Digital Commons Network^™

“Dead Or Alive?” Assessment Of The Binary End-Of-Event Outcome Indicator For The Nemsis Public Research Dataset, Mary E. Helander

Social Science - All Scholarship

OBJECTIVE: The broad absence of definitive patient outcomes in the NEMSIS public release data hinders research that seeks to understand the impact of pre-hospital care, operations, and overall patterns of population health – including geospatial and demographic differences. This study evaluated the recently proposed binary end-of-event outcome indicator to provide additional validity of the method, to evangelize its employment for more studies to analyze survival impact following an emergency medical event, and to identify appropriate use and interpretation given imperfection in predicted outcomes. METHODS: A recently published binary end-of-event outcome indicator was applied to datasets for each year from 2017 …

Exploration Of Positive Deviance In Prevention Of Underweight In The Under-Five: A Qualitative Study On Low-Income Urban Families, Irwan Budiono, Lukman Fauzi, Dewi Sari Rochmayani

Kesmas

Children under the age of five (the under-five) from low-income families are more vulnerable to experience underweight. This nutritional vulnerability is evident in the preliminary study, where 35.1% of the under-five experience underweight, and 28.48% are low-income families. This study aimed to explore Positive Deviance (PD) behaviors in preventing underweight among the under-five. The study applied a qualitative approach with a case study design. Data collection took place in July-August 2022, focusing on low-income families in the Gunung Brintik area. Data were collected through two focus group discussions, seven in-depth interviews, and five key informant interviews. Coding, subtheme, and theme …

Exploring Informal Caregivers’ Perspectives On Oral Care For Stroke Patients, Haslina Rani, Saidatul Najibah Muhammad Zamzuri, Ezzah Omar, Tuti Ningseh Mohd-Dom, Aznida Firzah Abdul Aziz, Mohd Fairuz Ali

Kesmas

Stroke often results in physical disability and functional impairment, which may severely limit patients' ability to care for personal hygiene, including oral care. This study aimed to identify the challenges faced by informal caregivers in managing the oral health of stroke patients. This study conducted semi-structured individual interviews with eight home-based caregivers of stroke patients recruited from a community-based clinic facility of a public university in Malaysia. The interviews took 30-45 minutes to complete and were transcribed verbatim. Transcripts were analyzed thematically using a phenomenological approach. Relevant themes that emerged were variations in oral hygiene care, caregivers’ concerns in providing …

A Needs-Assessment Survey Of The High School Lgbtq+ Environment By A Health Science Center Interprofessional Team, Rafael Velasquez, Mary E. Moore, Gabrielle Sheets, Christian Nieves-Rivera, Sonya Van Nuland, Martha Cuccia, Fern Tsien, Andrew D. Hollenbach

School of Medicine Faculty Publications

Despite improvements in the awareness and acceptance of lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) individuals, the LGBTQ+ community continues to experience discrimination, which can result in adverse health outcomes. In particular, LGBTQ+ youth have an increased risk of experiencing depression, substance abuse, and suicide. Societal stigma and rejection, bullying, and familial disapproval all contribute to these health disparities. In recognition of these inequities, an interprofessional team of biomedical faculty members, staff, and trainees from the Louisiana State University Health Science Center (LSUHSC) in New Orleans developed the needs-assessment evaluation, the Gender and Sexual Minority …

Determinants Of Testicular Cancer Survival Rates In American Indian/Alaska Natives, Mufaya Nganzi

Walden Dissertations and Doctoral Studies

Testicular cancer is the most common solid tumor among male young adults between 15 to 34 years old. Despite progress with the testicular cancer survival rate, American Indians or Alaskan Natives (AI/ANs) have the highest mortality rate of testicular cancer compared to all other racial groups in the United States. There is a shortage of reported studies on social-related factors that affect the survival rate of testicular cancer patients among AI/ANs. The purpose of this study was to examine the association between stage at diagnosis, treatment, insurance status, and marital status as independent variables and the survival rate (in months) …

Perceptions Of Hiv-Related Comorbidities And Usability Of A Virtual Environment For Cardiovascular Disease Prevention Education In Sexual Minority Men With Hiv: Formative Phases Of A Pilot Randomized Controlled Trial, S Raquel Ramos, Harmony Reynolds, Constance Johnson, Gail Melkus, Trace Kershaw, Julian F Thayer, Allison Vorderstrasse

Faculty, Staff and Student Publications

Background: Sexual minority men with HIV are at an increased risk of cardiovascular disease (CVD) and have been underrepresented in behavioral research and clinical trials.

