Medicine and Health Commons^™

Economic Analysis Of Population-Based Next Generation Sequencing For Breast Cancer, Sapphire Curelaru

University Honors Theses

Breast cancer develops due to accumulated DNA replication insults which causes cancer to uncontrollably proliferate. An individual's predisposition to developing cancer, as well as the composition of a tumor, can be sequenced using genetic tests. Myriad's BRACAnalysis CDx^® seems to be the most utilized genetic test. However, Next Generation Sequencing (NGS) seems to be a better genetic test for breast cancer when compared to Myriad's BRACAnalysisCDx^® in terms of return-time, accuracy, efficiency, and healthcare cost. By using Next Generation Sequencing tests, stakeholders can save money on genetic testing which can be invested in more genetic tests. Payers can …

Laughing Through The Pain: An Analysis Of Dark Humor In Trauma-And-Crisis-Centered Occupations, Zoe R. Potter

University Honors Theses

The use of dark, or "black" humor by professionals in trauma-and-crisis-centered occupations is common, with fields such as healthcare, crime, emergency response, and social work reporting frequent use of dark humor on the job. Using a literature review approach, peer-review articles were examined to understand the function that dark humor plays in trauma-and-crisis-centered fields. The findings suggest that dark humor acts as a coping mechanism, and contributes to various group dynamics between colleagues. The literature was also reviewed for the effects that dark humor has on patients or people in contact with trauma-and-crisis personnel. While some preliminary findings point to …

Treatment Disparities In Emergency Medical Services: The Influence Of Race/Ethnicity, Obesity, And English Proficiency, Jamie Kennel

Dissertations and Theses

Different treatment in healthcare settings provided to different social groups of people may lead to disparities in health, quality of life, and life span. Despite the critical role among healthcare services that Emergency Medical Services (EMS) provides disproportionately for marginalized communities, it remains unclear if and to what extent treatment disparities take place in the pre-hospital setting. Guided by the theoretical frameworks of social worth, aversive racism, and stigma, this study utilizes medical chart data from three different public and private datasets to investigate treatment disparities by Emergency Medical Service providers for racial minority, obese, and limited English proficiency patients. …

Science In Service Of Man: Towards An Understanding Of Medicine As An Institution Of Control, Amanda M. Strother

University Honors Theses

This paper applies the theoretical work of Frantz Fanon to discuss healthcare as an institution that upholds the will of the dominant authority in the contemporary United States. The use of Fanon's work outside of its original context is justified by applying the internal colonialism theory. Correctional healthcare is discussed as an area of overtly controlling and dehumanizing medical care, highlighting caregiver loyalty to correctional authority and reciprocal distrust between prison physicians and patients. This inquiry proposes that clinical healthcare displays the same power relationships through loyalty to the business of healthcare and the reciprocal distrust between physicians and patients …

Survey Deficiencies As Quality Indicators In Oregon Assisted Living Communities, Ozcan Tunalilar, Sunny C. Lin, Paula C. Carder

Institute on Aging Publications

Background and Objectives License inspection data have commonly been used as a quality measure for nursing homes but has not yet been used to assess the quality of assisted living/residential care (AL/RC) communities. Drawing on resource dependency theory, we test the hypothesis that structural and environmental characteristics influence AL/RC quality as measured by deficiency citations (“deficiencies”) issued during license inspections.

Research Design and Methods Using data from 526 licensed AL/RC communities in Oregon that received a license inspection visit between 2008 and 2016, we examined the prevalence of deficiencies by type and year. We estimated regression models to identify structural …

Employer-Reported Access To Paid Parental Leave: A Study Of San Francisco’S Paid Parental Leave Ordinance, Julia M. Goodman, Holly Elser, William H. Dow

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: A growing body of research finds that paid leave policies have significant population health benefits for workers and their families, but the lack of a national paid leave policy in the United States leaves most workers without access to any paid leave. In 2017 San Francisco implemented the nation’s first fully paid leave policy, mandating that covered employers provide up to six weeks of leave to care for a new child. The objective of our study is to examine how the San Francisco Paid Parental Leave Ordinance (PPLO) affected paid leave access, including among workers in low-wage industries. Methods: …

