COMMUNITY HEALTH PAPER ON MY NEIGHBORHOOD

Ozone park is a neighborhood found in the 1840s and is located in the southwestern section of the borough of Queens. The northern border is Atlantic Ave, the southern border is South Conduit Ave, the western border Brooklyn/Queens borderline and the eastern border is up to 108^th and Aqueduct Racetrack. The name “Ozone Park” was chosen for the development to “lure buyers with the idea of refreshing breezes blowing in from the Atlantic Ocean to a park-like community. I have lived in this community for approximately 10 years of my life and noticed that it is a continuously growing community. In the past decade, the neighborhood has seen a tremendous transformation, with new developments and an increasingly diverse population (Lasky 2018).

The population of this community as of 2015 was calculated to be 124,511 and it is considered to be a suburban area. The population of male was reported to be 26,880, women to be 27,889. These numbers increased 4.9% since 2000 and 1.5% since 2010. This community is continuously growing in a rapid rate and is an upcoming “Harlem of Brooklyn.” The racial composition is broken down to be 26% White, 24% Asian, 23% Hispanic, 21% Black and 6% other. The population by age was broken down into groups which are the following: 22% are 0-17 year of age, 10% ages 18-24, 56% 25-64, and 13% 65 ages and over. As far as marital status in Ozone Park, 16,067 reported to fall under the category as married, 13,886 never married, 3,001 separated, 2,197 divorced, and 647 widowed.

Higher education are said to be associate with better health outcomes. Forty-five percent of the population in Ozone Park have reported to be foreign born and twelve percent were reported to have limited English proficiency. “In South Ozone Park and Howard Beach, most adults have either completed high school or some college, or have college degrees; however, one in five adults has not completed high school” (Community Health Profiles 2015). In Ozone Park and Howard Beach, the statistic for of college graduates was only 29%. In comparison to the Financial District, where college graduation rate is 84%. In Queens overall, the college graduation rate was calculated to be 38% in comparison to New York City as a whole which was similar, 41%. The percentage of high school graduate and some college in Ozone and Park and Howard Beach was 51%. This percentage was imperatively high compared to areas such as Financial District (12%), Queens (42%) and New York City (39%). The percentage of those who completed less than high school was 21%, compared to those in the Financial District which was immensely low; only reaching 4%, and Queens and New York City both reporting 20%. I find these results to be appalling because there are actually numerous high schools in the area of Queens and transportation is not an issue for Ozone Park due to the availability of public transportation. We have two bus lines in the area, the Q7 and the Q8 which lead to the front of multiple different high schools. The duration of the trip would be approximately 20-30 mins. As for college, there aren’t any college in Ozone Park however, it is easy to get around by train to different boroughs, whether it be Manhattan, Brooklyn or the Bronx. The A train line is located in Ozone Park. The A line is one of the rare lines that runs through Queens, into Brooklyn and then many parts of Manhattan. It also allows its passengers to get around to other train lines because many of the stops have transfers available. For example, the A train goes to Broadway Junction in Brooklyn and allows passengers to transfer to the C, L, J and Z train. Therefore, I find it difficult to understand why the percentage of college and high school graduates were so low compared to other areas in New York City. Colleges such a City Tech is one train ride away from Ozone Park and takes no more than 30 mins to get there. Kingsborough is located in Brooklyn however, from Ozone Park it is only about 20-25 mins away when driving there on the Belt Parkway which is right next to Crossbay Blvd. Furthermore, Hunter College can be reached in about one hour and ten minutes by 3 trains. I attended college in the Bronx for two years and traveled 1 hour and 30 minutes going and coming 5 days a week when I was obtaining my Associates.

When it comes to occupation and income, Ozone Park by observation is doing well. There are many residential houses and the prices for the property have gone up over the decades. The prices that the houses are going for are anywhere between $800,00 to $1.2 million. However, statistically, the population consists of 3,353 individuals who fall under the category White Collar and 1,842 as Blue Collar. White collar is defined as work that may be performed in an office or other administrative setting. Blue collar is defined as jobs that require manual labor. A lot of individuals in Ozone Park have not obtained a college degree and many were foreign born as mentioned above. Therefore, I have noticed that many of the men work as Uber drivers or manual labor jobs such as butchers. The average total household income was reported to be $69,637 and the median income being $55,046. When broken down, the median income for those under the age of 25 was found to be $45,786, those who are 25-44 median income was $49,946, ages 45-64 was $64,573 and ages over 65 was $53,529 (Point2Homes).

