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Item Examining rurality and social determinants of health among women with GDM: a 15-year comprehensive population analysis(Springer Nature, 2024-08-24) Ali, Umama; Cure, Laila; Lewis, Rhonda K.; Rattani, Ajita; Hill, Twyla J.; Woods, Nikki KeeneBackground: Gestational diabetes mellitus (GDM) is a common pregnancy complication with long-term health consequences for mothers and their children. The escalating trends of GDM coupled with the growing prevalence of maternal obesity, a significant GDM risk factor projected to approach nearly 60% by 2030 in Kansas, has emerged as a pressing public health issue. Methods: The aim of this study was to compare GDM and maternal obesity trends in rural and urban areas and investigate maternal demographic characteristics influencing the risk of GDM development over a 15-year period. Trend analyses and a binary logistic regression were employed utilizing 2005 to 2019 de-identified birth record vital statistics from the Kansas Department of Health and Environment (N = 589,605). Results: Over the cumulative 15-year period, a higher prevalence of GDM was observed across age, race/ethnicity, education, and insurance source. Throughout this period, there was an increasing trend in both GDM and obese pre-pregnancy BMI age-adjusted prevalence, with noticeable rural-urban disparities. From 2005 to 2019, women, including Asians (OR: 2.73, 95% CI 2.58%-2.88%), American Indian or Alaskan Natives (OR: 1.58, 95%, CI 1.44-1.73%), Hispanics (OR: 1.42, 95% CI 1.37%-1.48%), women residing in rural areas (OR: 1.09, 95%, CI 1.06-1.12%), with advanced maternal age (35-39 years, OR: 4.83 95% CI 4.47%-5.22%; ?40 years, OR: 6.36 95%, CI 5.80-6.98%), with lower educational status (less than high school, OR: 1.15, 95% CI 1.10%-1.20%; high school graduate, OR: 1.10, 95% CI 1.06%-1.13%), Medicaid users (OR: 1.10, 95% CI 1.06%-1.13%), or with an overweight (OR: 1.78, 95% CI 1.72%-1.84%) or obese (OR: 3.61, 95% CI 3.50%-3.72%) pre-pregnancy BMI were found to be at an increased risk of developing GDM. Conclusions: There are persistent rural-urban and racial/ethnic disparities present from 2005 to 2019 among pregnant women in Kansas with or at-risk of GDM. There are several socioeconomic factors that contribute to these health disparities affecting GDM development. These findings, alongside with prominent rising maternal obesity trends, highlight the need to expand GDM services in a predominantly rural state, and implement culturally-responsive interventions for at-risk women. © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2024.Item Culture Change in Older Adult Care Settings: A Bibliometric Review(Gerontological Society of America, 2024) Ivanitskaya, Lana V.; Bogner, Matthew P.Background and Objectives: We systematically analyzed research on the culture change movement, in the context of global efforts to transform the provision of older adult care in institutional settings. Research Design and Methods: Using Web of Science and Scopus publications relevant to person-centered care, culture change, or older adult care settings, we built bibliometric networks for keywords and terms extracted from titles and abstracts. Overlays depicted corresponding authors' countries, publication recency, funding, scientific impact, and concept use. Results: The keyword network for 337 publications revealed variability in culture change settings and study indexing. Term network overlays showed geographical and chronological research variation. Corresponding authors from 14 countries contributed publications, mostly from the United States (69% of publications), Canada (9%), and Australia (5%). Social environment and person-centeredness studies, particularly in dementia care settings, were more recent than studies on physical environment, quality, organizational culture, turnover, and staffing. Scholars listed funding sources for 38% of publications; funding and scientific impact did not always overlap. Well-cited studies on standards of care and policy were funded at a lower rate than topics of lower impact. Over 60% of titles, abstracts, or keywords referred to quality and person-centeredness. Discussion and Implications: Originating in the 1990s in the United States, culture change quickly became an international phenomenon, drawing researchers' attention. Change research has deep roots in quality improvement and person-centered philosophy. We offered practical strategies for querying this hard to access literature. With some database-related limitations, empirical data on scientific impact can be used to allocate research funding. © 2023 The Author(s). Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.Item Evaluation and comparison of aging education for undergraduates across multiple fields of study(Routledge, 2024) Hawley, Suzanne R.; St.Romain, Theresa; Rogers, Nicole L.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. © 2024 Taylor & Francis Group, LLC.Item Health literacy, health outcomes and equity: A trend analysis based on a population survey(SAGE Publications, 2023-01-23) Keene Woods, Nikki; Ali, Umama; Medina, Melissa; Reyes, Jared; Chesser, Amy K.Health literacy continues to be an issue among minority groups. Population surveys are one strategy used to help better understand health disparities. The Behavioral Risk Factor Surveillance System (BRFSS) in Kansas added health literacy questions to the survey in 2012. This study examined population health literacy levels and health trends from 2012 to 2018. The health status variables included health care coverage status, general health rating, presence of chronic conditions, and length of time since the last check-up. The percentage of individuals reporting low health literacy decreased from 67% in 2012 to 51% in 2018. The percentage of participants with income levels less than 15,000 dollars was 9% in 2012 and 7% in 2018. Health literacy was lowest among the age group 18 to 24-year-olds, those who identified as multiracial, separated, not graduated from high school, out of work for more than 1 year, income less than 10,000 dollars with other living arrangements, and living in a suburban county of metropolitan statistical area. Additionally, many health conditions improved, and those reporting health insurance increased slightly. The study demonstrates how health literacy continues to be an issue, and how education and primary prevention are necessary to improve limited health literacy and health outcomes. Findings from both state-level and national BRFSS population surveys can help educate the public health and clinical health services workforce to provide better care and address health disparities for high risk populations.Item Creating a vision for a healthier workforce using a systems-based approach(Wolters KLuwer, 2022-03-01) Walkner, Laurie; May, Kathleen; Goldman, Bailey; Shultz, Hannah; Armbruster, Sonja; Grimm, Brandon; Hawley, Suzanne R.; Menke, Abigail; Orr, Shirley; Wilson, Kristin; Moody, Jeneane; Uden-Holman, Tanya; Ginn, KaciContext: 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.