Medicine and Health Sciences Commons^™

The Relationship Between The Electronic Health Record Patient Portal And Shared Decision Making, Gloria Esoimeme

Theses and Dissertations

Shared decision making (SDM) is a collaborative decision-making style where the patient and the physician are involved in the clinical decision-making process. The goal of this dissertation project was to examine the relationship between the patient portal of an electronic health record (EHR) and SDM.

The SDM process has three main components: information sharing, deliberation and decision making. Patients participate in SDM at varying levels: some patients may prefer to share information and deliberate but leave the final decision making to the provider while others prefer to participate in all the three components of SDM. The patient portal of an …

Women’S Socio-Economic Empowerment And Uptake Of Hiv Testing In Ethiopia, Dawit Alemu

Theses and Dissertations

Introduction: Sub-Sahran Africa constitute two-thirds of all people living with HIV in the world. HIV infection rate is high in the continent with women comprising 56% of new HIV infections among adults 15 and older. Women 15 to 24 are the most affected constituting 66 % of new infections occurring among this age group. The purpose of this study was to examine how gender power relations between men and women affect health seeking behavior, particularly HIV testing, among Ethiopian women age15 to 49.

Methods: The Ethiopian Demographic and Health Survey (EDHS) from 2016 served as the data source for …

Dietary Advanced Glycation End-Products (Ages) And Breast Cancer Risk And Survival, Omonefe Opeyemi Omofuma

Theses and Dissertations

Introduction: Advanced glycation end-products (AGEs) are implicated in the pathogenesis of chronic diseases including cancer. AGEs are produced endogenously and are also consumed from foods. High amounts of AGEs are found in animal products and processed foods, and AGE formation is accelerated during cooking at high temperatures. Using data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), we assigned and quantified NƐ-carboxymethyl-lysine (CML)-AGE content in food and investigated the association between dietary AGE intake and breast cancer (BrCa) risk. We assessed whether the risk was modified by race/ethnicity, obesity status, fruit and vegetable intake, BrCa invasiveness …

Did Medicaid Expansion Under The Affordable Care Act Reduce The Likelihood That People Report Employment Status Changes Due To Health, U.S., 2009-2017, Songyuan Deng

Theses and Dissertations

Medicaid expansion of Affordable Care Act (ACA) extended coverage to low-income working adults. While Medicaid expansion led to increased healthcare use and national healthcare expenditures, current studies do not examine the effects of Medicaid expansion on health status from the perspective of social roles, for example, changes in employment status. This study use data from the Current Population Survey to examine the association between Medicaid expansion and the probability to attribute part-time work or not-in-labor- force to health issues among people with family annual income no more than 138 of Federal Poverty Level, with a difference-in-differences study design. We found …

The Association Of Reimbursement Methods With The Tendency Of Primary Care Physicians To Apply The American Diabetic Association’S Recommendations And Make Referrals To Specialists Among Ambulatory Care Patients In Us Outpatient Settings., Abdullah Alharbi

Theses and Dissertations

We report on a study of the comparison of two reimbursement methods, capitation (CAP) and fee for service (FFS), as well as mixed payment, with respect to the implementation of the ADA recommendations for Diabetes Type 2 (DM2) management and referral rates for specialist health care in the outpatient setting of the United States.

Our purpose in examining these specific topics is to determine whether there is any difference in the implementation of the ADA recommendations or the frequency of referral between visits paid under CAP vs under FFS because both quality and cost of healthcare is affected by these …

Individual- And Community- Level Associations With Healthcare Utilization Among A Health System, Emergency Department Population, Carlene A. Mayfield

Theses and Dissertations

AIM: The primary aim of this study was to examine individual-level and community- level characteristics associated with ambulatory or primary care utilization, emergency department (ED) utilization, and ED charges among a sample of ED patients.

