Digital Commons Network^™

Treatments And The Perspectives Of Developing A Vaccine For Chagas Disease, Priscila Silva Grijó Farani, Kathryn Marie Jones, Cristina Poveda

Faculty, Staff and Students Publications

Chagas disease (CD) treatment and vaccine development are critical due to the significant health burden caused by the disease, especially in Latin America. Current treatments include benznidazole and nifurtimox, which are most effective in the acute phase of the disease but less so in the chronic phase, often with significant side effects. Here, using the available literature, we summarize the progress in vaccine development and new treatments that promise to reduce CD incidence and improve the quality of life for those at risk, particularly in endemic regions. New treatment options, such as posaconazole and fexinidazole, are being explored to improve …

Ammonia Exposure Based On The Length Of Work To Lung Function Abnormalities Among Traditional Scavengers, Maulyda Shakeela Jasmine, Fajaria Nurcandra, Nayla Kamilia Fithri, Arga Buntara

Kesmas

Lung function abnormalities can be caused by smoking habits or air pollution. Sanitary landfills can produce ammonia, which can cause lung function abnormalities. This study aimed to determine a relationship between ammonia exposure based on the length of work and lung function abnormalities among traditional scavengers at the Sumur Batu Landfill, Bekasi City, West Java Province, Indonesia. This analytical observational study applied quantitative methods and cross-sectional design. A total of 85 scavengers were selected using purposive sampling from March to May 2023. Data was obtained using a respondent characteristics questionnaire, spirometry, and spectrophotometer and analyzed using the Cox Regression Model. …

N-Acetyl-S-(N-Methylcarbamoyl)-Cysteine (Amcc) As Cumulative Biomonitoring Of Dimethylformamide Exposure Among Industrial Workers, Angga Arifianto, Muhammad Ilyas, Herqutanto .

Occupational and Environmental Medicine Journal of Indonesia

Background: N,N-Dimethylformamide (DMF) is an aliphatic amide which is miscible with water and a majority of organic liquids. Due to its amphiphilic properties, it is a widely used industrial solvent, especially for polymers. DMF has been consistently hepatotoxic, inducing effects on the liver at lowest concentrations or doses. N-acetyl-S-(N-methylcarbamoyl)cysteine (AMCC) which is one major metabolites of DMF, found in urine after DMF exposure of the whole workweek.

Objective: To determine the way of AMCC can be use as biomarker of DMF exposure and the best possible sampling time.

Method: This study conducted a literature search using evidence-based databases …

Mckenzie Exercise For Reducing Low Back Pain Complaints In Office Worker: An Evidence-Based Case Report, Bonnie Medana Pahlavie, Dewi S. Soemarko, Indah Suci Widyahening

Occupational and Environmental Medicine Journal of Indonesia

Background:

Low back pain (LBP) is pain that is felt in the lower back area, namely between the corners of the lowest ribs and the lower buttocks (lumbar or lumbo-sacral area) and can be local pain or radiate to the upper thighs/legs or both. Low back pain is a 10% debilitating condition that results in a change in life expectancy due to disability. Low back pain is not a malignancy and is a self-limiting condition, but patients always seek treatment to reduce the severity of their symptoms. Chronic Low Back Pain can alter lifestyle and increase the rate of prolonged …

Health And Environmental Pollution: A Literature Review, Elsa Yuniarti, Levi Anatolia S.M. Exposto, Indang Dewata, Fitra Arya Dwi Nugraha, Alfitri Alfitri

Kesmas

This study aimed to review various studies focusing on pollution that could adversely affect health, including sources, types, and mitigation efforts. The data used were obtained through a search on the Scopus website using the keywords "Health" AND "Pollution" from 2016 to 2023. Using these two keywords, 72 titles and abstracts of papers were successfully found. The results of this literature review were then analyzed with the assistance of NVivo 12 Pro, which grouped the findings based on their impact on health, reasons for pollution, types of pollution, and preventive measures. It was identified that the most common disease was …

Data Mining Analysis With Orange In The Development Of Tuberculosis Among Diabetes Mellitus Patients, Malahayati Rusli Bintang, Adang Bachtiar, Cicilya Candi

