Digital Commons Network^™

Nutritional Medicine: Education For Advanced Practice Providers, Natalie Organ

DNP Research Projects

Abstract

OBJECTIVE: The project's primary goal was to educate the APP and develop positive attitudes and beliefs concerning plant-based nutrition regarding obesity, diabetes, cardiovascular disease, and cancer. The project addressed a crucial gap in healthcare education. APPs were not routinely given the chance to learn nutritional medicine, leading to decreased confidence in providing nutritional guidance in clinical practice.

METHODS: The DNP project participants were practicing advanced practice providers. The Knowledge, Attitude, Behavior (KAB) education theory and CREATION Life were used. This project used Qualtrics to send a pre-and post-intervention survey titled Student Survey for Nutritional Medicine. The intervention was a …

A Lifestyle Management Coaching Intervention For Fear Of Cancer Recurrence In Young Breast Cancer Survivors, Lisa R. Murphy

DNP Research Projects

Abstract

Objective: A significant challenge facing young breast cancer (BC) survivors is learning how to manage fear of cancer recurrence (FCR) during survivorship. Limited tailored FCR interventions and age-appropriate support exist. This Doctor of Nursing (DNP) project, based upon best practice guidelines, aimed to evaluate how a Lifestyle Management Coaching Intervention (LMCI) could help young female BC survivors learn how to decrease and manage their FCR more effectively and experience improved health outcomes.

Method: Eligible participants were female BC survivors aged 18-59 with Stage I-III BC demonstrating elevated baseline FCR screening scores during the extended survival period recruited from the …

How Perspectives On Food Safety Of Vendors And Consumers Translate Into Food-Choice Behaviors In 6 African And Asian Countries, Sejla Isanovic, Shilpa V. Constantinides, Edward A. Frongillo Ph.D., Shiva Bhandari, Sharraf Samin, Emma Kenney, Sigrid Wertheim-Heck, Stella Nordhagen, Michelle Holdsworth, Paula Dominguez-Salas, Ramya Ambikapathi, Amos Laar, Crystal L. Patil, Bharati Kulkarni, Salome A. Bukachi, Mariah Ngutu, Christine E. Blake Ph.D., Rd

Faculty Publications

Background: Consumption of unsafe foods increases morbidity and mortality and is currently an issue, particularly in low- and middle-income countries. Policy actions to ensure food safety are dominated by mitigation of biological and chemical hazards through supply-side risk management, lessening the degree to which consumer perspectives of food safety are considered. Objectives: This study aimed to provide an in-depth understanding, from vendor and consumer perspectives, of how food-safety concerns of consumers translate into their subsequent food-choice behaviors in 6 diverse low- and middle-income countries. Methods: Six Drivers of Food Choice projects (2016–2022) provided transcripts from 17 focus group discussions and …

Effectiveness Of An Integrated Multilevel Early Child Development Intervention On Caregiver Knowledge And Behavior: A Quasi-Experimental Evaluation Of The Malezi Program In Tanzania, Gretchen Antelman, Josephine Ferla, Michelle M. Gill, Heather J. Hoffman, Teopista Komba, Amina Abubakar, Pieter Remes, Ola Jahanpour, Martha Mariki, Mary A. Mang’Enya, Roland Van De Ven

Institute for Human Development, East Africa

Background The quality of caregiving and the parent-child relationship is critical for early child development (ECD) and has been shown to be modifiable. This study evaluated an ECD project in Tanzania, assessing the effectiveness of radio messaging (RM) alone and a combined radio messaging/video job aids/ECD (RMV-ECD) intervention.

Methods This two-arm pre-post evaluation study enrolled a cohort of caregivers of children 0–24 months in four districts of Tabora region, following them for 9 months. ECD radio messages were broadcast on popular stations at least 10 times/day reaching all study districts. In two districts, community health workers (CHW), trained in UNICEF’s …

Perceptions Of Adults With Type 1 Diabetes About Diabetes Management And Exercise, Meera Swaminath

