RIMI Pilot Projects
The following Pilot Projects are currently being undertaken under the auspices of the College of Health and Human Services' funding provided through the $5 million grant from the National Institutes of Health's (NIH) National Center on Minority Health and Health Disparities (NCMHD).
Variation in Fiber Types and Cross-Sectional Areas of Human Jaw Closing Muscles
Researcher
Mentor
Organizational Affiliation
- Department of Physical Therapy, College of Health and Human Services, Governors State University
Contact
Objective
There are three aims of this research, two of which are directly scientific and one that relates to students’ education. 1) Develop immunohistochemical and other laboratory methods to study muscle atrophy and hypertrophy in our laboratory at Governors State University; 2) Identify markers of muscle atrophy and hypertrophy using mice maintained on soft and hard diets; 3) Use these methods to study variation and indications of atrophy in human jaw muscles; 4) Provide opportunities to participate in types of research and hypothesis-testing that previously was not possible, which is essential for the newly-implemented doctoral programs in the GSU College of Health and Human Services (e.g., Doctor of Physical Therapy, Doctor of Nursing Practice).
Background
Past studies of human masticatory muscles have found these muscles to be heterogeneous and containing interesting combinations of fiber types, quite unlike, for example, the patterns found in limb muscles (Ringqvist, et. al., 1982; Thornell, et. al., 1984). In addition, studies of muscle fiber diameters demonstrate that human masticatory muscles are different from almost all other muscles that have been studied.
Methods
We have made great progress since we submitted our most recent report. We now have the tools in place in the lab to analyze both human and experimental muscle samples in order to identify pathways of muscle atrophy and expression of myosin isoforms.
Results
Our preliminary results are very intriguing. It appears that myostatin (GDF-8) expression begins to decrease quickly as the masticatory muscles respond to lower activity requirements. If this result is confirmed in our continuing analyses, it will mean that current opinions regarding the role of myostatin will have to be modified.
Myostatin is usually described as a negative regulator of muscle mass (e.g., Lee, 2004). If so, one would expect myostatin expression to increase as muscle atrophies. Previous studies have demonstrated that these pathways are complex. For example, Parsons, et al. (2006) showed that by using an antibody to decrease myostatin production in a mouse model of limb-girdle muscular dystrophy severity of the disease is decreased in young adults but not in older adult mice.
One possible explanation for many of the contradictory results is that is that the soft-diet model is a more physiologically realistic experimental method than immobilization, hind-limb suspension, and other common methods used to produce muscle atrophy.
Conclusions
In the next few months we should collect enough data from masticatory muscles of several mice on a soft diet for three days to publish our preliminary results. These data will include myosin isoform expression and quantification of expression of numerous molecular markers of atrophy pathways. We will then begin to study variation in myosin isoforms and the state of atrophy pathways in human masticatory muscles.
Title of Project: Disparities in Access to Hospitals with High Technology
Name of Researcher: Tae Hyun Kim, Ph.D. Mentor: Anthony T. Lo Sasso
Organizational Affiliation: Department of Health Administration, College of Health and Human Services, Governors State University
Contact information: t-kim@govst.edu
Objective
The specific objectives are to examine the relationship between inpatient racial/ethnic composition and hospital medical technology in an attempt to explain whether there exist disparities in both access to and quality of health care, since technology may help improve quality of care.
Background
Access to high technology hospitals might not be uniform across different patient groups, since prior studies suggest that racial/ethnic minorities and vulnerable populations have lower access to a variety of health care modalities.
Understanding the role of hospital characteristics in exacerbating or ameliorating health disparities could assist policymakers in devising strategies to reduce disparities. As a vital step to ensure that Americans can access quality healthcare, policymakers must understand the differences in access to high-tech hospitals by various populations.
Methods
This research project is a retrospective, longitudinal study that analyzes secondary datasets, including the Healthcare Cost and Utilization Project (HCUP)’s Nationwide Inpatient Sample (NIS) and the American Hospital Association (AHA)’s Annual Survey Data during 1998-2003. This study focuses on hospital discharge information, and tests if the proportion of patients with different demographic and socioeconomic characteristics is significantly associated with the level of hospital medical technology which includes CT scanner, PET scanner, MRI, diagnostics radiation facility, and Level 1 trauma center. Demographic and socioeconomic characteristics include age, gender, race/ethnicity, expected primary payer, and neighborhood income. This study seeks to improve on the previous study in two aspects. First, rather than using a cross-sectional design, it employs a longitudinal study to improve the ability to infer a causal relationship. Second, it uses a hospital-specific fixed effects model to address the effects of unmeasured, time-invariant characteristics of the hospital.
Results
To date, preliminary results suggest that an increase in the proportion of patients of Hispanic ethnicity is associated with a lower level of medical technology in hospitals. The proportion of Medicaid patients is negatively associated with the level of medical technology. In addition, a rise in the proportion of patients from lower-income neighborhoods lowers the level of medical technology.