Objective: This study aims to explore perceptions of HIV-related comorbidities and assess the interest in and usability of a virtual environment for CVD prevention education in Black and Latinx sexual minority men with HIV.

Methods: This is a 3-phase pilot behavioral randomized controlled trial. We report on formative phases 1 and 2 that informed virtual environment content and features using qualitative interviews, usability testing, and beta testing with a total of 25 individuals. In phase …

Needs Of Family Caregivers Of Hospitalised Adults With Dementia During Care Transitions: A Qualitative Study In A Us Department Of Veterans Affairs Hospital, Molly J Horstman, Tracy L Evans, Crystal Guo, Mandi Sonnenfeld, Aanand D Naik, Alan Stevens, Mark E Kunik

Faculty, Staff and Student Publications

OBJECTIVE: To identify the needs of caregivers of hospitalised adults with dementia in the hospital and during care transitions.

DESIGN: Pragmatic qualitative inquiry with semi-structured interviews.

SETTING: Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, USA.

PARTICIPANTS: 12 family caregivers (family member (n=11); friend (n=1)) and 15 health professionals (hospital medicine physicians (n=4), inpatient nurse case managers (n=2), social workers (n=4), outpatient geriatrics providers (n=2), a primary care provider (n=1), geriatric psychiatrists (n=2)) were interviewed. Caregivers were recruited while their care recipient was hospitalised and were interviewed at least 2 weeks after the care recipient was discharged from …

Obese African American Women’S Perceptions Of Transition From College To Workforce, Alea Lycorish

Walden Dissertations and Doctoral Studies

The rate of obesity continues to rise among adults in the United States, and African American (AA) women are at greater risk in comparison with any other group. This matter has become an alarming public health crisis. Obese AA women also face a higher risk of discrimination in the workforce. The purpose of this qualitative, multiple case study was to increase the understanding of the perceptions and experiences of bachelor degree educated, overweight AA women during the postgraduate phase, who entered the workforce within the past 10 years. The theoretical framework used in this study was Crenshaw’s intersectionality theory. The …

Economic Behavior And Hiv Risk Behavior Among Vulnerable Women: A Prospective Randomized Control Study In Southern Uganda, Joshua Kiyingi

Brown School Graduate Student Theses and Dissertations

In sub-Saharan Africa (SSA), the estimated population of women engaged in sex work (WESW) is 2.5 million, aged 15 to 49 years (Laga et al., 2023). WESW face numerous challenges, including high-risk behaviors that expose them to HIV, sexually transmitted infections (STIs), drug and alcohol abuse, criminalization, discrimination, mental health problems, and limited healthcare access. Globally, WESW are significantly affected by HIV, with new infections continuing to rise. Recent estimates show that although 8% of all new HIV infections are among WESW, 32.8% of them are unaware of their HIV status (UNAIDS, 2021a). The risk of acquiring HIV is 30 …

Appropriateness Of Imaging For Low-Risk Prostate Cancer-Real World Data From The Pennsylvania Urologic Regional Collaboration (Purc), Raidizon Mercedes, Dennis Head, Elizabeth Zook, Eric Eidelman, Jeffrey Tomaszewski, Serge Ginzburg, Robert Uzzo, Marc Smaldone, John Danella, Thomas Guzzo, Daniel Lee, Laurence Belkoff, Jeffrey Walker, Adam Reese, Mihir Shah, Bruce Jacobs, Jay Raman

Einstein Health Papers

Imaging for prostate cancer defines the extent of disease. Guidelines recommend against imaging low-risk prostate cancer patients with a computed tomography (CT) scan or bone scan due to the low probability of metastasis. We reviewed imaging performed for men diagnosed with low-risk prostate cancer across the Pennsylvania Urologic Regional Collaborative (PURC), a physician-led data sharing and quality improvement collaborative. The data of 10 practices were queried regarding the imaging performed in men diagnosed with prostate cancer from 2015 to 2022. The cohort included 13,122 patients with 3502 (27%) low-risk, 2364 (18%) favorable intermediate-risk, 3585 (27%) unfavorable intermediate-risk, and 3671 (28%) …

