Medicine and Health Sciences Commons^™

The Political Economy Of Intimate Partner Violence And Crisis Management: An Institutional Ethnography In Rural Vermont, Anna L. Mullany

Doctoral Dissertations

Intimate partner violence (IPV) is a significant public health issue affecting one in four women in the United States. Tasked with addressing IPV, crisis centers can significantly impact women’s health outcomes and approaches to perpetrator accountability and community education. Informed by eight months of field work at a rural crisis center and 40 in-depth interviews, this dissertation investigated how the lives of Vermont women experiencing violence and crisis center work are both shaped by larger social, political, and economic relations within capitalism. Dorothy Smith’s method of institutional ethnography provides an investigative pathway for centering survivor experiences and examining crisis center …

Elucidating Mechanisms Influencing Maternal Postpartum Health: The Protective Benefits Of Breastfeeding And Associations With Allostatic Load, Experiences Of Stress, And Resiliency, Bi-Sek J. Hsiao

Doctoral Dissertations

Research has established breastfeeding as protective of maternal health, but little is known about the ways breastfeeding interacts with chronic stress pathways and interfaces with stressors such as discrimination and neighborhood deprivation, which are salient in the experiences of many marginalized communities. This research addresses these knowledge gaps through secondary analyses of prospective cohort data generated by the Community Child Health Research Network through Community Based Participatory Research processes. Analytical samples were derived from 2510 postpartum women from five regions in the U.S. who self-identified as Black, Hispanic, or White. Study 1 investigated and found an inverse association between breastfeeding …

Restorative Streetscapes: Promoting Positive Mental Health Outcomes Through Urban Landscape Design In Winooski, Vermont, Sean R. Fitzsimmons

Landscape Architecture & Regional Planning Studio and Student Research and Creative Activity

The global health burden of mental health disorders is immense. The World Health Organization ranks depression as the single largest contributor to global disability; anxiety disorders alone rank sixth. One in four people will have a diagnosable mental illness in their lifetime and mental health conditions are increasing worldwide, rising 13% in the last decade. The economic implications are also immense, costing the global economy US $1 trillion each year. Mental health is more than the absence of disorders or disabilities, however. It is defined by the WHO as “a state of well-being in which an individual realizes his or …

Accelerometer-Determined Physical Behavior Metrics And Their Associations With Sarcopenia Among Oldest-Old Adults, Eric M. Eberl

Masters Theses

INTRODUCTION: Sarcopenia is a loss of muscle function and muscle mass which frequently occurs among the oldest-old adult population (aged 85+ years). The analysis of accelerometer-determined physical behavior volumes and patterns of oldest-old adults might provide novel insights into the associations with sarcopenia and its components. METHODS: A total of 145 participants in the primary sample and 87 participants in the subsample with a mean age of 88.2 (2.5) years from the Health, Aging, and Body Composition study cohort provided cross-sectional data of handgrip strength, appendicular lean mass, gait speed, and accelerometry. Probable, confirmed, and severe sarcopenia were assessed based …

Tai Chi And Mindfulness Training To Improve Balance In People With Multiple Sclerosis: A Community-Based Intervention Study, Julianna Eve

Doctoral Dissertations

Introduction: Tai Chi and meditation have led to improved quality of life, and reduced fatigue and depressive symptoms in people with multiple sclerosis (MS). Tai Chi interventions have successfully improved balance, however the few studies evaluating meditation impact on motor skill improvement have reported conflicting results. Benefits of meditation on improving alertness and attention have been reported, but it is unknown whether these benefits might extend to physical balance. Objective: determine the impact of an 8-week Tai Chi or Mindfulness Based Stress Reduction (MBSR) intervention on physical balance, psychosocial wellbeing, and sensorimotor function; and whether benefits are retained after …

Food Safety And Risk Of Foodborne Illness At A Food Center Extension: Toolkit For Front-Line Volunteers, Sara Anderson

Doctor of Nursing Practice (DNP) Projects

Background: Foodborne illness is a serious public health issue. One in six Americans has an episode of foodborne illness each year and over 50,000 are hospitalized. Food distribution centers are instrumental in decreasing food insecurity, however, some of the food donated is expired or may be damaged leading to increased risk of foodborne illness.

Purpose: The purpose of this project was to educate front-line volunteers at a local food center regarding food safety.

