Digital Commons Network^™

Large-Vessel Occlusion Stroke Knowledge And Training For Stroke Severity Assessment Among Emergency Medical Services Personnel In The United States, Kaiz S Asif, Robin Novakovic, Thanh N Nguyen, Santiago Ortega-Gutierrez, Youngran Kim, Amanda Jagolino-Cole, Sushanth Aroor, Alicia Castonguay, Prateek Kumar, Ashutosh P Jhadav, Dileep Yavagal, May Nour, Gabor Toth, Maxim Mokin, Sunil A Sheth, Mouhammad A Jumaa, Alhamza Al-Bayati, Mohamed Teleb, Ossama Y Mansour, Shashvat M Desai, Joshua Hartman, David S Liebeskind, Ameer E Hassan, Brijesh P Mehta, Svin Education And Speed Committees

Faculty, Staff and Student Publications

Background: Prehospital identification of large-vessel occlusion (LVO) stroke facilitates the development of a regional triage protocol that could lead to an improvement in intrahospital and interhospital workflows. This requires stroke education of emergency medical services (EMS) personnel to improve stroke recognition, severity assessment, and prenotification. However, the current state of EMS personnel's knowledge of LVO stroke, their training for stroke severity assessment, and their preferences for educational methods are unknown. We conducted a nationwide EMS survey across the United States to glean insights that can inform and customize future EMS educational efforts.

Methods: The Society of Vascular and Interventional Neurology, …

Community Consultation For Exception From Informed Consent Studies: Are Market Research Surveys Representative Of The Target Community Populations?, Shannon W Stephens, Russell L Griffin, Christy Carroll-Ledbetter, Sarah Duckert, Margaret Nelson, Joel Rodgers, Adam Mcclintock, Sara F Goldkind, Luke Gelinas, Amanda E Higley, Stacia Desantis, Claudia Pedroza, Luis Leon-Novelo, James Stubbs, Marissa B Marques, Henry Wang, John B Holcomb, Jan O Jansen, Troop Trial Investigators

Faculty, Staff and Student Publications

Background: 'Exception from informed consent' research requires community consultation to ensure that the views of the local population have been considered. Using market research companies to distribute surveys across local populations is attractive because it ensures adequate response rates. It is not known whether individuals who respond to surveys are typical of the targeted communities. The purpose of this study is to compare the demographics of the survey respondents with that of the general population in the same area.

Methods: This is an analysis of data collected as part of the 'Trauma Resuscitation with Group O Whole Blood or Products' …

A Directed Content Analysis For Greatest Problems Among People With And Without Traumatic Brain Injury, Emily Dudek, Michael W Williams, Chung Lin Novelle Kew, Annalyn Demello, Brittany Wright, Alexandra B Holland, Alyssa Day-Gorman, Alexa S Gonzalez, Luis Leon Novelo, Xiangyi Liu, Shannon B Juengst

Faculty, Staff and Student Publications

Objective: To characterize the greatest problem or need among individuals with a history of traumatic brain injury (TBI), as compared with individuals with a history of other neurologic conditions, mental health conditions, and no history of neurologic or mental health conditions.

Design: A directed content analysis of open-text responses to a single online survey question using a framework guided by the Mayo-Portland Adaptability Inventory-4.

Setting: Community.

Participants: A total of 2861 community-dwelling adults (n=274 with TBI; n=289 with other neurologic conditions besides TBI; n=454 with mental health conditions but no neurologic conditions; and n=1844 controls).

Interventions: Not applicable.

Main outcome …

Risk And Prognosis Of Hepatocellular Carcinoma In Mexican Americans With Type 2 Diabetes Mellitus, Rikita I Hatia, Lu-Yu Hwang, Ruosha Li, Catherine Troisi, Prasun K Jalal, Christopher I Amos, Henry F Gomez, Yun Shin Chun, Asif Rashid, Ahmed O Kaseb, Paul A Scheet, Manal M Hassan

Faculty, Staff and Student Publications

INTRODUCTION: Hepatocellular carcinoma (HCC) disproportionately affects Hispanic persons with higher age-specific incidence and increased mortality rates compared to non-Hispanic Whites. These high rates of incidence and mortality may be explained by the variation in risk factors. Given the high prevalence of type 2 diabetes mellitus (DM) among the Hispanic population, we aimed to assess the risk and prognosis of HCC in Mexican Americans with type 2 DM with consideration of treatment for DM.

