Digital Commons Network^™

Improving Oral Hygiene Practices In A Long-Term Care Setting For Individuals With Advanced Dementia: A Quality Improvement Initiative, Rachel L. Mcinerney

Capstone Experience: Master of Public Health

This quality improvement project utilized the Plan-Do-Study-Act framework to enhance oral hygiene practices in a long-term care setting for individuals with advanced dementia. Advanced dementia often leads to significant oral health challenges due to the individuals’ inability to communicate needs or independently manage oral care. Poor oral hygiene results in pain, systemic infections, and reduced quality of life. The project aimed to identify and address barriers to effective oral care delivery by focusing on organizational factors such as leadership, training, and caregiver support. This capstone paper provides insights into the quality improvement initiative’s aims, background, and methodology, while emphasizing its …

Integrated Primary Care And Mental Health In Rural Communities: A Comprehensive Literature Review To Understand Barriers, Zinab Alaskar

Capstone Experience: Master of Public Health

This comprehensive literature review capstone project identifies structural barriers to integrating primary care and mental health services in rural areas. It examined reliable literature and validated research articles to determine challenges and barriers to the adoption and expansion of integrating primary care and mental health services in rural communities. The hypothesis of this work is that the issues of workforce shortages, financial constraints, technological limitations, and stigma in a society limits the development and viability of integrated healthcare models. These structural limitations must be addressed to address issues related to access to health care, costs and patient well-being. As it …

The Politics Of The Black Womb: How Education And Power Reinforce The U.S. Black Maternal Health Crisis, Foluke Akinkunmi

Honors Scholar Theses

This study investigates the alarming maternal mortality rates among Black women in the U.S. today first by exploring the historical exploitation of Black maternal bodies during enslavement and with the rise of professionalized gynecology. It challenges the narrative that attributes these outcomes to individual choices or supposedly inherent biological factors, arguing instead that the devaluing of Black women’s well-being and authoritative knowledge have been constructed along with the United States itself. To advance a constructive response, the paper analyzes curriculum competencies for obstetric and midwifery healthcare providers, surveys of Black women's birthing experiences in the previous 20 years, and interviews …

Exercise As An Intervention For Postpartum Depression (Ppd), Kylie P. Mistretta

Honors Scholar Theses

Objective: To illustrate the applications of exercise for preventing the development of postpartum depression (PPD) and addressing associated risk factors identified in the literature. Data Sources: PubMed and EBSCO: Academic Search Premier were accessed using the search terms exercise OR physical activity OR yoga AND postpartum depression OR postnatal depression. A secondary search of PubMed was conducted using the search terms exercise AND pregnancy AND depression OR gestational diabetes OR weight gain OR sleep quality.

Study Selection: Studies selected for inclusion were peer-reviewed, published after January 2012, written in English, and relevant to the PPD risk factors examined. Only clinical …

Implementing And Evaluating An Ai-Powered Visual Decision Support System To Improve Antibiotic Usage Among Physicians With A Built-In Early Warning System, Akua Sekyiwaa Osei-Nkwantabisa

Theses and Dissertations

The widespread misuse and excessive prescription of antibiotics have played a pivotal role in the emergence and proliferation of antibiotic-resistant bacteria, posing a critical global public health crisis. Addressing this challenge necessitates innovative solutions that enhance antimicrobial stewardship. This study presents the development and implementation of a visual decision support system designed to monitor and optimize antibiotic usage among healthcare providers. The proposed system integrates advanced machine learning algorithms with real-time data analytics to provide a dynamic, evidence-based decision support tool. Specifically, a neural network model was developed after evaluating multiple machine learning approaches, including Random Forest, Logistic Regression and …

Health And Community Resource Book, Gabriela Gonzalez

Electronic Theses, Projects, and Dissertations

ABSTRACT

The High Desert Health and Resource Guide offers an in-dept exploration of the challenges and resources available to support the high desert communities, particularly to include cities of Apple Valley, Phelan and Victorville. These communities are composed of low-income households, and they face significant health disparities and food insecurity. Factors such as limited access to healthcare, mental health services, homeless shelters, and limited availability of health food choices. Additionally, many cities in the region are affected by food deserts, which further hinder resident’s ability to access nutritious, wholesome food. The resource guidebook highlights both the challenges and issues that …

