Background: India has the highest number of undernourished children worldwide. Understanding trends, predictors, and consequences of child undernutrition is important to inform strategy for addressing this public health crisis. Methods: We used data from four National Family Health Surveys (1992-93, 1998-99, 2005-6, 2015-16 NFHS) to examine trends of undernutrition before and after the 2005 implementation of the National Rural Health Mission, India’s flagship public health initiative (Aim 1). We used the 2016 NFHS to build a predictive model that identifies infants at-risk for child undernutrition (Aim 2). Lastly, we used data from the 2005 and 2012 India Human Development Surveys to investigate the consequences of early childhood undernutrition (Aim 3). Results: NRHM was more effective at addressing acute than chronic undernutrition but its prioritization on high focus states resulted in an increase of acute undernutrition among children living in normal focus states. We demonstrate that it is feasible to predict 5-year risk of child undernutrition at the time of birth. Child undernutrition is associated with adverse physical and cognitive outcomes during pre-adolescent years, with female undernourished children experiencing the worst outcomes. Higher female education in the household helps overcome gender and nutrition-based disadvantage among Indian children. Conclusion: There is an urgent need to reduce nutrition-related disparities among Indian children. Short-term strategy could include a predictive model that can be used to more effectively provide resources and intervention to the most disadvantaged population. Long term strategy should focus on elevating women’s status through improved female education in India.

Chronic diseases are a significant cause of illness and mortality in the United States. Hereditary predisposition to chronic diseases is a useful indicator for identifying people at risk for disease development. An ideal tool for determining this predisposition is the CDC, NIH, and AAFP recommended third-degree family health history (FHH). The aim of this quantitative, cross-sectional study, based on the theoretical frameworks of social constructivism and the health belief model, was to assess the possible influence between the completed third-degree FHH and the participant's perception of disease risk. Two-hundred seventy-three participants were recruited from health care facilities and from the general population using convenience sampling. Bivariate and multivariate tests were applied to analyze the obtained data. Binary regression indicated a statistically significant association between the presence of heart disease, stroke, breast cancer, ovarian/cervical cancer, prostate cancer, colon cancer, and diabetes, and the perception of risk for the particular disease as noted in the FHH. A familial history of stroke appeared to be the strongest predictor of perception of disease risk. Moreover, increasing age, particularly within the age range of 40 to 57, was associated with increasing levels of perception of disease risk for heart disease, stroke, and prostate cancer. Individuals from the general population significantly indicated higher-than-average risk for colon cancer compared to those from health care facilities. Social change implication of this study may be the widespread implementation of a familial health history questionnaire that leads to an impactful, higher degree of disease risk awareness, prompting preventive action on the part of the individual, and leading to improved individual and population health.

Hypertension is a major chronic health problem that can lead to heart attack, stroke, and kidney failure. African Americans disproportionately suffer from the morbidity and mortality of hypertension-related illnesses. The purpose of this comparative project was to determine the impact of peer support educational workshops as an avenue for lifestyle modification, using changes in blood pressure (BP) before and after participation. The target population consisted of 64 African Americans with hypertension in Brooklyn NY, aged 20 to 65 years old. BP measurements were taken within 1 month before and after participating in a weekly peer support educational workshop facilitated by designated healthcare providers. The health belief model, using the tenets of lifestyle modification, societal support and health education, was used to guide the study. Demographic data were collated and categorized, considering numeric values used to represent age, income level, and education. Normality testing of the study variables was performed to ensure that the data followed a normal distribution. The study variables included the pre- and post-test systolic and diastolic BP. A t test was used in order to compare the 2 groups, revealing a statistically lower significant score from African Americans who participated than those who did not. African Americans who adhered to peer support educational regimens in the workshops revealed a statistically significant lower diastolic BP than those who did not participate. This research contributes to social change by providing evidence-based recommendations that government and health care professionals may use to create strategic plans to promote the well-being of individuals and communities.