METHODS: A case-control study of 241 Mexican American HCC patients and 500 healthy controls in Texas was conducted. Multivariable logistic regression analysis was performed to determine the …

A Systematic Review And Narrative Synthesis Of Factors Affecting Pre-Exposure Prophylaxis Willingness Among Black Women For Hiv Prevention, Alexis Sims Haynes, Christine Markham, Vanessa Schick, Robert Suchting, Nivedhitha Parthasarathy, Sumaita Choudhury, Mandy J Hill

Faculty, Staff and Student Publications

Pre-exposure prophylaxis (PrEP) can significantly reduce human immunodeficiency virus (HIV) transmission among Black women in the United States (U.S.), a group disproportionately affected by HIV. However, PrEP uptake in this HIV-vulnerable population is low. This review analyzes the factors influencing Black women's PrEP willingness using the Behavioral Model for Vulnerable Populations (BMVP). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Population, Intervention, Comparison, Outcome, Study Design (PICOS) framework, we conducted a systematic literature search and selected 24 peer-reviewed studies on PrEP willingness. Narrative synthesis revealed a heterogeneous landscape of the determinants affecting PrEP willingness …

Association Between Trust In The Incumbent President And Covid-19 Preventive Behaviors During The Pandemic In Four Latin American Countries, Juliana Mejía-Grueso, Gloria Isabel Niño-Cruz, Javiera Alarcón-Aguilar, Pablo Roa-Urrutia, Sergio Mauricio Moreno-López, Adriano Akira Ferreira Hino, Alexandre Augusto De Paula Da Silva, Fernando López, Deborah Salvo, Rodrigo Siqueira Reis, Guillermo Rosas, Andrea Ramírez-Varela

Faculty, Staff and Student Publications

The COVID-19 pandemic revealed disparities in policy responses in Latin America. We examined the association between trust in the president and COVID-19 preventive behaviors in Brazil, Chile, Colombia, and Mexico. We used data from the Collaborative COVID-19 Response Survey by the McDonnell Academy at Washington University in St. Louis (United States), from September 2020 to March 2021. Nonprobabilistic sampling included adult citizens from the four countries. Multivariate negative binomial regression models were applied. The study included 8,125 participants, with Brazil showing the lowest adherence to preventive behaviors (65.5%). Increased adoption of preventive behaviors was linked with ages 18-26 (aIRR = …

A Comparison Of Floating Catchment Area Parameters With Applications To A Dataset Of Clinics Enrolled In A Statewide Child And Adolescent Psychiatric Consultation Program, Jocelyn Hunyadi, Lara S Savas, Kehe Zhang, Jeanette E Deason, Ryan Ramphul, Melissa F Peskin, Erica L Frost, Cici Bauer

Faculty, Staff and Student Publications

INTRODUCTION: Healthcare resources are often crucial but limited, requiring careful consideration and informed allocation based on population needs and potential healthcare access. In resource allocation settings, availability and accessibility of resources should be examined simultaneously. The two-step floating catchment area (2SFCA) method has been previously used to evaluate spatial accessibility to healthcare resources and services, and to address health-related disparities. The 2SFCA methods have regained significant popularity during the COVID-19 pandemic, as their application proved crucial in addressing priority public health data analysis, modeling, and accessibility challenges. However, comprehensive comparisons of the 2SFCA method input parameters in the context of …

Untargeted Metabolome Atlas For Sleep-Related Phenotypes In The Hispanic Community Health Study/Study Of Latinos, Ying Zhang, Brian W Spitzer, Yu Zhang, Danielle A Wallace, Bing Yu, Qibin Qi, Maria Argos, M Larissa Avilés-Santa, Eric Boerwinkle, Martha L Daviglus, Robert Kaplan, Jianwen Cai, Susan Redline, Tamar Sofer

Faculty, Staff and Student Publications

BACKGROUND: Sleep is essential to maintaining health and wellbeing of individuals, influencing a variety of outcomes from mental health to cardiometabolic disease. This study aims to assess the relationships between various sleep-related phenotypes and blood metabolites.