Methods: A toolkit was developed to teach food safety to the front-line volunteers. Seven classes were given to front-line volunteers including a pre and post intervention …

Adolescent Mental Health Training For Middle School Educators, Sarah Minton

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Adolescent mental health disorders are an increasing concern in the United States. School systems, specifically educators, are in the unique role to aid in early identification of mental health disorders, as well to intervene in mental health distress. However, mental health training for educators is lacking, leaving educators unprepared to manage mental health concerns within their classroom.

Purpose: The purpose was to utilize an evidence-based training, the “Teacher Knowledge Update Guide” from TeenMentalHealth.org to train middle school educators on the signs and symptoms of mental health conditions in the adolescent population with the intent to increase awareness, knowledge, …

Improving Chinese Mothers’ Health Literacy: A Wechat Intervention, Qiong Chen

Doctoral Dissertations

The health literacy and eHealth literacy of women during the reproductive age is crucial, as it can affect their health and the health of their children. Promoting health literacy is essential to achieve mothers’ empowerment by improving access to and capacity of using health information effectively. However, functional, interactive, and critical health literacy and eHealth literacy have never been assessed among Chinese women. The first study during this dissertation assessed functional, interactive, and critical health literacy and eHealth literacy among 421 of Chinese mothers with children under 3 years old. The results revealed overall less than optimal level of health …

Measuring The Impact: A Re-Aim Framework For Evaluation Of A Needle Exchange Program, Lindsay Novacek

Doctor of Nursing Practice (DNP) Projects

Background: Needle exchange programs (NEPs) have been widely documented over the past three decades as an effective and economic approach to controlling human immunodeficiency virus (HIV). As of July 1st, 2016, these programs have been legalized in North Carolina. Purpose: To perform stage 1 of an evaluation of a needle exchange program in North Carolina by utilizing a public health framework: the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM). Methods: First, the RE-AIM framework was used to create a plan for a program evaluation of a local NEP. Then, the first stage of the evaluation was completed. NEP program participants …

Improving Blood Pressure Control Among Hispanic Patient Population By Enhancing Providers' Attention To Culturally Competent Solutions Aimed At Increasing Self-Care And Treatment Adherence At And Post Hospital Discharge: A Quality Improvement Project, Katarzyna Swistak

Doctor of Nursing Practice (DNP) Projects

Background and Review of Literature: Hypertension is a primary, preventable risk factor for coronary heart disease, heart failure, and stroke. However, despite advances in preventive care and treatment modalities related to blood pressure control, the prevalence of hypertension in the United States remains at an undesirable level and disproportionately affects Hispanic patients. Purpose: The purpose of this quality improvement (QI) project was to determine if a culturally sensitive, multifaceted intervention focused on promotion of hypertension awareness and self- management strategies increases treatment compliance and blood pressure control among Limited English Proficiency (LEP) Hispanics. Design/Methods: The DNP project included a QI …

Predictors Of Anemia Among Hiv Patients In Uganda, Catherine Nagawa

Masters Theses

HIV-related anemia is associated with increased risk of death. Prior studies suggest an inverse relationship between CD4 cell count and anemia, and a positive relationship between HIV-clinical stage and anemia. However, none have assessed the role of antiretroviral therapy (ART) treatment combinations in these relationships. Therefore, we conducted a cross-sectional study to evaluate the relationship between CD4 cell count, HIV clinical stage and anemia among 4803 Ugandan HIV-patients, and assessed the role of ART treatment combinations. We included HIV patients (> 15 years) receiving ART therapy combinations between 2010- 2015. We evaluated CD4 cell count and anemia using blood tests, …

Fluoride Varnish Application In The Pediatric Population, Ellen Gnaedinger

Doctor of Nursing Practice (DNP) Projects

Purpose: The United States (U.S.) has a persistent problem of dental caries in primary teeth with a greater prevalence of dental caries found in minority and poor children. The majority of children in the U.S. experience dental caries in their primary teeth by age eight. This problem could be addressed by primary care providers applying fluoride varnish (FV) to children's teeth starting at the age of primary tooth eruption. The causes of dental caries in children’s primary teeth are multifactorial and therefore require multiple interventions. Around the world providers are utilizing FV as an effective and easily administered strategy. This …

Mobile Produce Markets: A Strategy For Increasing Access To Fruits And Vegetables Among Low Income Urban Residents, Bi-Sek J. Hsiao