Kesmas

Prevention and treatment of diabetes will have a positive influence on tuberculosis (TB) since people may get TB because they have diabetes mellitus (DM). Recording and reporting through the TB Information System are not run optimally because of many factors. The information system must be strengthened to be used by private health facilities. This study used secondary data from the 2013 and 2018 Indonesian Basic Health Research (IBHR). The data was analyzed univariately and analyzed further using Orange Data Mining Tools to test the screening tool model used to predict TB in diabetic individuals. The total sample in this study …

Development And Implementation Of An Emergency Preparedness Policy And Procedure, Educational Intervention, And In-Situ Simulation In A Pediatric Primary Care Office: A Quality Improvement Project, Kaitlin Patel

Doctor of Nursing Practice Scholarly Projects

Background. Pediatric primary care offices are frequently unprepared to respond to clinical emergencies that may present to or occur at their site. The purpose of this project was to improve office emergency preparedness at a pediatric primary care office to align with the American Academy of Pediatrics policy statement for pediatric office emergency preparedness.

Methods. A PRISMA-guided literature review found support for both educational interventions and in-situ simulation to improve aspects of emergency preparedness. The aim of this project was to develop a practice-specific emergency preparedness policy and procedure and implement a training and in-situ simulation to increase medical and …

Development And Validity Of The 'Modified Mediterranean Prime Screen' To Assess Dietary Intake Among Women Of Reproductive Age In Lebanon, Mariam Assaad, Sara Ajjour, Maya Rahme, Laila Al-Shaar, May Sakr, Hala Ghattas Ph.D., Ghada El-Hajj Fuleihan, Jana Jabbour

Faculty Publications

The Mediterranean Region registers an increasing prevalence of obesity. The region lacks a diet screener to assess obesogenic nutrients. This study aimed to evaluate the reproducibility and validity of the Modified Mediterranean Prime Screen (MMPS) in estimating obesogenic nutrients' intake among women of reproductive age, as compared with a culturally validated Food Frequency Questionnaire (FFQ), in Lebanon. We developed the MMPS consisting of thirty-two food/beverage items specific to the Lebanese Mediterranean culture. The MMPS and FFQ were administered in two visits (2 weeks-6 months apart), face to face and via telephone during the coronavirus disease 2019 pandemic. The reproducibility and …

In Silico Analysis Of The Rop29 Protein As A Vaccine Candidate Against Toxoplasma Gondii, Amir Karimipour-Saryazdi, Fatemeh Ghaffarifar, Abdolhossein Dalimi, Masoud Foroutan, John Horton, Javid Sadraei

Faculty, Staff and Student Publications

The progression of Toxoplasma gondii (T. gondii) invasion is aided by rhoptry proteins (ROPs), which are also crucial for the parasite's survival in host cells. In this study, in silico analysis was performed to examine the various aspects of the ROP29 protein, such as physicochemical properties, potential T- and B-cell epitopes, and other significant features. The research revealed that there were 55 possible sites for posttranslational modification in the ROP29 protein. The secondary structure of the ROP29 protein consists of a random coil, an alpha-helix, and an extended strand, which account for 49.69%, 36.81%, and 13.50%, respectively. Moreover, …

The Interplay Between Gender And Duration Of Hospitalization Modulates Psychiatric Symptom Severity In Subjects With Long Covid-19, Alessio Simonetti, Antonio Restaino, Claudia Calderoni, Emanuela De Chiara, Antonio Maria D'Onofrio, Salvatore Lioniello, Giovanni Camardese, Delfina Janiri, Matteo Tosato, Francesco Landi, Gabriele Sani

Faculty, Staff and Students Publications

Long COVID-19 is characterized by ongoing symptoms or prolonged or long-term complications of SARS-CoV-2 contraction which persist beyond 4 weeks from the initial onset of symptoms. Gender and duration of hospitalization (DH) are key risk factors for developing long COVID-19 syndrome, but their impact and interplay need further study. This research involved 996 long COVID-19 patients, and we compared the levels of general psychopathology, depression, agitated depression, anxiety, and medication use between hospitalized and non-hospitalized males and females. In the hospitalized patients, multivariate regressions assessed the impact of gender, DH, and the interaction of these variables. The females had higher …

