Evaluation and comparison of aging education for undergraduates across multiple fields of study.

The college years represent a key opportunity for broadening the future gerontology workforce by introducing students to the aging content that may influence their career decisions, yet this content is often limited to students with behavioral health and health professions majors. The present study sought to determine the degree to which a Midwestern university's general education course on aging could increase learning, interest, knowledge, and ability to use knowledge for undergraduates across multiple fields of study. Participants included 560 undergraduate students, 48% of which were health professions majors, 28% behavioral health majors, and 23% majors in other fields. While all groups reported significant increases in learning, knowledge, and interest in aging studies, ANOVA found significant differences by students' field of study in reported ability to apply course knowledge in their career or organization. As demand increases for workers versed in the needs of the older adult population, it will be important for educators to incorporate career connections into aging studies coursework and make abundantly clear how students in all fields of study are necessary for the future gerontological workforce.

Creating a Vision for a Healthier Workforce Using a Systems-Based Approach.

CONTEXT: The public health system faces unprecedented challenges due to the pandemic, racism, health inequity, and the politicization of public health. At all levels of the system, the workforce is experiencing distress, burnout, safety issues, and attrition. Public health is being challenged to demonstrate and justify its impact and value, while also leveraging opportunities for learning and system strengthening. PROGRAM: To explore the current state and identify opportunities to strengthen the public health system, the Region 7 Midwestern Public Health Training Center (MPHTC), with support from Engaging Inquiry, embarked on a distinctive type of systems analysis, called "dynamic systems mapping." IMPLEMENTATION: This approach brought together diverse sectors of public health partners in the region to develop a rich contextual narrative and system-level understanding to highlight and align existing and emergent strengths, areas for growth, and tangible goals for the immediate- and long-term sustainability of local and regional health. EVALUATION: Focus groups and workshops were conducted with diverse practitioners to identify upstream causes and downstream effects of 11 key forces driving system behavior. These focus groups resulted in the development of a visual map that MPHTC is utilizing to identify opportunities for leverage, develop strategies to maximize the potential impact of these leverage points, as well as facilitate continuous learning. DISCUSSION: Public health utilization of systems mapping is a valuable approach to strengthening local and national system responses to current and future public health needs. Outcomes and lessons learned from the systems mapping process are discussed.

Capacity Building for Public Health: Participant-Guided Training.

Growth in the demand for public health services, along with limited funding, makes workforce collaboration and capacity building imperative. The faculty and staff of the Midwestern Public Health Training Center, with two Robert Wood Johnson Public Health Nurse Leaders, postulated that training could be more effective, and public health workers more effective in the field, if workers contributed to training format and content. The learning paradigm was tested on diabetes prevention and self-management programs. Public health professionals were surveyed on infrastructure, practices, roles, and gaps in diabetes-related services. Responses influenced the format and content of a one-day diabetes summit training program. Participants submitted evaluations immediately afterward. Eight months postsummit, participants were surveyed to self-assess behavioral changes attributed to the training. Using the Kirkpatrick model for evaluation, participants (n = 112) stated that the training met their expectations and that knowledge gained was consistent with stated training objectives. Qualitative postsummit survey results indicated that improvements in participants' delivery of diabetes prevention services to the public could be attributed to the training they received at the summit. Results suggest that training about specific programs and practices, as well as facilitated sessions of collaboration, can yield individual and organizational change.

Collaborative health education for Somali Bantu refugee women in Kansas City.

OBJECTIVE: To partner with and understand the health of Somali Bantu refugee women, small group sessions were designed and conducted using a community-based collaborative action research (CBCAR) approach. Health topics identified by this community were presented in 42 sessions with eleven women. Follow-up individual interviews with the women were used to ask questions about health experiences and plan for future health education. The objective of this qualitative study was to provide refugee women with knowledge to help them adjust to new health challenges in the United States, and to share personal narratives in a safe environment. RESULTS: The process of sharing health information with the women resulted in a collaborative exchange of culture and community. Individual interviews allowed women to voice their opinions outside of the influence of their community elders. CBCAR is an effective tool to involve refugee communities, and other populations small in number, in addressing their unique health challenges. Results from this study demonstrated that small group sessions and a CBCAR approach can be effective in sharing knowledge within small communities of refugee women. Findings from the study will assist in the future planning of health education programs for refugee women and their families in this community.