Multilevel Factors Affecting Covid-19 Vaccination Among African American Communities In South Carolina, Ran Zhang

Theses and Dissertations

Background: Persistent health disparities has led to significant public health challenges, especially for African American (AAs) communities, and have been exacerbated by the COVID-19 pandemic. Achieving high population vaccination rates are crucial to controlling the virus’ spread. However, AAs have higher rates of COVID-19 infection and mortality than Whites, yet their vaccination rates remain relatively low. The dissertation aimed to investigate the multilevel factors and mechanisms that affect AAs’ vaccination behavior. The first objective is to assess the impact of the intrapersonal level factor (i.e., perceived barriers to vaccination) on vaccination behavior. The second objective is to investigate the impact …

Challenges In Traumatic Spinal Cord Injury Care In Developing Countries - A Scoping Review, Mohammad Hosein Ranjbar Hameghavandi, Elaheh Khodadoust, Mahgol Sadat Hassan Zadeh Tabatabaei, Farzin Farahbakhsh, Zahra Ghodsi, Sabra Rostamkhani, Shahryar Ghashghaie, Mahkame Abbaszade, Arash Arbabi, Seyedeh Maede Hossieni, Mohsen Sadeghi-Naini, Rasha Atlasi, Samuel Berchi Kankam, Alexander Vaccaro, James Guest, Michael Fehlings, Vafa Rahimi-Movaghar

Department of Neurosurgery Faculty Papers

OBJECTIVE: To evaluate the leading challenges in developing countries' traumatic spinal cord injury (TSCI) care.

METHODS: We conducted a systematic search in electronic databases of PubMed, SCOPUS, Web of Science, EMBASE, and Cochrane Library on 16 April 2023. Studies that investigated challenges associated with the management of TSCI in developing countries were eligible for review. We extracted related outcomes and categorized them into four distinct parts: injury prevention, pre-hospital care, in-hospital care, and post-hospital care.

RESULTS: We identified 82 articles that met the eligibility criteria including 13 studies on injury prevention, 25 on pre-hospital care, 32 on in-hospital care, and …

Factorial Trial To Optimize An Internet-Delivered Intervention For Sexual Health After Breast Cancer: Protocol For The Wf-2202 Sexual Health And Intimacy Enhancement (Shine) Trial, Kelly M. Shaffer, Jennifer Barsky Reese, Emily V. Dressler, Jillian V. Glazer, Wendy Cohn, Shayna L. Showalter, Anita H. Clayton, Suzanne C. Danhauer, Michelle Loch, Mai Kadi, Caleigh Smith, Kathryn E. Weaver, Glenn J. Lesser, Lee M. Ritterband

School of Medicine Faculty Publications

Background: Although most survivors of breast cancer report substantial sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to survivors of breast cancer via the internet could overcome many of the barriers to in-person treatment. Even when delivered remotely, survivor time constraints remain a leading barrier to sexual health intervention uptake. Objective: Guided by the multiphase optimization strategy methodological framework, the primary objective of this study is to identify the most efficient internet-delivered sexual health intervention package that is expected to provide survivors of breast cancer the greatest benefit with the fewest (and least-intensive) intervention …

Addressing Dermatologic Concerns And Teledermatology In Undomiciled And Sheltered Populations, Kennedy Gallagher, Sahithi Talasila, Anna Bistline, Rebecca Krain, Leena Ramani, Elizabeth Jones

Student Papers, Posters & Projects

Homelessness in the United States is a significant public health issue, with dermatologic disease being the most prevalent health concern among the undomiciled and sheltered populations. Despite a growing need for dermatologic care, the supply of dermatologists remains insufficient, contributing to disparities in healthcare access for this vulnerable group. This review aims to detail the spectrum of dermatologic conditions experienced by homeless individuals, identify barriers to adequate care, and explore teledermatology as a potential solution to bridge these gaps. A comprehensive literature review was conducted, analyzing studies and reports on dermatologic issues prevalent among the homeless population and the efficacy …