Conclusions
Hospitals serving an increasing proportion of racial/ethnic minorities and low-income patients may have not been able to invest in the latest medical technology. As a vital step to insure that Americans can access quality healthcare, policymakers must understand the differences in access to hospitals with different levels of technology by various populations.
Title of Project: Knowledge, Attitudes, and Self-Efficacy in Pregnant Asthmatics
Name of Researcher: Nancy MacMullen, Ph.D., RNCHR-OB, APN/CNS, CNE Mentor: Sharon Telleen, Ph.D.
Organizational Affiliation: Department of Nursing, College of Health and Human Services, Governors State University
Contact information: n-macmullen@govst.edu
Objective
The specific aim of this study of pregnant women with asthma is to report on their level of knowledge and awareness of attitudes of asthma in pregnancy and their self-efficacy in carrying out their self-management plan during pregnancy.
Background
The incidence of asthma is increasing rapidly in the US, with more than 16 million Americans affected (CDC, 2004). Of the approximately 6,401,000 pregnancies each year, 256,000 are complicated by asthma (NIH, 1993). Even for women with well-controlled asthma prior to pregnancy, the physiologic changes in pregnancy put added strain on the management of asthma and the pregnancy, necessitating changes in medication and incidence of symptoms.
Most studies on asthma target children -- very few are on prenant women, even though asthma attacks during pregnancy can be very dangerous. Pregnant women with asthma have greater risk for premature delivery, pregnancy induced hypertension, and increased rate of premature birth (NIH, 1993; Kallen, Rydstroem & Aberg, 2000). A paucity of literature is available on successful self-management, including disease knowledge, attitudes and self-efficacy. These are the areas to which this research will contribute knowledge; this knowledge is essential before preparing an educational intervention.
Methods
Due to the complexity of obtaining IRB approval at the University of Chicago (the original data collection site), patient data through a physicians private practice was collected at the outset of the study. IRB approval at the U of C was finally obtained on June 11, 2008, and data collection there began one month later.
Sixty-eight pregnant women who have an asthma diagnosis were given questionnaires two times (early and late trimesters) during their pregnancy.regarding knowledge, attitudes, and self-efficacy of asthma in pregnancy. A demographic data form and a health assessment form were also administered. Descriptive statistics, paired t-tests, and multiple regression analysis are being currently used to analyze the data.
Results
To date, a total of 68 subjects have been surveyed at Time 1 and Time 2. The data analysis phase is currently taking place.
Conclusions
Pregnant women with asthma have greater risk for premature delivery, pregnancy-induced hypertension, and increased rate of premature birth (NIH, 1993; Kallen, Rydstroem & Aberg, 2000). Research on asthma and pregnancy has focused on diagnosis and treatment. However, the effectiveness of these treatments is based on both the woman’s knowledge and understanding of asthma during pregnancy, and her ability to carry out the self-management plan. The specific aim of this study of pregnant women with asthma is to describe their knowledge and attitudes of asthma in pregnancy and their self-efficacy in carrying out their self-management plan during pregnancy.
Data collection should be completed by August, 2010, followed by published results in the fall, 2010. An NIH, NINR, or Challenge Grant research proposal will be submitted in the spring, 2011. An abstract will also be submitted to the Midwest Nursing Research Society.
Title of Project: Issues of Access to Services for Individuals with Cerebral Palsy; Understanding the Availability of Support Services for Adults with Neuromotor Disabilities
Names of Researchers: Dr. Roberta O’Shea, PT, Ph.D. Dr. Elizabeth Cada, Ed.D., OTR/L, FAOTA Mentor: Sue Campbell
Organizational Affiliations: Department of Physical Therapy and Department of Occupational Therapy, College of Health and Human Services, Governors State University
Contact Information: r-o'shea@govst.edu
Objective
The specific aims of this project are to better understand the barriers faced by individuals 21 years and older who have lifelong neuromotor disabilities, specifically cerebral palsy, as they attempt to access medical and therapy services in an urban/suburban area. This will be accomplished through the development of a registry for adults and an interactive website through which information regarding access/barriers to health care, housing & employment, recreation, and mobility and transportation will be collected from registry participants.
Background
There is no official information available about the number of adults with cerebral palsy (CP) who reside in the state of Illinois or United States. It has been difficult to determine what issues of access and barrier to services, particularly health care services, these individuals have or are currently experiencing. Findings from an earlier study of barriers that children with cerebral palsy and their families experience when seeking occupational and physical therapy services suggest that health care services for adults with cerebral palsy are woefully inadequate.