METHODS: Utilising data from the Hispanic Community Health Study/Study of Latinos, we performed association analyses between 40 sleep-related phenotypes, grouped in several domains (sleep disordered breathing (SDB), sleep duration, sleep timing, self-reported insomnia symptoms, excessive daytime sleepiness (EDS), and heart rate during sleep), and 768 metabolites measured via untargeted metabolomics profiling. Network analysis was employed to visualise and interpret the associations between sleep phenotypes …

Challenges And Opportunities Of Universal Health Coverage In Africa: A Scoping Review, Evaline Chepchirchir Langat, Paul Ward, Hailay Gesesew, Lillian Mwanri

Centre of Excellence in Women and Child Health

Background: Universal health coverage (UHC) is a global priority, with the goal of ensuring that everyone has access to high-quality healthcare without suffering financial hardship. In Africa, most governments have prioritized UHC over the last two decades. Despite this, the transition to UHC in Africa is seen to be sluggish, with certain countries facing inertia. This study sought to examine the progress of UHC-focused health reform implementation in Africa, investigating the approaches utilized, the challenges faced, and potential solutions.

Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, we scoped the literature …

Disparities In Maternal Healthcare: Examining The Impact Of Social Determinants Of Health On Provider Care Quality, Rishita Anumukonda

Honors Undergraduate Theses

Poor maternal health outcomes among racially and socioeconomically marginalized populations are a major public health concern in the United States. Effective clinician discussions during prenatal and postpartum care play an essential role in promoting maternal and infant well-being. However, the content of provider-patient discussions in maternal care and how it varies for patients exposed to different social determinants of health has not yet been well explored. This study aims to examine whether healthcare provider discussions about key maternal health topics, including preventative health tips, risk factors, and available resources, differ based on social factors such as income level and race. …

Caretaker Of Captors: The Experience Of Role Conflict Among State Correctional Officers, Camille M. Botticelli-Pohl

Antioch University Dissertations & Theses

A variety of policies at the national level over the last 70 years have resulted in the mass incarceration of various marginalized populations, inclusive of individuals with mental health problems or severe mental illness. Although Constitutional mandates require that psychology staff be available at all state and federal facilities, these providers spend a fraction of the time with incarcerated people than correctional officers do. Correctional officers seem to play an important, if often overlooked, supporting role in the management of the day-to-day lives of people in custody, including elements of their mental health care. They are also, theoretically, tasked with …

Multisociety Guidance For Infection Prevention And Control In Nursing Homes, Lona Mody, Sonali D. Advani, Muhammad Salman Ashraf, Allison H. Bartlett, Suzanne F. Bradley, Deborah P. Burdsall, Jennifer A. Hanrahan, Susan S. Huang, Robert L.P. Jump, Lindsay Nicolle, Mary-Claire Roghmann, Patricia Stone, Rekha K. Murthy

Department of Medicine Faculty Publications

This multisociety guidance was endorsed by SHEA, APIC, IDSA, PALTmed, and AGS. It provides recommendations for infection prevention and control (IPC) in the context of the complexity of nursing home care in the United States: increased medical acuity of residents, the spread of multidrug-resistant organisms, and the threat of emerging pathogens. Recommendations and implementation suggestions address IPC leadership, staffing, and resources, healthcare personnel and residents‘ adherence to precautions and effective hand hygiene, outbreak preparedness, training, occupational health, cleaning and disinfection in the care environment, and the involvement of IPC in the facility. The guidance also addresses the challenges of maintaining …

Development, Delivery, And Evaluation Of The Texas Epidemic Public Health Institute Pilot Infection Control Lecture Series, Kayla E Ruch, Anabel Rodriguez, Janelle Rios, Luis Ostrosky-Zeichner, Eric L Brown

Faculty, Staff and Student Publications

Introduction: The Texas Epidemic Public Health Institute (TEPHI) aims to keep Texans healthy and the economy strong by preparing for the next infectious disease outbreak. TEPHI's Small Rural Healthcare Preparedness core developed, delivered, and evaluated a pilot infection prevention and control webinar series called Infection Control for rural-serving health professionals and organizations based on infection prevention and control field best practices.