A Light-Responsive Neural Circuit Suppresses Feeding, Hailan Liu, Na Qu, Natalia Valdez Gonzalez, Marco A Palma, Huamin Chen, Jiani Xiong, Abhinav Choubey, Yongxiang Li, Xin Li, Meng Yu, Hesong Liu, Longlong Tu, Nan Zhang, Na Yin, Kristine Marie Conde, Mengjie Wang, Jonathan Carter Bean, Junying Han, Nikolas Anthony Scarcelli, Yongjie Yang, Kenji Saito, Huxing Cui, Qingchun Tong, Zheng Sun, Chunmei Wang, Xing Cai, Li Lu, Yang He, Yong Xu

Faculty, Staff and Students Publications

Light plays an essential role in a variety of physiological processes, including vision, mood, and glucose homeostasis. However, the intricate relationship between light and an animal's feeding behavior has remained elusive. Here, we found that light exposure suppresses food intake, whereas darkness amplifies it in male mice. Interestingly, this phenomenon extends its reach to diurnal male Nile grass rats and healthy humans. We further show that lateral habenula (LHb) neurons in mice respond to light exposure, which in turn activates 5-HT neurons in the dorsal Raphe nucleus (DRN). Activation of the LHb→5-HTDRN circuit in mice blunts darkness-induced hyperphagia, while inhibition …

Relationship Between Geographic Location, Race, And Socioeconomic Status On Adolescent Male Hpv Vaccination In The United States, Stacy Herb

Walden Dissertations and Doctoral Studies

Human papillomavirus (HPV) represents the most prevalent sexually transmitted infection in the United States. Despite readily available safe and effective vaccines and established knowledge of influencing factors, HPV vaccination rates in the United States remain suboptimal, particularly among adolescent males. This quantitative study addressed this gap by investigating the association between geographic location, race, and socioeconomic status with HPV vaccination uptake in adolescent males. A secondary data analysis was conducted using the 2022 National Immunization Survey (NIS)—Teen, comprised of 22,667 adolescent males. The fundamental cause theory served as the theoretical framework, guiding the exploration of why a safe and effective …

Caregiver Attitudes Toward Sexual Behavior And Sex Education For Children With Down Syndrome, Shawna Urban

Walden Dissertations and Doctoral Studies

This quantitative correlational study investigates caregivers’ attitudes toward sexual behavior and sex education for children with Down syndrome, drawing upon the theories of reasoned action and planned behavior. Data was collected from a convenience sample of 112 caregivers. The analysis revealed significant positive associations between caregivers’ attitudes toward sexuality and their perspectives on sex education. Binary logistic regression indicated that higher POS scores predict increased likelihood of endorsing sexual behavior and supporting sex education for children with Down syndrome. Notably, demographic factors such as gender, age, and educational level did not significantly influence caregivers’ decisions regarding sex education support. The …

Transitions Of Care And The Prevention Of Readmissions, Beatriz Granado

Student Scholarly Projects

Unplanned hospital readmissions often result from poor discharge planning and challenges during the transition from hospital to home, including medication errors and weak communication with primary care providers. A well-organized and personalized discharge plan can significantly reduce hospital stays, lower readmission rates, minimize medication errors, and improve patient outcomes, all while decreasing healthcare costs. In post-discharge Medicare-eligible patients (P), how does transitional care coordination through organized, personalized, and patient-focused discharge planning (I), compared with standard or no transitional care coordination provided (C), affect readmissions (O) within the 30-day post-discharge phase monitored over a 10–12-week period (T)? A search was conducted …

Hiv/Aids-Associated Knowledge And Attitudes Towards Treating Disadvantaged Communities Among Pre-Community-Based Dental Education Dental Students In The Us, Aditi Tomar, Hannah Balcezak, Shirley Lewis Miranda, Marie C Latortue, Richa Chinchkhandi, Lisa Wigfall

Faculty, Staff and Student Publications

This study examines HIV/AIDS-associated knowledge and attitudes towards treating disadvantaged communities among predoctoral dental students in U.S. dental schools who have not yet commenced their Community-Based Dental Education (CBDE) training. It also compares the difference in the knowledge and attitudes between students with reported community engagement with PLWHA and those without. Our study comprised 89 predoctoral dental students within their D1-D3 years of dental school who had not yet initiated their Community-Based Dental Education (referred to as pre-CBDE dental students). Their responses were collected via an online survey. The participants were 68% females, 94% heterosexual, and with a mean age …

Cruising Speed: Our Journal's 10-Year Voyage, Dennis J. Baumgardner, Joe Grundle

Journal of Patient-Centered Research and Reviews

In this invited editorial, two long-tenured editors for the Journal of Patient-Centered Research and Reviews recount the publication’s many impactful contributions to the medical literature over its first 10 years.

