Digital Commons Network^™

Cancer Center Regional Benchmarks For Psychosocial Care, Desiree R. Azizoddin

Loma Linda University Electronic Theses, Dissertations & Projects

The American College of Surgeons (ACoS) Commissions on Cancer (CoC) formulated and implemented standard 3.2 for Psychosocial Distress Screening. This standard requires that all accredited cancer centers evaluate psychosocial distress and provide appropriate triage and intervention for all cancer patients. Over the past decade, Loma Linda University Medical Oncology Center (LLUMOC) administration, physicians, nurses, psychosocial care staff, and chaplaincy collaborated to implement a psychosocial screening and referral program throughout cancer patient services. This current research includes qualitative analysis assessing strengths and barriers of the psychosocial program at LLUMOC from the perspective of LLUMOC providers and two directors of Supportive Care …

Coping As A Mediator Between Symptom Burden And Distress In Lung Cancer Patients, Spring F. Gehring

Loma Linda University Electronic Theses, Dissertations & Projects

Lung cancer is considered the leading cause of cancer death worldwide. An estimated 224,390 new cases of lung cancer are expected to be diagnosed and 158,080 Americans are expected to die from lung cancer in 2016 (National Institutes of Health, 2016; Siegel, Miller, & Jemal, 2016). Lung cancer patients also report the highest levels of psychological distress and symptom burden than any other forms of cancer (Linden, Vodermaier, MacKenzie, & Greig, 2012). Given the prevalence and impact of lung cancer, it is imperative to address the emotional toll this diagnosis can have on those suffering with the disease to develop …

Proteomic Profiling Of Serum Derived Exosomes From Prostate Cancer Patients, David Turay

Loma Linda University Electronic Theses, Dissertations & Projects

Touted among the major achievements in the diagnosis and management of Prostate cancer (PCa) in the past few decades has been, the dramatic decline of men with advanced/metastatic PCa at diagnosis coupled with a significant improvement ( >90%) in the five and ten year survival rates of the disease. Non-palpable PCa (potentially clinically treatable disease) now accounts for 70-80% of all newly diagnosed cases of PCa. Preceding these changes by about a decade was the introduction of Prostatic Specific Antigen (PSA) into clinical practice; first as biomarker for monitoring response to therapy and subsequently as a complementary screening tool. It …

Experiences Of Nurses And Midwives During The Ebola Outbreak In Liberia, West Africa, Erhuvwukorotu S. Kollie

Loma Linda University Electronic Theses, Dissertations & Projects

The 2014 – 2015 Ebola outbreak in the West African region resulted in many deaths and has been responsible for devastating health and socioeconomic upheaval. The decision of nurses and midwives whether or not to render care during outbreaks is vital for the containment of the disease. The purpose of this study was to explore the experiences of nurses and midwives during the Ebola outbreak in Liberia. A grounded theory method based on Corbin and Strauss (2015) and Charmaz (2014) was used, resulting in a conceptual model describing the process involved in the work decisions made by the study participants. …

Acculturation And Cardiovascular Behaviors Among Adult Asian-Americans, Monideepa Bhattacharya Becerra

Loma Linda University Electronic Theses, Dissertations & Projects

Background: The World Health Organization recommends the promotion of positive cardiovascular behaviors (healthy diet and physical activity), while reducing negative ones (tobacco and alcohol abuse) as critical steps in reducing the burden of cardiovascular diseases. Researchers have highlighted the role of acculturation in predicting such behaviors among immigrants, though similar studies among Asian-American subgroups are lacking. This study examines the putative relationship between acculturation and aforementioned cardiovascular behaviors among six Asian-American subgroups.

Methods: A secondary analysis of the California Health Interview Survey 2007, 2009, and 2011 public access data was conducted. Acculturation was assessed utilizing proxy measures of language spoken …

Benefits And Barriers To Hiv Testing In A Population Of Federal Detention Inmates, Nicole A. Knight

Loma Linda University Electronic Theses, Dissertations & Projects

Voluntary HIV testing in combination with early medical intervention has been shown to be effective in reducing the rate of new infections and improving the health and life expectancy of those living with HIV. There are however several high-risk populations in the US that remain largely unreached by HIV testing efforts, some of which could be reached while they spend time in prison or jail. Per current Bureau of Prisons (BOP) policy, HIV testing is routinely offered only to “high risk” pretrial and sentenced inmates. We conducted a cross-sectional study with 721 pretrial and sentenced inmates who entered a large …

Sympathetic Nerve Modulation Of Joint Pathology In Adjuvant-Induced Arthritis, Carlo Anthony Wood