Methods
In consultation with Dr. Sue Campbell, a plan was developed to design and implement a web-based registry to collect data about the experiences of adults with Cerebral Palsy. In addition to the registry, which would be considered “private” or secure, the website would provide a “public” side that would provide a forum and resources.
Results
Results
In collaboration with the CADE Center at UIC, the work on the website began in June, 2008. The secure or “private” side of the site will require each participant to complete an electronic consent form prior to accessing the registry; once the participant has registered, they will receive seven short surveys over a determined period of time. These surveys will allow us to collect data regarding healthcare providers, housing, employment, advocacy, life issues, recreation, mobility and transportation, as well as demographic information about the participant.
The secure portion of the website will also include social networking opportunities, blogging capabilities, and educational forums. The public access side of the website will contain a list of health care providers who have experience providing services for adults with CP and other resources that will provide information in the areas of housing, employment, advocacy, life issues, recreation, mobility, and transportation.
Conclusions
Through the course of 2010, project directors have searched for funding in order to maintain, populate, and utilize the website. Project directors have written continuation funding grants, and sought funding from private foundations and nonprofit associations. They estimate they will need approximately $70,000 to build the website so that data collection can begin.
Title of Project: Women Making Meaning of HIV/AIDS in Economically Marginal African American Communities: Implications for Community Based Health Education
Names of Researchers: Dr. Gerri Outlaw, Ed.D., Cynthia Carr, MS, OTR/L, and Carolyn Estes-Rodgers, Ph.D./ABD, MPH, MHS, CHES
Organizational Affiliation: Departments of Social Work and Occupational Therapy, and Center for the Care and Study of Vulnerable Populations, Governors State University
Contact Information: g-outlaw@govst.edu
Objective
African American adolescent girls and women are at high risk for human immunodeficiency virus (HIV) infection, but interventions specifically designed for this population have not reduced HIV risk behaviors.
Racial/ethnic disparity in health care and health status is a serious and growing concern for the nation. Despite major advancements in health care and medical technologies over the past 25 years, health disparities continue to exist and, in some cases, are increasing.
As the Office of Minority Health (OMH) suggests in National Partnership for Action, eliminating disparities requires effective intervention and outreach at the individual, community, and service systems levels, as well as strong partnerships to ensure practitioner competency, efficient use of evidence and evaluation, and enhanced practitioner-client communications.
This study explores with community-based providers alternative approaches to HIV and AIDS education and prevention specifically designed to address the particular needs of African American girls and women.
African Americans are significantly over-represented in the epidemic, accounting for 13 percent of the total population and 50.5 percent of new HIV/AIDS diagnoses (Holtgrave, 2007). The infection rate for African-American men is seven times that of white men; for African American women, the infection rate is 21 times higher. Forty-nine percent of African-American men diagnosed with HIV or AIDS in 2005 acquired the virus during unprotected sex with another man, while 78 percent of African-American women became infected through unprotected heterosexual intercourse.
Methods
This research project employed qualitative methods to assess the current prevention practices of community-based providers serving African American women. Five focus groups were conducted with community-based workers who provide a range of services to youth, families, and communities in the south Chicago and South Suburban areas of Chicago where disproportionately higher incidences of HIV and AIDS exists among African American youth and young adults. Staff members from seventeen agencies and eight service recipients participated in 90-minute focus groups based on three key themes:
1.) What programs/services can best meet the needs of the young girls/women you serve?
2.) What are the problems/challenges to developing and offering these programs/services? and
3.) What special training and or other resources do you/your agency need to address the challenges?
The focus groups were video and audio taped using a Nominal Group technique. In addition, discussion notes were recorded during each focus group. Tapes were transcribed to record all audio input. Data analysis was organized around the three thematic categories on which the focus group interview questions were based. Cross-coding of transcriptions and posted responses across all five focus groups were performed. Triangulation methods were used to establish validity and reliability in coding.
Results
Significant findings from the community stakeholders included the identification of programs and services that were or had the potential to best meet the needs of the young girls/women served, such as peer and cross-generational approaches, community awareness media, and counseling for service recipients and staff. The barriers to providing effective programs and services included the increasing lack of sufficient funding resources and funding priorities. The required training and other resources identified for adequately addressing the needs of young girls and females against STDs including HIV and AIDS included assistance with grant writing to fund programs, and the lack of qualified personnel.
The direct service staff that participated in the focus groups explored and reported the following themes as the barriers and resources required for effective HIV/AIDs education and prevention services for African American women.
Conclusions
Program structure, funding base, service planning and development, staffing, staff training and culturally competent and evidence-informed practice are the recurring themes reported across the focus groups. This study presents the elaboration of these themes and the implication for best practice in community-based HIV and AIDs prevention models to serve African American girls and women.
