Medicine and Health Sciences Commons^™

Restoring, Protecting, And Expanding Abortion Access In The United States: Seeking Consensus Through The Delphi Method, Sarah Pickering

Dissertations and Theses

Background: The Dobbs v. Jackson Women’s Health Organization Supreme Court decision exacerbated inequitable access to abortion in the US. Agreement is needed on which strategies should be prioritized to restore, protect, and expand abortion access.

Methods: We convened a multidisciplinary, geographically diverse Delphi panel of clinical, research, policy, legal, and advocacy experts to reach consensus (i.e., agreement >67%) on recommended actions. Using feedback from three rounds of surveys, and input from a select expert advisory group (N=10), we iteratively refined the statements and recommendations.

Results: The panel (N=85) developed 25 consensus statements and 32 recommendations for action by advocates, funders, …

Application Of Methods To Population-Based Surveys To Reduce Bias In Estimates Of Sars-Cov-2 Infection Burden In The Population, Saba Qasmieh

Dissertations and Theses

BACKGROUND: Population-based surveys designed to randomly sample the population can be a critical and complementary tool to traditional surveillance approaches. Probability-based surveys enable the measurement of SARS-CoV-2 testing and outcomes that avoid issues around self-selection into testing, making them an effective approach to address ascertainment bias in passive surveillance. For surveys to be a useful and reliable surveillance tool for understanding the burden and distribution of SARS-CoV-2 infection, they need to capture prevalence estimates that are both valid and reliable to be optimally informative for public health measures. The dissertation was undertaken to address three main gaps that have implications …

Strengthening U.S. Jail Systems’ Response To Infectious Diseases: An Evaluation Of The Covid-19 Pandemic, Erinn Bacchus

Dissertations and Theses

Jails across the United States were struck with increased infections and deaths during the COVID-19 pandemic. Studies have shown the structural make up of jails, lack of preparedness plans, and overcrowding contributed to health risks and poor health outcomes both inside jails and local communities. Yet little research has been dedicated to strengthening jail responses to infectious disease outbreaks spanning prevention measures, data collection, and reentry planning. Gaps include information on the (1) myriad infectious disease mitigation strategies used in jails and adherence to CDC prevention guidelines, (2) development of a standardized epidemiologic surveillance system, and (3) experiences working at …

Impacts Of Environmental Stressors On Native South Dakota Amphibian Physiology And Survival, Danielle Jean Galvin

Dissertations and Theses

Amphibian populations around the world are declining, with some of the most likely drivers behind these declines including emerging infectious diseases and environmental contaminants. To address major gaps in the current literature, I sought to evaluate the effect of two major environmental stressors on various aspects of amphibian physiology: emerging infectious diseases and environmental contaminants. Emerging infectious diseases of amphibians include fungal, viral, and parasitic pathogens which have expanded in host range, either geographically or in competent host species. Environmental contaminants include chemicals which may be naturally occurring in the environment, or which may be introduced to the environment, often …

Exploring Opportunities To Expand And Improve Prep Uptake In Vulnerable Us Communities., Pedro B. Carneiro

Dissertations and Theses

The implementation of preexposure prophylaxis (PrEP) in the United States has fallen short of meeting both 2020 and projected 2030 milestones, with less than one-third of those who would benefit most from PrEP choosing to initiate it. High discontinuation rates and persistently elevated HIV incidence underscore the need for improvement. However, opportunities exist to enhance PrEP uptake, supported by a growing pipeline of PrEP innovations. To achieve this, effective implementation of available tools to combat HIV and the inclusion of all communities as stakeholders are essential. One such tool is event-driven (ED) PrEP, also known as PrEP 2-1-1, which is …

Understanding Veteran Perceptions About Mental Health And Its Treatment, Quinn Turner Stoddard

Dissertations and Theses

Mental health illnesses are a growing issue for a large part of the country, and veterans in particular are vulnerable to the numerous negative effects they pose. Despite the high number of people that may benefit from treatment, a variety of issues with trust, stigma, and attitudes may act as barriers to care utilization. In response, this study investigated the perceptions that veterans within the Pacific Northwest hold in regards to mental health treatment as well as their intentions to seek it out should they require it. Using the integrated model of behavioral prediction (IMBP), data was gathered about veterans’ …