South Africa has one of the highest HIV prevalence rates globally, with nearly 2.5 million people accessing antiretroviral treatment (ART) at the end of 2013. Retaining patients on ART has become a major problem in this country. When patients no longer show up for ART for unknown reasons, they are considered lost to follow-up (LTF). LTF is the highest contributor to ART attrition. This study, guided by the health belief model, evaluated the effectiveness of a technology-based, mobile health (mHealth) appointment reminder intervention on LTF among patients accessing ART services. The study ascertained differences in 6- and 12-month LTF rates between patients enrolled in the mHealth intervention (n = 832) and those in the standard of care comparison group (n = 918). A quantitative, retrospective cohort approach was used to answer the research questions using binary logistic regression analyses. The mHealth intervention was found to be significantly linked to lower likelihood of 6- and/or 12-month LTF among patients. There were 2 other key findings: a positive correlation between pregnancy and LTF, and a positive correlation between viral load increases and LTF. This study added evidence to the existing literature on the effectiveness of using mHealth-based interventions to improve HIV/AIDS care. Based on these findings, professionals should pay special attention to pregnant women and those clients with increasing viral loads to ensure they are not LTF. Positive social change that may result from this study is better health outcomes for patients on ART due to reduced risk of HIV related complications and other illnesses. This awareness would improve the lives of the patients, and positively impact their families, communities, and ultimately the global community, by reducing the overall impact of HIV disease.

In this study, Naegleria fowleri, a pathogenic amoeba and the causative agent of Primary Amebic Meningoencephalitis (PAM), was utilized to determine the presence or absence of classically conserved Golgi molecules featured in the expression of a Golgi apparatus. Previous studies concluded no Golgi expression via light microscopy and transmission electron microscopy, but a recent report on Naegleria gruberi indicated the presence of dispersed Golgi tubules. Non-pathogenic species of the Naegleria genus such as Naegleria gruberi 30540 and Naegleria lovaniensis 30569 were utilized in Western immunoblot analysis compared to reduced whole-cell lysate proteins of two strains of N. fowleri and Vero CCL-81, Chlorocebus sp. kidney epithelial cells, which were utilized as a positive control for Golgi expression. N. fowleri and N. lovaniensis whole-cell lysates had indications of a 110 kDa reduced protein, associated with the predicted molecular weights of the beta-COPI subunit of the COPI cis-Golgi vesicular transport complex with further Western immunoblot indication of a weak band around 25 kDa corresponding to rabbit polyclonal antibodies specific for ARF1. Serial Dilutions of Wheat Germ Agglutinin Alexa Fluor 488TM were performed on Vero cells, Naegleria fowleri 30894, and N. gruberi 30540 with 1:100 dilution of recommended stock dilution of WGA 488 determined for utilization in sequential immunofluorescence. Sequential immunofluorescence with Wheat Germ Agglutinin Alexa Fluor 488TM and then blocked with 3% BSA:PBS [wt/vol] dilution with subsequent incubation in rabbit anti-beta-COPI primary 1:250, and 1:1000 of Alexa Fluor 594 goat anti-rabbit secondary antibody exposure showed strong indications of organized cis- and trans-punctate Golgi body markers in close association in individual and dividing cells of Naegleria fowleri and conserved Golgi expression in the positive control Vero cells, but further experiments are necessary to verify this finding with N. fowleri.

Acute and chronic pain is a common hallmark of sickle cell disease (SCD) in children and adolescents, which can have a profound effect on their quality of life (QOL). However, this relationship is not well quantified. The purpose of this quantitative study was to examine the relationship between SCD pain burden and QOL among Black children ages 8-17 in Mississippi with SCD. The secondary aim was to compare children and caregiver reports of SCD pain burden and QOL with SCD. The social ecological model was used to identify personal factors that influence SCD pain burden and QOL of children with SCD. Eighty-five children and caregiver pairs completed paper surveys on demographics, pain burden, and QOL. Hierarchical linear regression results indicated that increased child SCD pain burden was statistically associated with decreased child's QOL (P

Choice of nutrition has a great effect on the early development of human growth. Despite increased knowledge on the benefit of breastfeeding to both mother and child, some mothers still choose to formula feed. The purpose of this study is to explain how maternal health contributes to choices. The theory of maternal role attainment and the social cognitive theory are used to evaluate these feeding choices. This study tests for the association between maternal weight status and choice of infant feeding practices, the association between postpartum depression and choice of feeding and finally, if depression mediates the relationship between maternal weight gain and infant feeding choices. This retrospective cohort study employed a quantitative approach, utilizing secondary data with a sample size of 4902, retrieved from Infant Feeding Practices Study II. The data contained information on pregnant women in their third trimester until the first year of infants' life. Logistic regression was employed to answer these research questions. The result indicated that compared to those who are obese, mothers with normal weight are 29.6% more likely to breastfeed. Depressed mothers are 45.9% less likely to breastfeed. There is no possible mediation effect identified in this study. Further studies may need to collect mother's depression status prior to conception. Based on the outcome of this study, there is a need for caregivers to identify at-risk mothers prior to delivery while offering solutions that contribute to better feeding choices. For social change, mothers who are overweight or those experiencing depression prior to conception will make better feeding choices if they receive adequate support and counseling on the implication of their health condition on their infants.