Methods: Data from the first year of the Infection Control series was collected through attendee registration forms, attendance records, knowledge, and post-lecture evaluation surveys using Qualtrics. The data were analyzed using Qualtrics software. Lectures were free and open to …

Journey To Well-Being: An Exploration Of Thrivership Post-Domestic Violence, Kader Gumus

Antioch University Dissertations & Theses

Domestic violence profoundly affects multiple facets of a survivor’s life. While most existing literature on survivorship addresses the immediate aftermath of domestic violence, this study delves into the extended process following the trauma of abuse to attain “thrivership,” a new concept in the scholarly and practice literature that emphasizes enduring well-being and flourishing. This dissertation examines the journeys from surviving to thriving for 13 women who transformed themselves and their lives to achieve well-being after traumatic domestic violence. Bronfenbrenner’s ecological systems theory was applied to examine the multiple layers of environmental influences on an individual’s development, including the micro, meso, …

Stigma Of Obesity And Healthcare Utilization, Moya A. O'Leary

Antioch University Dissertations & Theses

The impact of personal factors on healthcare utilization is an essential area of research to improve overall health outcomes among the population. This study explored the relationship between perceived stigma and healthcare avoidance among men and evaluated the relationship between self-reported body mass index (BMI) and avoidance of healthcare appointments due to weight-related stigma and other reasons. This study found no significant relationship between BMI and avoidance of preventive medical appointments due to perceived stigma. However, men from all weight categories endorsed avoiding preventive healthcare appointments due to weight-related reasons and for other reasons. This study explored the reported reasons …

Post-Migration Living Distress And Suicidal Behavior In Refugee Populations Resettled In Vermont, Phoebe K. Lewis

Antioch University Dissertations & Theses

The study of refugee psychology and suicidal distress is a comparatively nascent field when compared with the body of research concerning non-refugee populations. Over the past fifty years, however, the post-migration refugee experience has been the subject of growing clinical interest. In particular, the construct of post-migration living distress (PMLD) has been identified as a salient factor contributing to psychological distress in refugee populations. This dissertation explores the relationship between PMLD and suicidality in a sample of refugees resettled in a New England city. Guided by the Interpersonal Theory of Suicide (IPTS), this dissertation considers how elements of the post-migration …

Associations Between Perceived Discrimination And Sleep Health: Results From The Future Of Families And Child Wellbeing Young Adult Sleep Study, Angel I.M. Collie, Adwoa Dadzie, David A. Reichenberger, Lindsay A. Master, Gina M. Mathew, Lauren E. Hale, Anne-Marie Chang, Orfeu M. Buston

Department of Preventive Medicine Faculty Publications

Objectives. We investigated cross-sectional associations between perceived discrimination and actigraphic sleep health among young adults.

Methods. Data from the age 22 wave (mean±SD age=22.1±0.4 years) of the Future of Families and Child Wellbeing Young Adult Sleep Study, a national birth cohort originally drawn from 20 U.S. cities, included young adults (n=334; 68.9% Black, 14.7% Hispanic/Latino) who self-reported experiences of discrimination. Wrist-worn actigraphy was collected across ~2 weeks from 2020-2024 and measures included sleep duration, onset, midpoint, maintenance efficiency (SMeff), and wake after sleep onset (WASO). Multiple linear regression models examined the association between experiencing a specific type of …

Development Of A Stress Response Framework For Understanding Sogie Refugee Health, Arooran Saravanan Ananthavel Murugan

Theses and Dissertations (Comprehensive)

As an increasing number of individuals flee persecution on the basis of sexual orientation and gender identity expression (SOGIE), Canada has become a prominent destination for SOGIE refugees. The chronic stressors encountered by this marginalized population remain insufficiently studied, particularly in relation to physical health outcomes. This qualitative study investigates the cumulative health impacts of chronic stress among SOGIE refugees through the application of a cell-to-society framework, underpinned by Minority Stress Theory (MST). The study seeks to develop a SOGIE-specific stress response framework that theorizes the processes by which social and environmental stressors become biologically embedded, thereby contributing to elevated …

Association Between The Social Vulnerability Index And Adverse Pregnancy Outcomes, Tetsuya Kawakita, Misa Hayasaka, Lindsay Robbins, Juliana Martins, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Objective: To assess the association between the Social Vulnerability Index (SVI) and racial disparities in pregnancy outcomes across U.S. counties and to quantify these racial disparities.