Masters Theses

Mobile produce markets (MPM) are a community-based strategy to improve produce access in areas with few fruits and vegetables (FV) retail options. The purpose of this thesis is to assess the functionality of MPM in low-income urban neighborhoods. This thesis includes three studies. Study 1 investigates FV availability in areas around MPM locations (n=13). We found limited fresh FV availability in stores, but high prevalence of 100% juice, and canned FV and beans. Study 2 applied questionnaire data from MPM shoppers (n=143) to assess MPM experiences. Chi Square was used to compare shopping behaviors between older (≥ 60) and younger …

The Adoption Of Harm Reduction By Abstinence Program Staff: A Qualitative Analysis, Morgan Coe

Masters Theses

Opioid overdose fatalities have quadrupled in the United States since the turn of the century, and are becoming increasingly recognized as a nationwide epidemic. While naloxone (narcan) has long been the standard treatment for overdose in clinical settings, it has not been issued to opioid users or their family members in the U.S. until relatively recently. As naloxone distribution and overdose training become more widespread, they are being incorporated into more and more abstinence-oriented settings including detoxes, halfway houses, and outpatient methadone and suboxone treatment programs. This qualitative study explored whether the staff at such programs found that training their …

Improving Hpv Vaccination Initiation And Completion Rates: A Qi Project, Princy M. Varughese

Doctor of Nursing Practice (DNP) Projects

Human papillomavirus (HPV) is a common sexually transmitted infection in the United States and is the cause of most cervical cancers in women, as well as anogenital cancers, oropharyngeal cancer, and genital warts in both men and women (Centers for Disease Control [CDC], 2014b). The HPV vaccine is recommended for preteen girls and boys to protect against HPV infections (CDC, 2011). In line with the goal of Healthy People 2020, the purpose of this evidence-based quality improvement (QI) project was to implement a text message reminder system, and calculate the completion rate of the 3-dose HPV vaccination series among adolescents …

Pneumococcal Pneumonia In The Older Adult: Increasing Patient Education And Vaccination, Jessica E. Valletta

Doctor of Nursing Practice (DNP) Projects

Background:Pneumococcal disease is a transmitted infectious illness that results in serious complications and death every year in the United States. Given their increased susceptibility to the potential complications of this disease, patients aged 65 and older are considered to be high-risk, but vaccination compliance for this population remain well below state and national goals.

Purpose: The purpose of this project was to increase pneumococcal vaccination rates among adults aged 65 and older in a primary care clinic by increasing patient education.

Methods: An educational intervention was implemented within a large primary care practice located in Central Massachusetts. Educational …

Impact Of A Preschool Workplace Intervention On Classroom Teachers’ Physical Activity Levels And Quality Of Life, Ogechi O. Nwaokelemeh

Doctoral Dissertations

PURPOSE: To examine the feasibility and efficacy of a three-month, cluster-randomized workplace PA intervention on PA levels and wellbeing measures in preschool classroom teachers. METHODS: Ten preschool centers were randomized into two groups; short-bouts of structured PA (SBS-PA, n=5) or traditional unstructured PA (TRAD-PA, n=5). The SBS-PA intervention consisted of 10-minute structured, teacher-led PA routines implemented within the classroom setting, followed by 20 minutes of unstructured playtime. The TRAD-PA intervention consisted of supervised 30-minute of unstructured free playtime. Both interventions were implemented during the morning and afternoon designated gross-motor playtime for 30 min/session, five days/week for three months. Participants’ …

Asthma Education And Care Coordination In The Medical Home, Veronica G. Mansfield

Doctor of Nursing Practice (DNP) Projects

Asthma is the most common chronic disease in childhood. In spite of the many advances in the medical management of asthma, families frequently seek treatment for acute exacerbations of asthma in the emergency department. The purpose of this project was to evaluate asthma care provided to pediatric patients at a community health center in New England through scheduled nursing visits for asthma education and care coordination. The asthma education and care coordination program was developed based on both the NHLBI, NAEPP, Expert Panel 3, 2007 guidelines and ANA White Paper and Agency for Health Care Quality (AHRQ) value of nursing …

Parents' Gender Ideology And Gendered Behavior As Predictors Of Children's Gender-Role Attitudes: A Longitudinal Exploration, Hillary Paul Halpern