Modeling Repeated M Dwarf Flaring at an Earth-like Planet in the Habitable Zone: Atmospheric Effects for an Unmagnetized Planet.

Understanding the impact of active M dwarf stars on the atmospheric equilibrium and surface conditions of a habitable zone Earth-like planet is key to assessing M dwarf planet habitability. Previous modeling of the impact of electromagnetic (EM) radiation and protons from a single large flare on an Earth-like atmosphere indicated that significant and long-term reductions in ozone were possible, but the atmosphere recovered. However, these stars more realistically exhibit frequent flaring with a distribution of different total energies and cadences. Here, we use a coupled 1D photochemical and radiative-convective model to investigate the effects of repeated flaring on the photochemistry and surface UV of an Earth-like planet unprotected by an intrinsic magnetic field. As input, we use time-resolved flare spectra obtained for the dM3 star AD Leonis, combined with flare occurrence frequencies and total energies (typically 1030.5 to 1034 erg) from the 4-year Kepler light curve for the dM4 flare star GJ1243, with varied proton event impact frequency. Our model results show that repeated EM-only flares have little effect on the ozone column depth but that multiple proton events can rapidly destroy the ozone column. Combining the realistic flare and proton event frequencies with nominal CME/SEP geometries, we find the ozone column for an Earth-like planet can be depleted by 94% in 10 years, with a downward trend that makes recovery unlikely and suggests further destruction. For more extreme stellar inputs, O3 depletion allows a constant ∼0.1-1 W m-2 of UVC at the planet's surface, which is likely detrimental to organic complexity. Our results suggest that active M dwarf hosts may comprehensively destroy ozone shields and subject the surface of magnetically unprotected Earth-like planets to long-term radiation that can damage complex organic structures. However, this does not preclude habitability, as a safe haven for life could still exist below an ocean surface.

Parent health literacy and adherence-related outcomes in children with epilepsy.

BACKGROUND: The relationship between parent health literacy and adherence to treatment in children with epilepsy has not been fully explored. The purpose of this study was to determine whether parent health literacy and other variables predicted factors associated with adherence, such as missed medication doses, missed medical appointments, and seizure frequency, in children with epilepsy between 1 and 12 years old. METHODS: It was hypothesized that parents with adequate parent health literacy would report fewer missed doses, missed appointments, and seizure occurrences. Using a nonexperimental, cross-sectional study design, interviews were conducted with 146 parents and guardians of children with epilepsy who resided in rural communities. Univariate analyses, including ANOVA, and multiple linear regressions were conducted. RESULTS: Results indicated that parent health literacy was the strongest predictor of two of the adherence-related factors. Higher health literacy scores were associated with fewer missed medication doses and seizure occurrences. However, health literacy was not associated with missed medical appointments. Among other study variables, higher household income was also predictive of fewer missed doses. CONCLUSION: The study findings suggest that inadequate health literacy among parents may serve as an independent risk factor for adherence-related outcomes among children with epilepsy. Further research, as well as effective, targeted parent health literacy strategies used to improve epilepsy management and care in children, is recommended.

Unmet needs for dental care in children with special health care needs.

OBJECTIVE: The unmet need for dental care is one of the greatest public health problems facing U.S. children. This issue is particularly concerning for children with special health care needs (CSHCN), who experience higher prevalence of unmet dental care needs. The primary purpose of this study was to investigate regional differences in unmet dental care needs for CSHCN. Using the Social Ecological Model as a framework, additional variables were analyzed for regional differences. It was hypothesized that (H1) unmet dental care needs would be high in the CSHCN population, (H2) there would be regional differences in unmet dental care needs in CSHCN, and (H3) there would be differences in specific individual, interpersonal (family), community (state), and policy level factors by region. METHODS: Data were obtained from the 2009-2010 National Survey of CSHCN. SPSS was used for data management and analysis. RESULTS: Each of the study hypotheses was supported for the sample of 40,242 CSHCN. The West region was more likely to have more unmet needs for preventive and specialized dental care in CSHCN than the reference region (Northeast). The South region followed the West region in unmet dental care needs. Statistically significant differences in individual, interpersonal (family), community (state) and policy factors were found by region. CONCLUSION: Further research is recommended. Effective strategies that include policy to address unmet dental care needs at multiple levels of intervention are suggested.

