Digital Commons Network^™

Uncovering The Stories Behind The Numbers : A Case Study Of Maternal Death Surveillance And Response In Goma, Democratic Republic Of Congo., Baraka Muvuka

Electronic Theses and Dissertations

Globally, 303 000 women die each year from preventable causes related to pregnancy, with the Democratic Republic of Congo (DRC) having the tenth highest maternal mortality rate. Maternal Death Surveillance and Response (MDSR) is a surveillance-action cycle that aims to eliminate preventable maternal mortality by linking actionable data on maternal deaths with multi-level actions. While countries are increasingly adopting MDSR, there are research gaps on its implementation, outcomes, and best practices in developing countries including the DRC. This study assessed MDSR implementation in Goma Health Zone (HZ), DRC, specifically its structure, process, quality, outcomes, and influencing factors. A qualitative case …

Evaluation Of The Health And Exposure Histories Of A Community Surrounded By Industry And Industrial Waste : A Mixed Methods Approach., Lindsay Koloff Tompkins

Electronic Theses and Dissertations

Environmental pollution is not distributed equally across members of society. Low-income individuals are more likely to live near waste sites and other sources of pollution, and, therefore, face greater exposure to environmental health hazards. One such community in Louisville, Kentucky, the Riverside Gardens neighborhood, consists of approximately 300 homes that are surrounded on three sides by industry and industrial waste, including a remediated Environmental Protection Agency Superfund site, a former coal-burning power plant and coal ash storage site, and multiple chemical, rubber, and plastic manufacturing companies. Residents have reported elevated rates of cancer and other chronic diseases and have requested …

The Shape Study : The Survey Of Health And The Perceived Environment Study., Colette Patrice Davis

Electronic Theses and Dissertations

Introduction: Few studies have considered how an individual’s perception of their built environment may be a risk factor for being overweight or obese. Adolescents may be particularly vulnerable in the context of “impoverished environments”, which they may perceive to be difficult, dangerous, resource deficient, and unaesthetic. This study aids in clarifying how the built environment influences the risk of obesity among adolescents residing in a neighborhood in Louisville, KY. Objective: The overall objective was to conduct a cross-sectional epidemiologic pilot study among adolescents aged 12-17 years residing in West Louisville, Kentucky to evaluate the association between perceptions of …

Alcohol Use, Dietary, And Exercise Behaviors: A Latent Profile Analysis Of Young Adult Lifestyle Behaviors, Ryan Wesley Grant

Graduate Theses and Dissertations

As individuals enter adulthood, their lifestyles and lifestyle behaviors begin to change drastically. These lifestyle behavior changes in emerging adulthood provide a foundation for future health behaviors that often persist through all of adulthood. The aim of this study was to use Latent profile analyses (LPA) to discover distinct profiles of homogenous groups of young adults based on alcohol, diet, and exercise behaviors. Overall, five distinct profiles for both males and females were identified: Moderates, Unhealthy Eaters, Medium Drinkers, Healthier Eaters and Exercisers, and Heavy Drinkers. Heavy Drinkers and Unhealthy Eaters were the highest risk groups and reported the highest …

Reducing The Risk: Psychological And Technological Approaches For Improving Handwashing Practices In The Foodservice Industry, Jeffrey Allan Clark

Graduate Theses and Dissertations

As Americans are spending greater portions of their dollar on food consumed outside the home, the foodservice industry plays more of an integral part of daily existence compared to previous generations. Given the numerous annual foodborne illness outbreaks that threaten human lives while undermining confidence in the food supply, food safety is a pertinent issue for industry stakeholders, government regulators, and consumers. Food worker handwashing reduces the risk of foodborne illness transmission, yet compliance with this simple behavior is a complex problem. This dissertation addresses, predominantly, the issue of sub-optimal handwashing practices through applying psychology and technology, including wearable computers …

