Digital Commons Network^™

Knowledge, Perception, And Clinical Management Strategies Of Us Pediatric Dentists On Molar Incisor Hypomineralization, Courtney T. Brashier

Theses and Dissertations

Purpose: The purpose of this cross-sectional, survey-based study is to determine current US pediatric dentists’ knowledge, perceptions, and clinical management strategies for patients with molar incisor hypomineralization (MIH).

Methods: Following appropriate protocol and authorizations, all active pediatric dentists, general dentists, and post-doctoral student members identified by the 2020 American Academy of Pediatric Dentistry’s membership list were invited to partake in an anonymous email survey. Data regarding participants sociodemographic, education, and clinical backgrounds were collected in addition to information obtained from MIH-focused questions. Descriptive statistics and chi-square tests were used to compare and analyze data. A significance level was set at …

The Value Of Postoperative Appointments Following Full Mouth Dental Rehabilitation Under General Anesthesia, Priyanka Patel

Theses and Dissertations

Purpose: Follow-up appointments after full mouth dental rehabilitation under general anesthesia (GA) have been suggested as a method for preventing future caries and need for repeat treatment under GA. The purpose of this study is to determine current practitioner and parental perceived value of the postoperative GA appointment.

Methods: Three separate surveys were administered for this study. The pre-appointment survey asked about the guardian’s desire to have a follow-up appointment. At the follow-up appointment, the post-appointment survey ascertained the level of patient satisfaction with their follow-up appointment and postoperative experience. American Academy of Pediatric Dentistry (AAPD) members were e-mailed a …

Feeling The Squeeze: The Association Between Multigeneration Caregiving And Informal Caregivers’ Health, Christine L. Patterson

Theses and Dissertations

While U.S. public policy and research has focused on the health needs of the aging population, less attention has been given to the consequences informal caregivers face caring for this generation. With the segment of the population aged 65 years or older growing rapidly, it is important to understand the factors that place informal caregivers at risk for poor health outcomes and health behaviors. Since multigeneration caregivers balance more personal, work, and caregiving demands than single-generation informal caregivers of older adults, they may be at higher risk for poor health outcomes. The aim of this study was to examine the …

Modeling Substance Use And Mental Disorder Comorbidity Using Latent Variable And Network Approaches, Courtney T. Blondino

Theses and Dissertations

Introduction. Substance use disorder (SUD) is a common condition that affects millions of Americans. Addressing SUD has been complicated by comorbid mental disorders and co-occurring substance use. Consequently, detailing and addressing SUD and comorbid SUD represent an important goal to improve the health of Americans.

Objective. The research goal of this dissertation was to characterize the comorbidity between substance use, including tobacco use, and mental disorder symptoms measured as negative affect and externalizing symptoms in a population-based sample using latent variable and network approaches.

Methods. Waves 1 – 3 from the Population Assessment of Tobacco and Health Study were used. …

Urate Genetic Assessment In Asian And Pacific Islander Subgroups Of Pregnant Women: Implications For Personalized Medicine And Means To Reduce Health Disparities, Ali Alghubayshi

Theses and Dissertations

Gout is one of the most common rheumatic conditions and appears to have a higher prevalence in certain populations. Risk factors for gout and its precursor, hyperuricemia, are also significant risk factors for preeclampsia, major pregnancy-related morbidity. A retrospective cross-sectional study was conducted on 1059 pregnant women from different populations whom 100% reported their ethnicities from the Asian, Native Hawaiian, and Pacific Islander populations. Numerous uric acid (UA) genes and clinical conditions were addressed, and all study details were reviewed and exempted by the University of Hawaii human Studies Program (Protocol Number: 2018-00225). In this project, we hypothesized that UA …

Sleep-Related Problems, Sleep-Related Distress, And Sleep-Related Functional Status Among Adult Inpatients Receiving Palliative Care, Lisa C. Sievers

Theses and Dissertations

Palliative care patients may be at a higher risk for sleep-related problems and their negative effects compared to the general population, yet limited sleep research has been done with this population. The purpose of this dissertation was to determine prevalence rates for excessive sleepiness, insomnia, restless legs syndrome (RLS), and high risk for sleep apnea (HRSA); examine relationships between the aforementioned sleep-related problems, sleep-related distress (SD), and sleep-related functional status (SFS); and to determine which sleep-related problem measures along with age and gender predicted SD and SFS among a sample of adult palliative care inpatients. Secondary aims were to understand …

The Role Of Insurance Coverage In Outpatient Substance Use Disorder Treatment Referral, Utilization, And Outcomes, Huyen Pham