What Is The Economic Benefit Of Annual Covid-19 Vaccination From The Adult Individual Perspective?, Sarah M Bartsch, Kelly J O'Shea, Colleen Weatherwax, Ulrich Strych, Kavya Velmurugan, Danielle C John, Maria Elena Bottazzi, Mustafa Hussein, Marie F Martinez, Kevin L Chin, Allan Ciciriello, Jessie Heneghan, Alexis Dibbs, Sheryl A Scannell, Peter J Hotez, Bruce Y Lee

Center for Medical Ethics and Health Policy Staff Publications

Background: With coronavirus disease 2019 (COVID-19) vaccination no longer mandated by many businesses/organizations, it is now up to individuals to decide whether to get any new boosters/updated vaccines going forward.

Methods: We developed a Markov model representing the potential clinical/economic outcomes from an individual perspective in the United States of getting versus not getting an annual COVID-19 vaccine.

Results: For an 18-49 year old, getting vaccinated at its current price ($60) can save the individual on average $30-$603 if the individual is uninsured and $4-$437 if the individual has private insurance, as long as the starting vaccine efficacy against severe …

Internalizing Mental Health Symptoms And Nicotine Use Among Adolescents In Canada, England, And The Us From 2020-2022, Emily E. Hackworth

Theses and Dissertations

Background: There is a well-established bi-directional relationship between cigarette smoking and internalizing mental health (IMH) symptoms (e.g., symptoms of depression, symptoms of anxiety). However, it is unclear whether IMH symptoms are associated with using different types of nicotine products among adolescents, as adolescents are using a variety of nicotine products, including combustible products (cigarettes), non-combustible products (e-cigarettes), or combinations of both types of products. This dissertation examines associations between IMH symptoms and current use of various types of nicotine products across three countries from 2020-2022.

Methods: Data come from the 2020-2022 waves of the International Tobacco Control (ITC) Adolescents Tobacco …

The Role Of Telehealth And Obstetrics Capacity On Maternal Health Care: A Mixed Methods Approach, Shanikque L. Barksdale

Theses and Dissertations

Background: The United States (US) is experiencing a maternal health crisis, with rising severe maternal morbidity and mortality rates and persistent racial, ethnic, and geographic disparities. While telehealth can address access challenges, there is limited evidence of its impact on access to maternity care and outcomes among rural and minoritized communities. The overall objective of this study was to analyze the disparities in maternal outcomes and user satisfaction by hospital-based telehealth and obstetric care availability.

Methods: A convergent parallel mixed methods approach was used. A multinomial logistic regression was used to analyze whether the changes in the proportions of hospitals …

The Experience Of Homelessness And Its Effects On Gut Eubiosis, Kamerin Villagomez

University Honors Theses

Microorganisms which populate the human gastrointestinal tract (GIT) have a profound effect on overall human health. The relationship between host health and eubiosis, or balance, of the GIT microbiome is symbiotic and can have reciprocal relationships with quality of sleep, quality of diet, stress and mental health, and the experience of pain. These specific aspects of health are unique in populations experiencing homelessness due to the multi-dimensional and complex nature of their lived experience. Very few studies explore populations experiencing homelessness, with even fewer investigating the intersection between this population and the human GIT microbiome. It is important to do …

Associations Between The Use Of Ssri Medication In Older Adults And Cognitive Decline And Impairment, Paige Jones

Theses and Dissertations

Previous research has indicated that depression is a risk factor for dementia. Since SSRI medication is the most common treatment for depression, it is important to determine if SSRIs are associated with reduced dementia and better cognitive outcomes. Using longitudinal data from the 2004-2014 waves of the Health and Retirement Study merged with the 2005 Prescription Drug Study, we examined potential associations between SSRI and TCA medication and cognitive impairment and cognitive decline. The study population consisted of 1,775 older adults who participated in the PDS in 2005. We found that SSRIs were associated with significantly higher odds of cognitive …

Impacts Of Covid-19 And Taliban Takeover On U.S. Afghan Refugee Women’S Mental Health: A Socio-Ecological Approach To Resilience Resources, Atefeh Aghaei