Understanding Influenza Vaccine Hesitancy And Uptake Among U.S. Hispanic Adults During The Covid-19 Pandemic, Helen J. Arteaga

Dissertations and Theses

The health burden caused by seasonal flu is substantial in the general population and each season targeted efforts are needed to decrease the risk of flu illness, hospitalization, and death. Flu risks and the disease burden are disproportionately higher among Hispanic adults, yet little is known about the factors influencing flu vaccine hesitancy and uptake among this marginalized population. This cross-sectional quantitative study used national survey data from the Understanding America Study (UAS) and logistic regression to address three research aims. Aim 1 was to examine the most significant demographic factors associated with flu vaccine uptake among the Hispanic community. …

The Health Impacts Of The Trump Administration Among California Immigrants, Claudia M. Calhoon

Dissertations and Theses

Immigration policy was a marquee issue in the US presidential administration of Donald Trump. Trump’s administration employed both policy and rhetoric related to immigrants to mobilize voters, alter immigration policies and practices, and sustain a narrative of a nation under attack by immigrants. Administration officials were able to undertake these approaches because of existing immigration law, but they did so in more explicitly punitive ways than in recent administrations. The goal of this dissertation is to explore the health impacts of the administration’s practices and their effects. Paper 1 analyzes the immigration rhetoric and policies of US president Donald Trump …

"I Stayed There The Whole Night": Exploring Caregivers' Experiences With The Healthcare System When Caring For A Parent At The End Of Life, Lillian Mehran

Dissertations and Theses

Background: In the United States, there are nearly 53 million individuals serving as caregivers to a loved one. Half of all caregivers are caring for a parent or parent-in-law, and 79% of caregivers are caring for a person aged 50 or older. In New York State, there are an estimated 4.1 million caregivers who collectively provide over 2.6 billion hours of unpaid care, with those caring for a person at the end of life providing twice as many hours of caregiving per week compared to other caregivers. The number of individuals requiring caregiving is expected to increase as a significant …

Evaluation Of A Place-Based Asthma Reduction Initiative On Asthma-Related Morbidity Among Children In East Harlem And The Impact Of The Covid-19 Pandemic On Health Care Utilization And Medication Adherence Among Medicaid-Enrolled Children, Sarah C. Walters

Dissertations and Theses

Background: In New York City, asthma continues to be the leading cause of hospitalizations and emergency department (ED) visits among children, and disproportionally burdens Black and Latino children in low-income neighborhoods. Place-based, or geographically targeted, programs offer upstream strategies for addressing public health issues in these underserved neighborhoods, and given their targeted nature, quasi-experimental or other observational methods are needed to rigorously evaluate their impact. This dissertation uses multiple methodological approaches to assess the impact of the East Harlem Asthma Center of Excellence (EHACE) – an equity-focused, multi-faceted, place-based asthma mitigation initiative in the East Harlem neighborhood of a New …

Obesity Risk And Comorbidities Among Colombians In New York City And In Colombia, Carlos A. Devia

Dissertations and Theses

Introduction: The prevalence of obesity and overweight in adults and children continues to increase worldwide, accounting for the mortality and morbidity from several diseases. Obesity disproportionally impacts Latinos in the United States (U.S.), and despite their diversity in origins, ancestry, and culture, it is still unclear the burden of obesity by specific Latino groups. For example, little information is available about how obesity impacts Colombians in the U.S. (the largest South American population). New evidence also indicates that Latino immigrants may no longer be arriving with healthy weight status to the U.S. because Latin American countries are undergoing epidemiologic and …

A Hierarchical Decision Model To Evaluate Healthcare Organization's Readiness To Implement Clinical Decision Support Systems, Mohammed Oussama Laraichi

Dissertations and Theses

Clinical Decision Support Systems (CDSS) are essential tools for healthcare organizations as well as for healthcare providers to improve clinical care. However, successful implementation of CDSS can be challenging. Therefore, before implementing CDSS, it is crucial to assess the readiness of healthcare organizations to implement these tools.