One in eight South Ozone Park residents lives below the federal poverty level. Living in poverty limits healthy lifestyle choices and makes it difficult to access health care and resources that can promote health and prevent illness. Unemployment and unaffordable housing are also closely associated with poverty and poor health. About one in eight South Ozone Park and Howard Beach adults ages 16 and older is unemployed, and 59% of residents spend more than 30% of their monthly gross income on rent (Community Health Profiles 2015). South Ozone Park and Howard Beach rank 44^th for poverty, 22^nd for Unemployment and 10^th for rent burden when it comes to economic distress. Being ranked 44 for the poverty level in percentage equates to 13%.

With my observation, individuals in this community have been growing continuously at a high rate. People are moving from Brooklyn and other parts of Queens such as Richmond Hill and Lefferts Blvd. It is hard to find houses, even apartments to rent because once people settle, they do not have the desire to leave the community. Since I have been living in Ozone Park, the amount of local grocery stores has increased tremendously. The local grocery stores that have opened up are focused on the culture and group of people are who predominately live in the neighborhood which is Bengali. Numerous number of Bengali individuals have moved to Ozone Park with their families and there are constantly more and more coming in. Homes in this neighborhood are very high in demand however, they are unavailable because no one is selling their homes. The individuals in the community work hard even though not all have a career job, the men work day and night driving Uber, working in restaurants and make a good living for their kids to go to school as well as be able to purchase a home in the neighborhood. Homes in the neighborhood have been going for approximately $800-$1.3 million.

Child and adolescent health are a signal of a community’s current well-being and potential (Community Health Profile 2015). The percent of all live preterm birth for Ozone Park was reported to be 10.3 compared to NYC which was 9.0. The percent of teen births per 1,000 girls aged 15-19 in Ozone Park was calculated to be 17.3 compared to the percent in NYC which was 23.6. The incarceration rate in Ozone Park is lower than the citywide rate. In NYC, the incarceration rate was 93 per 100,00 adults who were 16 years and older. For Ozone Park, the number found was 70 per 100,000 adults, ages 16 years and older. The injury assault rate is also lower than the citywide rate. In Ozone Park, the number found was 41 per 100,00 population and for NYC, it was 64 per 100,000 population. The prevalence of tobacco retailers in South Ozone Park and Howard Beach is similar to the citywide prevalence. In Ozone Park alone, there are 9 tobacco retailers per 10,000 population compared to NYC, which was 11 per 10,000 population. The air pollution in Ozone Park consist of one of the most harmful air pollutant PM2.5 which was measured to be 8.0 micrograms of the fine particulate matter per cubic meter. My neighborhood was reported to have less maintenance defect compared to NYC as a whole. In Ozone Park, the number found was 45% and for NYC the number was 59%.

When it comes to high blood pressure, diabetes and other health problems, there are many risk factors that play a role. For example, smoking, diet and exercise. In Ozone Park, 12% of the population are reported to be smokers however, from my observation, that number has increased. The percentage of the population that consume 1 or more 12 ounces sugary drinks was 26% which was almost equivalent to NYC itself which was 27%. 86% of the population reported to consume at least 1 fruit or vegetable per day. Lastly 73% of the population showed to have some sort of physical activity within the last 30 days. Obesity, high blood pressure, diabetes and high cholesterol are the main health problems in this neighborhood. Twenty-seven percent of the adults in Ozone Park and Howard Beach are considered obese. Obesity can lead to many other illnesses and be an underlying cause that people are unaware of. Fifteen percent of Ozone Park and Howard Beach population are considered to have diabetes. Exercise is one way to maintain a healthy weight. Federal guidelines say that children should get 60 minutes of exercise per day, adults should get 150 minutes per week, and older adults should get 150 minutes per week as their physical abilities allow, with a focus on exercises to improve balance (Community Health Profile 2015). Nineteen percent of the adult population do not even have any healthcare. Furthermore, many individuals are unaware of the pros of vaccinations therefore, they refuse them. The percentage of those who received vaccines such as HPV, Flu or ever tested for HIV were all lower than NYC. Only 29% of the female population within the age range of 7-14 received the HPV vaccine which can reduce the risk for cervical cancer. Only 37% of the population received the flu vaccine. Three hundred thirty-six individuals per 100,00 were hospitalized due to stroke and 385 were hospitalized due to mental illness.

