Digital Commons Network^™

The Nature And Perceived Influence Of Lifestyle Discussions With Older Adults In Primary Care, Shoshana H. Bardach

Theses and Dissertations--Gerontology

The Nature and Perceived Influence of Lifestyle Discussions with Older Adults in Primary Care Rationale: A healthy diet and physical activity help with disease prevention and disease management and can promote quality of life regardless of the age at which an individual begins engaging in these behaviors. Despite the value of these health behaviors, many older adults do not follow lifestyle recommendations. Given that older adults frequently interact with the healthcare system, primary care providers are well situated to counsel older adults to improve their health behaviors. Unfortunately, we do not know how to most effectively engage in this counseling. …

Overall Diet Quality Of Collegiate Athletes, Amanda N. Ireland

Theses and Dissertations--Nutrition and Food Systems

Athletes appear healthy according to weight for height and body fat standards. Though athletes appear to be healthy, little is known about their diets. Research states there is a connection between athletic performance and nutrition. The objective of this study was to determine the diet quality of 138 collegiate athletes. Data were collected in a laboratory. Demographics were collected via survey. Anthropometrics were assessed using a free standing stadiometer and the BodPod® for body fat assessment. Block 2005 Food Frequency Questionnaire© was used to assess diets. The Healthy Eating Index (HEI) 2005 was used to calculate diet quality scores. The …

Multifactorial Modulation Of The Blood-Brain Barrier: Relationship To Stroke, Bei Zhang

Theses and Dissertations--Nutritional Sciences

The blood-brain barrier (BBB) is a dynamic interface, mainly consisting of highly specialized brain microvascular endothelial cells (BMECs) that segregate the central nervous system (CNS) from the peripheral circulation. Impairment of the BBB, due to disruption of tight junction (TJ) proteins and inflammatory responses, may initiate and/or contribute to the progress of CNS disorders, including stroke. Stroke is the second leading cause of death worldwide. It has been shown that aging and environmental pollutants can induce brain endothelium dysfunction, and are considered as risk factors for stroke.

Deficiency of telomerase is highly linked with aging-associated vascular diseases. Evidence indicates that …

Inhibition Of Calpains By Calpastatin: Implications For Cellular And Functional Damage Following Traumatic Brain Injury, Kathleen M. Schoch

Theses and Dissertations--Physiology

Traumatic brain injury (TBI) is a devastating health problem based on its high incidence, economic burden, and lack of effective pharmacological treatment. Individuals who suffer an injury often experience lifelong disability. TBI results in abrupt, initial cell damage leading to delayed neuronal death. The calcium-activated proteases, calpains, are known to contribute to this secondary neurodegenerative cascade. Prolonged activation of calpains results in proteolysis of numerous cellular substrates including cytoskeletal components, membrane receptors, and cytosolic proteins, contributing to cell demise despite coincident expression of calpastatin, the specific inhibitor of calpains.

A comprehensive analysis using two separate calpastatin transgenic mouse lines was …

Determination Of Farm-Specific Lawsonia Intracellularis Seroprevalence In Central Kentucky Thoroughbreds And The Identification Of Factors Contributing To Equine Proliferative Enteropathy, Allen E. Page

Theses and Dissertations--Veterinary Science

Lawsonia intracellularis and the disease it causes in horses, equine proliferative enteropathy (EPE), is an emerging pathogen of increasing importance to the horse industry from both an economic and welfare standpoint. Long recognized as an economically important disease of swine, the hallmark of EPE is a protein-losing enteropathy, where affected horses suffer weight loss and some ultimately succumb to the disease despite aggressive treatment. There are currently no known EPE preventative measures and the epidemiology of the disease remains poorly defined. While EPE is a sporadic disease affecting less than 25% of exposed horses, some farms experience clinical cases year …

Multistate Markov Chains And Their Application To The Biologically Resilient Adults In Neurological Studies Cohort, Erin L. Abner

Theses and Dissertations--Epidemiology and Biostatistics

Dementia is increasingly recognized as a major and growing threat to public health worldwide, and there is a critical need for prevention and treatment strategies. However, it is necessary that appropriate methodologies are used in the identification of risk factors. The purpose of this dissertation research was to develop further the body of literature featuring Markov chains as an analytic tool for data derived from longitudinal studies of aging and dementia.

