University of Houston System

This study investigates the evolving intersection of social vulnerability, climate exposure, and mental health distress in Harris County, Texas, from 2014 to 2022, with projections through 2030. Using census tract-level data and integrating indicators from the CDC Social Vulnerability Index, climate exposure metrics, and mental health outcomes, we developed predictive models to forecast future trends. Results indicate a significant rise in overall social vulnerability—from a score of 8.16 in 2022 to 8.87 by 2030, driven by increasing poverty, extreme heat, flooding, and deteriorating mental health. Mental health distress is projected to escalate from 18.7.0% to 22.7% of the population, underscoring a growing public health burden. The study highlights the compounding risks faced by underserved communities and emphasizes the need for targeted planning, mental health workforce expansion, and adaptive infrastructure strategies. These findings offer critical insights for policymakers and public health officials aiming to mitigate future climate-related health disparities.

IntroductionReports indicate increasing prevalence rates of successive natural disasters, and the negative impact on existing infrastructures are well documented. However, factors impacting outcomes on both communities and individuals remain unclear. For historically underserved communities, the effects of disasters are exacerbated by pre-existing barriers that make efforts to recovery difficult. Thus, understanding the nuance of their circumstances and experience is crucial to helping build resilience in these communities and inform preparedness and response efforts.ObjectiveThrough this study, we sought to qualitatively understand the lived experience of historically underserved communities in the context of natural disasters to support the development and/or adoption of resources.MethodsPhotovoice was used to guide semi-structured interviews with participants recruited from three communities (Kashmere Gardens, Greater Third Ward, Greater Fifth Ward) in Houston, TX. Reflexive thematic analysis was employed to generate themes accurately depicting participant experiences. Reflexivity, persistent observation, and triangulation were employed to increase trustworthiness in analysis.ResultsFive key themes emerged from analysis: 1) Acute and long-term damage from natural disasters requires sustained recovery efforts; 2) Gaps and opportunities exist in city, state, and federal support mechanisms; 3) Strengthening and expanding support networks and community resources after extreme weather events is critical; 4) Need to address structural barriers to disaster preparedness and coping; and 5) Recognizing and mitigating the broad mental health impacts of natural disasters.ConclusionThe lived experiences of individuals from historically underserved communities in Houston highlight a complex interaction of psychosocial, structural, and cultural factors that influence both community resilience and vulnerability. Understanding this interplay is crucial to informing policy efforts that prioritize resilience building in these communities. Implications from these findings are discussed.

IntroductionTraditional medical education emphasizes biomedical sciences but often underprepares learners for the challenges of working with medically underserved and excluded populations. An Inclusion Health elective was developed to integrate training in the social determinants of health and the skills necessary to provide high-quality care in low-resource environments.Pedagogical frameworksThe course draws on five complementary frameworks: service learning, problem-based learning, case-based learning, cultural humility, and experiential learning, to deepen students’ understanding of exclusion in health care and to equip them with both clinical and relational skills. Together, these frameworks collectively foster critical reflection, adaptability, and a systems-level perspective.Learning environmentThe elective combines classroom seminars, community-based clinical experiences, and applied learning assignments. Students work alongside outreach teams, healthcare for the homeless clinics, and social service organizations, developing practical skills in environments with limited referral networks and constrained resources.AssessmentEvaluation includes reflective writing, clinical supervision evaluations, faculty and community partner feedback, and concludes with a standardized patient assessment and reflection session, measuring cognitive and affective learning outcomes.DiscussionThe program demonstrates how integrating theory-driven pedagogy with immersive, community-engaged learning can address critical educational gaps, preparing future clinicians to navigate and challenge structural inequities.Acknowledgment of constraintsImplementation faced challenges, including scheduling within the medical curriculum, sustaining community partnerships, and evaluating long-term impacts on student practice patterns.

Green Management Information Systems (Green MIS) have emerged as a transformative solution to integrate sustainability into modern business practices. This study systematically reviews the role of Green MIS in addressing environmental challenges, emphasizing its alignment with global objectives such as the United Nations’ Sustainable Development Goals (SDGs). The research highlights the integration of advanced technologies, including artificial intelligence (AI), blockchain, and the Internet of Things (IoT), which enhance the effectiveness of Green MIS by enabling real-time analytics, transparency, and resource optimization. While Green MIS offers significant environmental and economic benefits, such as reduced carbon footprints and cost savings, its implementation faces barriers, including high initial costs and technical challenges. Addressing these challenges through financial incentives, standardized metrics, and collaborative efforts is essential for unlocking the full potential of Green MIS. The findings underscore the importance of Green MIS as a strategic tool for businesses to achieve operational efficiency and ecological responsibility.