Mortality And Cardiovascular And Respiratory Morbidity In Individuals With Impaired Fev 1 (Pure): An International, Community-Based Cohort Study, Mylinh Duong, Shofiqul Islam, Sumathy Rangarajan, Darryl Leong, Om Kurmi, Koon Teo, Kieran Killian, Gilles Dagenais, Scott Lear, Romaina Iqbal

Community Health Sciences

Background: The associations between the extent of forced expiratory volume in 1 s (FEV₁) impairment and mortality, incident cardiovascular disease, and respiratory hospitalisations are unclear, and how these associations might vary across populations is unknown.
Methods: In this international, community-based cohort study, we prospectively enrolled adults aged 35-70 years who had no intention of moving residences for 4 years from rural and urban communities across 17 countries. A portable spirometer was used to assess FEV₁. FEV₁ values were standardised within countries for height, age, and sex, and expressed as a percentage of the country-specific predicted …

Serum Cotinine Versus Parent Reported Measures Of Secondhand Smoke Exposure In Rural Appalachian Children, Samrat Yeramaneni, Kimberly Yolton, Kurunthachalam Kannan, Kim N. Dietrich, Erin N. Haynes

Journal of Appalachian Health

Background: Secondhand smoke (SHS) exposure in Appalachian children and associated adverse effects is understudied and not well documented. This study assessed the prevalence of SHS exposure in Appalachian children by parental self-report and internal biological measure.

Methods: SHS exposure was determined in children residing in rural Appalachian communities during their participation in the Communities Actively Researching Exposure Study between 2009 and 2013. Parents reported the number of smokers in the household and number of cigarettes smoked/day. Children ages 7-9 provided a serum sample for cotinine analysis. Parent reported measures and child serum cotinine measures of SHS exposure were compared with …

Targeted Advertising Can Increase Healthy Food Choices Among College Students, Stephanie Spera

Population Health Research Brief Series

Poor nutrition in young adulthood can increase risk of obesity, cancer, cardiovascular disease, and diabetes in mid- and later life. Targeted nutrition programs for young adults are essential to reduce the burden of chronic disease in the U.S. over the next several decades. This research brief describes a successful healthy food marketing strategy that was used at Syracuse University to promote healthy food purchasing among college students.

Health And Social Disparities Influence Opioid Misuse Among Adult Females Living In Rural Areas, Tequila Porter

Master of Science in Integrative Biology Theses

Since the early 1800s scientists have been working to create the best non-addictive pain medication derived from opium. In the early 1800s morphine was distilled from opium extracted from opium poppy plants (Quinones, 2015). Soon after a chemist invents a synthetic derivative of opium and names it diacetylmorphine (heroin) (Quinones, 2015, (Drugs and Morphine Text, 2018). Heroin originally was a safe cure for morphine addiction. Once this was proven to be false, and as having addictive properties, the government intervened and began initiatives to address the issue. This public crisis quickly grew to what modern scientists and healthcare professionals know …

Body Composition, Serum Biomarkers Of Inflammation And Quality Of Life In Clinically Stable Women With Estrogen Receptor Positive Metastatic Breast Cancer, Patricia M. Sheean, Sandra Gomez-Perez, Cara Joyce, Vasilios Vasilopoulos, Mary Beth Bartolotta, Patricia Robinson, Shelly Lo, Laurie Lomasney

Parkinson School of Health Sciences and Public Health

Limited data exist regarding body composition and associated patient-reported outcomes for women with metastatic BC. Demographic, clinical, blood, and questionnaire data were collected to quantify body composition and explore associations with symptoms, inflammation, and quality of life (QOL) in 41 women with ER + metastatic BC. Diagnostic/surveillance computed tomography (CT) images including the third lumbar region (L3) were obtained to evaluate skeletal muscle (SM) quantity and quality, and abdominal adipose tissue. Frequencies, medians and interquartile ranges are presented, stratified by sarcopenia and obesity (Body mass index (BMI) ≥ 30.0 kg/m2). Overall, 34% (n = 14/41), 49% (n = …