Prevalence of pediatric epilepsy in low-income rural Midwestern counties.

Epilepsy is one of the most common disabling neurological disorders, but significant gaps exist in our knowledge about childhood epilepsy in rural populations. The present study assessed the prevalence of pediatric epilepsy in nine low-income rural counties in the Midwestern United States overall and by gender, age, etiology, seizure type, and syndrome. Multiple sources of case identification were used, including medical records, schools, community agencies, and family interviews. The prevalence of active epilepsy was 5.0/1000. Prevalence was 5.1/1000 in males and 5.0/1000 in females. Differences by age group and gender were not statistically significant. Future research should focus on methods of increasing study participation in rural communities, particularly those in which research studies are rare.

Prevalence of epilepsy in rural Kansas.

PURPOSE: To determine the prevalence of active epilepsy in two southeastern rural Kansas counties. METHODS: Medical records were abstracted from the emergency rooms, out- and inpatient services and clinics of 9 hospitals, from 10 doctors' offices, and 1 nursing home in and surrounding the two counties. Letters were mailed from hospitals and doctors' offices to invite their potentially eligible patients to participate in an interview. Medical record information and the interview, when available, were used for the final determination of active epilepsy, seizure type, etiology, syndrome, age, and gender in consensus conferences. Prevalence of epilepsy was calculated, and capture-recapture methodology, which estimates prevalence based on what is known about the population, was employed to assess active epilepsy in the two counties. RESULTS: This study identified 404 individuals with active prevalent epilepsy who visited at least one of the 20 facilities during the observation period. The overall prevalence of active epilepsy was 7.2 per 1000. The seizure type for 71.3% of prevalent cases was unknown; among the 76 cases with known and classifiable seizure type, 55.3% had focal with secondary generalized seizures. Among the 222 cases with classifiable etiology, 53.1% were idiopathic/cryptogenic. About 75% (n=301) were captured at only one center, 72% (n=75) of the remaining 103 patients were captured at two centers, and 28 patients were identified at three or more centers. The capture-recapture assessment yielded an estimation of 982 prevalent patients. The overall estimated prevalence of epilepsy in the two Kansas counties using capture-recapture was 17 per 1000. CONCLUSIONS: The crude prevalence of epilepsy, using medical record survey methods, was similar to, but on the high end, of other total population prevalence studies in the United States. The capture-recapture assessment suggested that epilepsy prevalence might be considerably higher than the crude prevalence.

Attitudes towards male circumcision among Chinese and its implications.

Routine male circumcision (RMC) has been found effective in preventing HIV infection in Africa; at the same time, incidence of HIV infection has been rising in China. Hence, RMC may be a possible means by which Chinese nationals could address increasing HIV infection rates. A focus group study was conducted to explore perceptions of RMC among mainland Chinese nationals. The results indicated that 1) 90% of participants considered RMC to be an unfamiliar and culturally sensitive topic; 2) 80% felt that being uncircumcised had not created significant health drawbacks for them or males they knew; and 3) the group believed that RMC would not be a good strategy to address rising HIV rates and were dubious about the idea of mandated RMC in China. For Chinese nationals, cultural traditions regarding RMC appear to outweigh concerns about HIV infection.

Generating social capital through public health leadership training: a six-year assessment.

