Digital Commons Network^™

Assessment Of Obesity Management In A Primary Care Setting, Katie Diffenderfer

DNP Projects

Purpose: The purpose of this study was to evaluate the current practices related to obesity in the primary care setting in University of Kentucky’s Healthcare System. The specific aims were to: 1) Determine the proportion of obese patients who had an ICD-9/10 diagnosis code for obesity, 2) Determine the proportion of obese patients who received interventions related to their obesity, 3) Determine whether obesity diagnosis and interventions varied based on patient demographics, and 4) Compare actual obesity interventions to those outlined in the clinical practice guidelines.

Methods: A retrospective chart review of male and female patients between the ages of …

Exploring Geographic Distributions Of High-Risk Water, Sanitation, And Hygiene Practices And Their Association With Child Diarrhea In Uganda, Mitsuaki Hirai, Amira A. Roess, Cheng Huang, Jay P. Graham

Global Health Faculty Publications

Background: High-risk water, sanitation, and hygiene (WASH) practices are still prevalent in most low-income countries. Because of limited access to WASH, children may be put at an increased risk of diarrheal diseases.

Objectives: This study aims to 1) develop a new measure of WASH-induced burden, the WASH Resource Index (WRI), and estimate its correlation with child diarrhea and an additive index of high-risk WASH practices; 2) explore the geographic distribution of high-risk WASH practices, child diarrhea, and summary indices at the cluster level; and 3) examine the association between the WRI and child diarrhea at the individual level. …

Factors Affecting Injury History And Their Overall Impact On Athletic Performance In Distance Runners, Trevor Norris

Williams Honors College, Honors Research Projects

Distance running is a very precise mechanism of many intricate movements and abilities of the body. The amount of miles that a distance runner must run puts a lot of very intense stresses on one’s body. These stresses often appear at the bone level and lead to many injuries such as stress reactions and stress fractures but also may play important roles in tissue damages such as strains and pulls. In this study, we used division one college distance runners and examined many intricacies between their level of fitness and overall composition. These include looking at imbalances, dominant traits, and …

Foodservice Employees Behaviors And The Presence Of Foodborne-Illness Responsible Microorganisms On Smart Phones, Louise Louise De Gracia, R.D.

Master's Theses and Doctoral Dissertations

As technology advances, smart phone (SP) use is on the rise, including in foodservice establishments. Likewise, the incidence of foodborne-illness in the United States remains high. The presence of disease-responsible microorganisms on health care employees’ mobile phones is well-documented, but little research has examined this relationship concerning foodservice employees’ SPs. Employees (n=50) from a Michigan foodservice establishment were surveyed for their SP use behaviors, and their SPs were swabbed to detect Salmonella, coliforms, and norovirus. Poor hygienic behaviors, such as SP use in the bathroom (75.5%, n=37) were widespread. ServSafe®-certified employees (46%, n=23) were significantly (p=0.041) less likely to use …

Adolescent Girls Empowerment Programme In Zambia: Qualitative Evaluation Report, Zoe Duby, Chipo Natasha Zulu, Karen Austrian

Poverty, Gender, and Youth

The Adolescent Girls Empowerment Program (AGEP) reaches over 10,000 vulnerable girls 10–19 years old in five urban and five rural sites spread across four provinces in Zambia. The program works to build adolescent girls’ social, health, and economic assets, providing them with key skills and opportunities to help them transition from adolescence to adulthood in a healthy way. This report presents these valuable insight into the views and experiences of girls who were involved in the AGEP program, as well as the perceptions of program mentors, the girls’ parents, and community leaders. In addition, these findings highlight the areas in …

Delaying Child Marriage Through Community-Based Skills-Development Programs For Girls: Results From A Randomized Controlled Study In Rural Bangladesh, Sajeda Amin, Johana Ahmed, Jyotirmoy Saha, Md. Irfan Hossain, Eashita Haque

Poverty, Gender, and Youth

In Bangladesh, where efforts to prevent child marriage have focused on the enforcement of laws and policies, little research exists on what approaches work best to delay marriage and why. To help fill this evidence gap, in 2012 the Population Council and partners embarked on a four-year study to understand whether skills-building approaches to empower girls can delay marriage in three districts in southern Bangladesh where child marriage rates are high. The BALIKA project reported here is the first rigorously evaluated study to provide evidence on approaches to delay child marriage in Bangladesh. BALIKA results show that programs that educate …

A Systematic Review Of The Treatment And Management Of Pre-Eclampsia And Eclampsia In Pakistan, Saleem Shaikh, Ali M. Mir