Regional Variation In Comorbid Prediabetes And Diabetes And Associated Factors Among Hypertensive Individuals In Rural Bangladesh, Pakistan, And Sri Lanka, Liang Feng, Aliya Naheed, H. Asita De Silva, Imtiaz Jehan, Rubhana Raqib, Md Tauhidul Islam, Nathasha Luke, Anuradhani Kasturiratne, Hamida Farazdaq, Sahar Senan, Tazeen Jafar, Cobra-Bps Study Group

Community Health Sciences

We aimed to explore the cross-country variation in the prevalence of comorbid prediabetes or diabetes and determine the sociodemographic, lifestyle, and clinical factors, especially body mass index (BMI) and waist circumference, associated with comorbid diabetes in individuals with hypertension in rural South Asia. We analyzed cross-sectional data of 2426 hypertensive individuals of ≥40 years from 30 randomly selected rural communities in Bangladesh, Pakistan, and Sri Lanka. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dL without use of antidiabetic treatment and diabetes as FPG ≥126 mg/dL or use of antidiabetic medication. The prevalence (95% CI) of …

Integrative Approaches To The Undergraduate Public Health Major Curriculum: Strengths, Challenges, And Examples, Marc T. Kiviniemi, Sarahmona M. Przybyla

Health, Behavior & Society Faculty Publications

Many “first generation” undergraduate public health degree programs were designed based on “siloed” course structures centered around subunits in the discipline (e.g., Introduction to Epidemiology, Introduction to Environmental Health) that may be meaningful primarily to experts in the field. An alternative to the siloed approach is an integrative curricular design, in which courses are designed around meaningful thematic units (e.g., explaining public health problems, asking and answering scientific questions in public health), with an emphasis on drawing connections between knowledge from different but complementary disciplinary areas as a means to improve student learning and retention. The integrative approach shifts the …

Variation And Change Over Time In Promis-29 Survey Results Among Primary Care Patients With Type 2 Diabetes, Juell Homco, Kristin Rodriguez, David R. Bardach, Elizabeth A. Hahn, Suzanne Morton, Daren Anderson, David Kendrick, Sarah Hudson Scholle

Journal of Patient-Centered Research and Reviews

Purpose: We sought to describe results of patient-reported outcome measures implemented among primary care patients with diabetes and explore factors associated with changes in scores over time.

Methods: Two organizations serving diverse patient populations collected the PROMIS-29 survey at baseline and 3-month follow-up for patients with type 2 diabetes. Bayesian regression analysis was used to examine the relationship between patient characteristics and changes in PROMIS-29 scores. Exploratory analyses assessed relationships between goal-setting and changes in scores.

Results: The study population reported substantially more problems with physical functioning (mean: 42.5 at Site 1 and 38.9 at Site 2) and pain interference …

Medically Tailored Meals As A Prescription For Treatment Of Food-Insecure Type 2 Diabetics, Leslie J. Rabaut

Journal of Patient-Centered Research and Reviews

Type 2 diabetes mellitus is an immense burden to the health of our population and to our current health care system, and the weight of this burden is only projected to multiply in coming years. A nutritious diet is an indispensable aspect of diabetes treatment, and the lack of access to food engenders poor disease-state control, which correlates with increased health care utilization. Interventions aimed at improving access to food through medically tailored meals (MTMs) have demonstrated effectiveness in improving the health of food-insecure type 2 diabetic patients and reducing health care costs. Further studies are necessary to increase the …

Suffering In Silence: Is Gastroparesis Underdiagnosed?, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In this introduction to Volume 6, Issue 2, the editor-in-chief of the Journal of Patient-Centered Research and Reviews offers additional comment to the clinical review of diabetic gastroparesis authored by Farmer and colleagues (p. 148), regarding the problem of undiagnosed disease. Increased awareness of this entity and appropriate questioning regarding symptoms of diabetic gastroparesis in the primary care setting may prevent the “suffering in silence” experienced by many patients with this complication.