Background: Health-harming legal needs (HHLNs) significantly contribute to stress and have been linked to chronic disease burden in low-income populations. Medical-legal partnerships (MLPs) target HHLNs by embedding legal services within clinics. The impact of HHLNs on chronic disease, quality of life, and utilization is uncertain. This study sought to determine whether presence of and the number of HHLNs is associated with high blood pressure, worse quality of life, and higher healthcare utilization rates. Method: This is a cross-sectional study of a MLP program involving a federally qualified health center and non-profit legal services organization. The evaluation included all individuals, 18 years old and above, who received care at the clinic and were screened for HHLNs. All patients were offered HHLN screening (23-items) between March 2021 and December 2022. Blood pressure status was measured by two approaches: 1) the presence of hypertension diagnostic codes or anti-hypertensive medication, 2) the most recent mean arterial pressure (MAP). Quality of life was assessed using the number of unhealthy physical or mental days in a month. Participants reported the number of urgent care, emergency department (ED), and hospital visits over the prior 12 months. Using an available case analysis approach and logistic regression, we assessed the association between the total number and individual HHLNs and the presence of hypertension diagnoses or medications. For MAP, unhealthy days, and utilization, we used linear and negative binomial regression models. Results: Four hundred seventy-five participants completed surveys. Nearly half (198; 41.7%) reported at least one HHLN. There were no differences in HHLN reported across demographic groups. The number of HHLNs was associated with having a diagnosis of or medication for hypertension (OR=1.08, p=0.049) but was not associated with MAP (coeff=0.098, p=0.596). The number of HHLNs was similarly associated with more unhealthy physical (coeff=0.150, p=0.015) and mental days (coeff=0.157, p=0.002). More HHLNs were also associated with higher urgent care (coeff=0.252, p<0.001) and ED utilization (coeff=0.181, p=0.014) but not hospitalizations (coeff=0.099, p=0.150). Hypertension was found to be associated with individual HHLN: income issues, losing health insurance, immigration applications, food insecurity and housing instability (all p<0.05) over other needs. Several more HHLNs were associated with physical and mentally healthy days in past month (all p<0.05). Multiple relationships persisted after controlling for demographics. Conclusions: The number of HHLNs and several specific legal needs are associated with hypertension, higher unhealthy physical and mental days, and higher urgent care and emergency department utilization. In future studies, we will study the longitudinal outcomes of HHLNs that are addressed by the MLP.

The Diabetes Distress Scale-17 (DDS-17) is a common measure of diabetes distress. Despite its popularity, there are no agreed-on minimal clinically important difference (MCID) values for the DDS-17. To establish a distribution-based metric for MCID in the DDS-17 and its 4 subscale scores (interpersonal distress, physician distress, regimen distress, and emotional distress). This secondary analysis of a randomized clinical trial used baseline and postintervention data from a hybrid (implementation-effectiveness) trial evaluating Empowering Patients in Chronic Care (EPICC) vs an enhanced form of usual care (EUC). Participants included adults with uncontrolled type 2 diabetes (glycated hemoglobin A1c [HbA1c] level >8.0%) who received primary care during the prior year in participating Department of Veterans Affairs clinics across Illinois, Indiana, and Texas. Data collection was completed in November 2018, and data analysis was completed in June 2023. Participants in EPICC attended 6 group sessions led by health care professionals based on collaborative goal-setting theory. EUC included diabetes education. The main outcome was distribution-based MCID values for the total DDS-17 and 4 DDS-17 subscales, calculated using the standard error of measurement. Baseline to postintervention changes in DDS-17 and its 4 subscale scores were grouped into 3 categories: improved, no change, and worsened. Multilevel logistic and linear regression models examined associations between treatment group and MCID change categories and whether improvement in HbA1c varied in association with MCID category. A total of 248 individuals with complete DDS-17 data were included (mean [SD] age, 67.4 [8.3] years; 235 [94.76%] men), with 123 participants in the EPICC group and 125 participants in the EUC group. The MCID value for DDS-17 was 0.25 and MCID values for the 4 distress subscales were 0.38 for emotional and interpersonal distress and 0.39 for physician and regimen distress. Compared with EUC, more EPICC participants were in the MCID improvement category on DDS-17 (63 participants [51.22%] vs 40 participants [32.00%]; P = .003) and fewer EPICC participants were in the worsened category (20 participants [16.26%] vs 39 participants [31.20%]; P = .008). There was no direct association of DDS-17 MCID improvement (β = -0.25; 95% CI, -0.59 to 0.10; P = .17) or worsening (β = 0.18; 95% CI, -0.22 to 0.59; P = .38) with HbA1c levels among all participants. In this secondary analysis of data from a randomized clinical trial, an MCID improvement or worsening of more than 0.25 on the DDS-17 was quantitatively significant and patients in the EPICC group were more likely to experience improvement than those in the EUC group. ClinicalTrials.gov Identifier: NCT01876485.

