Medicine and Health Sciences Commons^™

Projecting, Persuading, & Protecting: A Mixed Methods Analysis Of Adult Children’S Predictions Of Parents’ Quality-Of-Life Valuations In Serious Illness States, Jessica Hahne

Arts & Sciences Electronic Theses and Dissertations

Older adults often face complex serious illness decisions and involve their adult children as shared or surrogate decision makers. However, previous research asking family members to predict older adults’ treatment preferences in serious illness situations typically shows poor concordance with older adults’ actual preferences. In the current mixed methods analysis, we surveyed older adults (n = 38) on their health state valuations in five serious illness scenarios. Two of their adult children (n = 76) predicted their parent’s preferences. Families also participated in a semi-structured conversation to discuss their preferences and predictions.

Quantitative analyses showed that parents’ average valuations were …

The Potential Of Mental Health Policy Implementation: Methods And Applications, Meagan Renee Pilar

Arts & Sciences Electronic Theses and Dissertations

Mental illness affects roughly 20% of the world in some capacity and can be debilitating. Though a large emphasis has historically been placed on individual-level interventions (e.g., therapy or medication), mental health policies present an opportunity to intervene on a large scale, with the potential to enhance impact and equity. This dissertation contributes to the mental health policy research literature in three main ways—(1) exploring factors affecting policymakers’ overall support of mental health policies; (2) assessing the use and quality of quantitative and qualitative methods within this field; and (3) exploring implementation determinants and outcomes, as well as strategies used …

On Arousal And The Internal Regulation Of Brain Function: Theory And Evidence Across Modalities And Species, Ryan Raut

Arts & Sciences Electronic Theses and Dissertations

The brain is an organ. It is subject to the same physiological regulatory processes that engage the rest of the body’s organs, sculpted over hundreds of millions of years to sustain life so effectively. The central message of this thesis is that the holistic functioning of the brain, rather than operating at some level above or independent from these systemic regulatory processes, is deeply related to them. In short, as our limited attention spans might suggest: brain function is internally regulated. I propose that this internal regulation is a primary function of intrinsic brain activity. Chapter 2 provides a theoretical …

A Secondary Data Analysis Of The Prevalence Of Reported Dementia And Subjective Cognitive Decline Across U.S. National Surveys, Matthew C. Picchiello

Arts & Sciences Electronic Theses and Dissertations

Within the United States, many large-scale, nationally representative studies exist with the goal of tracking and monitoring aspects of health. These studies are often used to establish the prevalence of dementia and subjective cognitive decline (SCD) in the population. The goal of the current study is to examine how different population-based studies probe respondents about conditions related to cognitive impairment, and to assess similarities and differences in point estimates. We reviewed eight studies and identified comparable items related to dementia and SCD. We calculated design-appropriate point prevalence estimates and compared weighted estimates across studies, finding a wide range and statistically …

Examining Mental Health In Northern Haiti, Michael Galvin

Arts & Sciences Electronic Theses and Dissertations

Mental health is a severely neglected field in low- and middle-income countries globally. Populations in countries such as Haiti demonstrate a high level of need for mental health services despite a lack of services and trained professionals. In addition to the dearth of biomedical services, local belief systems and explanatory models lead a majority of the population to rely on traditional medicine as their first option for care. The goal of this dissertation is to characterize mental health beliefs, practices, and services in northern Haiti by examining the relationship between traditional beliefs and mental illness, assessing the impact of traumatic …

Parental Psychological Distress After Prenatal Diagnosis Of Congenital Heart Disease: Patterns, Predictors, And Impact On Early Outcomes., Kathryn Mangin-Heimos

Arts & Sciences Electronic Theses and Dissertations

Congenital heart disease (CHD) is the most common birth defect and is often diagnosed during pregnancy. The transition to parenthood after prenatal diagnosis can be particularly challenging. Both mothers and fathers are at elevated risk for psychological distress, yet early distress frequencies and patterns have not been well characterized. The impact of psychological distress on parents’ perceptions of their readiness to care for their infant after hospital discharge is currently unknown. The association of psychological distress with early infant neurodevelopment has also been under investigated. To examine these gaps in knowledge, we conducted a single center, prospective cohort study of …

Sustainable Diets For Planetary Health: A Study Of Indigenous Based Agri-Food Systems In A Community Of The Central Highlands Of Ecuador, Carlos Andres Gallegos-Riofrio