The leading cause of death for Ozone Park like any other neighborhood is heart disease. Heart disease can be prevented in many ways if people were well educated and proper screening was done by individual’s primary care physicians. From my personal observation, I noticed that many individuals in my neighborhood smoke, chew tobacco, suffer from diabetes, hypertension, and high cholesterol (the triad). Therefore, I would create pamphlets educating the population on the prognosis mentioned. I would have the pamphlets in English, Bengali, Spanish and Chinese.

I noticed that the clinics in the neighborhood are very small and poorly managed. The staff who are supposed to be medical assistants are replaced by women who just know how to take height and weight, learned how to take blood pressure and learned to draw blood. However, they do not have the credentials to do so. The doctors who work at the clinic, work at a hospital and then come to these clinics after hours to “serve the community.” However, the treatment that the doctors give are very poor and basic. They do not go deep into treating patients, they do not educate their patients nor do they promote prevention.

PAPER ON DOWN SYNDROME

Introduction/Background

Have you ever noticed the many different individuals you see or encounter whether you’re on a simple train ride or at work? It is interesting how distinct features make up how one individual looks. For example, a narrow nose versus a wider nose, small eyes versus round eyes, small lips versus fuller lips, etc. It amazes me how the combination of all these distinct features gives every single individual on Earth their own physical identity. With the exception of identical twins, no two people look exactly alike; physical feature is one aspect that defines a human being from one another. Unfortunately, there are many disease or illnesses that can affect not only one’s mental status but also physical appearance. For example, Down Syndrome, which is a genetic disorder that affects a person intellectually, developmentally and physically (National Down Syndrome Society 2107). Every human being is made up of thousands of cells and each of these cells contain a nucleus. Typically, each nucleus contains 23 pairs of chromosomes, half of which is inherited from each parent (NDSS 2017). However, for someone who has down syndrome, they have a full or partial extra copy of chromosome 21 (NDSS 2017). An individual with Down Syndrome presents with profound physical features that distinguishes them from others and can be well noticed by health care clinicians of the illness. Their eyes tend to slant more upwards, are almond shaped, and have epicanthal folds (Stumbo). Epicanthal folds are small folds of skin at the inner corners of the eye (Stumbo). The outer parts of the iris may have light spots which are known as brushfield spots (Stumbo). The bridge of the nose is smaller than usual, giving the appearance of a slightly broader nose (Stumbo). These individuals tend to have a “flatter” profile because of their nose and their forehead which appears to be flat. The ears set slightly lower on the head (Stumbo). Moving down to the mouth, individuals who have Down Syndrome have low muscle tone, therefore the muscles in their mouth and tongue tend to be weak which causes a frowned (upside down smile) appearance (Stumbo). Their teeth may grow late and in an unusual order.

Pathophysiology

            The exact cause of down syndrome is yet to be determined however theories say that maternal age can play a big role in the chances of having a baby who presents with down syndrome. There is no definitive scientific research which indicates that down syndrome is caused by any environmental factors or the parents activity before or during pregnancy (NDSS 2017). Down Syndrome can occur in any given race however the likelihood of a having a baby with down syndrome increases the older the women is. For example, for a 35-year-old women, the chances of the baby being diagnosed with Down Syndrome is about 1 in 350; for women, the age of 40 increases to 1 in 100 and lastly, for a women age 45 is 1 in 30 (NDSS 2017).

(Table of Maternal Age versus the Incidence of Down Syndrome)

 

 

There are two types of down syndrome, trisomy 21 (nondisjunction) and mosaicism and both are due to an error in cell division. Trisomy 21, which accounts for 95% of cases, results with the embryo consisting of three copies of chromosome 21 rather than the typical two. Prior to or at conception, a pair of 21st chromosomes in either the sperm or the egg fails to separate, thus leading to the extra chromosome replicating in every cell as the embryo grows (NDSS 2017).

In mosaic down syndrome, there is a mixture of two types of cells, some containing the usual 46 chromosomes and some containing 47 chromosomes (NDSS 2017). The cells with 47 chromosomes contains the extra chromosome 21. This type of down syndrome is the least common and accounts for only 1% of cases.
(Mosaicism Down Syndrome)

The last 4% of cases that account for down syndrome is known as translocation. In this case, the total number of chromosomes is 46, however the additional copy or partial copy of chromosome 21 attaches to another chromosome which is commonly chromosome 14.