Data drawn from 649 participants in the University of Kentucky’s Alzheimer’s Disease Center’s (UK ADC) Biologically Resilient Adults in Neurological Studies (BRAiNS) cohort, which was established in 1989 and …

Data Mining And Pattern Discovery Using Exploratory And Visualization Methods For Large Multidimensional Datasets, Hsin-Fang Li

Theses and Dissertations--Epidemiology and Biostatistics

Oral health problems have been a major public health concern profoundly affecting people’s general health and quality of life. Given that oral health data is composed of several measurable dimensions including clinical measurements, socio-behavioral factors, genetic predispositions, self-reported assessments, and quality of life measures, strategies for analyzing multidimensional data are neither computationally straightforward nor efficient. Researchers face major challenges to identify tools that circumvent the processes of manually probing the data.

The purpose of this dissertation is to provide applications of the proposed methodology on oral health-related data that go beyond identifying risk factors from a single dimension, and to …

Methylphenidate And Atomoxetine Treatment During Adolescence In The Spontaneously Hypertensive Rat: Mechanisms Underlying High Cocaine Abuse Liability In Attention Deficit/Hyperactivity Disorder, Sucharita S. Somkuwar

Theses and Dissertations--Pharmacy

Effects of pharmacotherapies for Attention Deficit/Hyperactivity Disorder (ADHD) on cocaine abuse liability in ADHD are not understood. Spontaneously Hypertensive Rats (SHR), an ADHD model, exhibited greater cocaine self-administration than control Wistar-Kyoto and Wistar rats. Methylphenidate, but not atomoxetine during adolescence enhanced cocaine self-administration in adult SHRs compared to controls. The mesocortical dopaminergic system, including medial prefrontal (mPFC) and orbitofrontal (OFC) cortices, is important for ADHD and cocaine addiction. Dopamine and norepinephrine transporter (DAT and NET) are molecular targets for methylphenidate, atomoxetine and cocaine action.

In the current studies, SHR, Wistar-Kyoto and Wistar were administered methylphenidate (1.5 mg/kg/day, p.o.), atomoxetine (0.3 …

Mechanistic Basis For Atrial And Ventricular Arrhythmias Caused By Kcnq1 Mutations, Daniel C. Bartos

Theses and Dissertations--Physiology

Cardiac arrhythmias are caused by a disruption of the normal initiation or propagation of electrical impulses in the heart. Hundreds of mutations in genes encoding ion channels or ion channel regulatory proteins are linked to congenital arrhythmia syndromes that increase the risk for sudden cardiac death. This dissertation focuses on how mutations in a gene (KCNQ1) that encodes a voltage-gated K⁺ ion channel (Kv7.1) can disrupt proper channel function and lead to abnormal repolarization of atrial and ventricular cardiomyocytes.

In the heart, Kv7.1 coassembles with a regulatory protein to conduct the slowly activating delayed rectifier K^{+ …}

A Comparison Of Upper Extremity Function Between Female Breast Cancer Survivors And Healthy Controls: Typical Self- Report Of Function, Motion, Strength And Muscular Endurance, Mary Insana Fisher

Theses and Dissertations--Rehabilitation Sciences

Many women who have experienced breast cancer (BC) report continued impairments in upper extremity (UE) function beyond the time required for normal healing after surgical treatment. Most research supporting this has not made comparisons between survivors of breast cancer (BCS) to a sample of healthy women. This lack of comparison to a healthy cohort prevents an understanding of whether continued deficits in UE function are due to normal aging or the BC treatment.

The purpose of this research was to compare quality of life (QOL) and UE function among long term breast cancer survivors and similar aged women without cancer. …

Exploring Biopsychosocial (Bps) Facets Of Chronic Obstructive Pulmonary Disease (Copd) In Patients In An Acute Inpatient Physical Rehabilitation Facility (Irf), Ronnetta Williams

Theses and Dissertations--Educational, School, and Counseling Psychology

From a BPS perspective, COPD and other chronic diseases may have a significant negative impact on those living with them and may be associated with higher rates of depression and anxiety and lower levels of health-related quality of life (HRQOL). Certain factors, such as spirituality, may influence the negative impact of chronic disease on the relationship between mood and functional independence and HRQOL. Also, gender may influence the relationship between mood, spirituality, and HRQOL for men and women living with chronic diseases. The current study included 136 patients undergoing physical rehabilitation at an IRF. Anxiety, depression, spirituality, HRQOL, and functional …