Theses and Dissertations

Opioid-related overdoses increased dramatically in recent years. Medicaid plays a predominant role in paying for opioid use disorder (OUD) treatment. However, there is a critical gap in understanding the role of Medicaid coverage in referrals to treatment, treatment utilization, and treatment retention. The three studies used observational and quasi-experimental (i.e., natural experiment) designs leveraging state and year variation in Medicaid expansion to characterize the role of Medicaid coverage in OUD treatment. We found that individuals with OUD with Medicaid insurance were more likely to use outpatient treatment, whereas those who were uninsured were more likely to use self-help groups only. …

Cost-Effectiveness Of Interventions Targeting Hard-To-Reach Populations Living With Hiv In Eastern And Southern Africa, Deo Mujwara

Theses and Dissertations

In Eastern and Southern Africa, hard-to-reach populations (e.g., long distance truck drivers and female sex workers), defined as populations that are difficult to interact or engage with due to their unique behaviors and characteristics, are disproportionately affected by the HIV epidemic and are at high-risk of acquiring and transmitting HIV. Further, these populations have substantially low uptake of HIV testing services, and those that have been diagnosed with HIV and on antiretroviral therapy experience high loss-to-follow-up from treatment programs.

Hard-to-reach populations face unique barriers in accessing and utilizing routine HIV care such as provider stigmatization towards sex workers and highly …

Policies Addressing Barriers To Low-Income Women And Children’S Health Care Utilization In The United States And Kenya: The Role Of Physician Payments And Cash Transfer Programs, Muloongo Simuzingili

Theses and Dissertations

This dissertation examined two policies to improve low-income women and children’s healthcare utilization: physician payments and cash transfer programs. Higher physician payments increase the supply of healthcare services while cash transfers increase individuals’ demand for healthcare services. Cash transfer programs can improve health outcomes, yet the extent to which they are a cost-effective strategy is largely understudied. Therefore, this dissertation examines three overarching research questions:

1. Are Medicaid physician fees associated with access to substance abuse disorder (SUD) treatment among low-income women of reproductive age?
2. Do economic preferences moderate cash transfer program effects on children’s health care utilization? Evidence from a …

Intentions To Use Telerehabilitation For Communication And Treatment For Vision Impairments, Eric E. Hicks

Theses and Dissertations

BACKGROUND: Approximately 8.1 million people in the United States 18 and older have difficulty performing one or more daily activities because of vision impairment or blindness (Erickson, Lee, & von Schrader, 2020; Taylor, 2018). If the impairments caused by vision loss are not addressed, they can result in financial difficulties, suffering, disability, loss of productivity, and decreased quality of life (National Center for Chronic Disease Prevention and Health Promotion, 2011). Currently, in-person low vision rehabilitation services are the gold standard for teaching people how to adapt to and compensate for these deficits, however, the access and utilization of these services …

Impact Of Targeting Glycosylated Ceramides On Tumorigenic Properties, And Characterization Of Sphingolipids In Head And Neck Tumors, Katherine E. Hylton

Theses and Dissertations

Sphingolipids play a crucial role in signaling, membrane structure, and migration, making them important molecules in cancer development, metastasis, and drug resistance. While some sphingolipids have been associated with pro-apoptotic or pro-survival behaviors, the role of many sphingolipids in cancer remains poorly defined. Chapter 1 of this study investigated the impact of three enzymes that compose most of the ceramide to Lc3 ceramide pathway – UGCG, GBA, and B3GNT5 – and how their alteration impacts chemoresistance and basal membrane invasion in vitro. It was found that the CΒE-induced inhibition of GBA, which converts glucosylceramide to ceramide, has no effects on …

The Impact Of Healthcare Professional Students' Racial, Hiv-Related, And Abortion-Related Biases On Recommendations For Prenatal Care, Alison J. Patev

Theses and Dissertations

Black women and HIV-positive women have increased maternal mortality rates and other negative pregnancy outcomes, in part due to disparate prenatal care. Although women who seek abortions do not have the same negative outcomes, abortion stigma exists and is normalized in healthcare. Limited work has examined prenatal care provision for women in these groups, and even less work has explored the prenatal care provision by healthcare trainees (i.e., medical, nurse practitioner, and physician assistant students). Examining the role of bias on the prioritization of prenatal care items by healthcare trainees is imperative. Healthcare education sets the stage for future practice, …

Associations Between Social Determinants Of Health And Chlamydia Infections Among Georgia Counties, Bre'auna K. Beasley

Theses and Dissertations

Chlamydia is a growing public health concern that disproportionately impacts southern states. While social determinants of health are not direct causes of chlamydia infections, studies have found that these determinants do influence infections by creating environments that promote or hinder health seeking behaviors, as well as exposure to risk factors. Guided by the Social Ecological Model of Public Health and the Healthy People 2030 Social Determinants of Health Conceptual Framework, this dissertation study aimed to examine the associations between social determinants of health and chlamydia infections among Georgia counties. This study employed a correlational research design. Aggregate-level secondary data for …