How The Cahps Clinician And Group Patient Experience Survey Data Have Been Used In Research: A Systematic Review, Denise D. Quigley, Marc N. Elliott, Nabeel Qureshi, Zachary Predmore, Ron D. Hays

Journal of Patient-Centered Research and Reviews

Purpose: Patient experience is a key aspect of care quality. The Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG-CAHPS®) survey measures experiences with ambulatory care providers to inform public reporting, pay-for-performance initiatives, interventions, patient choice of physicians/practices, and quality improvement. Since the survey’s 2007 release, no systematic review of its use in research has been published.

Methods: We reviewed English-language, peer-reviewed articles published since 2008 using CG-CAHPS survey data in the U.S. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used the Checklist for Analytical Cross-Sectional Studies.

Results: We examined 126 articles …

Transcriptomic Analysis Reveals The Anti-Cancer Effect Of Gestational Mesenchymal Stem Cell Secretome, Salvatore Vaiasicca, Gianmarco Melone, David W James, Marcos Quintela, Jing Xiao, Seydou Yao, Richard H Finnell, Robert S Conlan, Lewis W Francis, Bruna Corradetti

Faculty, Staff and Students Publications

The environment created during embryogenesis contributes to reducing aberrations that drive structural malformations and tumorigenesis. In this study, we investigate the anti-cancer effect of mesenchymal stem cells (MSCs) derived from 2 different gestational tissues, the amniotic fluid (AF) and the chorionic villi (CV), with emphasis on their secretome. Transcriptomic analysis was performed on patient-derived AF- and CV-MSCs collected during prenatal diagnosis and identified both mRNAs and lncRNAs, involved in tissue homeostasis and inhibiting biological processes associated with the etiology of aggressive cancers while regulating immune pathways shown to be important in chronic disorders. Secretome enrichment analysis also identified soluble moieties …

East African Refugee Women Seeking Health Care After Government Assistance Ends, Sylivia Chelimo

Walden Dissertations and Doctoral Studies

East African refugee women arrive as a vulnerable population in their host country. Before coming to the United States, refugee women may have experienced varying levels of trauma due to civil wars, genocide, sexual assault, deaths of loved ones, terrorist attacks, being taken hostage, and torture in their home country. The purpose of this generic qualitative study was to explore the experiences of refugee women from East African countries seeking health care in the Central United States when government assistance ends. The framework of the behavioral model of health was the guide for examining the experiences of the participant refugee …

Full-Length Αiibβ3 Cryo-Em Structure Reveals Intact Integrin Initiate-Activation Intrinsic Architecture, Tong Huo, Hongjiang Wu, Zeinab Moussa, Mehmet Sen, Valerie Dalton, Zhao Wang

Faculty, Staff and Students Publications

Integrin αIIbβ3 is the key receptor regulating platelet retraction and accumulation and a proven drug-target for antithrombotic therapies. Here we resolve the cryoEM structures of the full-length αIIbβ3, which covers three distinct states along the activation pathway. Firstly, we obtain the αIIbβ3 structure at 3Å resolution in the inactive state, revealing the overall topology of the heterodimer with the transmembrane (TM) helices and the ligand-binding domain tucked in a specific angle proximity to the TM region. After the addition of a Mn2+ agonist, we resolve two coexisting structures representing two new states between inactive and active state. Our structures show …

Framing The Path To Fitness: Age Differences In Response To Framed Exercise Messages, Iliya Sherif, David B. Taullahu, Alyssa R. Minton, Joseph A. Mikels

DePaul Discoveries

Physical activity is one of the most protective health behaviors one can engage in, yet 75% of active adults in the US, meaning those who exercise regularly, fall short of the recommended levels of physical activity, with an even greater percentage of older adults living inactive lives, meaning they exercise minimally and engage in prolonged sedentary behavior (CDC, 2019). The goal of the current study was to explore different types of message framing targeted at encouraging older and younger adults to exercise. We recruited older adults (n = 184; Mage = 69.45 years, age range: 65- 80 years) and younger …