Arts & Sciences Electronic Theses and Dissertations

In order to explore the psychosocial and agroecological dimensions of sustainable diets and their roles in the rural Andean community of Caliata in the Ecuadorian highlands, I conducted a community-centered participatory mixed-methods study. Thirty-nine focus groups and ten key informant interviews were conducted, recorded, translated, transcribed, and analyzed using three-stage coding. The information was triangulated using participant observation, local records, and descriptive statistics from a survey of 57 female household heads, which included a modified 48-hour dietary recall module. Rural appraisal research assessed agroecological dimensions. Ten purposively selected sites were studied alongside local informants in order to obtain diversity indexes …

Dismantling Of Obesity-Related Policies, Alexandra Borosova Morshed

Arts & Sciences Electronic Theses and Dissertations

This dissertation fills an important research gap in the study of obesity policymaking by characterizing to what extent the phenomenon of dismantling is happening at the state level for obesity-related policies targeting the context of consumption, identifying determinants, and characterizing actors and processes involved. The five-year rate of dismantling of these policies is close to one-third for any attempts and one-tenth for enacted dismantling. Food and beverage tax policies face a particularly high rate of dismantling. Case studies and news coverage of state- level dismantling identified actors, motivations, and strategies used in the process of dismantling. Review of health-related empirical …

Pillars Of The Nutrition Transition: The Global Impacts Of Ultra-Processed Foods And Beverages On Overweight And Obesity And National Nutrient Supplies, Jacob Eaton

Arts & Sciences Electronic Theses and Dissertations

Malnutrition in some form impacts nearly one-third of the global population. Across the world, countries are undergoing the Үutrition transitionӠfrom traditional and largely unprocessed diets to Western-style, energy-dense diets. At the same time, rates of overweight and obesity and diet-related chronic diseases continue to climb. Ultra-processed foods (UPF), sugar-sweetened beverages (SSB), and vegetable oils are three of the foods driving the nutrition transition. This dissertation calculates changes in the global food supply between 1961 and 2013 and quantifies the influence of UPF and SSB (as measured through sales) on national nutrient supplies between 2005 and 2013 and trends in adult …

The Social Dynamics Of Antibiotic Use In A Large American Medical Complex, Katharina Rynkiewich

Arts & Sciences Electronic Theses and Dissertations

Based on 18 months of anthropological fieldwork, 35 in-depth interviews, and over 360 hours of participant observation with two specialty physician groups, my dissertation is an analysis of the social dynamics involved in antibiotic decision making, prescription, and use at a large North American medical complex in a Midwestern city. Due to the global problem of antimicrobial resistance, hospitals have been particularly interested in reducing antibiotic overuse and misuse. Though the use of antibiotics has long had an impact at the population level, physicians often advocate for additional antibiotic coverage in the individual patient. I examine a policy aimed at …

Scaling-Up Child And Youth Mental Health Services: Assessing Coverage Of A County-Wide Initiative, Cole Douglas Hooley

Arts & Sciences Electronic Theses and Dissertations

Over 7 million children and youth have a diagnosable mental illness any given year. There are evidence-based treatments (EBTs) to effectively treat these conditions, but these EBTs reach a very small percentage of their target population with treatment rates between 1-3%.1 We know very little about what influences these coverage rates. Beginning in 2009, the Los Angeles County Mental Health Department (LACDMH) began an ambitious agenda to scale-up the provision of EBTs in child/youth mental health care. The present study seeks to contribute to the scale-up literature by examining three questions based on LACDMH’s initiative: 1) To what extent have …

Executive Abilities And Academic Achievement In Children With Sickle Cell Disease, Erika Wesonga

Arts & Sciences Electronic Theses and Dissertations

Academic achievement is crucial to a child’s psychosocial and occupational success (Davaoudzadeh et al., 2015; Margari et al., 2013). In children with sickle cell disease (SCD), a genetic disorder resulting in abnormal hemoglobin and significant neurologic sequelae, poor academic achievement is common (e.g. Wang et al., 2001). Studies of typically-developing children have revealed links between academic achievement and neuropsychological abilities, particularly higher-order executive abilities that are mediated primarily by frontal brain regions (Altemeier et al., 2006; Bull & Scerri, 2001). In children with SCD, there is a wealth of evidence that executive abilities are impaired (Berkelhammer et al., 2007), but …

The Effect Of Retrieval Practice On Vocabulary Learning For Children Who Are Deaf Or Hard Of Hearing, Casey Krauss Reimer