DESIGN AND SAMPLE: Data for this cross-sectional study were obtained from three distinct sources: (i) electronic medical records (EMR); (ii) billing records; and (iii) the 2013-2017 American Community Survey (ACS). The individual-level EMR and billing sample included all adults residing in Mecklenburg County, North Carolina who visited an Atrium Health ED in 2017. The ACS sample included population and demographic estimates from Mecklenburg County’s 27 …

The Intergenerational Effects Of Adverse Childhood Experiences On Children’S Emergency Department Utilization And Depression And Anxiety In South Carolina, Eboni E. Haynes

Theses and Dissertations

Adult exposure to adverse childhood experiences (ACEs) is common in the U.S., with over half of adults reporting exposure to at least one ACE. Childhood trauma is associated with risk factors for premature death, disability, poor physical and mental health, and lower quality of life in adults. Traumatic experiences also influence parenting behaviors later in life, placing offspring at an increased risk of ACE exposure. Few studies have explored the intergenerational effects of ACEs on the health and well-being of offspring. This study sought to identify whether associations existed between caregiver ACE exposures and emergency department (ED) utilization for sick …

The Association Of Health Insurance And Prescription Drug Coverage On Cost-Related Non-Adherence And Hospitalization Across Age-Related Groups Of Individuals With Copd, Shamika Martin Walls

Theses and Dissertations

Background: COPD patients have poor adherence to prescribed treatment. Individuals with COPD have higher out-of-pocket treatment cost than individuals without COPD. The significant out of pocket COPD related treatment cost can lead to prescription drug non-adherence especially for individuals without health insurance or prescription drug coverage.

Significance: Since the implementation of Medicare Part D on January 1, 2006, there are no studies that have used national data to evaluate the association of health insurance and prescription drug coverage on cost related non-adherence and hospitalization among individuals 50-64 years old with COPD compared to individuals 65 years and older …

Longitudinal Trajectories Of Depressive Symptoms Among Youth And Young Adults With Type 1 Diabetes: Predictors And Health Outcomes, Melanie Whitmire Sutherland

Theses and Dissertations

Type 1 diabetes (T1D) is one of the most frequently diagnosed chronic illnesses among youth, and has many long-term complications, including retinopathy, neuropathy, and cardiovascular disease. The risk of these complications may be reduced through maintaining glycemic control and one potential risk factor for failure to achieve optimal glycemic control is elevated depressive symptoms among youth and young adults (YYA) with T1D. YYA with T1D are at increased risk of depression, which has been associated with adverse outcomes such as poor adherence to self-management and poor glycemic control. Although a robust body of research exists on the association between comorbid …

Hiv Care Location: An Evaluation Of Single Versus Multi Facility Utilization Of Hiv/Aids Care Services And Patient Health Outcomes And Clinical Indicators In South Carolina, Melanie Gwynn

Theses and Dissertations

Background: On the HIV/AIDS care continuum, the “retention in care” metric does not distinguish between single-facility (SF) or multi-clinic utilization (MC), also described as HIV care location (or type). SF utilization is vital as it has been linked optimal clinical outcomes among People Living with HIV/AIDS (PLWH). Published research detailing the prevalence of HIV care type and its association with health outcomes/clinical indicators, has been studied only in limited urban settings. Additionally, coinfections such as sexually transmitted infections (STIs), have yet to be evaluated as potential predictive factors for HIV care type.

Methods: A cross-sectional design was used …

Health Insurance Program For The Poor, Out-Of-Pocket Costs, And Catastrophic Health Expenditures In India, Shyamkumar Sriram

Theses and Dissertations

Background

India is currently taking steps to provide Universal Health Coverage (UHC) as envisaged in its National Health Policy 2017. Financial protection is considered the backbone of UHC. In India, OOP expenses accounts for about 62.6% of total health expenditure - one of the highest in the world. Out of 1.324 billion people in India, around 12.4% of the population is below the poverty line. Lack of health insurance coverage and inadequate coverage are important reasons for high OOP health expenditures. High OOP health expenditures push many households into poverty. The objective of this research is to examine the effect …

Analysis Of Hpv16 Variants In The Carolina Women’S Care Study And A Comparison Of Gene Expression Profiles Of Exfoliated Cervical Cells From Women Who Either Clear Or Do Not Clear An Hpv16 Infection, Erica Shirlene Green

Theses and Dissertations

Human papillomavirus (HPV) is the etiologic agent for cervical cancer with HPV type 16 (HPV16) being found in about 50% of cervical cancers worldwide. HPVs vary in genomic (DNA) sequence not only between types, but also within types, known as variants. Variants of a particular HPV type may differ by up to 2% in nucleotide sequence in the coding region and up to 5% in the noncoding region. Variants within HPV16 have been identified and grouped into six distinct phylogenetic branches, which segregate geographically: European (E), Asian-American (As.A), African-1 (Af-1), African-2 (Af- 2), Asian (As), and North American (NA). However, …