Computational Insights Into Sars-Cov-2 Main Protease Mutations And Nirmatrelvir Efficacy: The Effects Of P132h And P132h-A173v, Yuan-Ling Xia, Wen-Wen Du, Yong-Ping Li, Yan Tao, Zhi-Bi Zhang, Song-Ming Liu, Yun-Xin Fu, Ke-Qin Zhang, Shu-Qun Liu

Faculty, Staff and Student Publications

Nirmatrelvir, a pivotal component of the oral antiviral Paxlovid for COVID-19, targets the SARS-CoV-2 main protease (Mpro) as a covalent inhibitor. Here, we employed combined computational methods to explore how the prevalent Omicron variant mutation P132H, alone and in combination with A173V (P132H-A173V), affects nirmatrelvir’s efficacy. Our findings suggest that P132H enhances the noncovalent binding affinity of Mpro for nirmatrelvir, whereas P132H-A173V diminishes it. Although both mutants catalyze the rate-limiting step more efficiently than the wild-type (WT) Mpro, P132H slows the overall rate of covalent bond formation, whereas P132H-A173V accelerates it. Comprehensive analysis of noncovalent and covalent contributions to the …

Ai Driven Analysis Of Mri To Measure Health And Disease Progression In Fshd, Lara Riem, Olivia Ducharme, Matthew Cousins, Xue Feng, Allison Kenney, Jacob Morris, Stephen J Tapscott, Rabi Tawil, Jeff Statland, Dennis Shaw, Leo Wang, Michaela Walker, Leann Lewis, Michael A Jacobs, Doris G Leung, Seth D Friedman, Silvia S Blemker

Faculty, Staff and Student Publications

Facioscapulohumeral muscular dystrophy (FSHD) affects roughly 1 in 7500 individuals. While at the population level there is a general pattern of affected muscles, there is substantial heterogeneity in muscle expression across- and within-patients. There can also be substantial variation in the pattern of fat and water signal intensity within a single muscle. While quantifying individual muscles across their full length using magnetic resonance imaging (MRI) represents the optimal approach to follow disease progression and evaluate therapeutic response, the ability to automate this process has been limited. The goal of this work was to develop and optimize an artificial intelligence-based image …

What Constitutes Adequate Control Of High Blood Pressure? Current Considerations, Donald E. Casey, Alexander J. Blood, Stephen D. Persell, Daniel Pohlman, Jeff D. Williamson

College of Population Health Faculty Papers

An estimated 45% of adult Americans currently have high blood pressure (HBP). Effective blood pressure (BP) control is essential for preventing major adverse events from cardiovascular and other vascular-related diseases, such as chronic kidney disease, stroke and dementia. A large and growing number of medical professional societies, health care organizations, and governmental agencies have now endorsed a clinical practice guideline-based target for adequate control of HBP to a systolic BP of less than 130 mm Hg. However, adequate BP control to this goal has been recently estimated to be as low as 30%. The first and most important steps to …

Mixed-Methods Assessment Of Farmworkers’ Perceptions Of Workplace Compliance With Worker Protection Standards And Implications For Risk Perceptions And Protective Behaviors, Carly Hyland, Lisa Meierotto, Rebecca L. Som Castellano, Cynthia L. Curl

Public and Population Health Faculty Publications and Presentations

Introduction: The Environmental Protection Agency (EPA)’s Worker Protection Standards is the primary set of legislation aimed at protecting farmworkers from occupational pesticide exposure in the United States. Previous studies suggest that worker adoption of Pesticide Protective Behaviors (PPBs) promoted by WPS is associated with lower urinary pesticide concentrations. However, adoption of PPBs is often outside of the control of individual farmworkers and dependent on workplace factors such as employer provisioning of Personal Protective Equipment (PPE) and access to trainings/resources.

Methods: We conducted a mixed-method study including urinary pesticide biomonitoring, surveys, and interviews with 62 Latinx farmworkers in southwestern Idaho from …

Community Health Volunteers’ Experiences Of Implementing Covid-19 Vaccine Education And Promotion In Kenya: A Qualitative Descriptive Study, Constance Shumba, Peterson Kiraithe, Isabel Kambo, Sheila Shaibu

School of Nursing & Midwifery, East Africa

Background: Vaccination was a key measure in the COVID-19 pandemic response, though much work was needed to promote vaccine uptake and acceptance. In Kenya, Community Health Volunteers (CHVs) played a key role in vaccine education and promotion. We conducted this study to explore CHVs’ experiences of implementing COVID-19 vaccine education and promotion during the pandemic to increase COVID-19 vaccine uptake in two areas of Kenya.