Afghan Refugees And The Coronavirus Pandemic, Grant M. Farr

Sociology Faculty Publications and Presentations

The coronavirus, along with international economic sanctions and the collapse of the world oil market, has devastated Iran and its economy, bringing the jobs that Afghan refugees have depended on for a livelihood to a halt. Over the last four decades thousands of Afghans have fled their war torn country and have been living in Iran. Now these Afghan refugees are returning to Afghanistan. Although some of the refugees are leaving on their own, many thousands are being forcefully expelled. These returning refugees are overwhelming the meager medical resources of Afghanistan, spreading the coronavirus across the country. These returning refugees …

Racial/Ethnic Differences In Multimorbidity Development And Chronic Disease Accumulation For Middle-Aged Adults, Ana R. Quiñones, Anda Botoseneanu, Sheila Markwardt, Corey L. Nagel, Jason T. Newsom, David A. Dorr, Heather G. Allore

Psychology Faculty Publications and Presentations

Multimorbidity–having two or more coexisting chronic conditions–is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years.

We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly- available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic …

Health Behavior Among Men Occupying Multiple Family Roles And The Moderating Effects Of Perceived Partner Relationship Quality, Nicole Depasquale, Courtney A. Polenick, Jesse Hinde, Jeremy Bray, Steven H. Zarit, Phyllis Moen, Leslie B. Hammer, David M. Almeida

Psychology Faculty Publications and Presentations

Men in the U.S. are increasingly involved in their children’s lives and currently represent 40% of informal caregivers to dependent relatives or friends aged 18 years or older. Yet, much more is known about the health effects of varying family role occupancies for women relative to men. The present research sought to fill this empirical gap by first comparing the health behavior (sleep duration, cigarette smoking, alcohol consumption, exercise, fast food consumption) of men who only occupy partner roles and partnered men who also fill father, informal caregiver, or both father and informal caregiver (i.e., sandwiched) roles. The moderating effects …

Military Factors Associated With Smoking In Veterans, Sara E. Golden, Sujata Thakurta, Christopher G. Slatore, Hyeyoung Woo, Donald R. Sullivan

Sociology Faculty Publications and Presentations

Introduction: Given the high prevalence of smoking among Veterans and the economic, social, and clinical implications, it is important to understand the factors that contribute to smoking in order to focus efforts to mitigate these factors and improve smoking cessation efforts among Veterans. The availability of research on smoking in Veterans compared with civilians is limited given the military-specific differences in their life course. We aimed to identify military-specific factors combined with sociodemographic factors for ever smoking and current smoking among Veterans to inform future interventions. Materials and Methods: We used data from the 2010 National Survey of Veterans, the …

Impact Of The Childhood Vaccine Discussion Format Over Time On Immunization Status, Douglas J. Opel, Chuan Zhou, Jeffrey D. Robinson, Nora Henrikson, Katherine Lepere, Rita Mangione-Smith, James A. Taylor

Communication Faculty Publications and Presentations

Objective: Presumptive formats to initiate childhood vaccine discussions (e.g. “Well we have to do some shots.”) have been associated with increased vaccine acceptance after one visit compared to participatory formats (e.g. “How do you feel about vaccines?”). We characterize discussion format patterns over time and the impact of their repeated use on vaccine acceptance.

Methods: We conducted a longitudinal prospective cohort study of children of vaccine-hesitant parents enrolled in a Seattle-based integrated health system. After the child’s 2, 4, and 6 month visits, parents reported the format their child’s provider used to begin the vaccine discussion (presumptive, participatory, or …

The Summit Ambulatory‑Icu Primary Care Model For Medically And Socially Complex Patients In An Urban Federally Qualified Health Center: Study Design And Rationale, Brian Chan, Samuel T. Edwards, Meg Devoe, Richard Gil, Matthew Mitchell, Honora Englander, Christina Nicolaidis, Multiple Additional Authors

School of Social Work Faculty Publications and Presentations

Background: Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. We present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research.

Methods/design: Participants are patients at a Federally Qualified Health Center in Portland, Oregon that serves patients experiencing homelessness or …

Socioeconomic Determinants Of Health Disparities By Race And Ethnicity: The Mediating Role Of Social, Psychological And Behavioral Factors, Amanuel Zimam Melekin

Dissertations and Theses

Socioeconomic status (SES) is inversely related to health status. Disparities in health status among races and ethnic groups are partly attributable to differences in SES, but the indirect pathways by which SES may influence health status are not widely studied.