Awareness And Attitudes Toward Diabetes Among Students In The California State University System, Cesar Fajardo

Electronic Theses, Projects, and Dissertations

Background and Aims: The prevalence of type 2 diabetes has been increasing globally. Studies examining patient awareness and attitudes toward diabetes have been conducted and found that diabetes education does increase patient knowledge but has no effect on attitudes. Additionally, many of these studies did not assess university students’ views on type 2 diabetes. Given that type 2 diabetes incidence is increasing among young adults, more attention must be given to this population. Therefore, the aim of this study was to investigate CSUSB students' understanding and attitudes toward type 2 diabetes.

Methods: A cross-sectional study using electronic surveys with …

Disability Inclusion In Local Public Health Community Health Assessments And Community Health Improvement Plans, Haleigh Leslie

Electronic Theses and Dissertations

Introduction: Local health departments (LHDs) use community health assessments (CHAs) and community health improvement plans (CHIPs) to identify and address health needs of the populations they serve. People with disabilities experience health disparities, and there is limited information about how the health needs of people with disabilities are included in CHAs and CHIPs. The purpose of this study was to describe and quantify disability inclusion in LHD CHAs and CHIPs.

Methods: This cross-sectional, mixed methods study used the CHAs and CHIPs of accredited local health departments, data about LHDs and populations served, and interviews with LHD staff and community partners …

Assessing The Relationship Between The Incidence Of Campylobacteriosis And Ecological Risk Factors In Tennessee, Emmanuel Angmorteh Mensah

Electronic Theses and Dissertations

Background: Campylobacteriosis although is the leading causes of bacterial diarrheal illnesses, have not gained prominent awareness and there are gaps in the understanding of transmission routes for sporadic, non-outbreak cases and their risk factors at the communal level to humans. This study, therefore, aimed to identify the campylobacteriosis risk factors and risk perception from the existing literature in the United States, determine the incidence and ecological risk factors for campylobacteriosis zip code level in Tennessee, and to perform spatiotemporal analysis of campylobacteriosis incidence cases in Tennessee.

Method: To achieve the first aim, a scoping review was conducted to synthesize …

Rewriting The Rules: Impact Of Covid-19 On Norms In Science, The International Order, And China, Jacob Kissling '25

Honor Scholar Theses

The Covid-19 pandemic exposed both strengths and vulnerabilities in global responses, many of which were shaped by underlying norms and behavioral expectations within key institutions. Understanding how these norms influenced decision-making, collaboration, and communication—and how they were themselves challenged or reshaped by the crisis—can provide valuable insights for improving future responses. While some norms adapted in response to the evolving crisis, others remained stagnant or were inconsistently enforced, contributing to fragmented and, at times, ineffective responses. This paper investigates the role of norms in three critical sectors: the scientific community, the international order, and China. Within the scientific community, norms …

The Impact Of Emdr Therapy On Past Suicidal Ideation: Lived Experiences Of Young Adults, Lindsey Faehnrich

Undergraduate Honors Theses

This study explores the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy in reducing suicidal ideation and improving mental health outcomes among college-attending young adults (ages 18–24) with a history of trauma. EMDR is a body-based psychotherapy designed to alleviate distressing thoughts and trauma. It gained attention for its positive impact on PTSD and has more recently been applied to other mental health disorders. The literature review highlights risk factors including trauma, mental health disorders, suicidal ideation, and EMDR. The methods detail a phenomenological approach, interviewing four young adults who underwent EMDR and experienced past suicidal ideation. This provided …

Health Education And Sexual Health Education In High Schools Focused On Training And Curriculum, Kylee R. Horton

Electronic Theses, Projects, and Dissertations

Background: Health education instruction in schools is essential due to mandated state standards that require a range of topics to be taught at specific ages. Education Codes must be followed and integrated into the curriculum. Objective: To develop a handbook for middle and high school teachers in San Bernardino County, California, that explains the mandatory Health Education codes and provides resources to help teachers maintain compliance with these regulation codes. Methods: The research was conducted in a systematic review, and the data was collected from published secondary sources at the state and local levels. Results: Education Codes from the California …

The Role Of Medical-Legal Partnerships On Social Determinants Of Health For Vulnerable Populations In The Inland Empire, Sabrina C. Kinnally