Arts & Sciences Electronic Theses and Dissertations

The goal of the current study was to determine if students who are deaf or hard of hearing (d/hh) would learn more new vocabulary words through the use of retrieval practice than repeated exposure (repeated study). No studies to date have used this cognitive strategy—retrieval practice—with children who are d/hh. Previous studies have shown that children with hearing loss struggle with learning vocabulary words. This deficit can negatively affect language development, reading outcomes, and overall academic success. Few studies have investigated specific interventions to address the poor vocabulary development for children with hearing loss. The current study investigated retrieval practice …

Adapting The Lifestyle-Integrated Functional Exercise Program For Medically Underserved Older Adults, Yi-Ling Hu

Arts & Sciences Electronic Theses and Dissertations

Falls are a growing public health problem among the aging population. Structured exercise programs are effective in preventing falls, and many have been implemented for community-dwelling older adults in the U.S. However, low adherence rates for structured exercise are reported consistently for this population. The need to translate alternative evidence-based exercise programs the diverse older adult population is important. One promising alternative program, the Lifestyle-integrated Functional Exercise Program (LiFE), can significantly reduce falls but has not yet been implemented for diverse older adults residing in the US. To initiate the translation of LiFE, we targeted older adults residing in medically …

Understanding Adolescent Physical Activity In The Early Nutrition Transitioning Country Of Haiti, Haley V. Becker

Arts & Sciences Electronic Theses and Dissertations

The nutrition transition is underway in Haiti, giving rise to the dual burden of malnutrition. Physical activity (PA) plays an important role in mitigating the negative health consequences of nutrition transition and the dual burden, but heretofore this data has been unavailable for Haiti. This dissertation undertook an exploratory needs assessment providing baseline PA data for Haitian adolescents. It evaluated two different PA data collection methodologies: a cross-sectional survey adapted from the IPAQ long-form and objectively measured PA via Actigraph GT1M accelerometers. Next, it identified initial covariates of self-reported and objectively-assessed PA behaviors; data was operationalized as meeting the World …

The Role Of Personality In The Development Of Health Disparities During Late-Mid Life, Juliette Mcclendon Iacovino

Arts & Sciences Electronic Theses and Dissertations

Objectives: The current study examined race/gender disparities in initial levels and trajectories of self-reported physical and mental health, and health care utilization, as well as the impact of personality and stressful life events on race/gender disparities. We hypothesized that health disparities would remain stable or decrease over time; that at-risk personality traits (e.g., high neuroticism) would have a more robust negative impact on health for black participants; that trust would mediate racial disparities in health; and that personality traits would moderate the association between stressful life events and health trajectories differentially across race/gender. Methods: Analyses utilized the first six waves …

Prospective Memory Impairment In Parkinson Disease Without Dementia: Cognitive Mechanisms And Intervention, Erin R. Foster

Arts & Sciences Electronic Theses and Dissertations

Cognitive impairment among non-demented individuals with Parkinson disease (PD) produces significant disability, reduced quality of life, and restricted participation. This dissertation will cover PD-related impairment in prospective memory, or the ability to remember to execute delayed intentions at the appropriate moment in the future. Prospective memory impairment in PD is increasingly recognized as a functionally and clinically relevant problem and viable target for cognitive intervention. To lay the groundwork for the development of effective interventions for prospective memory in PD, this dissertation examines the cognitive mechanisms underlying prospective memory impairment in PD and the potential of training in a targeted …

The Intersection Of Intimate Partner Violence Perpetration, Intervention And Faith, Maxine Davis

Arts & Sciences Electronic Theses and Dissertations

In the U.S. most interventions with men who have acted abusively against intimate partners occurs because of a domestic violence conviction and court-mandate to complete treatment. This dissertation examines the intersection of intimate partner violence/abuse (IPV/A), intervention, and faith by investigating a parish-based voluntary partner abuse intervention program known as The Men’s Group (TMG). The function and implementation of TMG is first explored through a case study, laying the groundwork for understanding why men continuously participate in the program. This qualitative study then investigates how group members view the role of religious faith in relationship to IPV/A and how they …

Participation In Governance And Well-Being In The Yukon Flats, Jessica Charlene Black