Treatment of Pathway

Currently, there is no single, standard treatment for Down Syndrome (National Institute of Child Health). According to the National Institute of Child Health and Human Development, a variety of treatment therapies can be used in early intervention programs to promote the greatest possible development, independence and productivity throughout a person’s life. Examples of these therapies include physical therapy, speech-language therapy, occupational therapy, and emotional and behavioral therapy. Physical therapy includes activities and exercises that help build motor skills, increase muscle strength, and improve posture and balance. This therapy is very important in children because physical abilities lay the foundation for other skills (NIH). Because children with down syndrome often learn to speak later than their peers, speech-language therapy can help children with improving their communication skills and use language more effectively. Occupational therapy helps find ways to adjust everyday tasks and conditions to match a person’s needs and abilities. For example, this type of therapy can teach self-care skills such as eating, getting dressed and using a computer. It is not unlikely for a child with down syndrome to depict compulsive behaviors due to frustration. Emotional and behavioral therapists can try to understand why a child is acting out and create ways and strategies to avoid such behaviors or preventing them from occurring.

Diagnosing Down Syndrome can start as early as the prenatal stage. Diagnostic testing such as chronic villus sampling and amniocentesis which are performed prenatally are nearly 100% accurate in diagnosing down syndrome (NDSS 2017). Chronic villus sampling can be done as early as 10 to 13 weeks of gestation and it is done by obtaining cells from the chronic villi which are tiny fingerlike projections on the placenta (Baby Center Expert Advice). The healthcare provider will then send them to the lab for genetic analysis. An amniocentesis is usually performed in the second trimester (15 to 20 weeks of gestation). In an amniocentesis, the healthcare provider obtains a sample of the amniotic fluid (fluid that surrounds the baby in the uterus) using a long, thin and hollow needle which is inserted through the abdominal cavity and into the sac of fluid (Baby Center Expert Advice). Prior to the insertion of the needle, an ultrasound is done to pinpoint a pocket of amniotic fluid a safe distance from the baby and the placenta. The fluid sample is then sent to the lab for analysis and measuring the amount of alpha-fetoprotein (AFP) in the fluid (Baby Center Expert Advice).

The Direction of Future Research

            Although there is no single, standard treatment for down syndrome, there are many studies being conducted by Standford Medicine Down Syndrome Research Center to find a treatment. A new study that was conducted by Dr. Ahmad Salehi resulted in great promise for new classes of drugs to address intellectual disability in Down Syndrome (Stanford Medicine 2013). The study he conducted improved learning and memory in a mouse model for Down Syndrome with the use of a long acting ß2 adrenergic receptor agonist Standford Medicine 2013. This injection is also known as formoterol (Standford Medicine 2013). According to the study, formoterol injections led to structural changes in the hippocampus and improved cognitive function in treated mice (Standford Medicine 2013). The hippocampus is a brain region critical for memory, spatial navigation, and attention (Standford Medicine 2013). Damage to this region has been associated with various types of learning abnormalities (Standford Medicine 2013). Formoterol is approved as a bronchodilator and can be used to treat asthma and chronic obstructive pulmonary disorder (COPD), however in a much lower dose than the dose used in the study for the mice. The dose that was used in the study cannot be safely given to human beings because it will put the individual at high risk for respiratory side-effects (Standford Medicine 2013). According to the Stanford Medicine Down Syndrome Research Center, there is a great hope that new, more powerful, safer, and more effective ß2 adrenergic drugs with the ability to cross the blood brain barrier will be developed in the future.

Conclusion

Having or dealing with someone with Down syndrome can pose many challenges and obstacles. Aside from raising awareness about this condition, I chose to write about this subject because there was a moment in time where my family had a situation where there was a possibility where there could’ve been a genetic disorder. It was when my brother and his wife were expecting their second child a healthcare provider had told them that there was possibility for the child to have a genetic disorder with Downs Syndrome. My family started mentally preparing themselves for what was potentially to come and it was extremely difficult since this would be the first time we had anyone in our family to have or deal with this condition. My brother’s first child was a girl and everyone was really hoping for a boy for the second child. The baby was a boy however, with this news broken down to us, we were all scared and worried about what was to come. We were worried about providing a proper care taker because my brother and his wife both were working full time jobs. We were worried about how the other nieces and nephews would cope with their future cousin. Caring for a baby with such disability would require a lifestyle change and no one knew what to expect. At the end, my brother’s wife went through the whole pregnancy with everyone by her side, providing her support mentally, emotionally and physically. On April 18^th, 2016, she gave birth to a beautiful and healthy baby boy. My baby nephew did not come out with Down Syndrome. He did not have any cognitive disability and everything came out normal. We felt so relieved even though we all did prepare ourselves for what could’ve possibly occurred.