Electronic Theses, Projects, and Dissertations

San Bernardino and Riverside counties face significant challenges in addressing the Social Determinants of Health (SDOH) for vulnerable populations, including housing instability, healthcare access, and food insecurity. This project examined the role of Medical-Legal Partnerships (MLPs) in providing services to vulnerable populations. Through a systematic review, the study explored the current state of MLPs and their effectiveness in addressing SDOH to reduce health disparities. The other purpose is to assist Agape Legal Service, Inc. (AGAPE), a non-profit organization, in completing their strategic plan, which aims to address the legal needs of vulnerable populations within the Inland Empire. The systematic review …

Evaluating The Impact Of Community Gardens On Social Equity And Public Health: A Case Study Of Caramel Connections Foundation's (Ccf) Seeds Of Joy Community Garden, Elizabeth Pinder

Electronic Theses, Projects, and Dissertations

Community gardens have been increasingly recognized as effective public health interventions that address food insecurity, foster social cohesion, and promote environmental sustainability. This evaluation examines the impact of the Caramel Connections Foundation (CCF) Seeds of Joy Community Garden in Ontario, California, by assessing its effectiveness in advancing social equity, improving public health outcomes, and fostering community engagement. Using an evaluation framework, this study measures key program outcomes, including improvements in community well-being, inclusivity, and access to green spaces.

A mixed-methods evaluation design was applied, incorporating process and impact evaluation methodologies. Secondary data collected from CCF’s existing program records, survey responses, …

Investigating The Suitability Of Dichotomous Responses For The Water Insecurity Experiences (Wise) Scales Using Nationally Representative Data From 39 Countries, Indira Bose, Joshua D. Miller, Hilary J. Bethancourt, Olga P. García, Hugo R. Melgar-Quiñonez, Rosana Salles-Costa, Mauro E. Delgrossi, Scott M. Miller, Tessa L. Durham, Teresa Shamah-Levy, Pablo Gaitán-Rossi, Sera L. Young, Edward A. Frongillo Jr. Ph.D.

Faculty Publications

The Water Insecurity Experiences (WISE) Scales have been validated to comparably measure water insecurity globally. The scales consist of 12 items that can be administered in approximately 3 minutes. There is interest in developing more rapid versions of the tools for when time is limited. One alternative is to use a subset of 4 items, which has been validated, but has some drawbacks. Here we investigate another alternative: dichotomous (yes/no) response options instead of the original four levels of frequency-based (polytomous) responses. We used nationally representative data from 39 countries to simulate dichotomized responses by collapsing the four levels of …

Produce Prescription Policy Project For The Securement Of A Grant To Address Food Insecurity For Low-Income Type Ii Diabetic Patients, Isabel D. Garcia-Gallegos

Doctor of Nursing Practice Final Project Abstract

PURPOSE

This policy-focused Doctor of Nursing Practice (DNP) quality improvement (QI) project aims to secure grant funding through the Gus Schumacher Nutrition Incentive Program (GusNIP) to implement a produce prescription program at a community clinic in Texas. The program targets low-income adults (18-65 years) with type II diabetes who experience food insecurity and are affected by Medicaid non-expansion.

BACKGROUND

Texas’ decision not to expand Medicaid has exacerbated food insecurity among low-income residents, particularly those managing type II diabetes. This decision creates a healthcare policy gap that this project aims to address with a food-as-medicine program.

METHODOLOGY

Using the Plan-Do-Study-Act (PDSA) …

Reducing Extreme Heat Impacts On Health In Pregnant Women And Infants: A Community Based Intervention In Kilifi, Kenya, Adelaide Lusambili, Fiona Scorgie, Martha Oguna, Matthew Chersich, Stanley Luchters, Giorgia Gon, Veronique Filippi, Sari Kovats, Kevin Mccawley, Jeremy Hess

Institute for Human Development, East Africa

High ambient temperatures affect maternal and newborn health outcomes and wellbeing. The Climate Heat and Maternal and Neonatal Health in Africa (CHAMNHA) consortium conducted formative qualitative research in rural Kilifi, Kenya, to examine perceptions of heat risks among women, household members and community stakeholders. An intervention was co-designed together with community members. This paper presents the development, implementation, and evaluation of a behavior-change intervention aimed at reducing the burden of heat on maternal and newborn health. The intervention used Digital Audio-Visual (DAV) storytelling (encompassing short videos and a set of photographs) and facilitated group discussions. Intervention groups included pregnant and …