Ohes: Bringing Wellness To You, Marissa Rezes

Masters Theses/Capstone Projects

No abstract provided.

A Background Of The Opioid Epidemic And Its Relationship To The Medicaid Expansion, Er Yearn Jang

Senior Honors Theses

Despite the recent increase in public awareness of the opioid epidemic, the background of this epidemic is still disappointingly unknown to the public. The opioid epidemic is a national crisis which impacts, not only individuals’ wellbeing but the economy of the United States. The federal government sought to mitigate it through the enactment of the Patient Protection and Affordable Care Act. The Medicaid expansion, which was built into this law, sparked controversy; controversy which has yet to be solved to this day. Going forward, the knowledge we gather from examining the connection between this epidemic and the Medicaid expansion will …

Interprofessional Collaboration To Improve And Sustain Patient Experience Outcomes In An Ambulatory Setting, Natalie Sanchez, Kimberly Hermis

Patient Experience Journal

Patient experience is an important factor across diverse healthcare delivery settings. Despite enhanced attention to and advances in patient experience, many of the published initiatives focus on in-hospital care and opportunities have been identified to continue to strategically address patient experience in the ambulatory setting. This quality improvement initiative presents the development of an interprofessional approach to patient experience in a freestanding ambulatory oncology center. The objective of this initiative was to improve and sustain patient experience, as reflected in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores via Press Ganey. This approach consisted of redesigning a previously …

The Importance Of Physician To Physician Coaching, Medical Director And Staff Engagement And Doing “One Thing Different”, Ghazala Q. Sharieff

Patient Experience Journal

With the Center for Medicare and Medicaid Services incorporating patient experience into the Value Based Purchasing metrics, there is increasing hospital focus on improving this important aspect of patient care. The Value Based Purchasing program bases 25% of its value on the patient experience domain and is based on patient perspective as gathered via the Healthcare Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS). Our system chose to implement simultaneous pilot activities to train our 6 Hospitalist groups, obtain Hospitalist medical director buy in and deliver timely physician group feedback in a transparent manner. In addition, a single hospital …

Association Between Inflammatory Potential Of Diet And Bone-Mineral Density In Korean Postmenopausal Women: Data From Fourth And Fifth Korea National Health And Nutrition Examination Surveys, Woori Na, Susan Park, Nitin Shivappa, James F. Thrasher, Mi Kyung Kim, Cheongmin Sohn

Faculty Publications

Post menopause is considered a critical period for bone-mass loss. Impaired bone metabolism during this phase can increase the risk of fractures in old age. Inflammation is a risk factor for bone health, and diet is a potential source of inflammation. However, few studies have examined the association between the dietary inflammatory index (DII^®) and bone-mineral density (BMD) in postmenopausal women in Korea. The objective of this study was to determine, by means of a Korean cross-sectional investigation, whether higher DII scores are associated with decreased BMD in postmenopausal women. To that end, the raw data from the …

Early Identification Of Frailty Predictors In A Vowed Religious Community Of Catholic Men: A Strategy For Successful Aging In Place, Julia Senn-Reeves

Graduate Theses, Dissertations, and Capstones

Background: The population in the United States is aging and experiencing age- and disease-related changes, leading to increased frailty, as well as increased disability, morbidity, and mortality. Timely recognition of these vulnerabilities, and intervention implementation, are crucial to prevent adverse outcomes and to support successful aging in place. Purpose: The purpose of this project is to develop and implement a multifaceted assessment process to identify early predictors of frailty among members of a vowed religious community of Catholic men to ultimately support successful aging in place. Participants: A single vowed religious community of Catholic men in the United States, living …

The Inflammatory Potential Of Diet In Determining Cancer Risk; A Prospective Investigation Of Two Dietary Pattern Scores, Stina Bodén, Robin Myte, Maria Wennberg, Sophia Harlid, Ingegerd Johansson, Nitin Shivappa, James R. Hébert, Bethany Van Guelpen, Lena Maria Nilsson

Faculty Publications

Purpose Inflammation-related mechanisms may contribute to the link between diet and cancer. We sought to investigate the inflammatory impact of diet on cancer risk using the Dietary inflammatory index (DII) and an adapted Mediterranean diet score (MDS).