The Health Consequences And Healthcare-Seeking Strategies For South American Immigrant Careworkers In Genoa, Italy, Patti A. Meyer

Theses and Dissertations--Anthropology

This research on healthcare strategies of home-based, low-wage, immigrant careworkers contributes to the ways medical anthropology, migration studies and social science understand human-economy-family care relationships and health and carework as commodities in today's global economy. It reveals the consequences for workers as they defray the costs of care for the Italian government and contribute to their home economies. This research was conducted in Genoa, Italy, which has the largest percentage of people over the age of 70 in any city of its size in the world and a tradition of sending and receiving immigrant workers. The main question was: Under …

Nurse Practitioner Knowledge Of Urine Drug Testing, Jessica L. Estes

DNP Projects

This DNP Capstone seeks to the review the literature surrounding provider knowledge of urine drug testing, evaluate the use of psychiatric mental health nurse practitioners as treating professionals, and to investigate the knowledge of current nurse practitioners related to urine drug testing.

What Keeps Us Well? Professional Quality Of Life And Career Sustaining Behaviors Of Music Therapy Professionals, Shane C. Swezey

Theses and Dissertations--Music

Self-care can be seen as not only critical for individual professionals, but also for the growth of the helping professions and the quality of care which clients receive. The purpose of this study was to investigate use of career-sustaining behaviors and the levels of professional quality of life in music therapy professionals. This study investigated research questions regarding use of career sustaining behaviors and levels of professional quality of life, the relationship between these variables, the differences in the use of career sustaining behavior by demographics, and the use of music as a self-care strategy.

An online survey was sent …

An Investigation Of Perinatal Polychlorinated Biphenyl Exposure On Body Composition And Glucose Homeostasis, Cetewayo S. Rashid

Theses and Dissertations--Nutritional Sciences

Recent advancements have uncovered environmental contributions to obesity and diabetes etiology. In fact, perinatal malnutrition resulting in low birth weight (LBW) has been shown to correlate with later life obesity and impaired glucose tolerance in aged offspring. LBW can result from a myriad of developmental perturbations including macronutrient restriction, hypoxia, maternal stress and toxin exposure.

Polychlorinated biphenyls (PCBs) are ubiquitous environmental pollutants that bioaccumulate in the food chain resulting in dietary exposure in humans. Maternal and cord blood PCB levels are inversely associated with birth weight, and recent studies indicate that perinatal exposures to PCBs contribute to gender-specific obesity development …

Conviction Celerity, Punishment Severity, And Treatment Compliance As Predictors Of Dui Recidivism: Mediation And Moderation Models Of Deterrence, Megan F. Dickson

Theses and Dissertations--Sociology

Driving under the influence (DUI) is one of the most frequently committed offenses in the United States and approximately one-third of DUI offenders are recidivists. Researchers have evaluated multiple DUI prevention approaches, most of which have been rooted in deterrence theory. Recently, the criminal justice system has moved away from deterrence-based approaches and begun employing various forms of rehabilitation to reduce DUI recidivism. This shift in the criminal justice system has lead researchers to begin exploring the effects of rehabilitation on DUI offenders, including an examination of offender compliance with rehabilitation programs. Although each of these areas has been investigated …

The Influence Of Race And Socioeconomic Status On Routine Screening Practices Of Physician Assistants, Deshana Ann Collett

Theses and Dissertations--Educational Policy Studies and Evaluation

Health disparities in minorities and those of low socioeconomic status persist despite efforts to eliminate potential causes. Differences in the delivery of services can result in different healthcare outcomes and therefore, a health disparity. Some of this difference in care may attribute to discrimination resulting from clinical biases and stereotyping which may provide a possible source for the persistence of health disparities. Health disparities may occur because the delivery of services at some level is inadequate. Disparities resulting from the quality and quantity of care delivered by a practitioner result in differentiated delivery of healthcare, thus unequal health outcomes. The …

Description And Service Innovation In Adolescent Transition Within Kentucky State Agency Education Programs, Amy C. Marshall

Theses and Dissertations--Rehabilitation Sciences

Of all Kentucky youth, state agency children are at the highest risk of making unsuccessful post-secondary transitions to adulthood. The intent of both studies comprising this dissertation was to understand and guide transition planning to make future improvements to transitions of adolescents in state agency programs.