Social capital, or a sense of partnership leading to shared goals, provides a means for addressing today's public health workforce challenges. This concept is particularly important in underserved rural areas, though efforts to intentionally generate social capital have been limited. Within the rural state of Kansas, the Kansas Public Health Leadership Institute (KPHLI) has implemented a social capital pre/post assessment to quantify the impact of KPHLI training on social capital within the state's decentralized public health system. This paper discusses 38 assessment items related to bonding, bridging and linking social capital. The assessment was completed pre and post training by 130 of 148 scholars (87.8%) in six KPHLI training cycles. Data were analyzed using Wilcoxon paired t-tests in SPSS. Thirty-five of 38 items demonstrated statistically significant increases at post-test, across all 10 sub-domains. Leadership training by the KPHLI fosters quantifiable increases in characteristics of social capital, which are essential for public health systems to cope with increased workforce demands and prepare for accreditation. This study represents a key first step in examining the deliberate generation of social capital within a decentralized rural environment.

Oral health attitudes and practices among a German Mexican Mennonite farmworker community.

The oral health needs of migrant farm laborers are greater and more immediate than those of comparable populations. However, little is known about the conditions of oral health care among German-speaking Mexican Mennonites, a distinctive cultural subgroup of migrant farm laborers. The purpose of this study was to examine the oral health practices, perceived oral health status, and barriers to obtaining dental care among a community of Low German-speaking Mexican Mennonites residing in Southwest Kansas. Interviews were conducted with a sample of 25 individuals, with questions addressing access/barriers to care, oral health practices, and perceived oral health status. The most frequently identified barriers to dental care were limited finances, lack of adequate health/dental insurance, and limited awareness of available dental services. Although the majority of participants reported experiencing no problems related to language or scheduling dental appointments, the results also indicated low utilization levels of oral care services. Findings suggest that: (1) this population is at-risk for periodontal disease, (2) culturally appropriate programs are needed for preventive oral care education, (3) community and statewide support may help improve access to affordable oral health care.

Competency-based impact of a statewide public health leadership training program.

Previous public health leadership training research has assessed regional or national programs or evaluated program effectiveness qualitatively. Although these methods are valuable, state-level program impact has not been evaluated quantitatively. Public health core and leadership competency assessments are administered pre and post Kansas Public Health Leadership Institute training (N = 94). Wilcoxon signed rank tests note significant increases by each competency domain. Data are stratified by years of experience, level of education, and urban or rural status, and correlations calculated using Spearman's rho tests in SPSS/PC 14.0. Post training, participants improve significantly in all competency domains (p < .001). Participants with lower education, fewer years of experience, and rural status improve more in certain core competency domains. Lower education and rural status correlate with greater improvement in certain leadership competency domains. Similar assessment methods can be used by other public health education programs to ensure that programs appropriately train specific workforce populations for national accreditation.

The effect of a strong stellar flare on the atmospheric chemistry of an earth-like planet orbiting an M dwarf.

Main sequence M stars pose an interesting problem for astrobiology: their abundance in our galaxy makes them likely targets in the hunt for habitable planets, but their strong chromospheric activity produces high-energy radiation and charged particles that may be detrimental to life. We studied the impact of the 1985 April 12 flare from the M dwarf AD Leonis (AD Leo), simulating the effects from both UV radiation and protons on the atmospheric chemistry of a hypothetical, Earth-like planet located within its habitable zone. Based on observations of solar proton events and the Neupert effect, we estimated a proton flux associated with the flare of 5.9 × 108 protons cm⁻² sr⁻¹ s⁻¹ for particles with energies >10 MeV. Then we calculated the abundance of nitrogen oxides produced by the flare by scaling the production of these compounds during a large solar proton event called the Carrington event. The simulations were performed with a 1-D photochemical model coupled to a 1-D radiative/convective model. Our results indicate that the UV radiation emitted during the flare does not produce a significant change in the ozone column depth of the planet. When the action of protons is included, the ozone depletion reaches a maximum of 94% two years after the flare for a planet with no magnetic field. At the peak of the flare, the calculated UV fluxes that reach the surface, in the wavelength ranges that are damaging for life, exceed those received on Earth during less than 100 s. Therefore, flares may not present a direct hazard for life on the surface of an orbiting habitable planet. Given that AD Leo is one of the most magnetically active M dwarfs known, this conclusion should apply to planets around other M dwarfs with lower levels of chromospheric activity.