Reproductive Health

Pakistan is one of the six countries that account for more than 50 percent of the world’s maternal deaths. According to Population Council estimates, each year nearly 8.6 million women become pregnant in the country. Of these, 1.2 million women are likely to face obstetric complications. Each year, there are nearly 14,000 pregnancy-related deaths. Information is lacking on context-specific health-system barriers that prevent optimal use of the lifesaving medicine magnesium sulfate (MgSO4) in Pakistan. Although efforts in Pakistan both at the national and subnational level are ongoing on the prevention and treatment of pre-eclampsia and eclampsia (PE/E), results are generally …

Screening For Sexual And Gender-Based Violence In Emergency Settings In Uganda: An Assessment Of Feasibility, Chi-Chi Undie, Harriet Birungi, Jane Harriet Namwebya, Wossen Taye, Lilian Maate, Margaret Mak'anyengo, Anne Katahoire, David Apollo Kazungu, Darlson Kusasira, Zahra Mirghani, Joanina Karugaba

Reproductive Health

Sexual and gender-based violence (SGBV) is a global predicament to which over a third of women worldwide are exposed. Its negative consequences for reproductive, maternal, adolescent, and mental health are well-documented, however there is sparse evidence for the feasibility of SGBV screening interventions in emergency contexts. Employing a descriptive case study design, this study assessed the feasibility of implementing SGBV screening and referral protocols within health facilities in the emergency setting in Western Uganda. Providers from two health facilities were trained to screen female clients routinely for current exposure to intimate partner violence and lifetime exposure to nonpartner sexual violence. …

Progesterone Vaginal Ring: Beneficial Role In Supporting Breastfeeding, Population Council

Reproductive Health

This brief provides evidence for the benefits of the Progesterone Vaginal Ring (PVR), as it supports (and even promotes) breastfeeding so that infants and children are well nourished, protected from a host of illnesses, and benefit from nursing that is uninterrupted by a pregnancy. In addition, the PVR enhances contraceptive protection for the mother so that she has ample time to recover from the previous pregnancy and delivery, while devoting her attention to the newly delivered baby. In this context, when breastfeeding has been recognized as a health behavior that impacts both mother and child and has the potential to …

Landscape Analysis Report On Pre-Eclampsia And Eclampsia In Pakistan, Ali M. Mir, Saleem Shaikh, Mumraiz Khan, Irfan Masood, Karen Kirk, Amy Dempsey, Charlotte E. Warren

Reproductive Health

This report presents the findings of a landscape analysis of the policy, programming, and service environment around prevention and treatment of pre-eclampsia and eclampsia (PE/E) in Pakistan. The primary aim of the landscape analysis was to identify the policy and program level of activities, as well as gaps and challenges around prevention and treatment of PE/E and the use of magnesium sulphate at the provincial and district levels in Pakistan. The study was carried out by the Population Council in 2016, with the support of the United States Agency for International Development (USAID) as part of the Project entitled “Ending …

Formative Research On Assessing Barriers To Fistula Care And Treatment In Nigeria, Charlotte E. Warren, Rachel Agbonkhese, Salisu Mohammed Ishaku

Reproductive Health

This report documents results of a systematic study of peer-reviewed and “grey” literature which identified studies relevant for understanding barriers to accessing obstetric fistula (OF) care in developing countries. To more comprehensively and holistically understand these barriers in Nigeria and potential enabling factors for alleviation, this study explored the perspectives of those involved in both identifying fistula and accessing care, such as family members and other community stakeholders including patriarchs, matriarchs, community leaders, and other opinion leaders. It also examines the cultural patterns, myths, and perspectives related to OF and how they influence women’s willingness and capacities to access surgical …

Adolescents In Bangladesh: Programmatic Approaches To Sexual And Reproductive Health Education And Services, Sigma Ainul, Ashish Bajracharya, Laura Reichenbach

Reproductive Health

There is a gap in knowledge and understanding of effective adolescent sexual and reproductive health (ASRH) programming in Bangladesh, especially programming at scale. Initiatives to address ASRH have been implemented at different times by both the Government of Bangladesh and NGOs, but these activities have often been fragmented and are not well documented or evaluated, making it difficult to know what worked well and what did not. This policy brief presents selected findings from a comprehensive review and analysis of ASRH programming in Bangladesh, carried out by the Population Council’s Evidence Project, with financial support from USAID/Bangladesh, as part of …

Scaling Up Family Planning In Zambia—Part 1: Assessment And Feasibility Of Maintaining An Innovative Program, Benjamin Bellows, Mary Nambao, Luigi Jaramillo, Roz Fanaiayan, Mardieh Dennis, Karen Hardee

Reproductive Health

To support the Government of Zambia in addressing its reproductive health challenges and in meeting its goals for 2020, the United Kingdom Department for International Development funded a four-year effort to support public sector contraceptive expansion under the Scaling Up Family Planning (SUFP) Project, led by Abt Associates. Launched in 2012, and with a focus on hard-to-reach areas and youth and expanding access to long-acting reversible contraceptives, SUFP was a technical assistance program designed to strengthen the ability of the public sector to provide services to meet the country’s FP2020 goals. SUFP focused on capacity building, infrastructure strengthening, behavior change …