The Kentucky Youth at Risk in Transition Study was a mixed methods study that identified and described the understandings of student transitions in state agency education programs from the perspectives of youth and administrators. The study included 105 nontraditional education programs funded and supervised by the Kentucky Educational Collaborative for State Agency Children (KECSAC). …

Developing The Rehabilitation Education For Caregivers And Patients (Recap) Model: Application To Physical Therapy In Stroke Rehabilitation, Megan M. Danzl

Theses and Dissertations--Rehabilitation Sciences

Patient and caregiver education is recognized as a critical component of stroke rehabilitation and physical therapy practice yet the informational needs of stroke survivors and caregivers are largely unmet and optimal educational interventions need to be established. The objective of this dissertation was to develop a theory and model of “Rehabilitation Education for Caregivers and Patients” (RECAP) in the context of physical therapy and stroke rehabilitation, grounded in the experiences and perceptions of stroke survivors, their caregivers, and physical therapists.

Qualitative research methods with a novel grounded theory approach were used. Potential constructs of RECAP were identified from existing research. …

Untangling Neoliberalism’S Gordian Knot: Cancer Prevention And Control Services For Rural Appalachian Populations, George F. Bills

Theses and Dissertations--Sociology

In eastern Kentucky, as in much of central Appalachia, current local storylines narrate the frictions and contradictions involved in the structural transition from a post-WWII Fordist industrial economy and a Keynesian welfare state to a Post-Fordist service economy and Neoliberal hollow state, starving for energy to sustain consumer indulgence (Jessop, 1993; Harvey, 2003; 2005). Neoliberalism is the ideological force redefining the “societal infrastructure of language” that legitimates this transition, in part by redefining the key terms of democracy and citizenship, as well as valorizing the market, the individual, and technocratic innovation (Chouliaraki & Fairclough, 1999; Harvey, 2005). This project develops …

Influence Of Coping Styles On Emotional State, Illness Perception, And Information Sources Of Men With Prostate Cancer, Gwendolyn M. Hooper

Theses and Dissertations--Nursing

Prostate cancer (PCa) has been the leading cause of cancer death in men since1930. While studies pertaining to PCa have primarily focused on the disease and the subsequent side effects of treatment, psychological distress in this group has yet to be adequately addressed. The purpose of this dissertation was to: 1) conceptualize health related quality of life (HRQL) and health seeking behavior of men by describing lifestyle, cultural and health risks associated with being male, 2) evaluate the psychometric properties of the SF-12 Health Survey (SF-12) combined with the urinary and sexual portions of the UCLA PCa Index (UCLA-PCI), 3) …

Barriers To Effective Pain Management In Preterm And Critically Ill Neonates, Sharon W. Lake

Theses and Dissertations--Nursing

The purpose of this dissertation is to explore potential barriers nurses experience in providing effective pain management for preterm and critically ill infants in neonatal intensive care units (NICUs). The specific aims of the study conducted are to examine (a) NICU caregivers’ knowledge about pain, (b) scales used to evaluate pain in infants, (c) NICU nurses’ documented pain practices, and (d) bias in treating pain of certain types of infants.

This dissertation is comprised of three manuscripts. The first manuscript is an integrated review of the literature describing caregiver knowledge, barriers, and bias in the management of pain in neonates. …

Adherence To Physical Activity Among Individuals With Or Without Cardiovascular Disease, Zyad T. Saleh

Theses and Dissertations--Nursing

Cardiovascular disease (CVD) is a major public health problem and a primary cause of morbidity and mortality in the United States. Regular physical activity is recommended for prevention and management of CVD. Despite the cardiovascular health benefits of physical activity most adults are physically inactive. Therefore, the aim of this dissertation was to examine the factors associated with adherence to physical activity among individuals with or without CVD.

The first paper is a report of a study conducted to examine which baseline demographic (age, gender, marital status, socioeconomic status, and place of residency), psychosocial (social support, depression, anxiety, and fatalism), …

Evaluation Of Insulin-Like Growth Factor-1 As A Therapeutic Approach For The Treatment Of Traumatic Brain Injury, Shaun W. Carlson

Theses and Dissertations--Physiology

Traumatic brain injury (TBI) is a prevalent CNS neurodegenerative condition that results in lasting neurological dysfunction, including potentially debilitating cognitive impairments. Despite the advancements in understanding the complex damage that can culminate in cellular dysfunction and loss, no therapeutic treatment has been effective in clinical trials, highlighting that new approaches are desperately needed. A therapy that limits cell death while simultaneously promoting reparative mechanisms, including post-traumatic neurogenesis, in the injured brain may have maximum effectiveness in improving recovery of function after TBI. Insulin-like growth factor-1 (IGF-1) is a potent growth factor that has previously been shown to promote recovery of …