Title of Project: Emergency Room Usage among Patients with Access to a Primary Care Provider
Names of Researchers: Dr. Catherine Tymkow, Dr. Nancy MacMullen. Mentors- Dr. Jie Shen, Dr. Phil Kletke , and Dr. Penny Havlicek
Organizational Affiliation: Department of Nursing, College of Health and Human Services, Governors State University
Contact Information: c-tymkow@govst.edu
Objective
The objectives of this research are to 1) determine the impact of access to a primary care provider on emergency room usage among the uninsured and underinsured, and 2) estimate urgency and costs based on reasons for use of the emergency department. (Unchanged)
Background
Access to care for the uninsured and underinsured is a growing national issue and one of importance to the current president’s administration. Currently over 47,000,000 million Americans are uninsured.
Methods
The experimental group for this study is a random sample of patients from the catchment area served by a hospital that provides care to patients enrolled in Access to Care (ATC), a service offering affordable medical care to uninsured adult patients in Cook County, Illinois. Patients on the waiting list/or new enrollees (less than 3 months in ATC) represent a comparison group, and a random sample of residents living in the service area of any ATC provider facility clinic will be another comparison group. This revised sampling method represents a pilot sample and a change from the original plan since not all hospitals that serve ATC patients could be engaged in the study at this time. The addition of the second comparison group increased the number of subjects targeted/enrolled.
Three survey mailings using a questionnaire adapted from the National Household Survey of medical status and emergency room use were sent to study patients who participated in the Access to Care program and who lived in the catchment area of Westlake Hospital. Patients recently registered (less than three months in the program) were used as controls. Of the original mailings to two control groups (those inside and outside the catchment area) and two intervention groups (those inside and outside the catchment area), a total of 80 responses were returned. Most of the respondents were either intervention or control patients in the catchment area. The original design has been altered and after consultation with the Lead UIC Mentor, it was recommended that we simply use Hispanic vs. Non-Hispanic patients in the catchment area. Therefore the third mailing was only to this group. The data analysis and write up is in process.
Results
The Researchers requested an extension from the University IRB, and an extension for one year was approved on 06/12/08. Although it was originally anticipated that patient recruitment would be completed by October 2007, there were delays in obtaining IRB approval from the participating hospital because of canceled meetings and project negotiations such that final approval for reviewing participant records was not given until April 2008.
Conclusions
The plan is to complete write-up of results and submit for publication this fall. In addition, we will be exploring the feasibility of expanding the study to include comparison groups of other provider hospitals for ATC clients, with a fundable proposal by the end of the year, 2010.
Title of Project: Barriers to Higher Education for Hispanic/Latino/Latina Students
Name of Researcher: Maristela Zell, Ph.D., LCSW
Organizational Affiliation: Department of Social Work, College of Health and Human Services, Governors State University
Contact information: m-zell@govst.edu
Objective
This project examines the barriers encountered by Latino students in higher education, including transferring from community colleges to four-year institutions, such as Governors State University. This project encompasses two phases: 1) originally this exploratory study involved intensive one-on-one interviews with 17 community college Latina/o students. My sample included students from the community colleges in the Chicago area and in the Southland: Richard J. Daley College, Malcolm X College, Moraine Valley Community College, Olive Harvey Community College, Wilbur Wright College, and Kankakee Community College. I also aimed at a diverse sample of subjects in terms of gender and age and; 2) In October of 2008, I expanded the scope of the study to include Master’s level students from the College of Health and Human Services. My sample included 12 Latina/o students from the following master’s programs: Communication Disorders, Physical Therapy, Occupational Therapy, and Health Administration programs.
Background
In general, this has been an area of little study until very recently. Although there has been increasing interest in examining Latino students’ psychosocial experiences, most studies have focused on those attending four-year institutions, not community colleges. More than 65% of Latinos begin higher education in a community college, and their graduation and transfer rates are very low compared with other ethnic groups. This project increases our knowledge of how community colleges can better support Latino students’ academic goals. Furthermore, the results may lead to larger studies on the social determinants of academic success of the population.
By expanding the project and examining graduate level Latina/o students, this study will also contribute to further our knowledge about this underrepresented population. (Latina/o students comprise less than 5% of graduate students in the U.S.)
Methods
This study uses in-depth personal interviews to generate insights into the social and psychological experiences of Latino students, and the factors that influence their persistence toward achieving their education goals.
Results
In the beginning of 2009, I began to interview the master’s students for the new phase of the project. Individual interviews with the 12 students were tape recorded, and half of them have been transcribed by a research assistant. The narratives produced from the interviews are being analyzed to identify themes.
Conclusions
Now that the data collection is completed, I plan on finishing the data analysis of the 12 interviews I added to the study by the end of the summer of 2010. I hope to have a draft of a manuscript (focus on Latina/o graduate students) by the Winter of 2011.
Funding for this conference was made possible in part by P20MD001816 from the National Center on Minority Health and Health Disparities. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention by trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