Loma Linda University Electronic Theses, Dissertations & Projects

Background: There is increasing data suggesting a net increase in sympathetic tone plays an important role in rheumatoid arthritis. Several studies have reported altered distribution and density of autonomic nerves in patients with rheumatoid arthritis and animal models for the disease. This provides anatomical evidence that supports a neurally-mediated drive in inflammation and joint destruction. Methods: Adult rats were injected with complete Freund’s adjuvant. At 12 days post immunization, animals were randomly placed into a drug treatment group (SH1293, which interacts with - and ß2-ARs), an adjuvant arthritic group, or a control group. These animals were sacrificed at 14, 21, …

Evaluation Of The Survival Effect For Various Treatment Modalities Among Stage Ii And Iii Rectal Cancer Patients In California, 1994-2009, Myung Mi Cho

Loma Linda University Electronic Theses, Dissertations & Projects

Background: European trials evaluating the effect of preoperative (PreOP) versus postoperative chemoradiotherapy (PostOP CRT) found no survival benefit. However, the effect of a change from PostOP to PreOP CRT has not been evaluated in a population-based setting. We sought to evaluate multimodal treatment changes and overall survival for perioperative (PeriOP) CRT versus surgery alone and for PreOP versus PostOP CRT from 1994 through 2009 among patients receiving radical surgery for stage II and III rectal cancer (RC).

Patients and Methods: We conducted a nonconcurrent cohort study evaluating demographic predictors of multimodal therapy for stage II and III RC using …

The Morbidity & Mortality Of Prevalent Heart Failure, Jennifer Kwon

Loma Linda University Electronic Theses, Dissertations & Projects

The first study population included 292 unselected consecutive patients from the LLUMC heart failure clinic who were enrolled in the study from January to July 2006 and were followed up through the end of December 2010. The treatment policy at the clinic was to uptitrate dosages of beta-adrenergic blockade (β-blockers), angiotensin-converting-enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) to the most tolerable levels in order to reach target dosages, as recommended by the Heart Failure Society of America (HFSA). Patients were classified into systolic heart failure (ejection fraction (EF) < 40%) or diastolic heart failure (EF≥40%). All dosages of β-blockers, ACEi and ARB were extracted through chart reviews and were used as the main predictors of the patients' survival. Results from analyses showed that reaching target dosages of β-blockers and ACEi/ARB may increase survival when compared to not reaching target among the systolic HF population (HR_{β_biockers}= 0.64, 95% CI 0.26-1.56 and HR_ACEi/ARB=0.50, …

Self-Reported Exercise And Risk Of Osteoporosis In Prostate Cancer Patients Receiving Androgen Deprivation Therapy, Lori J. Mennen-Winchell

Loma Linda University Electronic Theses, Dissertations & Projects

Prostate cancer is stimulated to grow in response to testosterone. Androgen deprivation therapy (ADT) leads to chemical castration and suppression of prostate cancer cell production. Testosterone levels less then 300ng/ml decreases bone mineral density and could result in osteoporosis. Studies have shown that during the first year of ADT, fracture risk, mainly in hips and spine increases about 50%. In men, 40% of hip fractures result in death. Exercise may reduce the risk of osteoporosis and thus contribute to the prevention of hip and other fractures. There is limited data regarding whether exercise is associated with a reduced risk of …

Coronary Heart Disease Mortality And Long-Term Exposure To Ambient Particulate Air Pollutants In Elderly Nonsmoking California Residents, Lie Hong Chen

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study is to assess the effect of long-term concentrations of ambient PM on risks of all causes, cardiopulmonary, coronary heart disease (CHD), total cancer, and any mention of nonmalignant respiratory disease (NMRD) mortality.

The health effects of long-term ambient air pollution have been studied with up to 30 years of follow-up in the AHSMOG cohort, a cohort of 6,338 nonsmoking white California adults. Monthly concentrations of ambient air pollutants [particulate matter(PMio), Ozone (O3), sulfur dioxide (SO2), nitrogen dioxide (NO2) or particulate matter

In the AHSMOG cohort, each increment of 10 |ig/m3 in PMio in two-pollutant models …

Effects Of Acculturation On Hiv/Aids Sexual Risk Behaviors Among Asian And Pacific Islander (Api) Women, Margaret Cabotage Salud