Masters Theses

This longitudinal study examined the association between parents’ early and concurrent gender ideology and gendered behaviors and their children’s gender-role attitudes at age six. Specifically, parents' global beliefs about women's and men's "rightful" roles in society, as well as their work preferences for mothers, were considered in relation to the gender-role attitudes held by their first-graders. In addition, parents’ gendered behaviors, including their division of household and childcare tasks, division of paid work hours, and job traditionality were examined as predictors of children’s gender-role attitudes. Based on previous research, it was hypothesized parents’ early and concurrent behavior and ideology would …

Conversations With The Community: An Ethnography Of Two Case Studies Highlighting Community-Research Partnerships In Springfield, Ma, Vanessa Martinez

Doctoral Dissertations

This dissertation is both qualitative and collaborative. It emphasizes the participant observation and ethnographic documentation of two community-researcher partnerships on community-level health interventions in Springfield, MA. Drawing upon critical theories and reflexive methods, I explore and analyze the process of building and sustaining researcher-community partnerships in an era of limited funding. Two Springfield, MA-based projects – one on healthy cooking/eating, and the other on contingency management – serve as case studies to provide a concrete picture of the complex relationships of researcher-community collaborations. I use ethnographic storytelling to provide a multi-dimensional look at two different community-research partnerships on health disparities …

Copd Dyspnea Palliation Project: Dyspnea Palliation In End-Stage Copd Patients, Kaveri M. Roy

Doctor of Nursing Practice (DNP) Projects

Chronic Pulmonary Obstructive Disease (COPD) is a chronic and incurable disease that affects over 12 million Americans. The number of people with COPD is rising, and it is the third leading cause of death in the United States. Management and palliation of COPD symptoms has become a public health issue. The capstone project, the COPD Palliation Project, was a pilot study that combined nursing case management and patient education to provide optimal patient dyspnea palliation and self-efficacy of dyspnea management to end-stage COPD hospice patients. For the intervention, end-stage COPD patients were taught to use a dyspnea algorithm to palliate …

The Effectiveness Of Point-Of-Purchase Nutrition Education On Improving Beverage Choices And Nutrition Knowledge In A College Foodservice Setting, Heather A. Wemhoener

Masters Theses 1911 - February 2014

College students are among the highest consumers of sweetened beverages, drinking more than 25% of their daily calorie needs from sweetened drinks. They also tend to be low consumers of milk. This is important, as high consumption of sweetened drinks and low consumption of nutrient-dense drinks is associated with obesity, dental caries and bone disease. Point-of-purchase (POP) marketing and nutrition education programs are thought to be effective in changing food selection behaviors of college students. Therefore, we conducted a 2-week intervention that combined POP marketing and nutrition education aiming to 1. decrease sweetened beverage consumption 2. increase milk/milk equivalent consumption …

Heightening Mental Health Awareness On A Diverse, Urban Public University Campus Through A Media Outreach Campaign, Kathleen R. Golden Mcandrew

Doctor of Nursing Practice (DNP) Projects

Abstract

Mental health problems among students on college campuses have increased in severity over the last decade. On-campus health providers have reported seeing students with more complex problems such as depression, bipolar disorder, and mixed diagnoses that require frequent and regular follow-up and treatment. Students who require mental health services assistance from on-campus services need to be informed about what resources and services are available and how to access them. Since most on-campus counseling services are set up as short-term treatment models, providing students with community-based resource options is also important.

The purpose of this capstone project was to examine …

Using An Evidence Based Practice Informatics Guided Medication Safety Intervention To Improve Medication Safety Among Community Dwelling Older Adults, Raeann G. Leblanc

Doctor of Nursing Practice (DNP) Projects

Medication safety and prevention of medication related problems are important issues in promoting and maintaining health and safety in one’s home for community dwelling older adults. Assessment of medications and management of a medication schedule are essential elements of medication safety, medication review, and medication care coordination. The Framework for Geriatric Homecare Excellence (Collaboration for Home Care Advances and Practices, 2009) is used as the foundation of this project to improve medication management, and promote and maintain health and safety at home. An in-home medication assessment was completed, using a medication management software informatics system to review medications, identify medication …

Identifying Important Breast Cancer Control Strategies In Asia, Latin America And The Middle East/North Africa, John Fp. Bridges, Benjamin O. Anderson, Antonio C. Buzaid, Abdul R. Jazieh, Louis W. Niessen, Barri M. Blauvelt, David R. Buchanan