An estimated 215,000 children and adolescents younger than 20 years old were diagnosed with Type 1 or Type 2 diabetes in 2011. Management of children with Type 2 diabetes requires 24-hour care provided by health care providers, parents, and school nurses. Guided by the health belief model (HBM), the purpose of this qualitative case study was to explore and describe beliefs, attitudes, and practices of school nurses who manage children with Type 2 diabetes. A pilot study with 2 nurses was conducted to finalize interview guide. Volunteer school nurses were recruited through an e-mail announcement from their school district. Face-to-face, in-depth interviews with 10 female school nurses were conducted. School nurse work experience ranged from 4 to 20 years, selected from 4 school districts, including 8 European, 1 Asian, and 1 Hispanic American. Transcripts from digitally recorded interviews were analyzed using NVivo software version 11. Thematic analysis led to 5 themes of communication, education, management, perceived barriers (multiple schools assigned/student demand), and enablers (school aides). Individually and collectively, themes reflect a synergistic positive attitude in management of children with Type 2 diabetes. HBM constructs elucidated school nurses' behaviors and attitudes regarding severity and susceptibility to illness, benefits students received from preventive care, and barriers they encountered. The positive implications for social change include recommendations for increasing the number of school nurses per district to meet the demand in managing children with chronic diseases, and intensification of positive attitude interventions in diabetes management.

Our modern health care system requires technology that can deal with multidisciplinary and complex processes, operations, and situations. The EHR, by far, is one of the greatest health information technology innovations that satisfy these requirements because of its efficiency and the effectiveness of its features. This study sought to develop an in-depth understanding of how underserved patients' perspectives about their health and illness, can contribute to greater use of the EHR. It also sought to improve their health outcomes and maintain sustainable change in the lives of the underserved. A quantitative non-experimental design study was conducted over a 6-week period outside of three different internal medicine clinics, one in the Northwestern and the two others in the Southeastern regions of Washington, DC. Surveys were distributed directly to patients coming out of these health clinics, and participants sent their responses via mail. Data collection included 215 surveys out of 560, but, only 155 fit the overall study categories. A strong level of significance in the relationships between clinical outcome measures and the EHR was identified at a 95% confidence interval. There were considerable health determinants that demonstrated the essence of patients' perspectives and the need for its incorporation into health outcomes measures for the underserved populations. The study also identified sets of environmental health predictors which acted as facilitators and contributors to a holistic health management model designed to contribute to the needs of the underserved communities. The holistic health model and the individual care plan model derived from the study are applicable at the level of the underserved population. It can help achieve sustainable health outcomes that will save lives and promote better health.

Despite the evidence that colorectal cancer screening is effective in reducing the incidence of and mortality from colorectal cancer, racial and ethnic disparities in colorectal cancer screening persist in the United States. African-born immigrants in the United States have lower colorectal cancer screening rates than native-born Americans. The purpose of this quantitative, retrospective, cross-sectional study was to examine how family income, health insurance status, language of interview, length of stay in the United States, perceived health status, level of education, and having a usual place for medical care affect colorectal cancer screening among African-born immigrants in the United States. The immigrant health services utilization model provided the framework for the study. Secondary data collected in 2010, 2013, and 2015 through the National Health Interview Survey from 349 African-born immigrants age 40 years and above were analyzed using logistic regression and a chi-square test of independence. A stratified multistage sampling procedure was used to select the sample for the study. Results showed a significant association between colorectal cancer screening and health insurance status, length of stay in the United States, perceived health status, and having a usual place for medical care. However, no association was found between colorectal cancer screening and family income, education level, and interview language. Findings may be used to impact positive social change and guide policy decisions on colorectal cancer preventive interventions targeting African-born immigrants living in the United States.