Clinically Integrated Networks: The ‘Magic Pill’ For Improving The Quality Of Health Care?, Kaitlyn Ann Crosby

Theses and Dissertations

The Patient Protection and Affordable Care Act (ACA) served as a paradigm shift to reimburse physicians based on health outcomes or quality of care patients receive in relation to and conscious of the cost to provide care, rather than the traditional fee-for- service (FFS) system. To implement value-based care under the ACA, value-based care models (VBCM), such as patient-centered medical homes (PCMH) and accountable care organizations (ACO), were formed with the ultimate goal to advance quality of care. Among commercially insured populations, clinically integrated networks (CIN) have emerged as another type of VBCM.

Since CINs are the newest type of …

Susceptibility To Metabolic Disease And Individual Variations In Unfolded Protein Response In Deer Mice (Peromyscus Maniculatus), Amanda Rose Havighorst

Theses and Dissertations

The endoplasmic reticulum is the site where integral membrane and secreted proteins are synthesized and folded, and is also the site of synthesis of steroids, lipids, and other macromolecules. While ER is found in most cell types, hepatocytes in particular contain large amounts of both rough and smooth ER to facilitate their tasks, which include lipoprotein assembly and secretion, cholesterol biosynthesis, and lipid metabolism. As such, stress in the ER – and the cells’ ability to respond to it – plays a key role in disease pathogenesis. In particular, hepatic steatosis, or fatty liver, is linked to ER stress. However, …

Examining Women’S Perceptions Of Maternity Care In Public And Private Sectors Of National Guard Hospitals In Saudi Arabia: A Qualitative Study, Hanin M. Almahmoud

Theses and Dissertations

Every second, a baby is born. The process of birth is a complex one – biologically, medically, and emotionally. In particular, women in labor need both physical and emotional care. They need to be heard, to be comforted, and to be safe.

Women’s satisfaction can be used as a legitimate way to measure the quality of maternity care. Moreover, when health systems practice patient-centered care and listen to women’s concerns and what they want out of their care, it can lead to improvements in their satisfaction. Hospitals in Saudi Arabia are considered to be among the best and most technologically …

An Evidence Based Rationale For Making Tick - Borne Relapsing Fever A Nationally Notifiable Disease, Kyle M. Hatcher

Theses and Dissertations

Tick – borne relapsing fever (TBRF) is globally dispersed, and within the United States is found primarily in the mid – west, south - west, and north – west portions of the country. TBRF is a disease which causes patients to experience flu – like symptoms and is distinguished by multiple relapses of high fever which can cause individuals to be hospitalized multiple times over months. TBRF is caused by Borrelia spp. spirochetes and spread by Onthidoros spp. soft – shelled ticks. First diagnosed in the early 20th century, the disease has gone underdiagnosed and has attracted little attention for …

Contexts Of Recovery And Displacement: Investigating The Impact Of The 2015 South Carolina Floods Across Communities, Van Phan

Theses and Dissertations

In October 2015, South Carolina was devastated by weather complications related to hurricane Joaquin that lead to historic amounts of rainfall and flash floods that destroyed local communities and infrastructure, ultimately displacing over 400,000 people. Natural disasters are destructive and have shown to be correlated with a variety of negative outcomes, including high levels of stress and hopelessness. These effects can be even more pronounced when compounded with displacement as these victims not only have to deal with the usual consequences in the aftermath of a natural disaster, but also the stress of integrating themselves into a different community and …

Role Of Epigenome And Microbiome In Cannabinoid And Aryl Hydrocarbon Receptor-Mediated Regulation Of Inflammatory And Autoimmune Diseases, Zinah Zamil Al-Ghezi

Theses and Dissertations

Inflammation is considered to be the underlying cause of a majority of clinical disorders. Thus, studies aimed at understanding the signaling pathways that trigger inflammation could have significant translational impact. In the current study, we investigated the effect of activation of cannabinoid (CB) and Aryl hydrocarbon hydroxylase (AhR) receptors on the inflammatory response. To that end, we used cannabinoids such as Δ (9)-Tetrahydrocannabinol (THC) and cannabidiol (CBD), and a well-established AhR agonist namely 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD). These were tested against two inflammatory disease models: 1) Experimental autoimmune encephalomyelitis (EAE), an animal model for human multiple sclerosis (MS), and 2) Exposure to …

The Association Of Cardiorespiratory Fitness With Advancing Age Among Those With And Without Type Ii Diabetes, Amber Kathlyn Watson

Theses and Dissertations

OBJECTIVE: This study examined the relationship between cardiorespiratory fitness (CRF) and age to determine if the decrease in CRF associated with advancing age is greater among those with type 2 diabetes mellitus (T2DM) as compared to those without T2DM. This study also assessed if differences in CRF between persons with T2DM and those without are consistent across CRF percentiles.