David R Buchanan

Background: Breast cancer is the most frequent cause of cancer death in women worldwide, but global disparities in breast cancer control persist, due to a lack of a comprehensive breast cancer control strategy in many countries. Objectives: To identify and compare the need for breast cancer control strategies in Asia, Latin America and the Middle East/North Africa and to develop a common framework to guide the development of national breast cancer control strategies. Methods: Data were derived from open-ended, semi-structured interviews conducted in 2007 with 221 clinicians, policy makers, and patient advocates; stratified across Asia (n = 97), Latin America …

Vitamin D Levels And Risk Of Dyslipidemia Among Us Children With Diabetes And Obesity, Elsina E. Hagan

Masters Theses 1911 - February 2014

Dyslipidemia is increasing among U.S. children, and the prevalence is highest among children with diabetes and obesity. Recently, vitamin D deficiency has been suggested as a possible dietary risk factor for dyslipidemia. Despite the high prevalence of vitamin D deficiency amongst children, virtually no studies have evaluated the association between vitamin D and dyslipidemia among children. We evaluated the vitamin D and dyslipidemia relationship among 240 children and adolescents aged 2 through 21 years who were outpatients of a pediatric endocrinology unit at a large tertiary care facility in Western Massachusetts from April 2008 to April 2010. Eligible children were …

Transitions Home For Patients With Heart Failure: A Pilot Program At A Critical Access Hospital, Rita M. Willey

Doctor of Nursing Practice (DNP) Projects

Background: Heart Failure (HF) disease management programs (DMP) have shown to improve outcomes. The aim of this heart failure pilot program is an evaluation program. Measurement of functional capacity utilized the Duke Activity Status Index (DASI) questionnaire. Since the DASI uses the patient’s ability to perform a set of common activities of daily living to gauge functional capacity based on the known metabolic cost of each activity in MET units, it is thought to be well suited for population studies in which assessment of functional capacity during follow-up is needed.

Setting: Rural Critical Access Hospital (CAH) with outpatient cardiology services. …

Program Evaluation For Tdap Immunization Standing Orders In A Birthing Hospital, Helen Crean Taugher

Doctor of Nursing Practice (DNP) Projects

Newborn infants are vulnerable to pertussis infections. Although the Advisory Committee on Immunization Practices (ACIP) recommends that babies begin their diphtheria, tetanus and acellular pertussis (DTaP) immunization series at two months of age, the minimum age for administration of the vaccine is six weeks of age (Centers for Disease Control [CDC], 2008). Young infants are at risk for whooping cough infection transmitted from parents, siblings and care-givers during the pre-vaccination period in the first two months of life, particularly pertussis transmitted from their mothers. Since the licensure of adult/adolescent formulations of tetanus, diphtheria and acellular pertussis (Tdap) vaccine in 2005, …

A Photovoice Participatory Evaluation Of A School Gardening Program Through The Eyes Of Fifth Graders, Catherine Sands, Krista Harper, Lee Ellen Reed, Maggie Shar

Anthropology Department Faculty Publication Series

In the springtime, fifth grade students at the Williamsburg Elementary School in rural Western Massachusetts ask to snack on sorrel and chives from the school garden, between planting potatoes and building a shade structure for their outdoor classroom. They are members of the first cohort of the curriculum-integrated program initiated by Fertile Ground, a grassroots organization in western Massachusetts. The children’s delight in the fresh greens they have grown marks a national phenomenon: the farm-to-school movement. With limited resources, parents, teachers, students, administrators, and community activists are developing inroads to better school food and food education, by constructing school teaching …

Across The Bridge: Using Photovoice To Study Environment And Health In A Romani Community., Krista Harper, The Sajó River Association For Environment And Community Development, Hungary

Selected Publications of EFS Faculty, Students, and Alumni

This photo essay is the product of a partnership between Prof. Krista Harper, the Sajó River Association for Environment and Community Development, and community organizer Judit Bari. The project took place in a small city in northeastern Hungary hit hard by factory closings since the collapse of state socialism in 1989. The Roma community, about 20% of the town’s population, has been especially vulnerable. A team of six young people participated as photographers and discussion participants, working closely with Harper and Bari. Other community members joined discussions of the images. The team held a photo exhibition in the neighborhood where …