Through a literature review, the first step of this research explores the concept of clinical decision support and CDSS, discussing their features, characteristics, and organizational hurdles to implementation. It also provides perspectives on CDSS adoption in the context of Information Systems and Health Technology. The review helped identify research gaps, objectives, and questions. …

Experiences Of People With Serious Mental Illness Seeking Services At Community Mental Health Centers During The Covid-19 Pandemic, Emily Leickly

Dissertations and Theses

Community mental health centers (CMHCs) have been underfunded and overburdened since Reagan-era disinvestment and the United States' move toward neoliberalism. Rates of mental illness have been rising consistently, particularly in Oregon, as CMHCs face continuing financial pressures and staff retention issues. This was before the COVID-19 pandemic. Today, we are still trying to understand the ongoing pandemic's impact on people with serious mental illnesses (SMI). Most of the studies in this area thus far are quantitative, and first-hand accounts of the pandemic from people with SMI are largely absent. Additionally, research in this area fails to draw on critical alternative …

Will Clinical Decision Support Mechanisms Reduce The Amount Of Unnecessary Computed Tomography?, Andrea Ciarmello

Dissertations and Theses

Clinical Decision Support Mechanisms (CDSMs) are to patient safety. When used in Radiology, CDSMs can improve radiation dose, quality assurance, and patient care. When paired with the electronic health record, CDSMs provide clinicians with patient-specific data that will help lower healthcare costs and improve patient outcomes. This study demonstrates how introducing clinical decision support mechanisms in electronic health record software will help improve unnecessary CT scans and hinder patient radiation exposure. The ordering physician can now consistently and reliably choose the proper scan each time.

Understanding The Experiences Of Latino Medical Students In A Learning Medical Environment, Leslie García

Dissertations and Theses

Very little is known about the experiences and perceptions of underrepresented minority (URiM) medical students in the U.S. allopathic medical schools. The limited literature posits URiMs experience more adverse experiences in the learning environment and have different learning outcomes in comparison to their White peer counterparts. Latino medical students represent 7.1% of all entering medical students across all U.S. medical schools. While they represent the largest ethnic minority in the United States within parity lack representation among the physician workforce [sic]. There is a dearth of knowledge of what factors contribute to the success of Latino medical students progressing in …

Promoting Well-Being Among Intercollegiate Student-Athletes: A Gratitude Intervention Using Positive Psychology, Laura Kruger

Dissertations and Theses

Intercollegiate student-athletes face rising stress and pressures which challenge their well-being and mental health, and sometimes with alarming concerns. Over the years, supportive services and resources specifically available to student-athletes have not evolved at the same pace as student-athlete needs. Also, barriers and stigmas hinder student-athletes from readily accessing supportive mental health services. The high stress of student-athletes can contribute to the development of negative mental health symptoms and impairs positive well-being. Evidence supports how outreach initiatives help student-athletes. Positive psychology, including gratitude as a positive psychological state, has shown benefits to well-being. This experimental study design researched if the …

Intentional Misdiagnosis And Ethical Considerations Of Mental Health Counselors Working With Managed Care, Emily Lake

Dissertations and Theses

Abstract Research has discussed ethical dilemmas for professional counselors working with managed care. Professional counselors are faced with the implications of providing a diagnosis to clients to receive reimbursement by managed care and to assist clients in receiving care. The purpose of the study is to better understand the counselor’s role in intentional misdiagnosis due to billing requirements from insurance companies. Furthermore, the researcher is interested in the personal and professional characteristics of counselors predictive of the decision to engage in intentional misdiagnosis. Participants in this study were asked to complete the Marlowe-Crowne Social Desirability Scale and a researcher-created survey. …

Proteostasis & Neuroinflammation In Alzheimer's Disease, Christa C. Huber

Dissertations and Theses

Alzheimer’s Disease (AD) is a devastating disorder with no disease-modifying agent that stops or reverses the progression of the disease. Exosomes, 50 – 150 nanometers in diameter extracellular vesicles, play a role in intracellular communication and are currently being explored as a therapeutic agent in various diseases. In addition, exosomes possess favorable characteristics as a therapy; however, their low yield following isolation hinders their ability as a therapeutic agent. We exposed neuroprogenitor cells to heat shock (HS) before exosomes were isolated to explore the possibility of increasing exosome secretion. HS-derived exosomes exhibit significantly increased concentration and diameter compared to non-heat …