METHODS: Data from the Aerobics Center Longitudinal Study (ACLS, Dallas, Texas, 1970-2006) were utilized in the current study. CRF was measured by maximal treadmill exercise testing using the Balke protocol and T2DM status was determined by self-report of previous diagnosis by …

Disparities In Colorectal Cancer: Measuring Spatial Accessibility, Screening, And Surveillance Outcomes In South Carolina, Michele J. Josey

Theses and Dissertations

The purpose of this dissertation project is to add to the growing literature about the multi-faceted aspects of colorectal cancer (CRC) prevention and related disparities. We focused on the spatial distribution of facilities performing screening services to identify areas that underutilize colonoscopy screening. Next, we examined how the food and physical activity environment affects precursors of CRC by considering plausible pathways. Finally, we explored if access to health insurance reduced the racial disparity of receiving a timely surveillance colonoscopy after a CRC diagnosis.

We utilized the SC Ambulatory Surgery Discharge Database, an all-payer, population-based outpatient dataset with colonoscopy records from …

Experience Of Persistent Pain Among Military Service Members Participating In An Interdisciplinary Intensive Outpatient Program, Barbara Katarzyna Bujak

Theses and Dissertations

Persistent pain is one of today’s most complex issues in healthcare. In the U.S. military, persistent pain affects close to half of the service members who have deployed overseas and up to 73.2% of service members and veterans experiencing persistent pain. Interdisciplinary pain management, considered one of the most effective ways to manage persistent pain, utilizes the biopsychosocial model that illustrates the dynamic interaction between the physiological, psychological and social factors involved in the experience of persistent pain. Effective interdisciplinary programs address all components of the model and result in better coping skills to self-manage persistent pain, decreased fear of …

Disparities In Non-Small Cell Lung Cancer In The United States: An Examination Of Treatment, Survival, And Access To Care, Cassie Lewis Odahowski

Theses and Dissertations

Lung cancer is the leading cause of cancer-related deaths in the United States with a 5-year survival rate of only 18%. Differences in access to care and treatment utilization may play a role in observed survival disparities among rural patient populations. This dissertation aimed to examine rural disparities in all-cause and lung-cancer specific survival, time to treatment initiation, and utilization of surgical treatment among non-small cell lung cancer cases.

We utilized comprehensive cancer registry data from the Surveillance, Epidemiology, and End Results program linked with Medicare billing claims (SEER-Medicare) for non-small cell lung cancer (NSCLC) patients diagnosed between 2003-2011. We …

Astrocyte Sensitivity To Dopamine In Culture And Ex Vivo, Ashley L. Galloway

Theses and Dissertations

Dopamine is critical for processing of reward and etiology of drug addiction. Astrocytes throughout the brain express dopamine receptors, but consequences of astrocytic dopamine receptor signaling are not well established. This thesis illustrates effects of dopamine on cultured astrocytes and astrocytes in brain slices (ex vivo). In striatal cultures, extracellular dopamine triggered changes in astrocytic Ca²⁺ signaling and rapid concentration-dependent stellation of astrocytic processes that was not a result of dopamine oxidation, but instead relied on both cAMP-dependent and cAMP-independent dopamine receptor signaling. To isolate possible mechanisms underlying these structural and functional changes, whole-genome RNA sequencing was …

Macrophages And Associated Inflammation Differentially Impact Obesity, Colorectal Cancer And Obesity-Enhanced Colorectal Cancer, Jackie Bader

Theses and Dissertations

Colorectal Cancer (CRC) is the third-most common malignancy for men or women, with chronic inflammation considered as a primary risk factor. Obesity is also considered a chronic inflammatory disease and is associated with increased CRC incidence. Further, obesity and CRC occur in men and women differently with the highest incidence of either disease found in men, suggesting that female sex hormones may play a protective role in inflammatory diseases. Macrophages can promote inflammation and are a driving force in obesity-associated metabolic dysfunction. Conversely, macrophages also contribute to pro-tumoral responses including, proliferation, angiogenesis and tissue remodeling. This heterogeneity of macrophage behavior …