Public Health Theses

This study was conducted to understand participants’ experiences with diabetes management and relationships with exercise for a sample of adults (27-65 years old) with Type 1 diabetes living in the United States and identify potential technological features for a digital health tool supporting physical exercise and diabetes management. The sample consisted of 12 participants living across the nation. Participants were recruited online, through social media and healthcare system platforms. Participant data was collected in the form of surveys and interviews and analyzed using a constructivist framework and thematic analysis. Findings were collapsed into four major themes: 1) making exercise decisions …

A Deeper Dive Into Food Insecurity Among Women Involved In The Criminal Justice System, Jessica Robles

Public Health Theses

Background: The U.S. has the highest incarceration rate globally and a recent study found that 91% of formerly incarcerated individuals report being food insecure. Given that, women have become the fastest-growing segment in the incarceration system. Women who are involved in the criminal justice system (WICJ) are more at risk for experiencing food insecurity and chronic diseases. Therefore, this study aims to contribute to existing knowledge on the overall health of WICJ by assessing the prevalence of food insecurity and the social determinants of health (SDOH) that may contribute to food insecurity.Objective: To provide information on the overall health of …

“To Live In The Body Of A Survivor ”: Unique And Cumulative Disaster Exposure And Mental Health In A Sample Of Hurricane Katrina Survivors, Noelle Serino

Public Health Theses

Introduction: Fueled by the escalation of climate change, weather-related disasters are increasing in frequency and severity. Existing research has documented the extensive harm induced by such disasters, yet few studies have examined how individuals’ psychological well-being fares when exposed to multiple, diverse threats, including other weather-related and public health disasters (e.g., COVID-19). As such, the present study explores posttraumatic and psychological distress in the context of unique and cumulative disaster exposure.Methods: The data utilized for this study came from the Resilience in Survivors of Katrina (RISK) Project. The sample was comprised of 381 predominantly Non-Hispanic Black (84.5%) women who experienced …

Do Longitudinal Trends In Caloric Intake Vary By Income, Education, Or Race?, Daniel Davila

Public Health Theses

Background: The prevalence of obesity in the United States has increased over the last few decades. Reasons for the increases are abundant, but one factor consistently stands out, caloric intake. Cross-sectional data on differences in caloric intake by race/ethnicity and socioeconomic status are common; however, few studies have evaluated the long-term trends in calorie intake by these factors. Methods: We evaluated trends in average calories consumed by adults in the United States by income decile, educational attainment level, and race/ethnicity from 1971 to 2018 using data from the National Health and Nutrition Examination Survey (NHANES), which purposely assessed and recorded …

Estimating Urinary Nitrate Excretion In Rural Iowans From Dietary And Drinking Water Sources, Timothy Skalaban

Public Health Theses

Nitrate levels are increasing in our environment, and epidemiological studies have found evidence of adverse health risks from this exposure. Therefore, it is important to characterize the magnitude of nitrate exposure from food and drinking water sources. This study assesses the magnitude of nitrate exposure for 47 farmers from the Agricultural Health Study (AHS) in 2018-2019. The participants in our study use private wells as their main drinking water source and live in agricultural area of Iowa (10 counties) where ground water is vulnerable to nitrate contamination. The extent of nitrate exposure is determined by several factors, including the types …

“So We Create Happy Synergies” How An Overall Enabling Environment Helped Lao Pdr Legislate The Who Code On Breastmilk Substitutes: Lessons Learnt, Devina Buckshee

Public Health Theses

ABSTRACT

Background: Exclusive breastfeeding rates in Lao People’s Democratic Republic (Lao PDR) remain at 44% against a global goal of at least 50%, partly due to a weak understanding of the multifactorial and multilevel determinants of breastfeeding (UNICEF, 2021). Therefore, evidence-based advocacy efforts call for a systems approach to improve the enabling environment around breastfeeding. Aim: This study aims to stitch together the comprehensive patchwork of actors and dynamic ‘gears’ in the socio-ecological environment that came together to develop a much more enabling environment to improve child nutrition through breastfeeding promotion and protection in Lao PDR. Further, it aims to …

Psychological Resilience In U.S. Military Veterans: Results From The 2019-2020 National Health And Resilience In Veterans Study, Michael Georgescu