Methods: This was a cross-sectional study using restricted Centers for Disease Control and Prevention data sets, including natality data sets, fetal death data sets, and all-cause mortality data sets from 2016 to 2021. We limited analyses to Black or White individuals aged 15-44 years from 3,114 U.S. counties. Participants were categorized into quartiles based on county-level SVI. The primary outcome was maternal mortality rate while pregnant or within 42 days of the end of …

Mobile Health Intervention Tools Promoting Hiv Pre-Exposure Prophylaxis Among Adolescent Girls And Young Women In Sub-Saharan Africa: Scoping Review, Alex Emilio Fischer, Homaira Hanif, Jacob B. Stocks, Aimee E. Rochelle, Karen Dominguez, Eliana Gabriela Armora Langoni, H. Luz Mcnaughton Reyes, Gustavo F. Doncel, Kathryn E. Muessig

Department of Obstetrics & Gynecology Faculty Publications

Background:

In 2022, 3100 adolescent girls and young women in sub-Saharan Africa experienced new HIV infections each week. HIV pre-exposure prophylaxis (PrEP) is effective at preventing HIV but has limited uptake and persistence. Mobile health (mHealth) interventions can improve medication adherence; however, their utility to improve PrEP adherence among adolescent girls and young women is not well established.

Objective:

This scoping review synthesizes evidence supporting mHealth for PrEP among adolescent girls and young women in sub-Saharan Africa and identifies strategies for further evaluation.

Methods:

We searched PubMed and Google Scholar databases, expert referrals, and reference lists using the following eligibility …

The Reliability Gap: How Traditional Search Engines Outperform Artificial Intelligence (Ai) Chatbots In Rosacea Public Health Information Quality, Houston C. Nelson, Morgan T. Beauchamp, April A. Pace

Department of Medicine Faculty Publications

Background: The internet has become a primary source of health information for the public, with important implications for patient decision-making and public health outcomes. However, the quality and readability of this content vary widely. With the rise of generative artificial intelligence (AI) tools such as ChatGPT and Gemini, new challenges and opportunities have emerged in how patients access and interpret medical information.

Objective: To evaluate and compare the quality, credibility, and readability of consumer health information provided by traditional search engines (Google, Bing) and generative AI platforms (ChatGPT, Gemini) using three validated instruments: DISCERN, JAMA Benchmark Criteria, and Flesch-Kincaid Readability …

Consumption Of The Food Groups With The Revised Benefits In The New Wic Food Package: A Scoping Review, Qi Zhang, Priyanka T. Patel, Bidusha Neupane, Caitlin M. Lowery, Futun Alkhalifah, Faezeh Mahdavi, Esther May Sarino

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background: On 18 April 2024, the United States Department of Agriculture (USDA) published the first food package changes to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in over a decade, which reduced some food benefits (juice, milk, canned fish, and infant fruits and vegetables) and offered substitutes (cash-value vouchers (CVVs) or cash-value benefits (CVBs) to redeem for fruits and vegetables, cheese, soymilk, or other dairy products). Methods: To assess the impact of the changes on the consumption and redemption of these food groups, a systematic search was conducted, identifying 23 peer-reviewed publications between 2010 and 2024. …

Exploring The Impact Of Covid-19 And The Role Of The Church On African Americans’ Mental Well-Being In South Georgia, Adrian D. Lewis

College of Graduate Studies: Theses & Dissertations

The emergence of COVID-19 in 2020 disrupted the social dynamics of communities in the United States. Furthermore, public health mandates led to closures that changed how populations access faith. Historically, African Americans have utilized the church to cope with societal stressors. This study will explore the history of church utilization in the African American community, assess how COVID-19 public health mandates led to church closures for the first time in recent history and impacted this marginalized population, and provide a qualitative perspective on the quality of life during the closures and what changed after the closures for African Americans in …

Association Of Non-Communicable Diseases With Severe Covid-19 Among People Living With And Without Diagnosed Hiv/Aids In New York State, Ravi Kumar Balu

Electronic Theses & Dissertations (2024 - present)

Background: People living with diagnosed HIV (PLWDH) have a higher chance of co-infections and co-morbidities than the general population. When SARS-CoV-2 was first reported in China in December 2019 and later declared a pandemic, it was speculated that PLWDH might be more prone to SARS-CoV-2 infection and severe disease outcomes given their increased vulnerability to other respiratory infections like influenza, pneumococcal pneumonia and tuberculosis. However, several facets of COVID-19 disease in PLWDH are incompletely understood, including whether non-communicable diseases (NCDs) are strong risk factors for severe disease outcomes and death as they are in the general population.