Delivering Contraceptive Vaginal Rings To Breastfeeding Women, Population Council

Reproductive Health

The Progesterone Vaginal Ring (PVR) is a user-controlled contraceptive that helps breastfeeding women safely and effectively space, delay, or limit their next pregnancy. The Population Council and partners developed the PVR to help address the unmet need for contraception among breastfeeding women. The ring provides a convenient option that adds choices for new mothers and promotes optimal infant nutrition and health. This two-page brief provides fast facts for advancing nutrition and infant health with the PVR.

Evaluation Of The Impact Of Strengthening Union Health And Family Welfare Centers For Providing 24/7 Normal Delivery Services In Bangladesh, Md. Noorunnabi Talukder, A.K.M. Zafar Ullah Khan, Mohammed Sharif, Forhana Rahman Noor, Surojit Kundu, Shongkour Roy, Afsana Fatema Noor, Ubaidur Rob

Reproductive Health

In Bangladesh, the majority of the infant deliveries in rural areas take place at homes where there is a higher risk of morbidity and mortality. Most Union Health and Family Welfare Centers (UHFWCs) are unable to provide 24-hour normal delivery services in close proximity to most rural women. With this point of view, the Population Council has provided technical assistance to the Directorate General of Family Planning to implement an operations research (OR) study in 24 UHFWCs to test the effectiveness of a model to strengthen UHFWCs so that they can provide such services. This report presents the findings of, …

Using The Community Informant Based (Made-In And Made-For) Methodology For Estimating Maternal Mortality Ratio (Mmr) In Districts Haripur And Nowshera, Khyber Pakhtunkhwa, Population Council

Reproductive Health

Through its Reproductive Maternal and Neonatal Child Health project, GIZ Pakistan is assisting the Government of Pakistan in strengthening its health system’s capacities for ensuring effective, efficient, client-oriented, and affordable reproductive, maternal, newborn, and adolescent health care. GIZ engaged with senior national and provincial government officials who indicated their interest in applying the innovative Made-In/Made-For (Maternal Death, from Informants/Maternal Death, Follow On Review) methodology, a cost-effective alternative for generating reliable estimates of maternal mortality through community-based informant networks. This Population Council study in two pilot districts identified specific areas that need strong policy and programmatic interventions to improve maternal health …

Using The Community Informant-Based (Made-In And Made-For) Methodology To Estimate The Neonatal Mortality Rate (Nmr) In Nowshera, Khyber Pakhtunkhwa: A Feasibility Study, Ali M. Mir, Saleem Shaikh, Mumraiz Khan, Irfan Masood, Mansoor Qaisar, Sabahat Hussain, Rehan M. Niazi

Reproductive Health

Concerned about high levels of neonatal mortality, the Khyber Pakhtunkhwa district government in Pakistan expressed a need to adapt and test a new approach—commonly referred to as the “Made-In/Made-For” (MIMF) method—that uses community-based informants to estimate the number of maternal deaths. The current pilot study in Nowshera was commissioned by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH and conducted by the Population Council to test the feasibility of using the method, and community-based informant networks that had been used to measure maternal mortality, for estimating neonatal deaths. This study clearly shows that, in addition to identifying maternal deaths, informant …

Using The Community Informant Based (Made-In And Made-For) Methodology For Estimating Maternal Mortality Ratio (Mmr) In Khyber Pakhtunkhwa, Ali M. Mir, Saleem Shaikh, Mumraiz Khan, Irfan Masood

Reproductive Health

This report documents a study by the Population Council estimating the maternal mortality ratio of Khyber Pakhtunkhwa (KP) province in Pakistan using an innovative community informant–based method, known as the “Made-In/Made-For” (MIMF) technique, to collect data on maternal deaths. The report confirms that maternal mortality persists as a major public health issue in KP, and the problem may be much larger than assumed. The study’s success in identifying causes of death through verbal autopsies and their subsequent disaggregation into direct and indirect causes is important from policy and programmatic perspectives. Interventions need to focus both on direct and indirect causes …

Improving The Health Of African Americans In The Usa: An Overdue Opportunity For Social Justice, Allan S. Noonan, Hector Eduardo Velasco-Mondragon, Fernando A. Wagner

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Using a modified social ecological model, we conducted a review of the literature and nationwide statistics on African American health. We discuss the main social determinants of health and main health disparities, risk factors, the leading causes of morbidity and mortality, and access to health services for blacks in the USA. The mechanisms through which social determinants, including racism, exert their deleterious effects on black health are discussed at the macro and individual levels. Incarceration and mental health care issues are highlighted as priorities to be addressed. African Americans remain the least healthy ethnic group in the USA, a somber …