Using the Health and Retirement Study (HRS) data, this dissertation examined the pathways by which SES, via social, psychological, and behavioral factors predicted physical impairment and overnight hospitalization, and asked whether these indirect relationships differed by race/ethnicity. The HRS is a nationally representative multistage area probability sample administered biennially to respondents over the age of 51 and their spouses. Data …

Waiting For The Wisdom To Drop: A Photovoice Exploration Of Menopause, Delinda L. Free

Student Research Symposium

The purpose of this study was to create a women’s menopause discussion group based on the Photo Voice method, to use a narrative approach to learn what is currently relevant in the experience of menopausal women, to reveal insights about menopause as a phase of psychological development, and to bring a visual representation together with narratives to tell a story about the collective psychological themes. Participants were asked to meet and reflect on what has changed in their values, attitudes, aspirations, goals, and outlook on life. Then participants were asked to take pictures over the course of a week, and …

Psychosocial Challenges Facing Women Living With Hiv During The Perinatal Period In Rural Uganda, Scholastic Ashaba, Angela Kaida, Jessica N. Coleman, Bridget F. Burns, Emma Dunkley, Kasey O'Neil, Jasmine Kastner, Naomi Sanyu, Cecilia Akatukwasa, David R. Bangsberg, Lynn T. Matthews, Christina Psaros

OHSU-PSU School of Public Health Faculty Publications and Presentations

The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum.

We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and …

The Intersection Between Masculinity And Health Among Rural Immigrant Latino Men, Jason Daniel-Ulloa, Christina J. Sun, Scott D. Rhodes

OHSU-PSU School of Public Health Faculty Publications and Presentations

Latino men experience health disparities in STI/HIV, diabetes, hypertension, and cancer. Gender roles likely play a role in risk behaviors and outcomes; however, there has been little focus on masculinity in Latino men. We conducted 20 semi-structured interviews with Latino men living in North Carolina. The interviews, conducted by a trained bilingual/bicultural Latino male, prompted discussion around work, family, and stress. Four themes were identified: masculine roles of being a family provider and protector, sources of stress, family responsibility and interconnectedness to health, and coping mechanism. For Latino men, masculinity may have both positive and negative influences on health. For …

Bidirectional Associations Between Rheumatoid Arthritis And Depression: A Nationwide Longitudinal Study, Ming-Chi Lu, How-Ran Guo, Miao-Chiu Lin, Hanoch Livneh, Ning-Sheng Lai, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Rheumatoid arthritis (RA) and depression may be associated with each other pathophysiologically, but few studies have been conducted on the interplay between these two diseases using longitudinal measurement. Therefore, we used the National Health Insurance Research Database of Taiwan to investigate the bidirectional associations between RA and depression. One cohort was included to analyze RA predicting the onset of depression and a second cohort for analysis of depression predicting RA. A sex- and age-matched control group was included for both. The incidence of depression in RA subjects was higher than in non-RA subjects [15.69 vs. 8.95 per 1,000 person-years (PYs)], …

The Ability Of Narrative Communication To Address Health-Related Social Norms, Meghan B. Moran, Sheila T. Murphy, Lauren B. Frank, Lourdes Baezconde-Garbanati

Communication Faculty Publications and Presentations

Social norms are an important predictor of health behavior and have been targeted by a variety of health communication campaigns. However, these campaigns often encounter challenges related to the socially specific context in which norms exist: specifically, the extent to which the target population identifies with the specific reference group depicted and the extent to which the target population believes the campaign’s message. We argue that because of its capacity to effect identification among viewers, narrative communication is particularly appropriate for impacting social norms and, consequently, behavioral intention. This manuscript presents the results of a randomized trial testing the effectiveness …

Racial Disparities In Infant Mortality, 1990 To 2004: Low Birth Weight, Maternal Complications And Other Causes, Ginny Garcia-Alexander, Hyeyoung Woo

Sociology Faculty Publications and Presentations

Demographers have long studied the unacceptably high rates of infant mortality in the U.S., relative to other advanced countries. These higher rates are largely attributable to persistent racial gaps in infant health outcomes and are likely a reflection of social inequalities, which manifest as poorer infant health outcomes in certain groups. We extend on previous research in this area by utilizing the restricted 1990 and 2000 cohort linked birth-death files to examine the risk of infant death due to several main causes including: maternal complications, low birth weight, and other causes, and how it has changed over time. We estimate …