Methods This population-based, prospective cohort study used self-reported dietary data from the Västerbotten Intervention Programme, including 100,881 participants, of whom 35,393 had repeated measures. Associations between dietary patterns and cancer risk were evaluated using Cox proportional hazards regression. We also used restricted cubic splines to test for potential non-linear associations.

Results A total of 9,250 incident cancer cases were diagnosed during a median …

Prescription Medication Misuse Among American Indians In The Midwestern Us, Charley S. Lewis, Jordyn Gunville, Ryan Goeckner, Brian Chase, Lauren Clark, Jianghua He, Won S. Choi, Christine M. Daley

Journal of Health Disparities Research and Practice

Background: Prescription medications, particularly opioids, are often abused rather than used as intended by the prescribing physician. This is well-documented, though little data are available on American Indians. Misuse of other prescription medications is far less documented, but does occur and can have wide-spread effects.

Methods: We used a cross-sectional survey of American Indians in the Midwestern US (N=361) to begin to understand misuse of prescription medications, not necessarily to get high, but for any reason. Participants were recruited for this touchscreen computer-based survey at powwows, health fairs, and other community events through a convenience sample. We asked questions …

Cancer Risk Factors And Screening Behavior Among Korean Americans In The Sf Bay Area, Nhayoung Hwang, Hyunju Kim, Eugenia Yoo, Denny Cha, Winston Tseng Phd, Susan L. Ivey Md, Mhsa

Journal of Health Disparities Research and Practice

Background: Korean Americans (KA) have the highest prevalence of death from cancer among Asian American ethnic groups in the U.S. This KA prevalence rate is also substantially higher than that of non-Hispanic whites, yet little is known about their cancer risk factors. This paper is one of the first studies to explore cancer risk factors and screening behaviors of Korean Americans in the San Francisco Bay Area.

Methods: A survey instrument was created using items from the California Health Interview Survey (CHIS) from 2009-2012, which were translated into Korean. A cross-sectional survey assessing the prevalence of cancer risk factors and …

Examining The Impact Of Race And Rurality On Health Differences Among Overweight Youth Accessing Pediatric Endocrinology Care, Kelsee Halpin, Janelle R. Noel-Macdonnell, Yun Yan

Journal of Health Disparities Research and Practice

Methods: This study examines the impact of race and rurality on health differences, including prevalence of prediabetes and type 2 diabetes (T2D), among overweight children accessing pediatric endocrine specialty care. Cross-sectional analysis of overweight/obese youth 10 to 18 years of age receiving pediatric endocrinology consultation for weight gain, hyperglycemia, and/or T2D from 2013 to 2016 at a Midwest tertiary pediatric center.

Results: The 722 patients were 42% white, 25% black, 22% Hispanic; 88% lived in urban areas and 12% in rural areas. Rurality was determined using zip code approximation of Rural-Urban Commuting Area (RUCA) codes. After adjusting for confounders, black …

Nutrient And Food Group Intakes Of Low-Income Pregnant Women By Race/Ethnicity, Alla M. Hill, Danielle L. Nunnery Phd, Rdn, Ldn, Alice Ammerman Drph, Jigna M. Dharod Phd