Methods: The data …

Applying The Ecological Model Of Medical Encounters To Understand Patient-Centered Communication For Older Korean Migrants In The U.S., Seulgi Park

Electronic Theses & Dissertations (2024 - present)

Patient-Centered Communication (PCC) is defined as an approach that places patients at the center of communication with healthcare providers. PCC has been recognized as a strategy to address disparities experienced by minority populations. However, despite its associations with positive health outcomes and ethical significance, there has been a paucity of research on PCC in minority populations such as older Korean migrants in the U.S. Understanding PCC within this group may contribute to improving healthcare communication tailored to their needs. This dissertation aimed to (1) explore the expectations of PCC in primary care settings among older Korean migrants in the U.S., …

A Study Of Glyphosate, Pesticide Mixtures, And Metabolic Health Outcomes: Integrating Epidemiologic, Mechanistic, And Ecological Evidence On Environmental Drivers Of Metabolic Health, Sarah Otaru

Electronic Theses & Dissertations (2024 - present)

Glyphosate, the most extensively used herbicide worldwide, has become a ubiquitous environmental contaminant. Although initially considered safe due to its specific biochemical target in plants, emerging evidence suggests that chronic, low-level human exposure may disrupt metabolic processes. Simultaneously, the global rise in metabolic disorders such as metabolic syndrome (MetS), obesity, and type 2 diabetes, has created a pressing need to identify novel, potentially modifiable environmental contributors. This dissertation investigates the relationship between glyphosate and metabolic health through a triangulated framework that integrates individual-level epidemiological analysis, systematic synthesis of mechanistic evidence, and ecological evaluation of pesticide mixtures.

The first study employed …

Differences In Mental Health Outcomes In Immigrant Vs. U.S.-Born Populations In Urban Vs. Rural Areas In The United States, Zoë Gentles

Electronic Theses & Dissertations (2024 - present)

Background

The immigration process to the United States creates distinct mental stressors. These stressors are influenced by socioeconomic factors including income, education level and insurance status. In rural America, these factors are intensified due to a poor healthcare infrastructure that is limited. This study examines the relationship between urban-rural residence and mental health outcomes among immigrants vs. native-born residents in the United States.

Methods

Data from the National Health Interview Survey (NHIS) from 2019 and 2022 were used to examine the relationship. The exposure of interest was place of birth, and the outcome of interest was the presence of clinically …

Predictors Of Viral Suppression Among People Living With Hiv (Plhiv) On Antiretroviral Treatment In Almaty, Kazakhstan, Ainur Kussainova

Electronic Theses & Dissertations (2024 - present)

ABSTRACT

Introduction

The Eastern Europe and Central Asia (EECA) region is experiencing the world’s fastest-growing HIV epidemic, with Kazakhstan among the countries most affected. Despite progress in HIV testing and treatment, Kazakhstan continues to face significant challenges in achieving optimal viral suppression among PLHIV. While 82% of PLHIV in Kazakhstan know their HIV status, only 73% are on ART, and just 67% of those on treatment achieve viral suppression. Adherence to ART remains a critical barrier, influenced by a complex interplay of individual, social, and structural factors, including mental health disorders such as depression, substance use, stigma and discrimination. Understanding …

Polygenic Risk Scores Of Grip Strength In Men And Women With Or At Risk For Hiv, Sreevidya Sadananda Sadasiva Rao

Electronic Theses & Dissertations (2024 - present)

Background: Adequate hand function among older adults is necessary for the successful completion of activities of daily living and can affect whether an older adult is able to live independently. Current research highlights grip strength, the strength people have in their hands, as a robust predictor of morbidity and mortality, and explores the decline in grip strength over time. A person’s family history and genes (DNA) affect how much grip strength they have. Previous studies have identified genes that affect grip strength, mainly in European ancestry populations. In this study, we examined whether these genetic elements predict grip strength in …

Non-Profit Hospital Spending On Community Health Improvement: Catalysts, Impediments, And Opportunities In New York State, Isaac H. Michaels

Electronic Theses & Dissertations (2024 - present)

This dissertation assesses the distribution and determinants of spending by non-profit hospitals in New York State on community health improvement services and community benefit operations. Utilizing the Social Ecological Model of Health, this study considers multiple levels of influence on this spending, including organizational and community characteristics. Using quantitative analysis, it examines cross-sectional, spatial, and longitudinal patterns in spending and identifies organizational and community-level factors influencing it. Qualitative analysis investigates operational factors affecting spending, including individual and interpersonal influences. The results of this mixed-methods study can inform hospital administrators, public health officials, policymakers, and communities in optimizing policies and decision-making …