Public Health Theses

Psychological resilience is the most common response following exposure to traumatic life events. To date, most research has focused on factors associated with adverse post-trauma mental health outcomes rather than understanding those associated with psychological resilience. In particular, little is known about factors associated with resilience in veterans, despite their high rates of trauma exposure, such as combat and military sexual trauma. To address this gap, we used a discrepancy-based psychiatric resilience (DBPR) analytic approach to operationalize resilience and to identify modifiable health and psychosocial factors associated with resilience in a nationally representative sample of U.S. veterans (N = 4,069). …

Early Life Growth Patterns Among Infants Of Mothers With Diabetes, Hedy Ludwig

Public Health Theses

AbstractObjective: Exposure to diabetes during pregnancy increases the risk of insulin resistance, obesity, and cardiometabolic disease in offspring. Limited research exists regarding early postnatal growth patterns among moderate preterm and term infants. This study aims to evaluate growth patterns during the early postnatal period among term and moderate preterm infants of mothers with and without diabetes during pregnancy. Methods: In a prospective longitudinal analysis using data from Yale New Haven Hospital (YNHH), characteristics from term and moderate preterm infants were compared between diabetes exposure groups (n=148). Percent change in weight from birth to hospital discharge was compared between diabetes exposure …

Epidemiology Of Human Hookworm (Necator Americanus) Infection In Rural Ghana: Investigating Host-Parasite Factors That Mediate Infection, Savanna Randi

Public Health Theses

Abstract

Introduction: Hookworms are soil-transmitted helminths (STHs) that cause significant morbidity in high-risk populations, posing a global health concern in locations of rural poverty [1-5]. While there have been ventures by the World Health Organization to eliminate hookworms in Africa by 2030, there is variability in the effectiveness of current chemotherapy regimens. Studies have shown that benzimidazole anthelmintics have reduced effectiveness, and people living in endemic areas are quickly reinfected [6]. Critical gaps remain in understanding parasite-host interactions within communities, further challenging successful disease control. A study initiated in 2022 investigated the epidemiology of human hookworm infection in Beposo, Ghana. …

Antibiotic Prophylaxis For Prevention Of Surgical Site Infections In Orthopedic Surgery, Edwin Ruiz Fuentes

Public Health Theses

Background: In the past decades, there has been an increase in the proportion of orthopedic surgical site infections (SSIs) caused by gram-negative bacilli in various healthcare settings. SSI prevention guidelines suggest that gentamicin can be added to prophylactic antibiotic treatment to target gram-negative bacilli. However, the effectiveness of this strategy remains to be confirmed in orthopedic surgery.

Methods: A retrospective cohort study was conducted to investigate the association between antibiotic prophylaxis with adjunctive gentamicin and SSI rates in orthopedic surgeries. 5,571 patients who underwent hip, knee, spine, and hip fracture surgeries between January 2019 and July 2021 at Yale-New Haven …

Examining The Impacts Of Stress And Negative Affect On Eating And Weight Outcomes: A Meta-Analysis, Taylor Spadory

Public Health Theses

Overweight and obesity have become incredibly pressing public health issues in the United States. Rising rates of prevalence pose grave risks to population health and underscore the need for a greater understanding of the underlying mechanisms that contribute to increased eating and weight gain. While stress and negative affect (NA) have been recognized as possible predictors, the literature is inconsistent and experimental studies have produced mixed results. Therefore, we conducted a comprehensive quantitative meta-analysis to assess the prospective effects of stress and NA on eating and weight outcomes, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We …

Identifying The Factors Influencing Hiv Testing And Safe Sex Practices: An Ecological Approach, Shekwonya Evelyn Samuel

All ETDs from UAB

Introduction: HIV (Human Immunodeficiency Virus) is a sexually transmitted infection (STI) that is still a major health issue in the United States and the world. Emerging adults are more likely to engage in risky sexual behaviors such as multiple sexual partners and unprotected sex. HIV testing contributes to ending the HIV epidemic by identifying at-risk individuals and promoting early diagnosis.Methods: Secondary data analyses of the City Health II dataset were conducted to 1) identify the association between HIV testing and risky sexual behaviors among Black/African American emerging adults ages 18-25 years living in Birmingham metro area, 2) use social network …

Social Determinants Of Health And Blood Pressure Control In Black And White Us Adults, Oluwasegun Philip Akinyelure