Theses and Dissertations

In response to the escalating global refugee crisis, intensified by ongoing conflicts and environmental changes, this dissertation research focuses on the mental health of Afghan refugee women in the United States (U.S.), particularly in the context of the COVID-19 pandemic and the 2021 Taliban takeover. With over 114 million people displaced globally, Afghan refugees, notably women, encounter heightened mental health risks due to violence, deprivation, systemic persecution, and the challenges of migration. This vulnerability is exacerbated by recent mass traumatic events, including the pandemic and political upheaval in Afghanistan. Our study, conducted through semi-structured interviews with Afghan refugee women and …

Nutrition And Mental Health Related Factors Across Historically Black College And University Students, Nancy Anai Uriegas

Theses and Dissertations

The prevalence of food insecurity across college campus in the United States has been widely explored, with the primary focus placed on large, 4-year, primarily White institutions. Less is known about the prevalence of food insecurity and the impact it may have on health behaviors among minority serving institutions, including Historically Black Colleges and Universities (HBCU). Young adults attending college, and more specifically student-athletes (SAs), are typically in a new place, facing new stressors and high rates of food insecurity, which in turn may play a critical role in their current health status as it pertains to meeting their energy …

The Effect Of Covid-19 Restrictions On The Social Support Experiences Of Black Women Giving Birth In South Carolina Hospitals During The First Year Of The Covid-19 Pandemic (2020) As Compared To A Previous Birth, Tiffany Eva Byrd

Theses and Dissertations

The United States is experiencing a maternal health crisis, which disproportionately affects Black women. Black women die from pregnancy-related causes two to three times as often as their White counter parts, and the majority of maternal death are preventable. In recent years, public health and national governing authorities have devoted resources to monitoring the health crisis and raising the public’s knowledge of warning signs; however, maternal mortality rates continue to rise. Noted contributors to Black maternal mortality include, but are not limited to, racism, delayed treatment and response to health emergencies, and lack of social and emotional support during childbirth, …

Redoma: Bayesian Random-Effects Dose-Optimization Meta-Analysis Using Spike-And-Slab Priors, Cheng-Han Yang, Evan Kwiatkowski, J Jack Lee, Ruitao Lin

Faculty, Staff and Student Publications

The rise of cutting-edge precision cancer treatments has led to a growing significance of the optimal biological dose (OBD) in modern oncology trials. These trials now prioritize the consideration of both toxicity and efficacy simultaneously when determining the most desirable dosage for treatment. Traditional approaches in early-phase oncology trials have conventionally relied on the assumption of a monotone relationship between treatment efficacy and dosage. However, this assumption may not hold valid for novel oncology therapies. In reality, the dose-efficacy curve of such treatments may reach a plateau at a specific dose, posing challenges for conventional methods in accurately identifying the …

Factors Associated With Elevated Sars-Cov-2 Immune Response In Children And Adolescents, Sarah E Messiah, Rhiana Abbas, Emma Bergqvist, Harold W Kohl, Michael D Swartz, Yashar Talebi, Rachit Sabharwal, Haoting Han, Melissa A Valerio-Shewmaker, Stacia M Desantis, Ashraf Yaseen, Henal A Gandhi, Ximena Flandes Amavisca, Jessica A Ross, Lindsay N Padilla, Michael O Gonzalez, Leqing Wu, Mark A Silberman, David Lakey, Jennifer A Shuford, Stephen J Pont, Eric Boerwinkle

Faculty, Staff and Student Publications

BACKGROUND: Understanding the distinct immunologic responses to SARS-CoV-2 infection among pediatric populations is pivotal in navigating the COVID-19 pandemic and informing future public health strategies. This study aimed to identify factors associated with heightened antibody responses in children and adolescents to identify potential unique immune dynamics in this population.

