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Bilbo Baggins, a respectable, well-to-do hobbit, lives comfortably in his hobbit-hole until the day the wandering wizard Gandalf chooses him to take part in an adventure from which he may never return.

Background The Health Equity Collective (HEC), a multi-sector systems-level collective impact coalition in the Greater Houston region, partnered with the City of Houston Health Department (HHD) to launch a 2-year effort to implement a comprehensive approach towards strengthening the regional Community Health Workers (CHW) workforce infrastructure as a pathway to advancing health equity. Our paper presents the logic model, methods, and baseline qualitative and quantitative data from this initiative. Methods In the fall of 2022, the Health Equity Collective brought together a Network of CHW-employing or training organizations in the Greater Houston region. This Network was the working group of CHW employer/training organizations tasked with developing the shared agenda for collaborative action toward strengthening the regional CHW workforce. As part of the baseline needs assessment qualitative interviews were conducted to understand the role and add-value of CHWs in advancing health equity. A landscape scan survey was administered to assess CHW employer organization’s funding and sustainability mechanisms for their CHWs job stability, CHW focus areas, organizational health equity priorities, etc. A journey mapping exercise was also conducted to capture CHWs lived experiences in their own voices. Results The qualitative interviews outlined three themes that describe the role, barriers, and needs of CHWs. Landscape scan survey responses were obtained from 21 out of 29 organizations in the CHW Network. Responses provided insight into CHW employer organizational funding and sustainability mechanisms for CHWs job stability, CHW focus areas, etc. The journey mapping exercise outlines the various paths that brought the participants to pursue a CHW career path and their journey through CHW training and work. Conclusion In summary, our paper outlines the collective impact approach and baseline data guiding efforts to strengthen the regional CHW workforce. Strategies and priorities were developed based on CHW voices and engaging stakeholders across organizations employing and training CHWs.

Maintaining genomic stability is inevitable for organism survival and it is challenged by mutagenic agents, which include ultraviolet (UV) radiation. Whenever DNA damage occurs, it is sensed by DNA-repairing proteins and thereby performing the DNA-repair mechanism. Specifically, in response to DNA damage, H2AX is a key protein involved in initiating the DNA-repair processes. In this present study, we investigate the effect of UV-C on earthworm, Perionyx excavatus and analyzed the DNA-damage response. Briefly, we expose the worms to different doses of UV-C and find that worms are highly sensitive to UV-C. As a primary response, earthworms produce coelomic fluid followed by autotomy. However, tissue inflammation followed by death is observed when we expose worm to increased doses of UV-C. In particular, UV-C promotes damages in skin layers and on the contrary, it mediates the chloragogen and epithelial outgrowth in intestinal tissues. Furthermore, UV-C promotes DNA damages followed by upregulation of H2AX on dose-dependent manner. Our finding confirms DNA damage caused by UV-C is directly proportional to the expression of H2AX. In short, we conclude that H2AX is present in the invertebrate earthworm, which plays an evolutionarily conserved role in DNA damage event as like that in higher animals.

Partnerships between food prescription programs and food banks can address food insecurity and support health; however, few studies have examined the experience and perceptions of health care partners about these programs. Our objective was to analyze secondary qualitative data from clinicians and clinic staff involved in implementing a food prescription program in Houston, Texas. We collected data from 17 health care clinics from May 2018 through March 2021 to learn how implementation of the food prescription program was perceived, and we received 252 responses. Principal themes were the importance of a value-based care strategy, patient and food pantry barriers to success, the importance of interorganizational care coordination, and the need to integrate food prescriptions into clinic workflow. Insights of clinicians and clinic staff on implementation of food prescription programs can inform program development and dissemination.

Primary care physicians (PCPs) are well suited to manage patients with non-alcoholic fatty liver disease (NAFLD), but the limited, existing research suggests inadequate knowledge about the natural history, diagnostic methods, and management of NAFLD. The purpose of this qualitative study is to further understand the knowledge and practices for the diagnosis and management of NAFLD among PCPs. We conducted in-depth interviews with PCPs in the Greater Houston area, addressing current clinical practices used for diagnosing and managing NAFLD, as well as the perceptions of the PCPs regarding the burden of NAFLD on patients. We recorded interviews, transcribed them, coded transcripts, and identified patterns and themes. The interviewed PCPs (n = 16) were from internal or family medicine, with a range of experience (1.5-30 years). We found variations in NAFLD diagnosis and management across practices and by insurance status. Patients with abnormal liver imaging who had insurance or were within a safety-net healthcare system were referred by PCPs to specialists. Uninsured patients with persistently elevated liver enzymes received lifestyle recommendations from PCPs without confirmatory imaging or specialist referral. The role of PCPs in NAFLD management varied, with some helping patients set dietary and physical activity goals while others provided only general recommendations and/or referred patients to a dietitian. The diagnosis and management of NAFLD vary widely among PCPs and may be impacted by patients’ insurance status and clinic-specific practices. The increasing burden of NAFLD in the U.S. medical system highlights the need for more PCPs involvement in managing NAFLD.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Understanding sociodemographic, behavioral, clinical, and laboratory risk factors in patients diagnosed with COVID-19 is critically important, and requires building large and diverse COVID-19 cohorts with both retrospective information and prospective follow-up. A large Health Information Exchange (HIE) in Southeast Texas, which assembles and shares electronic health information among providers to facilitate patient care, was leveraged to identify COVID-19 patients, create a cohort, and identify risk factors for both favorable and unfavorable outcomes. The initial sample consists of 8,874 COVID-19 patients ascertained from the pandemic’s onset to June 12 th , 2020 and was created for the analyses shown here. We gathered demographic, lifestyle, laboratory, and clinical data from patient’s encounters across the healthcare system. Tobacco use history was examined as a potential risk factor for COVID-19 fatality along with age, gender, race/ethnicity, body mass index (BMI), and number of comorbidities. Of the 8,874 patients included in the cohort, 475 died from COVID-19. Of the 5,356 patients who had information on history of tobacco use, over 26% were current or former tobacco users. Multivariable logistic regression showed that the odds of COVID-19 fatality increased among those who were older (odds ratio = 1.07, 95% CI 1.06, 1.08), male (1.91, 95% CI 1.58, 2.31), and had a history of tobacco use (2.45, 95% CI 1.93, 3.11). History of tobacco use remained significantly associated (1.65, 95% CI 1.27, 2.13) with COVID-19 fatality after adjusting for age, gender, and race/ethnicity. This effort demonstrates the impact of having an HIE to rapidly identify a cohort, aggregate sociodemographic, behavioral, clinical and laboratory data across disparate healthcare providers electronic health record (HER) systems, and follow the cohort over time. These HIE capabilities enable clinical specialists and epidemiologists to conduct outcomes analyses during the current COVID-19 pandemic and beyond. Tobacco use appears to be an important risk factor for COVID-19 related death.