Understanding Predictors Of Telemedicine Adoption Before, During, And After The Covid-19 Pandemic, Bradford S. Pierce

Theses and Dissertations

This study examined change in physicians’ use of telemedicine before, during, and expectations after the COVID-19 pandemic. It also examined the ability of personal and environmental variables to predict telemedicine adoption, and applied the theory of reasoned action and technology acceptance model to physicians’ adoption of telemedicine during the pandemic. A total of 230 licensed physicians currently practicing in the United States were recruited. Telemedicine accounted for 3.72% of physicians’ clinical work prior to the pandemic, 46.03% during the pandemic, and predicted 25.44% after the pandemic ends. Physicians within hospitals reported less telemedicine use during the pandemic (M = …

Strengthening Mental Health Diagnostic Detection In Integrated Primary Care, Julia Brechbiel

Theses and Dissertations

Primary care behavioral health (PCBH) is crucial for providing mental health treatment to underserved, minority, and uninsured populations. There is a lack of knowledge about accurate mental health diagnoses at PCBH. Underdetection of mental health symptoms has the potential to worsen racial and socioeconomic disparities. Using an expert review process, I developed an abbreviated diagnostic clinical interview (ADCI) for integrated primary care. Next, patients (N = 82) completed the interview after attending PCBH appointments. According to the interview, 63.4% of participants met criteria for a diagnosis, while 64.7% received a diagnosis from their provider. A large portion of patients …

Ck2 Phosphorylation Of Human Papillomavirus 16 E2 On Serine 23 Promotes Interaction With Topbp1 And Is Critical For E2 Plasmid Retention Function, Apurva Tadimari Prabhakar

Theses and Dissertations

Human papillomaviruses (HPVs) are the causative agents in most cervical cancers and have been implicated in a rising number of oropharyngeal cancers. HPV positive oropharyngeal cancers have increased significantly over the last two decades with no specific anti-viral therapeutic options for the treatment of HPV diseases. During its lifecycle, HPV16 encoded E2 protein interacts with host cellular factors to regulate viral transcription, replication and genome segregation/retention. Our understanding of the cellular partner proteins that E2 uses to mediate its functions remains incomplete.

Previously, an interaction between E2 and the host protein TopBP1 was identified. In earlier studies, it was also …

Validation Of A Screening Tool For Pediatric Obstructive Sleep Apnea: A Pilot Study, Julia A. Giardina

Theses and Dissertations

Purpose: The purpose of this study was to evaluate the Pediatric-Modified-STOP-Bang (PM-STOP-Bang) as a screening tool to assess sleep related breathing disorders (SRBD) within a pediatric population. The specific aims of this study were: 1) compare the PM-STOP-Bang scores with those from the validated Pediatric Sleep Questionnaire (PSQ), 2) determine the ability of the PM-STOP-Bang and the PSQ screening tools to accurately detect children of high risk for SRBD from a one-night home sleep apnea test (HSAT).

Methods: Orthodontic patients were screened using the PM-STOP-Bang at VCU Graduate Clinic. Patients (n=10) who were recruited and enrolled. Five were determined to …

Patient Perspectives On Teledentistry And Face-To-Face Doctor Interaction During Orthodontic Treatment, Jackson K. Griffeth D.M.D.

Theses and Dissertations

Purpose: Orthodontic patients were surveyed to determine the perceived value of doctor-to-patient face-to-face interaction, the desire for convenience and attitudes toward specific uses of teledentistry.

Methods: Participating private practice orthodontists emailed the survey to active patients. 75 self-pay patients from VCU Orthodontic clinic were also invited to complete the survey. Patients 18 years or older were asked to complete the survey regarding their own treatment. Parents of patients under age 18 were asked to complete a separate survey regarding their child’s treatment. Questions asked patients about the importance of face-to-face interaction with their orthodontist and their preferences for the inclusion …

The Harm In Seeking Care: Assessing The Relationship Between Healthcare Discrimination And Healthcare Avoidance Behaviors In The Past Year And Since The Start Of The Coronavirus Pandemic In A Transgender And Gender Independent Sample, Kyle L. Mason

Theses and Dissertations

Background: Gender minorities encounter a myriad of barriers to accessing general and gender affirming healthcare. Financial disparities impacting affordability of healthcare costs and insurance-based denials for gender-affirming care are among prominent barriers discussed. Considerations of the prevalence of stigma, discrimination, and erasure of gender minority identities must not be neglected when seeking to understand healthcare accessibility and utilization in this population. Previous researchers have examined gender minority patients’ experiences of discrimination in healthcare settings and delaying care due to fear of discrimination. There is a dearth of knowledge about the relationship between lifetime exposure to varied forms of healthcare discrimination …