All ETDs from UAB

Black adults in the US have 2 to 3 times higher rates of cardiovascular disease (CVD) mortality compared to White adults. Most of the excess CVD mortality in Black adults has been attributed to their higher prevalence of hypertension and uncontrolled blood pressure (BP). In October 2020, the US Surgeon General published a Call-to-Action to improve hypertension control and identified social determinants of health (SDOH) as a major contributor to Black:White disparities in hypertension control. Prior research has showed that SDOH are associated with excess hypertension risk among Black compared with White adults, but data on their association with BP …

Caregiving To Older Adults With A Physical Limitation: Evidence From The Mexican Health And Aging Study, Carlos Díaz-Venegas, Rafael Samper-Ternent, Rebeca Wong

Faculty, Staff and Student Publications

BACKGROUND AND OBJECTIVES: Many older adults face physical limitations to performing activities of daily life (ADLs) and instrumental activities of daily life (IADLs) and seek help performing them. In Mexico, family caregivers, especially spouses and adult children, traditionally take care of older adults. However, a detailed characterization of the care received has not been thoroughly provided. We sought to identify socioeconomic, demographic, and health-related differences in receiving help among older adults reporting physical limitations.

RESEARCH DESIGN AND METHODS: Using the 2012 wave of the Mexican Health and Aging Study, we provided information on adults aged 60 and older who reported …

A Coalition-Driven Examination Of Organization Capacity To Address Food Insecurity In Greater Houston: A Qualitative Research Study, Jemima C John, Jennifer Gonzalez, Sara-Grace Chan, Heidi Mcpherson, Jennifer N Aiyer, Esperanza Galvan, Nicole Browning, Shreela V Sharma

Faculty, Staff and Student Publications

BACKGROUND: Economic and social hardships have worsened food insecurity, particularly among low income and racial-ethnic minority groups. Given the core goal of the 150+ member Houston Health Equity Collective (HEC) to reduce food insecurity by 5% in 2025, we explored member organizations' capacity and challenges faced in screening and responding to food insecurity through care coordination efforts.

METHODS: A twice-administered Qualtrics XM survey (Provo, Utah) with 76 organizations, followed by five focus groups with 22 of these organizations, explored reach and response efforts to food insecurity. Qualitative assessments lasted between 0.5 to 1.5 h, were audio-recorded, cleaned, coded, and thematically …

Observed And Perceived Benefits Of Providing Physical Activity Opportunities In Elementary Schools: A Qualitative Study, Timothy J Walker, Derek W Craig, Christopher D Pfledderer, Michael C Robertson, Paula Cuccaro, Keisey Fumero, John B Bartholomew

Faculty, Staff and Student Publications

INTRODUCTION: Schools play an important role in promoting physical activity for youth. However, school-based physical activity opportunities often compete with other academic priorities, limiting their implementation. The purpose of this study was to qualitatively explore elementary school teacher and staff perspectives on providing physical activity opportunities and how they impact students and learning.

METHODS: We partnered with a school district in Texas to conduct semi-structured individual interviews. We used a purposeful sampling approach to recruit elementary teachers and staff knowledgeable about the physical activity opportunities provided at their school. Interviews included questions about participant opinions of providing physical activity opportunities …

Semiparametric Regression Modeling Of The Global Percentile Outcome, Xiangyu Liu, Jing Ning, Xuming He, Barbara C Tilley, Ruosha Li

Faculty, Staff and Student Publications

When no single outcome is sufficient to capture the multidimensional impairments of a disease, investigators often rely on multiple outcomes for comprehensive assessment of global disease status. Methods for assessing covariate effects on global disease status include the composite outcome and global test procedures. One global test procedure is the O'Brien's rank-sum test, which combines information from multiple outcomes using a global rank-sum score. However, existing methods for the global rank-sum do not lend themselves to regression modeling. We consider sensible regression strategies for the global percentile outcome (GPO), under the transformed linear model and the monotonic index model. Posing …

Effect Of "Maccog" Tcm Tea On Improving Glucolipid Metabolism And Gut Microbiota In Patients With Type 2 Diabetes In Community, Biyue Hu, Tongtong Yin, Jiajia Zhang, Minjing Liu, Hang Yun, Jian Wang, Renmei Guo, Jie Huang, Yixia Zhou, Hongyan Meng, Li Wang

Faculty, Staff and Student Publications

OBJECTIVES: This work aimed to observe the effect of consuming Chinese herb tea on glucolipid metabolism and gut microbiota in patients with type 2 diabetes mellitus (T2DM).

