Medicine and Health Sciences Commons^™

Social Determinants Of Cardiometabolic Disease Control: An Ecosocial Approach, Cristina Huebner Torres

Doctoral Dissertations

Cardiovascular disease (CVD) is the leading cause of death in the United States. Diabetes mellitus, hypertension, and dyslipidemia are three primary risk factors for CVD. Each is disproportionately distributed in the population by race/ethnicity. Social determinants of health (SDoH) research indicate that social and environmental factors upstream of individual behaviors can impede an individual’s chronic disease control. Guided by Michael Marmot’s SDoH theoretical framework and by an ecosocial approach, this study used data from a cross-sectional mixed methods study conducted in Western Massachusetts at a federally qualified health center from 2014 to 2018 (RxHL) to examine the association between SDoH—food …

Organizational Factors Influencing Quality And Equity In Pediatric Primary Care: A Mixed Methods Study, Sarah L. Goff

Doctoral Dissertations

The research conducted for this dissertation broadly explored the relationship between characteristics of healthcare organizations and quality and equity in pediatric healthcare. The first of the three studies identified characteristics of pediatric practices with high scores on measures of quality and patient experience using qualitative methods. The second study assessed whether the candidate characteristics identified in the first study were quantitatively associated with performance on quality measures using a statewide survey and publicly available quality data. This study found several potentially modifiable factors associated with performance, including an organizational culture characterized by good communication and interpersonal relationships amongst providers and …

Gender, Class, Caste And Health Status Of Abandoned Elderly Women In Bangalore, South India, Olya Clark

Doctoral Dissertations

The research study centers on issues of health, quality of life, and access to health care among abandoned elderly women in Bangalore, India, specifically focusing on interrelationship of class, caste, structural factors and health. Despite increasing feminization of India’s older population, elderly women’s abandonment and its health consequences has received little attention in existing research literature. The study seeks to explain the causes of elderly female abandonment and concomitant social and health consequences, by examining how their life experiences are shaped, sustained and changed by their class, caste, and gender positions. Elderly abandonment is not unique to India but exists …

Maternal Postpartum Depression And Father Involvement Across The Transition To Parenthood, Katie Newkirk

Doctoral Dissertations

Maternal postpartum depression is a common complication of childbirth that affects the whole family. Fathers’ greater involvement in childcare can buffer children from the negative effects of mothers’ depression, and aid in mothers’ recovery, so it is important to understand under what conditions fathers become more or less involved when mothers are depressed. Prior research has supported both a compensation hypothesis, whereby fathers compensate for the effects of mothers’ depression on mothers’ parenting by being more involved in parenting, and a spillover hypothesis, whereby mothers’ negative emotionality causes fathers to pull back from family life and be less involved in …

Evaluating The Toxicity And Formation Of Halobenzoquinones In Point-Of-Use Chlorinated Drinking Water, Stephanie Hung

Masters Theses

Chlorine has effectively reduced the prevalence of waterborne diseases, however there are secondary consequences to this public health advancement. Disinfection byproducts (DBPs) are chemicals formed when chlorine reacts with natural organic matter (NOM) in water. A new class of DBPs, halobenzoquinones (HBQs), has recently been identified and data suggests it could be potentially carcinogenic and up to 1000 times more toxic than some regulated DBPs. So far, in vitro studies have assessed HBQ toxicity without taking into account its transformation in cell media into potentially less toxic compounds. This study evaluated the toxic effects of one HBQ, 2,6-DCBQ, and its …

Searching For The Fulcrum: Can Accountable Care Organizations Lower Spending By Balancing Specialists-To-Primary Care Providers?, Vishal Shetty

Masters Theses

Background:

While value-based payment models emphasizing care coordination have been widely implemented to improve quality and lower expenditures, supporting empirical evidence is sparse. Our objective was to quantify the impact of specialist-to-primary care physician involvement within accountable care organization (ACO) and its association with lower spending.

Methods:

We conducted a retrospective cohort study of Medicare Shared Savings Program ACOs from 2012-2016 using publicly available data provided by the Centers for Medicare and Medicaid Services at the ACO level. We examined the association between the proportion of primary care services delivered by specialists versus other types of care providers and ACO …

Phthalates, Embryo Development, And Sperm Dna Methylation, Haotian Wu

Doctoral Dissertations

Infertility affects 15% of all couples and presents a major public health issue. Animal and human data indicate that epigenetic dysregulation in sperm is associated with poor male reproductive health and extensive epigenetic reprogramming during spermatogenesis presents a window of vulnerability for environmentally-induced epigenetic dysregulation. Phthalates is a class of ubiquitous environmental contaminant and global health concern. Phthalate exposure in humans has been associated with diminished male fertility, adverse birth outcomes, and altered offspring development. In order to facilitate additional research on this topic, we aimed to developing a higher throughput method of sperm nucleic acid extraction. In addition, this …

