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 …

The Experience Of Living With Breast Cancer: Puerto Rican Women Tell Their Stories, Madeline Hernández-Ramirez

Doctoral Dissertations

Abstract Breast cancer is the most common form of cancer in women of all ethnic groups. Women living with breast cancer encounter not only physical problems but also psychological stress. The breast cancer diagnosis causes crisis for both patients and their families. Research of the lived experience of Puerto Rican women with breast cancer is scarce, and the little research found often classifies Puerto Rican women together with other groups such as Latin or Hispanic. While similarities of breast cancer experiences exist within Latin subgroups, aspects experienced by Puerto Rican women might be unique to them. Unique elements of a …

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 …

Ipmtc- An Emerging Nursing Theory On Transitioning Individuals With Traumatic Brain Injury From Long-Term Care Facilities To The Community Under Medicaid Waiver Programs, Sylvia Abbeyquaye

Doctoral Dissertations

This study aims to explore the process of transitioning individuals with traumatic brain injury (TBI) from long-term care settings to the community and develop a theory of transition. Also, it explores the definition of successful transitioning and the perceived role of the nurse in the transitioning process. A constructivist grounded theory method guided by symbolic interactionism was used in this study. The research sample was recruited throughout the Commonwealth of Massachusetts. The sample included individuals with TBI, family caregivers, professional caregivers, and community service providers involved with the Acquired Brain Injury and the Money Follows the Person waiver programs in …

The Lived Experience And Factors Affecting Disclosure Of Pregnant Victims Of Domestic Violence, Pedro Vargas Ortiz

Doctoral Dissertations

Domestic violence is defined as a pattern of assaultive and coercive behaviors that includes the threat or infliction of physical, sexual, or psychological abuse that is used by perpetrators for the purpose of intimidation and control over the victim. The lived experience and meaning of domestic violence in Puerto Rican pregnant women has not been well researched. This study described pregnant women’s lived experience of domestic violence and examined the factors influencing the process of disclosure of domestic violence among pregnant women in the southern region of Puerto Rico. A phenomenological method was used where women who have experienced domestic …

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 …

Using Motivational Interviewing To Increase Walking And Functional Ability In Older Adults: A Quasi-Experimental Study, Erin Lamoureux

Doctoral Dissertations

The purpose of this study was to determine if brief motivational interviewing (MI) sessions would increase daily steps and functional ability in older adults. Regular exercise in the older adult can slow the physical, psychological, and functional decline that is often associated with aging. However, only 25% of adults aged 65 and older meet the suggested physical activity recommendations of the American Heart Association and the National Institute of Health. Understanding what may contribute to the initiation and adherence of exercise within the older adult population might identify interventions that would successfully increase physical activity. This study focused specifically on …

The Influence Of Patellofemoral Pain On Muscle Coordination, Segment Coordination, And Segment Coordination Variability In Runners, Carl Jewell

Doctoral Dissertations

Management of patellofemoral pain syndrome (PFPS) remains a significant challenge in clinical practice and there is a need to understand the mechanisms for altered gait and muscular function which may lead to poor patient outcomes. The overall aim of the three studies in this dissertation was to determine if runners with current PFPS adapt their gait and muscle activation as a result of long-term, daily pain and/or in response to an acute pain flare and exertion during a moderate intensity 21-minute treadmill run compared to healthy controls. In addition, a resolved, asymptomatic PFPS group was included to investigate potential mechanisms …

Exploring How Nurse Beliefs And Attitudes Influence End-Of-Life-Care Practice, Cara Chandler

Doctoral Dissertations

Nurses are the cornerstones to provide safe patient care. Studies about nurses experiencing challenges while providing end-of-life care (EOLC) are limited. It is imperative to understand how nurses’ beliefs and attitudes influence their actions while providing EOLC. The aims of this study were to (a) explore the relationship of personal factors and nurse beliefs and attitudes on providing EOLC and (b) examine the relationship of nurse beliefs and attitudes on intention and performance to provide EOLC. These aims were explored in a convenience sample of nurses working in multiple adult patient settings. The Theory of Planned Behavior guided a cross-sectional …

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 …

Real-Time Dengue Forecasting In Thailand: A Comparison Of Penalized Regression Approaches Using Internet Search Data, Caroline Kusiak

Masters Theses

Dengue fever affects over 390 million people annually worldwide and is of particu- lar concern in Southeast Asia where it is one of the leading causes of hospitalization. Modeling trends in dengue occurrence can provide valuable information to Public Health officials, however many challenges arise depending on the data available. In Thailand, reporting of dengue cases is often delayed by more than 6 weeks, and a small fraction of cases may not be reported until over 11 months after they occurred. This study shows that incorporating data on Google Search trends can improve dis- ease predictions in settings with severely …