Researching Medical Treatment Assessments From United States Military Veterans Diagnosed With Substance Use Disorder, And Determining Interest In The Matrix Model Of Treatment For Potential Application In Their Treatment Programs, Christopher R. Strunk

Dissertations and Theses

The purpose of this research study is to learn the beliefs and thoughts on the current state of medical treatment provided to United States (US) military Veterans diagnosed with substance use disorder (SUD), and gauge Veterans’ levels of interest and support in the potential application of the Matrix Model of Treatment (MMT) in their healthcare programs. This proposal focused on verifying the Veterans’ interest in the MMT model since the US Department of Veterans Affairs (DVA) does not currently implement this full-spectrum, 16-week treatment system. It is believed interest will be strong enough to merit supporting its consideration with approving …

Water And Brain Function: Effects Of Hydration Status On Neurostimulation And Neurorecording, Sam Critzer

Dissertations and Theses

Introduction: TMS and EEG are used to study normal neurophysiology, diagnose, and treat clinical neuropsychiatric conditions, but can produce variable results or fail. Both techniques depend on electrical volume conduction, and thus brain volumes. Hydration status can affect brain volumes and functions (including cognition), but effects on these techniques are unknown. We aimed to characterize the effects of hydration on TMS, EEG, and cognitive tasks. Methods: EEG and EMG were recorded during single-pulse TMS, paired-pulse TMS, and cognitive tasks from 32 human participants on dehydrated (12-hour fast/thirst) and rehydrated (1 Liter oral water ingestion in 1 hour) testing days. Hydration …

The Makings Of Creativity And Empathy: Maps Of Maternal Representations, Anielle M. Fredman

Dissertations and Theses

ABSTRACT

The Makings of Creativity and Empathy: Maps of Maternal Representations

by

Anielle M. Fredman

Advisor: Sasha Rudenstine, Ph.D.

The present study investigates the relationship between maternal fantasy of the child and their relationship, and children’s unconscious processes. In addition, the study aims to ascertain the link between maternal representations and aspects of the child’s intrapsychic world, including ego functioning, object relations, and processes of separation-individuation.

Maternal fantasy was measured in an original way with a tripartite typology of Positive, Mixed-Complex, and Contradictory Representations, applied to the Parent Development Interview-Revised Short (Slade et al., 2004), adapted from the Working Model …

A Study Of Verbal Rumination, Relationships, Stress And Identity On Health Communication In Collegiate Athletics, Landon Mary Ellen Kemp

Dissertations and Theses

College athletes are a unique group of individuals as they face many positive and negative challenges when competing in a collegiate sport. Verbal rumination is repetitive talk about a particular issue, accompanied by adverse effects for an individual. Verbal rumination is a common strategy athletes use to cope with difficulties along with managing challenging situations in their athletic program. To explore factors that might inspire or impede verbal rumination in collegiate athletics, the present study examines the quality of coach and teammate relationships, perceived stress and athlete identity. Results revealed the impact of relationships between coaches and athletes in respect …

The Impact Of Resilience And Professional Practice Demographics On The Professional Quality Of Life Of Recreational Therapists, Kelley Mccubbin

Dissertations and Theses

Compassion fatigue can worsen recreational therapists’ quality of life, leaving lasting impacts on a professional’s a professionals' work, home, and social environments. There is little to no research that discusses the impact of resilience and professional practice demographics on compassion satisfaction and compassion fatigue among recreational therapists. This nonexperimental correlational dissertation study examined the impact of resilience and professional practice demographics on the professional quality life (compassion satisfaction and compassion fatigue) in a group of recreational therapists. A total of 677 recreational therapists were analyzed after responding to an online survey that included a professional practice demographic questionnaire, the Professional …

Research Model Applications In The Investigation Of Vascular Disease Treatments, Alex Anthony Dangler

Dissertations and Theses

Cardiovascular disease (CVD) is a pressing global health issue with significant socioeconomic consequences. Within the spectrum of CVDs, peripheral artery disease (PAD) and aortic disease necessitate the development of effective and safe treatments. To achieve this, various research models are employed to investigate molecular mechanisms of cells, understand cellular interactions in vascular diseases, assess biocompatibility, and test and evaluate medical devices. This dissertation examines research models and their applications in the advancement of treatments for vascular diseases. For the evaluation of liposome delivery systems in PAD, an ApoE-/- cellular mouse model was employed to investigate the cellular uptake of liposomes …