The Influence Of Scientific, Genetic, And Health Literacy On Carrier Screening Decision-Making, Brenna D. Albracht

Dissertations and Theses (Open Access)

For those wishing to assess their reproductive risks and make informed decisions in their reproductive planning, carrier screening for autosomal recessive and X-linked conditions, as well as cell-free DNA (cfDNA) screening for aneuploidy, are recommended during pregnancy. Despite similarities in purpose, sample requirements, insurance coverage, and safety, a lower percentage of individuals elect carrier screening than cfDNA screening, suggesting there may be a disconnect in what patients perceive as valuable information for their pregnancy. Previous studies have attempted to explain the factors associated with carrier screening uptake or decline; however, no models have yet accounted for a patient’s literacy level …

Planning For Scale: Analysis Of Adaptations And Contextual Factors Influencing Scale-Up Of The Quali-Dec Intervention To Optimize Caesarean Section Use, Soha El-Halabi, Claudia Hanson, Alexandre Dumont, Amanda Cleeve, Helle Mölsted Alvesson, Charles Kaboré, Guillermo Carroli, Pisake Lumbiganon, Quoc Nhu Hung Mac, Ana Pilar Betran

Centre of Excellence in Women and Child Health

Background: Researchers are encouraged to plan for scale through purposeful and guided assessment of scalability of an intervention. This study analysed factors potentially influencing scale-up and synthesised early adaptations of the QUALI-DEC intervention aiming to improve the appropriate use of caesarean section. The intervention consists of opinion leader engagement, audit and feedback for caesarean section, a tool to help women make an informed decision on the mode of birth, and labour companionship.

Methods: We conducted a framework analysis, which was guided by the scalability assessment framework by Zamboni et al., a 34-item checklist with a three-point scale. We used data …

Pregnancy Care Integrating Translational Science, Everywhere (Precise): A Prospective Cohort Study Of African Pregnant And Non-Pregnant Women To Investigate Placental Disorders – Cohort Profile, Rachel Craik, Joseph Akuze, Marie-Laure Volvert, Hannah Blencowe, Moses Mukhanya, Angela Koech, Grace Mwashigadi, Marleen Temmerman, Marvin Ochieng, Emily Mwadime

Centre of Excellence in Women and Child Health

Purpose: The Pregnancies' Care Integrating translational Science, Everywhere Network was established to investigate specific placental disorders (pregnancy hypertension, preterm birth, fetal growth restriction and stillbirth) in sub-Saharan Africa. We created a repository of clinical and social data with associated biological samples from pregnant and non-pregnant women. Alongside this, local infrastructure and expertise in the field of maternal and child health research were enhanced.

Participants: Pregnant women were recruited in participating health facilities in The Gambia, Kenya and Mozambique at their first antenatal visit or at the time a placental disorder was diagnosed (Kenya and The Gambia only). Follow-up study …

The Perception Of Waiting Times On Patient Satisfaction And Patient Care: A Cross-Sectional Study At A Tertiary Health Care Institution In Kenya, Soud Seif, Jasmit Shah, Ali Chandani, Sayed Karar

Internal Medicine, East Africa

Introduction: Patients often spend significant time waiting for care, which influences patient satisfaction, perceived quality, access to care, and utilization of various health care services. Waiting time and resulting implications remain understudied in low- and middle-income countries like Kenya. This study aimed to describe the impact on the perception of waiting times on patient satisfaction and care at a tertiary healthcare institution in Kenya.

Method: We conducted a prospective cross-sectional study between the first of April 2023 and the thirty-first of August 2023 at the Emergency Room (ER) at Aga Khan University Hospital, Nairobi. Data was collected through a structured …

Survival In Patients With Rheumatoid Arthritis And Recently Diagnosed Early-Stage Colorectal, Lung, Or Prostate Cancer Receiving Tumour Necrosis Factor Inhibitors: A Retrospective Cohort Study, Juan I Ruiz, Xiudong Lei, Sharon H Giordano, Hui Zhao, Suja S Rajan, Heather Lin, Maria E Suarez-Almazor

Faculty, Staff and Student Publications

Background: Tumor necrosis factor (TNF) inhibitors could impair tumoural immunity in patients with rheumatoid arthritis and cancer. We aimed to investigate the association between survival and TNF inhibitor treatment during the first 3 years after a diagnosis of colorectal, lung, or prostate cancer in patients with rheumatoid arthritis.