Background: Kidney ischemia reperfusion injury (IR) is the common pathophysiology of acute kidney injury (AKI) associated with immune cell infiltration including T cells. Male kidney is more susceptible to AKI than females. Recently, we have shown that IR causes infiltration of CD45+T cells in male rats and AT2R activation reduced renal CD45+ T cells infiltration and modulated CD4+T cells into anti-inflammatory Tregs ameliorating AKI. Infiltration of these cells in females and the mechanism of AT2Rmediated modulation of CD4T cells into Tregs are unknown. Methods: Bilateral IR was performed on female SD rats for 30 mins. The rats were divided into 3 groups: sham, IR, and IR+C21 (AT2R agonist, i.p. 0.3 mg/kg b.wt). After 3 days kidney cells were isolated and analyzed with flow cytometry for investigating CD45+, CD3+, CD4+, and FoxP3+ Treg cells. Also B6 mouse splenic CD4+T cells were isolated using magnetically labelled anti-CD4, which were activated with anti-CD3/anti-CD28/IL2/ TGFβ and treated with C21 alone or in the presence of AT2R antagonist PD123319, NO synthase inhibitor LNAME, PP2A inhibitor okadaic acid. Results: The female rats showed CD45+, CD3+ and CD4+ T cells infiltration 3days after IR. However, the renal accumulation of CD45 and Tregs is lower in female (<1% of total kidney cells) compared to 3 days IR data in male (7%) rats- suggesting a sex difference. C21 administration reduced the CD45+ T cells infiltration, and increased CD4+FoxP3+ regulatory T cells population and reduced kidney injury as evident by reduced plasma creatinine. However, BUN and proteinuria analysis did not suggest any significant changes with AT2R activation at 3 day post-IR. The ex-vivo splenic CD4+T cells revealed that C21 treatment modulated the CD4+T cells into CD4+Treg cells as determined by 2- fold increase in transcription factor FoxP3 expression. AT2R antagonist PD123319 reduced 2- fold, suggesting the involvement of AT2R. The PP2A inhibitor okadaic acid remarkably attenuated C21-induced FoxP3 increase indicating while the NO synthase inhibitor L-NAME caused only a moderate reduction in C21-induced FoxP3 expression. Conclusions: IR causes a lower immune cell infiltration in females than males and the AT2R-mediated protection and Treg modulation occurs via PP2A pathway. Funding: Other NIH Support - NIH R01DK117495 and NIHR01DK061578 support

Urban adaptation to climate change is a global challenge requiring a broad response that can be informed by how urban societies in the past responded to environmental shocks. Yet, interdisciplinary efforts to leverage insights from the urban past have been stymied by disciplinary silos and entrenched misconceptions regarding the nature and diversity of premodern human settlements and institutions, especially in the case of prehispanic Mesoamerica. Long recognized as a distinct cultural region, prehispanic Mesoamerica was the setting for one of the world’s original urbanization episodes despite the impediments to communication and resource extraction due to the lack of beasts of burden and wheeled transport, and the limited and relatively late use of metal implements. Our knowledge of prehispanic urbanism in Mesoamerica has been significantly enhanced over the past two decades due to significant advances in excavating, analyzing, and contextualizing archaeological materials. We now understand that Mesoamerican urbanism was as much a story about resilience and adaptation to environmental change as it was about collapse. Here we call for a dialogue among Mesoamerican urban archaeologists, sustainability scientists, and researchers interested in urban adaptation to climate change through a synthetic perspective on the organizational diversity of urbanism. Such a dialogue, seeking insights into what facilitates and hinders urban adaptation to environmental change, can be animated by shifting the long-held emphasis on failure and collapse to a more empirically grounded account of resilience and the factors that fostered adaptation and sustainability.

Food allergy prevalence is increasing among children; however, it is not clear how children's food allergy status impacts family mealtimes. This study's purpose was to systematically synthesize research regarding the relationship between children's food allergies, parental meal-centered stress, and family mealtime dynamics. Data sources for this study include peer-reviewed, English language sources from CINAHL, MEDLINE, APA PsycInfo, Web of Science, and Google Scholar. Five keyword categories (child, food allergies, meal preparation, stress, and family) were utilized to identify sources regarding how food allergies of children (from birth-12years) relate to family mealtime dynamics or parental meal-centered stress. All 13 identified studies determined that pediatric food allergies relate to either increased parental stress, meal preparation issues, mealtime problems, or changes to family meals. Studies also indicate that meal preparation takes longer, requires more vigilance, and is more stressful due to children's food allergies. Limitations include that most studies were cross-sectional and based on maternal self-report. Children's food allergies are associated with parental meal-centered stress and mealtime issues. However, there is a need for research to account for specific changes to family mealtime dynamics and parent feeding behaviors so that pediatric health care professionals can alleviate parental meal-centered stress and provide guidance towards optimal feeding behaviors.