Effects Of Human Dopamine Transporter (Dat) Mutations And Novel Allosteric Modulatory Compounds In Disrupting Hiv-1 Tat-Dat Protein Interaction, Pamela Marie P. Quizon

Theses and Dissertations

More than 37 million people are living with HIV worldwide. Despite the widespread use of antiretroviral therapy (ART), up to 70% of HIV-positive individuals suffer from cognitive and behavioral deficits collectively known as HIV-associated neurocognitive disorders (HAND). HIV-mediated damage to the dopaminergic system is a mediating factor in HAND. Dopamine (DA) transporter (DAT)-mediated reuptake is essential for maintaining DA homeostasis. Because most ART cannot efficiently cross the blood-brain barrier (BBB), the brain serves as a viral reservoir that facilitates the spread of infection to microglia and astrocytes. Infected cells shed viral proteins such as Tat, which plays a critical role …

Investigating The Neural Correlates Of Nicotine Withdrawal Phenotypes In Mice: Involvement Of Creb-Dependent Nrg3-Erbb4 Signaling In Mediating Anxiety-Like Behavior, Miranda Fisher

Theses and Dissertations

Addiction to nicotine and the ability to quit smoking are influenced by genetic factors. Therefore, it is important to understand how genes and drugs of abuse mechanistically impact each other. One well-characterized protein responsible for regulating both response to drugs and gene expression is the transcription factor cAMP response element-binding protein (CREB). Work from our lab indicates that hippocampal specific alterations in CREB signaling and synaptic plasticity underlie certain nicotine withdrawal (WD) phenotypes in a region-specific manner. We found that CREB deletion in the ventral hippocampus (VH), a region known for regulation of mood and emotion, results in amelioration of …

The Association Of Rural Hospital Closures With In-Hospital And 30-Day Post Hospital Discharge Mortality From Emergency Care Sensitive Conditions, Melinda A. Merrell

Theses and Dissertations

Purpose

Over 100 rural hospitals have closed in the U.S. since 2010. Continuous pressures on the rural health care delivery system suggest that the trajectory of closures will continue in at least the short-term. While the causes of rural hospital closures have been described in the literature, the effects on the health outcomes of populations that experience these closures are still poorly understood. The purpose of this study was to determine associations between rural hospital closures and in-hospital and 30-day post hospital discharge mortality rates for affected residents experiencing time-sensitive emergencies in two U.S. states.

Methods

Rural hospital closures were …

Epigenetic And Purinergic Regulation Of Mast Cells Mediator Release, Zahraa Abdulmohsin Mohammed

Theses and Dissertations

Mast cells (MCs) are well known for their implications in allergic reactions. They are also known to have multiple functions in the innate and adaptive immune system. Their activation plays an essential role in many aspects of physiological and pathological conditions. Allergies are considered chronic conditions that affect more than 60 million people in the U.S. These diseases are driven by the activation of MCs in response to IgE-mediated antigen, rendering these cells as targets for the management of allergies and asthma. Therefore, this research considers the understanding of their activation and the regulation of their response to be an …

Exploration Of Early Spelling In Children With Hearing Loss, Carson Aho

Theses and Dissertations

Purpose: The purpose of this study was to determine differences in spelling errors between children with normal hearing and children with hearing loss in kindergarten.

Method: Participants included 21 children with normal hearing and 23 children with hearing loss. All children used spoken English as their primary language. The children with hearing loss all utilized a hearing amplification device. Participants completed three single-word spelling assessments, a language assessment, and an oral reading assessment. An independent samples t-test was used to determine if the groups had differences in the number of spelling errors and whether a difference was observed within the …

Speech Entrainment To Improve Spontaneous Speech In Broca's Aphasia., Helga Thors

Theses and Dissertations

Speech entrainment, a treatment method that requires participants to mimic the speech of an audiovisual model in real time, has been shown to benefit individuals with non-fluent aphasia when they speak about trained topics. It is unclear if it improves spontaneous speech, which does not pertain to trained items, in the same way. In an effort to investigate this matter, the current study examined the effects of speech entrainment on spontaneous speech that does not relate to trained items, it also estimated effect sizes associated with improvements in speech production as a result of this treatment approach, and explored participant …