We investigated class clustering patterns of four behaviors—physical activity, fruit and vegetable (F & V) intake, smoking, and alcohol use—in a faith-based African American cohort. Guided by socio-ecological models, we also examined the psychosocial and neighborhood social environmental factors associated with the clustering patterns. Participants were 1,467 African American adults recruited from a mega church in the metropolitan Houston, TX, in 2008-2009. They completed a survey and health assessment. Latent class analysis and multinomial regression analysis were conducted. Results supported a three-class model: Class 1 was characterized by low physical activity, low F & V intake, and low substance use (smoking and alcohol use). Class 2 was characterized by high physical activity, low F & V intake, and mild drinking. Class 3 seemed to be the healthiest group, characterized by high physical activity, moderate-to-high F & V intake, and low substance use. The probabilities of being included in Classes 1, 2, and 3 were. 33,. 48, and. 19, respectively. Participants in Class 1 (vs. Class 3) reported lower physical activity norm (p <. 001) and higher smoking norm (p =. 002) and lower neighborhood social cohesion (p =. 031). Participants in Class 2 (vs. Class 3) reported higher cancer risk perception (p <. 001), lower F & V norm (p =. 022), lower physical activity norm (p <. 001), higher smoking norm (p <. 001), and lower social cohesion (p =. 047). As health behaviors are clustered together, future interventions for African Americans may consider targeting multiple health behaviors instead of targeting a single health behavior. Interventions addressing social norm and neighborhood social cohesion may enhance multiple health behaviors engagement in this population.

ObjectivesEarly first trimester prenatal counseling could reduce adverse maternal and child health outcomes. Existing literature does not identify the length of time between suspecting pregnancy and attending their first prenatal visit. Identifying this potential window for change is critical for clinical practice, intervention programming and policy change.MethodsThe study sample was composed of women in the United States who responded to the Pregnancy Risk Assessment Monitoring Systems survey in 2016, for the following questions—when they first suspected pregnancy, when they attended their first prenatal visit, were they able to receive prenatal care as early as they wished, and perceived barriers to receiving prenatal care.ResultsOn average, participants became certain they were pregnant at 6.0 (SE = 0.1) weeks gestation, while participants reported having their first prenatal care visit at 9.3 (SE = 0.1) weeks, with clear health disparities by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished. Structural or financial barriers in the health care system were common: 38.1% reported that no appointments available, 28.2% reported not having money or insurance to pay for the visit, 27.3% reported that the doctor or health plan would not start care, and 22.5% reported not having a Medicaid card.Conclusions for PracticeThis study illustrates a window for opportunity to provide earlier prenatal care, which would facilitate earlier implementation of prenatal counseling. Strategies to address barriers to care on the patient, provider and systemic levels, particularly among vulnerable population groups, are warranted.What is already known on this subject?Seeking prenatal care early is associated with better health outcomes for women and infants. A window of opportunity exists between suspecting pregnancy and attending a first prenatal visit.What this study adds?Clear health disparities were apparent in both recognizing their pregnancies, and receiving early prenatal care by race, age, WIC participation, education level, and marital status. About 15% of women reported not receiving prenatal care as early as they wished, and many attributed this later care to structural or financial barriers in the health care system.

OBJECTIVE:This study examined physical activity (PA) profiles of hospital employees and evaluated associations between PA domains (occupation, commute, leisure, and domestic) and intensity levels (light, moderate, and vigorous) with body mass index (BMI). METHODS:Nine hundred twenty employees across six Texas hospitals were enrolled in the multisite study, 2012 to 2013. Analysis of covariance tests assessed equality of means (minutes) across PA measures, and mixed effects analyses evaluated associations between PA measures and BMI, while controlling for covariates. RESULTS:Over 78% of participants were overweight or obese. Mixed effects models showed significant inverse associations with BMIlight leisure PA (β = –0.0183|P = 0.003), moderate leisure PA (β = –0.0182|P = 0.005), vigorous leisure PA (β = –0.0248|P = 0.000), moderate commute PA (β = –0.0315|P = 0.02), moderate domestic PA (β = –0.0087|P = 0.018), and vigorous occupation PA (β = –0.0158|P = 0.001). CONCLUSION:Delivery of effective interventions in this population must consider the nature of the work environment as well as employees’ PA profiles.