Immigrants vs. non-immigrants: attitudes toward and practices of non-therapeutic male circumcision in the United States of America.

OBJECTIVES: To explore and compare attitudes toward and practices of non-therapeutic male circumcision (NTMC) between immigrants and non-immigrants. STUDY DESIGN: We conducted 8 focus groups involving 44 participants of the lay public (21 immigrants and 23 non-immigrants) and 14 extended interviews with physicians (9 family physicians and 5 pediatricians). RESULTS: Four themes regarding NTMC were identified: knowledge and awareness, benefits and drawbacks, Medicaid and American Academy of Pediatrics practices and recommendations, and medical and cultural competence issues. CONCLUSIONS: The influx of immigrants may decrease the incidence of NTMC in the United States. Health professionals need to be culturally competent in interacting with both immigrants and non-immigrants regarding NTMC-related issues.

Community-based participatory research in developing an obesity intervention in a rural county.

This research includes a study of body mass index (BMI) measurement for 11-year-old students (n = 174) within a rural county during the 2005-2006 academic year. School entry assessments were used to determine students' individual BMIs longitudinally and determine prevalence of risk of overweight (weighted for gender and age). Results were provided to county school districts and communities, which used the data to determine policy and curriculum changes related to school wellness program planning and development, develop wellness activities, and pursue funding support. This study has implications for data collection and school health program development within a rural setting.

An assessment of a pilot asthma education program for childcare workers in a high-prevalence county.

OBJECTIVE: To assess changes in knowledge, attitudes, and intentions among childcare workers before and after an asthma-management-education session. METHODS: Between May and August 2004 five asthma-education sessions were provided for childcare workers from Sonoma County, California. A total of 71 childcare workers came to the sessions. Before and after each session we assessed the participants' knowledge, attitudes, and intentions about asthma. RESULTS: Participant knowledge of asthma causes (eg, air quality, common cold) and interventions (eg, bronchodilators), asthma trigger control plans, ability to identify a child who needs medical attention for asthma, and comfort level with caring for a child with asthma increased significantly. Their knowledge about asthma triggers, early warning signs, and asthma control plans was high before and after the asthma education intervention. Their stated intentions to utilize their asthma knowledge were high before and after the training, which may indicate willingness to implement knowledge and attitude change. CONCLUSIONS: Asthma education can improve childcare workers' knowledge about asthma-control strategies and attitudes toward asthma interventions.

Evaluation of mental health emergency preparedness among health professionals.

The purpose of this study was to identify if health professionals report an increase in mental health preparedness abilities with having only two mental health components as part of a 2-day preparedness training conference. At each of three conferences, identical pretraining and posttraining surveys were administered to conference participants. A 3-month follow-up survey was administered to respondents who volunteered to complete them. At pretraining, respondents (n = 603) reported generally greater mental health preparedness abilities than non-mental health preparedness abilities. This trend continued at posttraining (n = 490) and at 3 months posttraining (n = 195). Participants reported significantly increased mental health preparedness abilities at immediate posttraining and at 3 months posttraining from pretraining. This current study suggests that even when mental health items are included as a secondary component of disaster preparedness training, significant and meaningful growth in participants' confidence in their abilities can occur.

Measures of adherence to epilepsy treatment: review of present practices and recommendations for future directions.

Epilepsy is one of the most common neurological disorders worldwide, and the majority of people with epilepsy who live in developed countries manage their condition with antiseizure medication. Surprisingly, therefore, the literature on epilepsy does not document a comprehensive investigation of patient adherence to medication treatment. This paper reviews existing literature on direct and indirect measures of adherence. Based on this review, areas in need for further research have been identified, including improvement of self-report instruments, consideration of cultural factors, attention to patient literacy or numeracy levels, and inclusion of patient-guided measures. While no single method of determining adherence has proved effective, combining direct and indirect measures in a patient-guided, culturally competent atmosphere may increase adherence to treatment, improving health outcomes for this population.