Methods: In this cohort study, we conducted a secondary data analysis of the Surveillance, Epidemiology, and End Results Medicare-linked dataset. We included patients aged 66 years and older with rheumatoid arthritis diagnosed with colorectal, lung, or prostate cancer between Jan 1, 2008, and Dec 31, 2019, using ICD-O-3 site and histology codes. …

An Updated Systematic Review And Consensus Definitions For Standardised Endpoints In Perioperative Medicine: Patient Comfort And Pain Relief, Paul S Myles, Sophie Wallace, Oliver Boney, Mari Botti, Frances Chung, Allan M Cyna, Tong J Gan, Michael P W Grocott, Mark P Jensen, Henrik Kehlet, Andrea Kurz, Maxime Leger, Ulrica Nilsson, Phillip Peyton, Daniel I Sessler, Martin R Tramèr, Christopher L Wu, Alfred Health Patient Experience And Consumer Engagement Group

Faculty, Staff and Student Publications

Background: Improving comfort during and after surgery is a key concern for anaesthetists and other clinicians. With the inclusion of patient and public involvement, we undertook a Delphi consensus process to update previously recommended endpoints to be used in clinical trials evaluating treatments aiming to improve patient comfort after surgery.

Methods: We undertook a systematic review to identify domains and outcome measures of patient comfort used in perioperative studies. Focus groups, workshops, and a multi-round Delphi consensus process that included clinician-researchers and a patient experience and consumer group updated a recommended list of standardised endpoints focused on patient comfort. Consensus …

Associations Between The Timing Of 24 H Physical Activity And Diabetes Mellitus: Results From A Nationally Representative Sample Of The Us Population, Qian Xiao, Qiuyu Feng, Martin K Rutter, Gali Albalak, Heming Wang, Raymond Noordam

Faculty, Staff and Student Publications

Aims/hypothesis: Growing evidence suggests that timing may be an important aspect of physical activity that influences cardiometabolic health. However, the current literature is inconclusive regarding the time of day that physical activity offers the greatest metabolic advantages. We investigated associations between hourly physical activity levels and diabetes mellitus and glycaemic biomarkers in a cross-sectional and nationally representative sample of US adults.

Methods: We studied 7074 adults (mean age 48 years; 52% women) from the National Health and Nutrition Examination Survey (2011-2014). Physical activity was measured by actigraphy. A monitor-independent movement summary (MIMS) unit was used to derive the total activity …

Comparison Of Risk Assessment Tools' Prediction Of Outcomes For Penetrating Trauma, Jeffrey Santos, Catherine M Kuza, Xi Luo, Tiffany Moon, Thomas Shoultz, Anne Feeler, Roman Dudaryk, Jose Navas, Georgia Vasileiou, Kazuhide Matsushima, Matthew Forestiere, Tiffany Lian, Areg Grigorian, Joni Ricks-Oddie, Jeffry Nahmias

Faculty, Staff and Student Publications

Introduction: The Trauma and Injury Severity Score (TRISS) uses anatomic and/or physiologic variables to predict mortality; however, Injury Severity Score is less reliable for penetrating trauma. National Surgical Quality Improvement Program Surgical Risk Calculator (NSQIP-SRC) and American Society of Anesthesiologists Physical Status (ASA-PS) include functional status and comorbidities. This study evaluates the accuracy of these tools in predicting mortality, length of stay (LOS), and complications for operative penetrating trauma.

Methods: Adult penetrating trauma patients (≥18 y) who underwent surgery within 24 h of admission were included in this subgroup analysis of a prospective observational study at four trauma centers. The …

Measured And Self-Reported Hypertension Among Women Of Reproductive Age, Gambia, Kenya, Mozambique, Laura Magee, Esperanca Sevene, Anne Rerimoi, Rachel Craik, Ashley Muteti, Marleen Temmerman, Marianne Vidler, Umberto D’Alessandro, Anna Roca, Jeffrey Bone

Centre of Excellence in Women and Child Health

Problem In sub-Saharan Africa, hypertension prevalence is usually estimated from participant recall. We assessed the accuracy of self-reported hypertension in women of reproductive age.