METHODS: Data collected between July and December 2023 from the Texas Coronavirus Antibody REsponse Survey (Texas CARES), a statewide prospective population-based antibody survey among 1-to-19-year-old participants, were analyzed. Each participant had the following data available for analysis: (1) Roche Elecsys® Anti-SARS-CoV-2 Immunoassay for Nucleocapsid protein antibodies (Roche N-test), (2) qualitative and …

Personalized Nutrition: Tailoring Dietary Recommendations Through Genetic Insights, Saiful Singar, Ravinder Nagpal, Bahram H. Arjmandi, Neda S. Akhavan

Kinesiology and Nutrition Sciences Faculty Research

Personalized nutrition (PN) represents a transformative approach in dietary science, where individual genetic profiles guide tailored dietary recommendations, thereby optimizing health outcomes and managing chronic diseases more effectively. This review synthesizes key aspects of PN, emphasizing the genetic basis of dietary responses, contemporary research, and practical applications. We explore how individual genetic differences influence dietary metabolisms, thus underscoring the importance of nutrigenomics in developing personalized dietary guidelines. Current research in PN highlights significant gene–diet interactions that affect various conditions, including obesity and diabetes, suggesting that dietary interventions could be more precise and beneficial if they are customized to genetic profiles. …

Novel Applications Of Syndemic Theory For Global Public Health: Considerations For Gender Based Violence And Mixed Methods Research, Luissa Vahedi

Brown School Graduate Student Theses and Dissertations

Syndemic theory highlights that epidemics do not occur in isolation. Due to harmful political inequalities, epidemics can co-occur and interact with one another to magnify the overall burden of disease. Certain contexts and populations are more prone to syndemic vulnerabilities. Gender based violence (GBV) has been labeled as an epidemic in low- and middle-income countries (LMICs). Epidemiological evidence has demonstrated that GBV co-occurs alongside other epidemics such as HIV and substance use. This dissertation extends the application of syndemic theory to GBV in LMIC for the purpose of improving methodological and analytical approaches as well as global health applications. Three …

Writing For The Journal: A Guide For Community-Based Organizations, Randy Wykoff, Rachel E. Dixon

Journal of Appalachian Health

The Journal of Appalachian Health welcomes submissions from a variety of stakeholders interested in and contributing to improvement of health across the Appalachian Region. This editorial provides basic guidelines for those working in community settings who may with to make JAH (or any other journal) their publication home.

Association Between High Health Literacy, Doctor's Recommendation, And Prostate Cancer Screening Among Men In The United States, Felicia Njideka Akunna

Walden Dissertations and Doctoral Studies

To efficiently identify and prevent the advancement of prostate cancer and decrease mortality rates, it is crucial to examine the impact of health literacy. Despite potential advantages associated with enhanced health literacy and early detection, the United States continues to witness a significant rise in both new prostate cancer cases and mortality rates, emphasizing the severity of the condition. However, it is unclear if those with high health literacy are discouraged from participating in prostate cancer screening due to the risks associated with screening. Based on the stimulus organism response model, 2016 Behavioral Risk Factor Surveillance System data were analyzed …

Socioeconomic Determinants And Maternal Mortality In Liberia, Monee Sherman

Walden Dissertations and Doctoral Studies

High rates of pregnancies and childbirth contribute to a heightened risk of maternal mortality among women between 15 and 49 in Liberia. Most women are uninformed about their maternal risk behaviors, symptom severity, and delayed care-seeking. The mortality rate for women between 25 and 34 during pregnancy and childbirth is unacceptably high. The highest increase in maternal mortality rates is seen among women between 40 and 44 who choose to delay motherhood. In Liberia, the deaths of 4.5 women a day are caused by complications during pregnancy and childbirth. We examined the influence of participant background characteristics, socioeconomic factors, and …

A Social Media Game To Increase Physical Activity Among Older Adult Women: Protocol Of A Randomized Controlled Trial To Evaluate Challenge, Michael C Robertson, Maria Chang Swartz, Karen M Basen-Engquist, Yisheng Li, Kristofer Jennings, Debbe Thompson, Tom Baranowski, Elena Volpi, Elizabeth J Lyons

Faculty, Staff and Student Publications

BACKGROUND: Older adult women often do not engage in sufficient physical activity (PA) and can encounter biological changes that exacerbate the negative effects of inadequate activity. Wearable activity monitors can facilitate PA initiation, but evidence of sustained behavior change is lacking. Supplementing wearable technologies with intervention content that evokes enjoyment, interest, meaning, and personal values associated with PA may support long term adherence. In this paper, we present the protocol of an NIA-funded study designed to evaluate the efficacy of CHALLENGE for increasing step count and motivation for PA in insufficiently active older women (Challenges for Healthy Aging: Leveraging Limits …