Line-Addressable Micromirror Arrays

This research involved the design and implementation of a complete line-addressable control system for a 32x32 electrostatic piston-actuated micromirror array device. Line addressing reduces the number of control lines from N2 to 2N making it possible to design larger arrays and arrays with smaller element sizes. The system utilizes the electromechanical bi-stability of individual elements to bold arbitrary bi-stable phase patterns. The control system applies pulse width modulated (PWM) signals to the rows and columns of the micromirror array. Three modes of operation were conceived and built into the system. The first was the traditional signal scheme which requires the array to be reset before a new pattern can be applied. The second is an original scheme that allows dynamic switching between bi-stable patterns. The third and final mode applies an effective voltage ramp across the device by operating above mechanical cutoff. Device characterization and control system testing were conducted on predesigned and prefabricated samples from two different foundry processes. Testing results showed that the control system was successfully integrated. However, bi-stable control of individual mirror elements was not successfully demonstrated on samples due to flaws in the device design. A more robust device design which corrects these flaws and increases operational yield is proposed

Relationships between Posttraumatic Stress, Acculturation, and Maternal Sensitivity in Vietnamese and Hmong Mothers

The purposes of this study were to determine if posttraumatic stress (PTS), depression, and anxiety occurred in a community sample of Vietnamese and Hmong mothers and to describe relationships between PTS, depression, anxiety, acculturation and maternal sensitivity. Transition theory (Bridges, 1980), and a conceptual model of parenting in immigrant populations building on Belsky\u27s (1984) work, provided the theoretical framework (Foss, 1996). The sample was divided evenly between Vietnamese and Hmong participants. Ages ranged from 17–43 years, time lived in the United States ranged from 3–21 years, and education ranged from no formal education to completion of college. Maternal sensitivity was measured with Ainsworth\u27s Sensitivity vs. Insensitivity to the Communication of the Baby Scale; PTS, depression, and anxiety with the Vietnamese and Hmong versions of the Hopkins Symptom Checklist-25 (HSCL-25), and acculturation with the Suinn-Lew Self-identity Acculturation Scale (SL-ASIA). The SL-ASIA was translated into Vietnamese and Hmong prior to data collection. All data were collected by the investigator in the home. Interpreters were used for half of the sample. The Statistical Package for the Social Sciences 6.1 (SPSS) was used to analyze the data, explore relationships, and perform regression analyses. Results were (a)Vietnamese mothers experience PTS, anxiety, and depression to the same degree as the general Vietnamese and Hmong population, (b)Hmong mothers experience PTS, depression and anxiety to a much greater degree than Vietnamese mothers, (c)maternal sensitivity remained very high, even when clinical levels of PTS, anxiety, or depression were present, (d) there was a trend for more depressed Vietnamese mothers to be less sensitive to their infants, but for more depressed Hmong mothers to be more sensitive to their infants, and (e)more acculturated mothers tended to be less sensitive mothers. Further analyses revealed that the number of years spent in transit from the homeland to the United States was associated with greater maternal sensitivity, especially in the Hmong group; lower maternal sensitivity was associated with a greater number of the husband\u27s family living in the United States, and having more pregnancies was strongly associated with greater depression. Recommendations for research and practice were offered