Adaptation To Sport Retirement In Division I Student-Athletes, Andrea Cota Powell

Dissertations and Theses

This dissertation utilizes a mixed-methods design to explore adaptation to sport retirement among Division I student-athletes. Sport retirement is a major life transition that can elicit changes in support systems, identity crises, and feelings of loss, failure, and grief. Transitioning out of sport is a phenomenon that over 90% of collegiate student-athletes experience when their four years of NCAA eligibility expires. It is a phenomenon that all athletes experience at some point in their lives. To transition out of sports, one must adapt to post-sport life. Study one of this dissertation explored the phenomenon of occupational retirement through concept analysis …

Patient Frailty: A Review, Lakshmi Sailaja Kodavati

Dissertations and Theses

According to Geriator (2011), frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes such as falls, incident disability, hospitalization, and mortality. An operational definition of frailty is the existence of at least three out of five observable criteria indicating compromised energetics: low grip strength; low energy; slowed walking speed; low physical activity; and unintentional weight loss (Fried, et al. 2001).

According to Dubois and Charpillet (2017), most transitions into frailty are due to unintentional weight loss which, in turn, impacts gait performance and subsequent general mobility. In this literature review, the …

Working Conditions, Type 2 Diabetes Mellitus, And Health Behaviors In Latino And Other Minoritized Groups Living In The United States, Tailisha M. Gonzalez

Dissertations and Theses

Background: Type 2 Diabetes Mellitus (T2DM or ‘diabetes’) poses a significant public health challenge to the healthcare system, economy, and well-being of communities in the United States (U.S.). There are also substantial racial/ethnic and social disparities in diabetes incidence and control that have persisted for decades. For Latinos and other minoritized groups in the U.S., diabetes disparities may be linked to working conditions. Globally, work is considered a major determinant of health and yet studies in the U.S. tend to focus on legacy hazards, such as chemical, biological, and environmental factors. In recent years, occupational health scholars have argued …

An Assessment Model Of The Healthcare Entrepreneurship Ecosystem To Foster Solutions For Underserved Communities, Abdalilah Saleh Owaishiz

Dissertations and Theses

There are significant disparities in access to healthcare treatment and this study investigates the healthcare entrepreneurship ecosystem and the challenges and considerations associated within. There is a lack of research on how to evaluate and assess the healthcare entrepreneurship ecosystem especially when applying multi-criteria decision-making (MCDM) methods. The Hierarchical Decision Model (HDM) has been utilized to identify several perspectives and factors grouped under them by the expert’s quantification. This research concentrates on underserved communities because that is where the biggest needs and impact can be made to support achieving health equity and universal health coverage. The findings of this research …

Effect Of Body Mass Index, Testosterone, And Insulin On Breast Cancer: A Mendelian Randomization Study And Investigation Of Selection Bias, Kezhen Fei

Dissertations and Theses

BACKGROUND: Female breast cancer is the most studied cancer, and the second leading cause of cancer death in women, whose aetiology is still not completely clear. The parallel increase of incident obesity and breast cancer in women worldwide raises the question of the role of adiposity, measured by body mass index (BMI), and of major anabolic hormones, such as insulin and testosterone, on breast cancer. Observational studies are open to confounding making it difficult to clearly demonstrate causal effects. Several mendelian randomization (MR) studies have shown inverse association of BMI with breast cancer. To assess selection bias in MR …

Health Literacy And People Diagnosed With Mental Illness, Beckie Child

Dissertations and Theses

Health literacy is a well-studied concept that has a large literature base. Yet, little is known about health literacy and people diagnosed with mental illnesses, and even less health literacy research speaks to people diagnosed with mental illness. I used a framework and approach of lived experience of psychiatric diagnosis and psychiatric survivor research to conceptualize and inform the study. It explores health literacy with people diagnosed with mental and physical health diagnoses using a small quantitative survey, focus groups, and an individual interview. The findings suggest that health literacy is a dynamic and complex construct that interacts with the …