Trends And Disparities In Postpartum Sterilization Following C-Section, 2000-2008, Ginny Garcia-Alexander, Dawn M. Richardson, Kelly Gonzales, Adolfo Gabriel Cuevas

Sociology Faculty Publications and Presentations

Objectives. We examined variations in the prevalence of postpartum tubal sterilizations following cesarean sections (C-sections) from 2000 to 2008. Methods. We used data from the National Hospital Discharge Survey (NHDS) to estimate odds ratios for patient- (race, marital status, age) and system-level factors (hospital size, type, region) on the likelihood of receiving tubal sterilization after C-section. Results. A disproportionate share of postpartum tubal sterilizations following C-section was covered by Medicaid. The likelihood of undergoing sterilization was increased for Black women, women of older age, and non-single women. Additionally, they were increased in proprietary and government hospitals, smaller hospital settings, and …

Conceptualizing Risk And Effectiveness: A Qualitative Study Of Women’S And Providers’ Perceptions Of Nonsurgical Female Permanent Contraception, Elizabeth K. Harrington, Diane Gordon, Isabel Osgood-Roach, Jeffrey T. Jensen, Jennifer Aengst

Anthropology Faculty Publications and Presentations

Objective: Novel approaches to nonsurgical permanent contraception (NSPC) for women that are low cost and require no incision or hysteroscope/surgical equipment could improve access to, and the acceptability of permanent contraception (PC). To better understand opportunities and limitations for NSPC approaches, we examined women's and OB/GYN providers' perceptions of NSPC in Portland, OR.

Study Design: Semi-structured, qualitative interviews were conducted with 40 women recruited from outpatient clinics with purposive sampling, and a focus group was conducted with 9 OB/GYNs in academic and community practice. Transcripts were coded and inductively analyzed with a grounded theory approach.

Results: The majority of women …

Activist Doctors: Explaining Physician Activism In The Oregon Movement For Single-Payer Healthcare, Jennifer Cullen Loomis

Dissertations and Theses

Changes in American healthcare over the last half century have created social and economic crises, presenting challenges for doctors and patients. The recently-implemented Patient Protection and Affordable Care Act is an incremental reform that does little to change the complex multi-payer financing characterizing American healthcare. There have been growing demands for more equitable financing arrangements, notably, a single-payer healthcare system in which medical care is financed through a single, non-profit payer and in which medical care is treated as a public good and medically-necessary care is available to everyone.

Nationally-representative surveys have demonstrated widespread physician support for single-payer legislation. Yet, …

Association Of Childhood Physical And Sexual Abuse With Intimate Partner Violence, Poor General Health And Depressive Symptoms Among Pregnant Women, Yasmin V. Barrios, Bizu Gelaye, Qiuyue Zhong, Christina Nicolaidis, Marta B. Rondon, Pedro J. Garcia, Pedro A. Mascaro Sanchez, Sixto E. Sanchez, Michelle A. Williams

School of Social Work Faculty Publications and Presentations

Objective

We examined associations of childhood physical and sexual abuse with risk of intimate partner violence (IPV). We also evaluated the extent to which childhood abuse was associated with self-reported general health status and symptoms of antepartum depression in a cohort of pregnant Peruvian women.

Methods

In-person interviews were conducted to collect information regarding history of childhood abuse and IPV from 1,521 women during early pregnancy. Antepartum depressive symptomatology was evaluated using the Patient Health Questionnaire-9. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).

Results

Any childhood abuse was associated with …

Congestive Heart Failure Self-Management Among Us Veterans: The Role Of Personal And Professional Advocates, Eleni Skaperdas, Anaïs Tuepker, Christina Nicolaidis, Jessica K. Robb, Devan Kansagara, David H. Hickam

School of Social Work Faculty Publications and Presentations

Objective: Understand patients’ experiences with primary care services for congestive heart failure (CHF) and explore the relationship between health services and self-management.

Methods: We conducted semi-structured interviews with thirty-nine patients with CHF receiving care at one Veterans Affairs Medical Center (VA). We analyzed data using thematic content analysis.