Vitamin D, Calcium, And Dairy Consumption And Risk Of Early Menopause, Alexandra C. Purdue-Smithe

Doctoral Dissertations

Early menopause, defined as the cessation of ovarian function before the age of 45, affects roughly 10% of women in Western populations. Current research suggests that women who experience early menopause are at increased risk for cardiovascular disease and other adverse health outcomes. Early menopause may also have substantial financial and psychological consequences for family planning, particularly as women increasingly delay childbearing into the later reproductive years. Emerging research suggests that modifiable lifestyle factors such as diet may play an important role in ovarian aging. According to our review of the current biologic and epidemiologic literature in Chapter 1, vitamin …

Hormonal Contraceptive Use Among Active Duty Army Servicewomen. Trends And Implications For Risk Of Musculoskeletal Injury., Melanie K. Hosker

Doctoral Dissertations

Almost 40% of servicewomen use hormonal contraception every year, and 60% will use a contraceptive method in their military career. Rates of contraceptive use and musculoskeletal injury are higher among servicewomen as compared to civilians. Gender differences in rates of musculoskeletal injury have led investigators to question the role of sex hormones, including contraception. Recent studies suggest that hormonal contraceptives may decreased risk of anterior cruciate ligament (ACL) injury, potentially decreasing early onset osteoarthritis (OA). We utilized the Total Army Injury and Health Outcome Database, which prospectively captured demographics, clinical and pharmacy records on over 5.6 million Army soldiers since …

Investigations Of The Role Of Acculturation In Cancer Screening And Phthalates In Breast Cancer Risk And Weight And Body Mass Index Change, Mary V. Diaz Santana

Doctoral Dissertations

INVESTIGATIONS OF THE ROLE OF ACCULTURATION IN CANCER SCREENING AND PHTHALATES IN BREAST CANCER RISK AND WEIGHT AND BODY MASS INDEX CHANGE MAY 2018 MARY V. DIAZ SANTANA, B.S., UNIVERSITY OF PUERTO RICO RIO PIEDRAS CAMPUS M.S., UNIVERSITY OF PUERTO RICO MEDICAL SCIENCE CAMPUS Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Katherine Reeves Phthalates, endocrine-disrupting chemicals, are hypothesized to increase obesity and, as a result, risk of obesity-related cancers, such as breast cancer. However, findings are not consistent across studies. Identifying whether phthalates impact obesity is critical for understanding the pathways by which phthalates may affect cancer risk. Experimental …

Consumer Behaviors, Added Sugar Intake, Diet Quality, Inflammation And Metabolic Syndrome Risks Among Adults From The National Health And Nutrition Examination Survey 2007-2010, Shanshan Chen

Doctoral Dissertations

We carried out a secondary data analysis of adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) 2007-2010. All analyses were weighted using NHANES sample weights to account for the complex survey design, survey non-response, and post-stratification. Overall, the majority of our population (60.4%) exceeded the USDA/HHS recommendation on added sugar consumption. In the first study, soft drink availability at home was positively associated with added sugar intake (p In the second study, added sugar intake was negatively associated with diet quality determined by Healthy Eating Index (HEI) 2015, after adjusting for covariates. With regards …

Foki Vitamin D Receptor Gene Polymorphisms And Metabolic Health In Pregnant Saudi Women, Maysa Alzaim

Doctoral Dissertations

Lifestyles have been dynamically changing in the past few years in Saudi Arabia, and the prevalence of non-communicable diseases (NCDs), such as obesity, diabetes, hypertension, high cholesterol, and other cardiovascular diseases (CVD), is notably increasing. In fact, NCDs are affecting a growing number of people in SA, especially women of childbearing age. Vitamin D deficiency has also become pandemic and a major public health concern among the Saudi population despite the abundance of sunlight. The most vulnerable groups are pregnant women and their newborns. Previous studies have correlated low vitamin D status with a higher risk of adverse short- and …

Impacts Of Casino Gambling Availability In Plainville, Massachusetts: A Repeated Cross-Sectional Analysis, Danielle M. Venne

Masters Theses

The impacts of the introduction of casino gambling in Plainville, MA and surrounding communities are of interest in developing informed policy. Problem gambling is a public health issue as associated harms include physical and mental illness, impaired relationships with one’s close social network, impacts on school or work, financial difficulties and illegal behavior. The results of surveys prior to and after the introduction of the casino were used to evaluate potential differences in the prevalence of at-risk and problem gambling, associations amongst health and gambling behavior covariates with at-risk and problem gambling status by year, and changes of covariate relationships …