Loma Linda University Electronic Theses, Dissertations & Projects

Background. In the US women are the fastest growing group for sexually transmitted infections (STIs), including HIV and AIDS. In addition, the estimated AIDS cases among female adults and adolescents, aged 13-19, increased from 7% in 1985 to approximately 26% in 2002. Most infections occur by heterosexual transmission with 53% occurring through contact with a high-risk sexual partner. While overall HIV/AIDS rates in the Asian Pacific Islander (API) community remain low, they are rising and HIV testing rates, one of the major prevention strategies for HIV, are lower than that of other populations. Furthermore, very little is known about APIs …

Development Of A Lung Cancer-Specific Model For Support Group Interest, Laura Testerman

Loma Linda University Electronic Theses, Dissertations & Projects

Despite high levels of both emotional and physical distress and desire for utilization of support group services, lung cancer patients rarely participate in these supportive services. Lung cancer survivors’ interest in and use of supportive psychosocial services remains poorly understood, and Internet-based services may be of particular benefit to this population. The Behavioral Model for Vulnerable Populations, which emphasizes Predisposing (i.e., demographic as well as attitudes about support services), Enabling (i.e., accessibility of services), and Illness (i.e., need for services based on health) factors, was applied to the prediction of survivors’ behavioral intention to participate in face-to-face support groups (F2F) …

The Role Of Unrealistic Optimism In Explaining Preventive Behaviors In High Versus Low Endemic Malaria Settings In Belize, Daniel G. Handysides

Loma Linda University Electronic Theses, Dissertations & Projects

Background: Of all the diseases an individual can encounter in the world, malaria is one of the most destructive. Simple measures like sleeping under a bednet would greatly reduce the burden (Abeku, 2007). When people estimate their risk relative to others, they are most often unrealistically optimistic, which may explain why those at risk often fail to perform behaviors, such as using a bednet that will reduce their risk. However, one study showed that people at high risk for malaria held pessimistic perceptions of their risk for the disease, but the reasons for this finding are unclear (Morrison, Ager, & …

Fetal Programming By Nicotine Increases Cardiac Susceptibility To Ischemic Injury, Jennifer Charlotte Alexie Lawrence

Loma Linda University Electronic Theses, Dissertations & Projects

Fetal programming is the area of study that focuses on the prenatal origins of adult onset disorders. Previous studies have associated an adverse prenatal environment with the onset of physiologic and metabolic diseases during adulthood. Fetal malnutrition, hypoxia, and exposure to drugs - such as cocaine and nicotine - have been associated with adult disease states. Cigarette smoking is the number one cause of preventable death in the developed world. Among the many dangerous chemicals found in tobacco products is nicotine, the compound responsible for the addictive nature of tobacco use. Nicotine use during pregnancy is a known cause of …

Hiv Risk Among Nursing Students In Rwanda : Self-Efficacy, Knowledge And Attitudes, Jacqueline Wosinski

Loma Linda University Electronic Theses, Dissertations & Projects

Acquired immune deficiency syndrome (AIDS) is the leading cause of death in sub-Saharan Africa. With a prevalence rate of 3.1% in 2006, Rwanda is one of the hardest hit countries. Nurses are often the leading health professionals in rural communities and at the forefront of the fight against the HIV pandemic. Little has been written on how nurses are prepared to intervene successfully along the continuum of HIV prevention and care. A mixed-methods sequential exploratory approach was used to explore this question.

In the first phase, cognitive, socio-psychological, and environmental factors of nursing education in Rwanda in regard to HIV …

Oxidative Stress-Mediated Anticancer Activity Of Novel Ahr Modulators Af & 5f203, Lancelot S. Mclean

Loma Linda University Electronic Theses, Dissertations & Projects

Estrogen receptor positive (ER+) breast cancer tends to respond to anti-estrogen agents such as Tamoxifen. Approximately 40% of ER+ breast cancer is resistant to these agents and those that initially respond often acquire resistance. Estrogen receptor negative (ER-) breast cancer remains largely unresponsive to these agents. It is therefore vital to discover drugs that are potent in both forms of breast cancer. Aminoflavone, (5-amino-2, 3-fluorophenyl)-6,8-difluoro-7-methyl-4H-l-benzopyran-4-one; AF; NSC 686288) and 5F203, (2-[-Amino-3-methy phenyl]-5-flurobenzothiazole) are novel anticancer candidate agents that display potent in vitro and in vivo anti-proliferative activity against select human tumor cells with a unique anticancer activity profile in the …

Application Of The Asset Mapping Model To Church Based Hiv/Aids Prevention And Control In Aba, Abia State, Nigeria, Godwin Nwadibia Aja