METHODS: Ninety patients with T2DM were recruited from a community and randomly divided into the control group (CG) and intervention group (IG). CG maintained conventional treatment and lifestyle, and IG accepted additional "maccog" traditional Chinese medicine (TCM) tea (mulberry leaf, radix astragali, corn stigma, cortex lycii, radix ophiopogonis, and gynostemma) for 12 weeks. Glucolipid metabolism, hepatorenal function, and gut microbiota were then measured.

RESULTS: After the intervention, the decreases in fasting plasma glucose …

Application Of Implementation Mapping To Develop Strategies For Integrating The National Diabetes Prevention Program Into Primary Care Clinics, William B Perkison, Serena A Rodriguez, Fernanda Velasco-Huerta, Patenne D Mathews, Catherine Pulicken, Sidra S Beg, Natalia I Heredia, Pierre Fwelo, Grace E White, Belinda M Reininger, John W Mcwhorter, Roshanda Chenier, Maria E Fernandez

Faculty, Staff and Student Publications

BACKGROUND: Diabetes is considered one of the most prevalent and preventable chronic health conditions in the United States. Research has shown that evidence-based prevention measures and lifestyle changes can help lower the risk of developing diabetes. The National Diabetes Prevention Program (National DPP) is an evidence-based program recognized by the Centers for Disease Control and Prevention; it is designed to reduce diabetes risk through intensive group counseling in nutrition, physical activity, and behavioral management. Factors known to influence this program's implementation, especially in primary care settings, have included limited awareness of the program, lack of standard clinical processes to facilitate …

Understanding The Influence Of Atomizing Power On Electronic Cigarette Aerosol Size And Inhalation Dose Estimation, Jinho Lee, Wei-Chung Su, Inkyu Han

Faculty, Staff and Student Publications

Although many studies have estimated the inhalation dose of aerosols emitted from electronic cigarettes (e-cigs), the association between the atomizing power and inhalation dose of e-cig aerosols has not been fully examined. The aim of this study was to determine the mass and inhalation doses of e-cig aerosols and their association with the atomizing power of vaping devices. Size-segregated aerosol masses were collected using an 11-stage cascade impactor and the deposition dose in the human respiratory tract was estimated using the size-segregated aerosol mass. The results showed that an increase in atomizing power was positively associated with the amount of …

An Open-Source System For Efficient Clinical Trial Support: The Comet Study Experience, Jonathan Clutton, Robert Neal Montgomery, Dinesh Pal Mudaranthakam, Erin M Blocker, Ashley R Shaw, Amanda N Szabo Reed, Eric D Vidoni

Faculty, Staff and Student Publications

Exercise clinical trials are complex, logistically burdensome, and require a well-coordinated multi-disciplinary approach. Challenges include managing, curating, and reporting on many disparate information sources, while remaining responsive to a variety of stakeholders. The Combined Exercise Trial (COMET, NCT04848038) is a one-year comparison of three exercise modalities delivered in the community. Target enrollment is 280 individuals over 4 years. To support rigorous execution of COMET, the study team has developed a suite of scripts and dashboards to assist study stakeholders in each of their various functions. The result is a highly automated study system that preserves rigor, increases communication, and reduces …

Plasma Protein Biomarkers Of Healthy Dietary Patterns: Results From The Atherosclerosis Risk In Communities Study And The Framingham Heart Study, Shutong Du, Jingsha Chen, Hyunju Kim, Maura E Walker, Alice H Lichtenstein, Nilanjan Chatterjee, Peter Ganz, Bing Yu, Ramachandran S Vasan, Josef Coresh, Casey M Rebholz

Faculty, Staff and Student Publications

Background: Molecular mechanisms underlying the benefits of healthy dietary patterns are poorly understood. Identifying protein biomarkers of dietary patterns can contribute to characterizing biological pathways influenced by food intake.