Methods: In a qualitative descriptive study, we conducted 30 structured in-depth interviews with 20 CHVs and 10 Community Health Assistants from rural Kilifi County and Kangemi, an urban informal settlement of Nairobi County in Kenya …

The Blessed Assembly: Irreplaceable Physical Co-Presence In Worship And Healthy Hybridity Reimagined After The Pandemic In The Digital Age, Yvette, Ying Wai Lau

Doctor of Pastoral Music Projects and Theses

Because of the unprecedented and unexpected force of the pandemic since 2020, most churches around the world have experienced some online worship during the lockdown of their cities or the mandated closure of the church buildings. For many people, online worship seems to be an equivalent, if not better, alternative for gathering together—a physical co-presence in worship—even after the pandemic has ended. As necessary and vital as online worship experiences have been for Christians during the pandemic, the witness of the church from Pentecost throughout Christian history indicates that gathered worship in physical spaces is irreplaceable for faith formation and …

Ultrapotent Broadly Neutralizing Human-Llama Bispecific Antibodies Against Hiv-1, Jianliang Xu, Tongqing Zhou, Krisha Mckee, Baoshan Zhang, Cuiping Liu, Alexandra F Nazzari, Amarendra Pegu, Chen-Hsiang Shen, Jordan E Becker, Michael F Bender, Payton Chan, Anita Changela, Ridhi Chaudhary, Xuejun Chen, Tal Einav, Young Do Kwon, Bob C Lin, Mark K Louder, Jonah S Merriam, Nicholas C Morano, Sijy O'Dell, Adam S Olia, Reda Rawi, Ryan S Roark, Tyler Stephens, I-Ting Teng, Emily Tourtellott-Fogt, Shuishu Wang, Eun Sung Yang, Lawrence Shapiro, Yaroslav Tsybovsky, Nicole A Doria-Rose, Rafael Casellas, Peter D Kwong

Faculty, Staff and Student Publications

Broadly neutralizing antibodies are proposed as therapeutic and prophylactic agents against HIV‐1, but their potency and breadth are less than optimal. This study describes the immunization of a llama with the prefusion‐stabilized HIV‐1 envelope (Env) trimer, BG505 DS‐SOSIP, and the identification and improvement of potent neutralizing nanobodies recognizing the CD4‐binding site (CD4bs) of vulnerability. Two of the vaccine‐elicited CD4bs‐targeting nanobodies, G36 and R27, when engineered into a triple tandem format with llama IgG2a‐hinge region and human IgG1‐constant region (G36×3‐IgG2a and R27×3‐IgG2a), neutralized 96% of a multiclade 208‐strain panel at geometric mean IC80s of 0.314 and 0.033 µg mL−1, respectively. Cryo‐EM …

Communicating About A Nicotine Reduction Policy Among People Who Use Little Cigars And Cigarillos, Charity Afi Ntansah

Theses and Dissertations

The U.S. Food and Drug Administration (FDA) has proposed rulemaking to reduce the nicotine content in cigarettes and other combusted tobacco products to non-addictive levels. A very low nicotine content (VLNC) policy aimed primarily at cigarettes could drive people to other combusted products like little cigars and cigarillos (LCCs), potentially undermining its effectiveness. Expanding the policy to include LCCs requires effective messages for people who use LCCs. This dissertation explores how to communicate the reduced nicotine policy to people who use LCCs. The research recruited four populations with the highest prevalence of cigar use: African American and White males and …

Pediatric Oral Health Literacy Among Caregivers Of Young Children, Melissa L. Sullivan

Health Services Research Dissertations

Early childhood caries (ECC) is a common dental condition that affects the primary teeth of infants and young children. ECC can have a significant negative impact on a child’s oral health and overall well-being. Caregivers have an important role in the prevention of early childhood caries through knowledge, understanding, and awareness of good oral hygiene practices. Caregivers who possess adequate oral health literacy (OHL) may be more likely to recognize the risks associated with ECC, implement proper oral hygiene practices, and make informed oral health choices for themselves and their child.

The overarching purpose of this dissertation is to explore …