Developmental Exposure To Xenoestrogens: Effects On The Mouse Mammary Gland Development And Response To Estrogen, Durga Kolla

Masters Theses

Humans experience ubiquitous exposures to estrogenic environmental chemicals from food, personal care products, and other industrial and consumer goods. Bisphenol A (BPA), a well-studied xenoestrogen, is known to alter development of estrogen-sensitive organs including the brain, reproductive tract, and mammary gland. Bisphenol S (BPS), which has a similar chemical structure to BPA, is also used in many consumer products, but its effects on estrogen-sensitive organs in mammals has not been thoroughly examined. In our study, pregnant CD-1 mice were orally exposed to BPS or ethinyl estradiol (EE2, a positive control for estrogenicity) from gestational day 9 through postnatal day (PND) …

Traffic Related Air Pollution And Lung Function In Bilateral Lung Transplant Patients, Jennifer A. Gaudreau

Masters Theses

No abstract provided.

Association Of Follicle-Stimulating Hormone And Depression And Depressive Symptoms In Older Postmenopausal Women, Dana Fritz

Masters Theses

Worldwide, between 5 and 18% of postmenopausal women experience depression. While the associations of estrogens with depression have been researched extensively, relations with other postmenopausal hormones remain unclear. We evaluated the association of follicle stimulating hormone (FSH) levels with prevalent depression the Kuopio Ischaemic Heart Disease Risk Factor Study (n = 588). Study participants were postmenopausal women aged 53 to 73 years and not using hormone therapy at enrollment (1998-2001). FSH was measured by radioimmuno-assays. Depression symptoms were measured using a scale based on DSM-III criteria (score range = 0-12), with a score ≥5 indicative of probable depression. We assessed …

Vitamin D Status And Bone Health Among Young Adult Women, Caroline Stone

Masters Theses

Background:

Osteoporosis is estimated to affect 200 million women in the world, affecting 10% of women aged 60, 20% of women aged 70, 40% of women aged 80 and 67% of women aged 90. Osteoporosis is characterized by low bone density and increases the risk for fractured bones; however, it may be prevented with modifiable factors such as supplements, diet, and physical activity. Vitamin D deficiency leads to bone mineral density loss, as Vitamin D₃ is responsible for calcium absorption into the bones. Bone consolidation is believed to occur between 20 and 30 years old; thus, attaining peak bone …

Outreach Strategies To Recruit Low-Income African American Men To Participate In Health Promotion Programs And Research: Lessons From The Men Of Color Health Awareness (Mocha) Project, Louis F. Graham, Lamont Scott, Erus Lopeyok, Henry Douglas, Aline Gubrium, David Buchanan

Health Promotion and Policy Faculty Publication Series

African American men continue to bear a disproportionate share of the burden of disease. Engaging these men in health research and health promotion programs—especially lower-income, African American men who are vulnerable to chronic disease conditions such as obesity and heart disease—has historically proven quite difficult for researchers and public health practitioners. The few effective outreach strategies identified in the literature to date are largely limited to recruiting through hospital clinics, churches, and barbershops. The Men of Color Health Awareness (MOCHA) project is a grassroots, community-driven initiative that has developed a number of innovative outreach strategies. After describing these strategies, we …

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 …

Development And Evaluation Of An Emergency Department-Based Nurse Practitioner Care Delivery Model, Tiesha Johnson

Doctor of Nursing Practice (DNP) Projects

Background: Acute mental health care needs are not always optimally managed in the Emergency Department (ED) with the traditional approach to care and management. The ED encounter for psychiatric patients is lengthy, costly, fragmented, inefficient and often ineffective, contributing to poor outcomes.. Purpose: To introduce the evidence- based advanced nursing practice model to ED professionals and staff for feedback and evaluation of an ED-based Psychiatric Nurse Practitioner care delivery model for the acute care of psychiatric patients. Implementation: The care delivery model was created based on evidence and presented to professionals and staff at one medical center ED. A focus …

Center Based Help For Elder Depression And Emotional Reinforcement (Cheer), Jennifer Taylor

Doctor of Nursing Practice (DNP) Projects

Purpose.

The aim of this project was to decrease depression of those socially isolated, and/or homebound seniors, through behavioral activation by using CHEER and emotional support, along with bridging access to programs and the needs of seniors in the community.

Background.

As we age we face functional, medical, and social complexities that frequently become hard to manage. Depression is a problem that is present but often goes unrecognized in society. It is more prevalent in younger adults, however, depression has more acute affect in older persons. Depression can potentially be debilitating and increase adverse events with other health issues such …