Objectives: This study aimed to identify protein biomarkers associated with four indexes of healthy dietary patterns: Healthy Eating Index-2015 (HEI-2015); Alternative Healthy Eating Index-2010 (AHEI-2010); DASH diet; and alternate Mediterranean Diet (aMED).

Methods: Analyses were conducted on 10,490 Black and White men and women aged 49-73 y from the ARIC study at visit 3 (1993-1995). Dietary intake data were collected using a food frequency questionnaire, and plasma proteins were quantified using …

Application Of Implementation Mapping To Develop Strategies For Integrating The National Diabetes Prevention Program Into Primary Care Clinics, William B Perkison, Serena A Rodriguez, Fernanda Velasco-Huerta, Patenne D Mathews, Catherine Pulicken, Sidra S Beg, Natalia I Heredia, Pierre Fwelo, Grace E White, Belinda M Reininger, John W Mcwhorter, Roshanda Chenier, Maria E Fernandez

Faculty, Staff and Student Publications

BACKGROUND: Diabetes is considered one of the most prevalent and preventable chronic health conditions in the United States. Research has shown that evidence-based prevention measures and lifestyle changes can help lower the risk of developing diabetes. The National Diabetes Prevention Program (National DPP) is an evidence-based program recognized by the Centers for Disease Control and Prevention; it is designed to reduce diabetes risk through intensive group counseling in nutrition, physical activity, and behavioral management. Factors known to influence this program's implementation, especially in primary care settings, have included limited awareness of the program, lack of standard clinical processes to facilitate …

Examining Neighborhood-Level Hot And Cold Spots Of Food Insecurity In Relation To Social Vulnerability In Houston, Texas, Ryan Ramphul, Linda Highfield, Shreela Sharma

Faculty, Staff and Student Publications

Food insecurity is prevalent and associated with poor health outcomes, but little is known about its geographical nature. The aim of this study is to utilize geospatial modeling of individual-level food insecurity screening data ascertained in health care settings to test for neighborhood hot and cold spots of food insecurity in a large metropolitan area, and then compare these hot spot neighborhoods to cold spot neighborhoods in terms of the CDC's Social Vulnerability Index. In this cross-sectional secondary data analysis, we geocoded the home addresses of 6,749 unique participants screened for food insecurity at health care locations participating in CMS's …

A Study On The Prevalence Of Vitamin B12 Deficiency In Eastern Indian Type 2 Diabetes Mellitus Patients With Peripheral Neuropathy On Metformin Presenting To A Tertiary Care Hospital, Ajay Hanumanthu, Soumik Goswami, Kavya Bhadrapura Thimmegowda, Nilanjan Sengupta, Arjun Baidya, Pranab Kumar Sahana

Digital Journal of Clinical Medicine

Introduction:

The association between long-term metformin use in type 2 diabetes mellitus (T2DM) and low vitamin B12 levels has been proven and screening for the same is recommended by American Diabetes Association (ADA) guidelines. The potential of the deficiency to cause or worsen diabetic peripheral neuropathy (DPN) in T2DM patients has been investigated in previous studies. However, the prevalence estimates of vitamin B12 deficiency in T2DM patients treated with long term metformin and having established DPN is lacking in our country. The aim of our study was to estimate the prevalence of vitamin B12 deficiency in T2DM patients with DPN …

Relationship Between Femoral Artery Intima-Media Thickness And Atherosclerosis In Patients With Chronic Kidney Disease- A One Year Hospital-Based Cross-Sectional Study, Dr. Somashekhar Sogi, Dr. Ravi Sarvi, Dr. Pradeep Goudar, Dr. Mallikarjun Karishetti, Dr.V.V Hattiholi, Dr.Meenakshi Sarvi

Digital Journal of Clinical Medicine

Introduction: Chronic kidney disease (CKD) is one of the leading causes of morbidity and mortality worldwide. CKD and Peripheral arterial disease both independently increase the risk for cardiovascular disease (CVD) events and contribute significantly to morbidity and mortality. There is limited data about the co-relation between ultrasound measures of the femoral artery in peripheral vascular disease (PVD) & renal functional status. This research hence will help us in the establishment of a relationship between femoral intima-media thickness (fIMT) with CKD. Also, IMT assessment might help in earlier detection of atherosclerotic plaques & hence PVD.

Materials and methods: A cross sectional …