Arts & Sciences Electronic Theses and Dissertations

This dissertation explains the relationship between participation in governance and well-being in the Yukon Flats. To garner a deeper understanding of this relationship, definitions of governance and well-being are sought from the participants, thus providing holistic, Indigenous definitions of these concepts. Both formal and informal governance are also explored to understand the important institutions that underpin these larger relationships. Lastly, this dissertation investigates the relationship between participation in traditional hunting, fishing, and gathering and well-being in the Yukon Flats. Qualitative methods, including semi-structured interviews, observations, and photographs are all used to document these relationships. Applied thematic analysis is used due …

Mental Health And Academic Outcomes Among Adolescents In South Korean Orphanages, Hollee Ann Mcginnis

Arts & Sciences Electronic Theses and Dissertations

Research conducted over the past 100 years in Western nations support the adverse effects of orphanages on children’s emotional, developmental, and social well-being as well as economic costs to society (Save the Children UK, 2009; Bakermans-Kranenburg, Van IJzendoorn & Juffer, 2008; Williams & Greenberg, 2010). Globally, the number of orphaned and abandoned children is conservatively estimated to be around 143 million, of whom the majority reside in Asia, followed by Sub-Saharan Africa (UNICEF, UNAIDS, & USAID, 2004). South Korea (hereafter “Korea”) is an exemplary nation for study because it has a well-established child welfare system, including family-based alternatives (domestic and …

Transitional Care For Older Adults With Dementia: Variation Across Patients And Providers, Patricia Prusaczyk

Arts & Sciences Electronic Theses and Dissertations

Older adults with dementia are particularly vulnerable to negative outcomes and adverse events when they transition between healthcare settings such as being discharged from the hospital. However, little is known about how healthcare providers help patients prepare for a care transition – known as transitional care – among older adults with dementia. Therefore, this study sought to understand the transitional care currently delivered by hospital healthcare providers to older adults with dementia, how it compared to that received by older adults without dementia, and how it varied across different patient and provider characteristics. Guided by key provider/informant interviews and theory, …

Social Support And Intimate Partnerships In African American Women With Breast Cancer, Tess Thompson

Arts & Sciences Electronic Theses and Dissertations

This mixed methods study investigated social support in African American breast cancer patients in one Midwestern metropolitan area. The study includes a quantitative analysis of social support in 227 African American breast cancer patients participating in a quality of life study, as well as a qualitative component involving a subsample of 15 married participants. In the larger sample, growth curve models were used to assess factors contributing to initial levels of perceived social support and change in social support over time. Interviews with women in the qualitative study allowed an in-depth exploration of how breast cancer affected womens relationships with …

Can We Walk? Environmental Supports For Active Travel In India, Deepti Adlakha

Arts & Sciences Electronic Theses and Dissertations

Background: Rapid rates of increase of obesity, diabetes, and associated chronic and co-morbid non-communicable diseases (e.g., cardiovascular diseases and some cancers) are being documented in India, yet in-country evidence-based research of associated risk factors is lacking. Physical activity has been identified as a preventative factor to counter the risk from obesity-related non-communicable diseases. Built environment supports for physical activity represent promising strategies to curb the rise in non-communicable diseases. Mounting research evidence suggests that the built environment can facilitate or constrain physical activity. However, a majority of this research has been conducted in developed nations. Built environment correlates of physical …

Relationships Between Age And White Matter Integrity In Children With Phenylketonuria, Erika M. Wesonga

Arts & Sciences Electronic Theses and Dissertations

Objective: Phenylketonuria (PKU) is a hereditary metabolic disorder associated with cognitive compromise. Diffusion tensor imaging (DTI) has allowed detection of poorer microstructural white matter integrity in children with PKU, with decreased mean diffusivity (MD) in comparison with healthy children. However, very little research has been conducted to examine the trajectory of white matter development in this population. The present study investigated potential differences in the developmental trajectory of MD between children with early- and continuously-treated PKU and healthy children across a range of brain regions.

Methods: Children with PKU (n = 31, mean age = 12.2 years) were …

Partnership Development Among Mental Health Organizations, Alicia C. Bunger

Arts & Sciences Electronic Theses and Dissertations

Mental health organizations can play a key role in enhancing youths' access to care by working together to bridge gaps in service delivery systems. This dissertation study examines partnerships among a network of children's behavioral health organizations. The specific aims are to (1) describe and understand the network of partnerships among members of the Children's Services Coalition, (2) assess the capacity of the system to provide coordinated service delivery, and (3) test how patterns of organizational characteristics influence conditions that facilitate and inhibit partnerships among the Children's Service Coalition organizations.

This dissertation is a predominantly quantitative cross-sectional network study of …