Approach In PRECISE (PREgnancy Care Integrating translational Science, Everywhere), an observational prospective cohort study, we recruited 1825 non-pregnant women of reproductive age, 610 in the Gambia, 609 in Kenya and 606 in Mozambique. We compared self-reported and measured hypertension (systolic blood pressure ≥ 140mmHg or diastolic blood pressure ≥ 90mmHg). We adjusted hypertension prevalence for age, body mass index, education, parity, and antihypertensive medicine and oral contraceptive use.

Local setting PRECISE was conducted in both urban …

Beyond Opioids: The Role Of Polysubstance Exposure In Neonatal Abstinence Syndrome Treatment And Hospitalization, Caelyn Harrison

Undergraduate Honors Theses

This thesis explores the impact of prenatal polysubstance exposure, specifically focusing on the need for pharmacological treatment for Neonatal Abstinence Syndrome (NAS) and the duration of their hospital stay. A retrospective analysis of 462 infants, including 121 exposed to polysubstances during pregnancy, showed significant associations between polysubstance exposure and adverse neonatal outcomes. Infants with prenatal polysubstance exposure were more likely to require pharmacological treatment for NAS (52.8%) compared to non-exposed infants (38.7%), as determined by chi-square analysis (χ²(1, N = 462) = 7.36, p = .007). Additionally, infants exposed to polysubstances experienced longer hospital stays on average (M = 14.88 …

Addiction In The Prison System: Recidivism And Alternatives, Daniel R. Bowers

Undergraduate Honors Theses

The United States criminal justice system has the highest number of incarcerated individuals in the world, with nearly 2 million people currently being behind bars, and around 7.5 million arrests per year according to the most recent available statistics. A key factor in this is addiction, specifically substance use disorders. Between 58% to 68% of adults arrested are addicted to one or more substances, with 68% of drug involved individuals being rearrested within three years of being released. This recidivism rate is incredibly high, and when combined with current prison and jail overcrowding, has created massive problems for the United …

Public Health Messaging About Dengue On Facebook In Singapore During The Covid-19 Pandemic: Content Analysis, Shirley S. Ho, Mengxue Ou, Nova Mengxia Huang, Agnes S.F. Chuah, Vanessa S. Ho, Sonny Rosenthal

Research Collection College of Integrative Studies

Background:Dengue, a mosquito-borne disease, has been a health challenge in Singapore for decades. In 2020, during the COVID-19 pandemic, Singapore encountered a serious dengue outbreak and deployed various communication strategies to raise public awareness and mitigate dengue transmission.Objective:Drawing on the Crisis and Emergency Risk Communication (CERC) framework, this study examines how dengue-related messages communicated on Facebook (Meta) during the COVID-19 pandemic fall into the CERC themes. This study also seeks to understand how these themes differ between dengue outbreak (eg, 2020) and nonoutbreak years (eg, 2021). In addition, we explore how message themes on dengue changed across different CERC phases …

Dose Prediction Via Deep Learning To Enhance Treatment Planning Of Lung Radiotherapy Including Simultaneous Integrated Boost Techniques, Wenhua Cao, Mary Gronberg, Stephen Bilton, Hana Baroudi, Skylar Gay, Christopher Peeler, Zhongxing Liao, Thomas J Whitaker, Karen Hoffman, Laurence E Court

Faculty, Staff and Student Publications

Background: Recent studies have shown deep learning techniques are able to predict three-dimensional (3D) dose distributions of radiotherapy treatment plans. However, their use in dose prediction for treatments with varied prescription doses including simultaneous integrated boost (SIB), that is, using multiple prescription doses within the same plan, and benefit in improving plan quality should be validated.

Purpose: To investigate the feasibility and potential benefit of using deep learning to predict dose distribution of volumetric modulated arc therapy (VMAT) including SIB techniques and improve treatment planning for patients with lung cancer.

Methods: The dose prediction model was trained with 93 retrospective …