Low-Income Adults Food Management Practices And Nutrition Behaviors And The Association With Diet, Sarah Elizabeth Lewis

Theses and Dissertations--Nutrition and Food Systems

Food insecurity and diet quality are concerns in low-income populations, contributing to high rates of obesity. Food management skills may enable low-income populations to obtain a healthy food supply rather than relying on less expensive and less nutritious foods to fill their diets. The purpose of this study was to assess the relationship between food management practices and diet quality in SNAP-ED/EFNEP participants. This study examines the association between food management behaviors and dietary outcomes (Healthy Eating Index totals, total calories, carbohydrates, protein, fat, and fiber, and servings of fruits, vegetables, milk, and meats/beans) as measured by the Behavior Checklist …

Celiac Disease: A Gluten Free Diet And Diet Quality, Taylor M. Stauble

Theses and Dissertations--Nutrition and Food Systems

The media has highlighted a proposed link between a gluten free diet (GFD) and weight loss. However, research related to weight gain and a GFD for persons with celiac disease (CD) has shown the opposite effect. A GFD is the only known treatment for persons with CD. If a patient with CD consumes a diet high in GF processed foods, weight management may be difficult to achieve.

Participants with self-reported CD completed a modified GF food frequency questionnaire (FFQ) to assess typical dietary consumption of whole grains, sweets, fruits, vegetables and regular soda. Additionally, body mass index (BMI) and exercise …

Disordered Eating Habits And Behaviors Among Elite Collegiate Athletes, Ann M. Armes

Theses and Dissertations--Nutrition and Food Systems

Eating disorders and disordered eating habits and behaviors were measured using the Eating Disorders Inventory-3 Referral Form (EDI-3 RF). The sample consisted of 159 elite, collegiate student athletes, males and females, aged 18 to 22. Five sports were represented, including basketball, gymnastics, soccer, swimming & diving, and volleyball. Overall, findings support the position that athletes, as a distinct population, and specifically female athletes and those that participate in lean sports, are at an increased risk for disordered eating behaviors and diagnosable eating disorders. Of the 159 total athletes that completed the questionnaire, 33% (n=53) of the athletes sampled met one …

Psychotropic Medication Utilization In Care Home Residents Age 65 Or Older Compared With The Equivalent General Population In Scotland, Tyler P. Stewart

MPA/MPP/MPFM Capstone Projects

Purpose: In Scotland, care homes provide assisted living and medical services. Psychotropic medications (antipsychotics, anxiolytics, and hypnotics) may be over utilized in these facilities. This study compared psychotropic medication utilization in elderly care home residents to the equivalent population of non-care home residents. It is hypothesized that patients in care homes utilize psychotropic medications more than non-care home residents.

Methods: Demographic and prescription information for all patients aged 65 years and older on January 1, 2011 who received at least one prescription for a psychotropic medication during 2011 was retrieved from the national Prescribing Information System (PIS). Patients were grouped …

Evaluation Of Depression Screening Practices For College Women In A Primary Care University Health Clinic, Sarah E. Lester

DNP Projects

Mental disorders, including depression, are increasing in frequency and intensity in the college student population. College-aged women appear to be particularly vulnerable to depression. Primary care providers play an important role in addressing this issue, as they are the principal health care contacts for more than 50% of patients with mental illnesses. Guidelines from the 2009 United States Preventative Services Task Force recommend screening all adults (age 18+) for depression in primary care when depression care supports are in place. However, current screening rates for depression in the primary care setting from are estimated at only 1.6 to 3.3% (United …

Health Status And Care Access Of The Uninsured In Kentucky, Douglas Keith Branham

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

ABSTRACT/EXECUTIVE SUMMARY

With the individual mandate of the Patient Protection and Affordable Care Act (ACA) set to go into effect in 2014, as well as the Medicaid expansion in some states, the federal and state governments have a difficult road ahead planning how to respond to the anticipated increase in health services use. Kentucky is an undecided state regarding the Medicaid expansion and as one of the more impoverished states in the U.S. potentially has much to gain from the new law.

Many studies have focused on the U.S. as a whole in describing the health status of the uninsured. …