Clpxp-Regulated Proteins Suppress Requirement For Reca In Dam Mutants Of Escherichia Coli K-12, Amie Savakis

Masters Theses

Double strand breaks (DSB) are a common source of DNA damage in both prokaryotes and eukaryotes. If they are not repaired or are repaired incorrectly, they can lead to cell death (bacteria) or cancer (humans). In Escherichia coli, repair of DSB are typically accomplished via homologous recombination and mediated by RecA. This repair pathway, among others, is associated with activation of the SOS response. DNA adenine methyltransferase (dam) mutants have an increased number of DSB and, therefore, are notorious for being RecA-dependent for viability. Here, we show that the synthetic lethality of Δdam/ΔrecA is suppressed when clpP is removed, suggesting …

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 …

Bodies Under Siege: Intersections Of Warfare And Hiv/Aids, Daniel Nevarez Araujo

Doctoral Dissertations

Analyzing works by Juan Goytisolo, Rabih Alameddine, and Derek Jarman, this dissertation studies the similarities of war and AIDS as sensorial experiences socially located and complexly embodied. This study looks at the ways bodies engage with, are affected by, and respond to both war and AIDS, specifically within the AIDS/War Narrative; that is, narrative spaces that foreground both experiences simultaneously. Influenced by Mark Paterson’s notion of felt phenomenology and positioned at the nexus of Comparative Literature, Disability Studies, and Husserlian phenomenology, this dissertation studies texts that exhibit an awareness of the phenomenal characteristics governing the experiences of AIDS and war, …

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 …

Extrinsic And Intrinsic Factors In Liver Development, Amrita Palaria

Doctoral Dissertations

Liver is the largest internal organ of the human body. It performs a multitude of functions. Therefore, it is provided with a huge regenerative capacity however, because of the same reason it is also prone to various diseases. Hence, it is essential to understand liver development in order to understand liver regeneration and liver diseases to provide better therapeutic targets and solutions. Liver development is orchestrated by a variety of intrinsic and extrinsic factors. The major focus of this dissertation thesis is to elucidate the role of BMP signals and YY1/VEGFA regulated signals in liver development. Liver organogenesis initiates with …

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 …

The Effect Of Social Networks On Self-Care Behaviors And Health Outcomes Among Older People Living With Multiple Chronic Conditions, Raeann G. Leblanc

Doctoral Dissertations

Background: Older adults are the fastest growing segment of the population in the United States. By 2030, 72.1 million Americans will be over sixty-five years of age and many live with and manage multiple chronic conditions. Self-care behaviors are a priority to effectively manage chronic conditions, yet a gap exists in our understanding of how social networks influence the outcomes of self-care behavior and health within the context of aging and managing multiple chronic conditions. Objective: The aim of this study was to determine how social network features and functions influence self-care behaviors and health among community dwelling older adults …

The Impact Of Perceived And Observed Food Environments On Fruit And Vegetable Consumption And Obesity: A Theory-Based Study Among U.S. Older Adults, Qianzhi Jiang

Doctoral Dissertations

The overall diet quality of U.S. older adults is less than optimal, featured by inadequate fruits and vegetables (FV), whole grains and dairy, and excessive sodium and fat. The current food environment can be challenging for older adults to improve their FV consumption. Both perceived and observed food environments are linked to FV consumption and health outcomes such as Body Mass Index (BMI) with mixed results. My research was guided by a social-ecological framework and the theory of planned behavior (TPB) to identify environmental supports for FV consumption in older adults. Adults aged 60 and older in Massachusetts, Iowa, and …

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 …

Maternal Outcomes Of Women Who Prefer To Communicate In English Compared To Women Who Prefer To Communicate In A Language Other Than English In New England, Katharine Green

Doctoral Dissertations

Introduction: Language acquisition is the primary marker of acculturation to the dominant society in a receiving geographic area, and effective communication in English is a marker of acculturation in the United States. There is good evidence that women who receive midwifery care have improved maternal outcomes, and that women who are not well acculturated to the dominant culture in the United States have improved neonatal outcomes. However, the maternal outcomes of women who do not communicate in English are not well studied, nor is it known whether care during parturition by physicians when compared to nurse midwives makes a difference …

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 …

“Tell Me A Story®”: Promoting Resiliency In Military Children, Katherine-Marie Conover

Doctoral Dissertations

Multiple and lengthy deployments of military members are common and negatively impact children’s well-being. Programs seek to increase resiliency and reduce potential negative impact of parental deployment on children exist but lack empirical evidence to support their effectiveness. Increased parent engagement through reading and subsequent discussion with their children has positive psychology implications and potential to improve resilience. Thus, this study’s purpose was to examine the effectiveness of the intervention Tell Me A Story® (TMAS) in improving resiliency in school-age children (aged 6 to 10 years) of active duty military members. This study also aims to examine the impact of …

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 …