Journal of Health Disparities Research and Practice

In an exploratory study, a convenience sample of 148 pregnant women was recruited from a WIC clinic in the southeast region of the U.S. to: 1) Examine and compare daily nutrient and food group intakes of WIC pregnant women to national guidelines, and; 2) Determine racial/ethnic differences in nutrient and food group intakes among WIC pregnant women. Women were selected for the study if they were: ≥ 18 y, in 2^nd trimester of pregnancy, and if they spoke English or Spanish as a first language. Upon recruitment, participants were interviewed to collect information on their socio-demographics, including race/ethnicity. Additionally, …

Utilization Of Media-Driven Technology For Health Promotion And Risk Reduction Among American Indian And Alaska Native Young Adults: An Exploratory Study, Todd M. Sabato

Journal of Health Disparities Research and Practice

Across the developmental spectrum, American Indian and Alaska Native (AI/AN) adolescents and young adults experience considerable behavioral and mental health disparities, including substance abuse, depression, and engagement in sexual behaviors which enhance risk of pregnancy and sexually transmitted infections. Health-focused interventions utilizing digital and media technology hold significant promise among tribal communities, as they have the capacity to eliminate geography-based barriers. Utilizing a sample of 210 self-identified AI/AN students attending tribal colleges, this study identified the most effective technologies and intervention strategies, as well as health seeking patterns and preferences, which may impact implementation and sustainable use in tribal settings. …

Five-Year Trend In Diabetes Clinical Care And Self-Management Among Adults With Diabetes In West Virginia: 2010-2014, Ranjita Misra 2934168, Usha Sambamoorthi

Journal of Health Disparities Research and Practice

Objective: To examine the five-year trend in clinical care and diabetes self-management activities among adults living in the Appalachian state of West Virginia.

Methods: This study used a cross-sectional design with data from the Behavioral Risk Factor Surveillance System in 2010 (N=685) and 2014 (N=958), among noninstitutionalized adults with diabetes. Five-year trend in recommended diabetes clinical care, diabetes self-management activities and diabetes education was analyzed after adjusting for sex, education, income, insurance, age, obesity, comorbid hypertension, race and lifestyle behaviors (exercise and smoking).

Results: A significant increase in percentage of adults with 2 or more A1C tests was …

Native American Weight Loss Movement: Pilot Test Of A Culturally Tailored Weight Loss Program For American Indians, Christine M. Daley, Jason W. Hale, Shelley Bointy, Kelly Berryhill, Joseph Lemaster, Byron J. Gajewski

Journal of Health Disparities Research and Practice

American Indians (AIs) have higher rates of obesity than other racial/ethnic groups, placing them at heightened risk for cardiovascular diseases, diabetes, and certain cancers. Culturally appropriate weight loss interventions may be the key to reducing risk. The most successful program used in AI communities has been the Diabetes Prevention Program (DPP), which limits enrollment to individuals with a clinical diagnosis of pre-diabetes. The purpose of this pilot project was to modify and culturally tailor a weight loss intervention to AI communities in Kansas to improve weight loss related behaviors among those who do not qualify for the DPP. The Native …

Lack Of Association Between Dietary Inflammatory Index And Low Impact Fractures In The Brazilian Population: The Brazilian Osteoporosis Study (Brazos), Melissa Morimoto, Nitin Shivappa, Patricia De Souza Genaro, Ligia Araujo Martini, Natielen Jacques Schuch, James R. Hebert, Marcelo Medeiros Pinheiro

Faculty Publications

Introduction: Adequate nutrition, including intake of dietary calcium and vitamin D, is important to maintain bone health. Evidence suggests that a deficiency in micronutrients may contribute to bone loss during aging and exert generalized effects on chronic inflammation. Recently, the Dietary Inflammatory Index (DII) was developed to assess the inflammatory potential of individual diets. Our aim was to evaluate the DII in a representative sample and verify its association with low-impact fractures.

Methods: Individuals from The Brazilian Osteoporosis Study (BRAZOS) database had their DII calculated. BRAZOS is an important cross-sectional epidemiological study carried out with a representative sample of men …