Results: Participants acknowledged the importance of ongoing engagement in the plan of care for CHF. They attributed success in this effort to be greatly influenced by personal advocates. The advocates included both members of the healthcare team with whom they had a continuity relationship and friends or family members who assisted on …

Citizenship Documentation Requirement For Medical Eligibility: Effects On Oregon Children, Brigit A. Hatch, Jennifer E. Devoe, Jodi A. Lapidus, Matthew J. Carlson, Bill J. Wright

Sociology Faculty Publications and Presentations

BACKGROUND AND OBJECTIVES: The Deficit Reduction Act (DRA) of 2005 mandated Medicaid beneficiaries to document citizenship. Using a prospective cohort (n=104,375), we aimed to (1) determine characteristics of affected children, (2) describe effects on health insurance coverage and access to needed health care, and (3) model the causal relationship between this new policy, known determinants of health care access, and receipt of needed health care.

METHODS: We identified a stratified random sample of children shortly after the DRA was implemented and used state records and surveys to compare three groups: children denied Medicaid for inability to document citizenship, children denied …

Exploring The Effects Of Multi-Level Protective And Risk Factors On Child And Parenting Outcomes In Families Participating In Healthy Start/Healthy Families Oregon (Hs/Hfo), Peggy Nygren

Dissertations and Theses

While many studies focus on the links between multiple risk factors and negative outcomes such as child maltreatment, less is known about the influence of protective factors in the face of risks. The theoretical base of this study was a social ecological model of interactive influences including individual parent, family, and neighborhood level factors to predict outcomes. Protective Factor Index (PFI) and Risk Factor Index (RFI) predictors were developed to explore potential multi-level protective factor buffering effects on key child development and parenting outcomes. Participants were first time mothers enrolled in a randomized controlled study of the Healthy Start/ Healthy …

The Association Between Insurance Status And Cervical Cancer Screening In Community Health Centers: Exploring The Potential Of Electronic Health Records For Population-Level Surveillance, 2008-2010, Stuart Cowburn, Matthew J. Carlson, Jodi A. Lapidus, Jennifer E. Devoe

Sociology Faculty Publications and Presentations

Introduction: Cervical cancer incidence and mortality rates in the United States have decreased 67% over the past 3 decades, a reduction mainly attributed to widespread use of the Papanicolaou (Pap) test for cervical cancer screening. In the general population, receipt of cervical cancer screening is positively associated with having health insurance. Less is known about the role insurance plays among women seeking care in community health centers, where screening services are available regardless of insurance status. The objective of our study was to assess the association between cervical cancer screening and insurance status in Oregon and California community health centers …

Public Opinion And The Oregon Death With Dignity Act, Peggy Jo Ann Sandeen

Dissertations and Theses

Oregon voters legalized physician-assisted death in 1997 by passing the Oregon Death with Dignity Act. This law allowed terminally ill, mentally competent adult residents of the state to legally obtain a physician's prescription to hasten death under narrow sets of circumstances. The purpose of this study was twofold: to examine contemporary patterns of support for the law in Oregon and to explore how opinions have changed over time on the issue. This study examined patterns of public support among a random sample of registered Oregon voters for the state's death with dignity law, using a mixed mode (mail, online, and …

System Dynamics Modeling Of Prescription Opioid Pain Reliever Abuse, Alexandra Nielsen

Systems Science Friday Noon Seminar Series

The nonmedical use of prescription opioid pain relievers and associated overdose deaths have been labeled an epidemic by the Centers of Disease Control and Prevention. While these medicines play an important role in the treatment of pain, the benefits of opioids for the treatment of pain need to be balanced against these very real risks. Alex has been working closely with Professor Wayne Wakeland, Teresa Schmidt, and Dr. Dennis McCarty (OHSU) to create a dynamic systems-level model of opioid use, abuse, and diversion in order to give context to current research in this area and to provide a better understanding …

Toward A Culture Of Healing: Why Alternative Therapies And A Feminist Framework Are Needed In The Care Of Pregnant Women And Treatment Of Postpartum Mood Disorders, Angela Leonardo

Anthós

Pregnancy, birth, and early motherhood are areas of human development that have systematically migrated away from their roots as a series of natural life events to a highly, and perhaps unnecessarily, medicalized arena. This shift has been detrimental for women, especially for poor, socially isolated, single, and/or ethnic minority women. In this paper, I outline my concerns with the increased medicalization of birth and postpartum care, as well as with the status of mothers in the United States, and critically examine the patriarchal context in which this shift has occurred. My focus is on maternal health and mortality, including depression …