Influence Of Immigration Status On The 10-Year Trajectories Of Psychosocial Functioning In Individuals With Traumatic Brain Injury, Chimdindu Ohayagha

Theses and Dissertations

The population of racially/ethnically diverse groups within the U.S. is growing at an exponential rate. The U.S. Census Bureau estimated the number of foreign-born individuals in the U.S. to be nearly 40 million or 13% of the total population (Grieco et al., 2012). Racially/ethnically diverse groups in the U.S. have a higher incidence of traumatic brain injury (TBI; Gary et al., 2009). Although racial/ethnic disparities have been documented in numerous outcomes, research has yet to thoroughly explore differences in rehabilitation outcomes for immigrants relative to U.S.-born individuals. The purpose of this study was to compare the functional and mental health …

Evaluating Patient And Health Care Provider Acceptance Of A Personal Health Record In An Integrated Health Care System In The Kingdom Of Saudi Arabia, Consuela C. Yousef

Theses and Dissertations

With the shift to patient- and person-centered care, personal health records (PHRs) have been touted as a strategy to empower patients, improve patient-provider communication, and support self-management. Health care organizations around the world have implemented PHRs in a global push to meet three aims of health care—improve access to care, reduce costs, and increase the quality of care. The capabilities that PHRs support vary by organizations, yet basic functions include allowing patients to view their laboratory results, refill prescription medications, and request appointments. More advanced PHRs enable patient-centered communication through secure messaging.

As the burden of chronic disease grows, PHRs …

Value Of Pediatric Sleep Questionnaire In Referrals For Obstructive Sleep Apnea At Vcu Pediatric Dental Clinic, Elizabeth H. Hering

Theses and Dissertations

Purpose: The purpose of this study is to determine the number of VCU pediatric dental patients screened for obstructive sleep apnea (OSA) relative to the number of referrals made for a pediatric sleep study.

Methods: This was a retrospective chart review of children between the ages of 1-18 years seen at the VCU Pediatric Dental Clinic between 2016-2020. Patients with a completed sleep apnea screening questionnaire in the health history form or sleep apnea form/referral were identified. The data was used to determine how many referrals were made for a pediatric sleep study in patients screening positive for sleep apnea. …

The Role Of Community Belongingness In The Mental Health And Well-Being Of Black Lgbtq Adults, Keith Justin Watts

Theses and Dissertations

The impact of racial and sexual minority stigma, prejudice, and discrimination on the mental health and well-being of Black and LGBTQ individuals, respectively, has been well documented in the literature. Research on these relationships for Black LGBTQ individuals who are multiply marginalized due to their position at the social intersections of gender identity, sexual orientation, and race/ethnicity is less common. Belongingness to identity-based communities can protect against the negative impact of these minority stressors for Black and LGBTQ individuals and aid coping processes. However, Black LGBTQ individuals often experience stigma and discrimination in their racial, sexual, and gender minority communities …

Comparing The Sensitivity And Specificity Of Cbct And Mri In Detecting Osteoarthritis Of The Tmj: A Systematic Review, Gabriel R. Saavedra

Theses and Dissertations

The aim of this systematic review was to compare the sensitivity and specificity of cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) in detecting osteoarthritis (OA) of the temporomandibular joint (TMJ). This was done by using computed tomography (CT) and the research diagnostic criteria for temporomandibular disorders (RDC/TMD) as reference methods and using CBCT and MRI as index methods. A specific search strategy was developed and applied to these electronic databases: PubMed, Embase, DOSS, and Cochrane. The search results returned 802 articles, which were then narrowed down using the inclusion/exclusion criteria, to four final articles that were included in …

Intermittent Theta Burst Stimulation: Application To Spinal Cord Injury Rehabilitation And Computational Modeling, Neil Mittal

Theses and Dissertations

Loss of motor function from spinal cord injuries (SCI) results in loss of independence. Rehabilitation efforts are targeted to enhance the ability to perform activities of daily living (ADLs), but outcomes from physical therapy alone are often insufficient. Neuromodulation techniques that induce neuroplasticity may push the limits on recovery. Neuromodulation by intermittent theta burst transcranial magnetic stimulation (iTBS) induces neuroplasticity by increasing corticomotor excitability, though this has most frequently been studied with motor targets and on individuals not in need of rehabilitation. Increased corticomotor excitability is associated with motor learning. The response to iTBS, however, is highly variable and unpredictable, …