Loma Linda University Electronic Theses, Dissertations & Projects

This study examined whether HIV/AIDS activities were more frequent among churches with needs and assets for HIV/AIDS prevention and control in Aba, Nigeria and whether this connection was mediated by collective efficacy. A cross-sectional design was used to obtain data in two phases. First, a three-step forum focus group discussion (FFGD) method was used to obtain data from 32 representatives of five denominations. Second, a quantitative survey questionnaire was constructed based on the result of the FFGD and the collective efficacy model. This questionnaire was administered to 830 members aged 18 years and above from 83 churches that had operated …

Consider The Source : The Effects Of Adult Sources Of Human Immunodefciency [Sic] Virus And Sexually Transmitted Infection Prevention Information On Teen Risk Behaviors For Sexually Transmitted Infection, Janet E. Flores

Loma Linda University Electronic Theses, Dissertations & Projects

Sexually transmitted infections (STIs), including the Human Immunodeficiency Virus (HIV), are major health problems for adolescents, who represent over 26% of new cases of STIs diagnosed annually in the United States. Half of all HIV cases in people under age 25 result from sexual transmission during adolescence. Adolescent STI prevention is a national priority for the United States, and parents, schools, and medical providers, among others, are expected to have the greatest impact on adolescent STI risk reduction in teens.

This study used secondary Youth Risk Behavior Surveillance Survey (YRBS) data to explore the prevalence of high school students with …

Effects Of Distress On Health Care Utilization In Cancer Survivors (Nhis 2004), Natalie Christine Kaiser

Loma Linda University Electronic Theses, Dissertations & Projects

Distress rates have been found to be around 43%, as indicated by a study of five comprehensive cancer centers and as measured by the Distress Thermometer (Jacobsen, et ah, 2005). Furthermore, few studies have examined the current health care utilization among cancer patients as predicted by distress. Thus, population-based data from the NHIS (2004) was analyzed using SUDAAN software 1) to ascertain the current levels of distress as measured by the Kessler 6 scale experienced by cancer survivors based upon demographic characteristics, family structure, physical comorbitities, and cancer-related variables, and 2) to determine whether distress rates reported among cancer survivors …

Predictors Of Emotional Reactions In Women Treated For Breast Cancer, Erin E. Ramirez

Loma Linda University Electronic Theses, Dissertations & Projects

Breast cancer can be a devastating disease that impacts a woman in all spheres of her life (Ingram, 1989). Previous studies have examined the impact of breast cancer on body satisfaction, as well as the impact on emotional well-being. Studies have also examined the role of the coping style that a woman engages in response to the diagnosis and treatment of breast cancer in the woman's psychological adjustment to the disease. However, to date, no research has introduced and tested a multifaceted model.

The purpose of this study was to develop a model predicting psychological maladjustment in women treated for …

Predictors Of Emotional Reactions In Women Treated For Breast Cancer, Erin E. Ramirez

Loma Linda University Electronic Theses, Dissertations & Projects

Breast cancer can be a devastating disease that impacts a woman in all spheres of her life (Ingram, 1989). Previous studies have examined the impact of breast cancer on body satisfaction, as well as the impact on emotional well-being. Studies have also examined the role of the coping style that a woman engages in response to the diagnosis and treatment of breast cancer in the woman's psychological adjustment to the disease. However, to date, no research has introduced and tested a multifaceted model.

The purpose of this study was to develop a model predicting psychological maladjustment in women treated for …

Repeatability Of Serial Carotid Intima Media Thickness Scanning On Individual Subjects, Judi Nightingale

Loma Linda University Electronic Theses, Dissertations & Projects

Background. Heart disease affects millions of Americans each year. In order to improve primary prevention, early risk identification is essential. B-mode ultrasound of the common carotid artery (CCA) intima-media thickness (IMT) assesses risk of a coronary event early in the process of plaque development. Because IMT changes are so small over time, in order to determine clinically significant versus clinically insignificant changes in IMT over a 12 month time period, a protocol is needed which can detect the least significant difference (LSD) of at least 0.030 mm.

Purpose. The purpose of this study was to develop and test a well-defined …

The Association Between Lifestyle Factors And Inflammatory Markers, Kerry Ann Stonebrook

Loma Linda University Electronic Theses, Dissertations & Projects

Background: Cardiovascular disease (CVD) is the leading cause of death for both men and women in the United States. While smoking, high blood pressure, and elevated cholesterol levels are established risk factors for CVD, inflammation is being evaluated as a potential independent risk factor. A key cytokine regulator of the inflammatory response, interleukin-1 (IL-1), has emerged as playing a particularly important role at the genetic level in determining the degree to which the inflammation pathway is turned on. How an individual’s genetic make-up affects inflammation, CVD risk, and response to lifestyle intervention is an area of research that is in …

The Impact Of The Chip Program On Depression And Well-Being: A Pilot Study, Carmen Diehl Thieszen

Loma Linda University Electronic Theses, Dissertations & Projects

Reliable studies have demonstrated that intensive and comprehensive lifestyle changes can reduce coronary risk, which, in turn, can prevent, postpone, and reverse coronary heart disease (CHD) and affect its underlying atherosclerotic lesions. These well-established studies have focused their interventions on moderating biophysical risk factors. In the past 10 years, however, burgeoning research is supporting the idea that psychological factors, such as depression and well-being, are also important CHD risk factors. Little research has addressed, in a non-subjective way, how an intervention program focused on modifying biophysical risk factors may influence psychological factors. Using the Beck Depression Inventory-Short Form, the Dartmouth …

The Potential Role Of Ledgf/P75 In Prostate Cancer, Tracy Ruth Daniels

Loma Linda University Electronic Theses, Dissertations & Projects

The serum autoantibody repertoire from cancer patients is currently being exploited for the identification of tumor associated antigens (TAA) and the design of TAA arrays. Such arrays would facilitate autoantibody profiling and potentially aid in the serological diagnosis and prognosis of tumors. The goal of this study was to identify and characterize prostate-specific TAA. We observed that while the general frequency and titers of autoantibodies in PCa patients were relatively similar to those in matched controls, significant differences could be detected between the two groups in the autoantibody response to the lens epithelial-derived growth factor p75 (LEDGF/p75). LEDGF/p75 is a …

Psychological Factors Associated With Anticipatory Nausea And Vomiting, Melinda L. Nielsen

Loma Linda University Electronic Theses, Dissertations & Projects

Many cancer patients experience adverse chemotherapy-related side effects. The present study examined the relationships among disease variables (i.e. stage of cancer, type of breast cancer), medical treatment variables (i.e. toxicity of chemotherapy regimen, strength of antiemetic treatment), psychological variables (i.e. health locus of control, anxiety sensitivity, desire for control, coping strategies), and anticipatory nausea and vomiting in women with breast cancer. One hundred women with breast cancer completed the Multidimensional Health Locus of Control Scale - Form C, the Anxiety Sensitivity Index, the Krantz Health Opinion Survey, the Coping Inventory for Stressful Situations, and the Morrow Assessment of Nausea and …

Ionizing Radiation And Endostatin Gene Therapy Against Lung Tumor, Xian Luo

Loma Linda University Electronic Theses, Dissertations & Projects

Although many advances have been made in radiotherapy, tumor radioresistance and normal tissue damage continue to always be important issues for radiation oncologists. Numerous reports have also documented that radiation exposure increases the risk for malignancy and suppresses immune mechanisms. However, increasing evidence has suggested that anti-angiogenic therapy that targets tumor blood supply may alter abnormal tumor vasculature, thus synergizing radiotherapy. The governing hypothesis of the present study was that modification of tumor vasculature by antiangiogenic gene therapy can increase the efficacy of radiotherapy and that radiation can also improve DNA transfection efficiency by increasing expression of the administered gene. …

Validation Of A Serotonin Checklist In A Parkinson’S Disease Population, Kelly Diane Darby-Holder

Loma Linda University Electronic Theses, Dissertations & Projects

Although the distinctive pathological marker of Parkinson’s Disease is the progressive death of neurons that produce dopamine, there are also alterations in the production of quantities of other neurotransmitters, such as norepinephrine and serotonin that contribute to the disease. Parkinson’s Disease (PD) can be divided into two distinct classes based on the manifestation of motor symptoms, Type A and Type B Parkinson’s Disease. Type B PD patients often manifest symptoms in which serotonin deficiency plays an important role, which often includes a history of depression. Within the brain and spinal cord serotonin has wide spread projections, acting as an important …

Potential Mechanisms Explaining The Antitumor Effect Of Total-Body Irradiation, Glen Michael Miller

Loma Linda University Electronic Theses, Dissertations & Projects

While numerous reports have documented that radiation exposure increases the risk for malignancy and suppresses immune mechanisms, increasing evidence has suggested that low-dose total-body irradiation (TBI) may alter leukocyte composition and function leading to heightened immune responsiveness and long-term remission of certain cancers. Having observed that moderate-dose TBI produces an antitumor effect in the Lewis lung carcinoma (EEC) model, the major goal of this study was to determine whether changes in tumor growth could be correlated with radiation-induced alterations of immune system parameters. The governing hypothesis was that selective immune augmentation, i.e. upregulation of specific leukocyte subsets, is primarily responsible …