Hispanic Health In The Usa: A Scoping Review Of The Literature, Hector Eduardo Velasco-Mondragon, Angela Jimenez, Anna G. Palladino-Davis, Dawn Davis, Jose A. Escamilla-Cejudo

Faculty Publications & Research of the TUC College of Osteopathic Medicine

Hispanics are the largest minority group in the USA. They contribute to the economy, cultural diversity, and health of the nation. Assessing their health status and health needs is key to inform health policy formulation and program implementation. To this end, we conducted a scoping review of the literature and national statistics on Hispanic health in the USA using a modified social-ecological framework that includes social determinants of health, health disparities, risk factors, and health services, as they shape the leading causes of morbidity and mortality. These social, environmental, and biological forces have modified the epidemiologic profile of Hispanics in …

The Waist To Height Ratio Is A Better Anthropometric Index Of Abdominal Obesity And Its Association With The Prevalence Of Diabetes Among Asian Americans, Yu Xiao

All Master's Theses

There is limited information about diabetes prevalence among Asian Americans. Diabetes risk factors include abdominal obesity (AO), which can be assessed by measuring waist circumference (WC) or waist-to-height-ratio (WHtR). The purpose of this study was to compare the prevalence of diabetes among Asians with non-Asians in the United States and compare WC and WHtR as predictors of diabetes. Data from the National Health and Nutrition Examination Survey (NHANES) 2011-14 was analyzed using SAS 9.2. There were 8,615 adult non-pregnant non-Asians and 1,224 Asians included in this study. Despite a lower prevalence of obesity among Asians compared to non-Asians (12% vs …

Prevalence Of Risk Factors For Metabolic Syndrome In Uninsured Hispanic Adults From Low Income Communities In El Paso, Texas, Juan Antonio Aguilera

Open Access Theses & Dissertations

Metabolic syndrome (MetS) consists of a group of associated risk factors for cardiovascular disease and other related chronic diseases. In the U.S. it is estimated that nearly 35% of the adult population have metabolic syndrome. According to National Institutes of Health (NIH) guidelines risk factors for developing MetS include large waistline, high blood pressure, high triglyceride level, low high density lipoprotein (HDL) cholesterol level, and elevated fasting blood glucose level. The goal of this study was to investigate the prevalence of risk factors for MetS among uninsured, low socioeconomic status adult Hispanics in El Paso, Texas. The study population resided …

Low Self-Esteem Leads To Depression Among Elderly: Case Study Of Nursing Home, Savera Aziz Ali, Nadir Suhail, Sumera Aziz Ali

School of Nursing & Midwifery

Background: Self-esteem is defined as “how we value our self”; it affects our trust and relationships in every part of life. Person with low self-esteem may feel powerless and incompetent about himself/herself. Moreover, low self-esteem operates as a risk factor for depression, which is most common disorder among elderly people both in developed and developing countries, causing multiple behavioral changes as well as may increase the chances of depression and suicide among the elderly people. Objective: The objective of this case study was to understand the problems faced by elderly people in the nursing home and to relate the self-esteem …

Engaging Moms On Teen Indoor Tanning Through Social Media: Protocol Of A Randomized Controlled Trial, Sherry L. Pagoto, Katie Baker, Julia Griffith, Jessica L. Oleski, Ashley Palumbo, Barbara Walkosz, Joel J. Hillhouse, Kimberly L. Henry, David Buller

ETSU Faculty Works

Background: Indoor tanning elevates the risk for melanoma, which is now the most common cancer in US women aged 25-29. Public policies restricting access to indoor tanning by minors to reduce melanoma morbidity and mortality in teens are emerging. In the United States, the most common policy restricting indoor tanning in minors involves parents providing either written or in person consent for the minor to purchase a tanning visit. The effectiveness of this policy relies on parents being properly educated about the harms of indoor tanning to their children.

Objective: This randomized controlled trial will test the efficacy …

Influence Of Teacher Participation On Student Fitness And Student Participation In Physical Education, Whitney Morris

Walden Dissertations and Doctoral Studies

Physical activity plays a key role in the health of children. Childhood obesity is increasing in the United States, and children are spending less time being physically active. Active participation by a physical education (PE) teacher in physical activities has been suggested as a means of promoting student fitness. The purpose of this quasi-experimental quantitative study was to determine whether modeling of physical activity by a PE teacher would increase student participation and physical fitness. Bandura's social learning theory provided the theoretical framework for the study. Participants included 311 4th and 5th grade elementary students enrolled in physical education classes. …

Impact Of Medicare And Medicaid Beneficiaries With Selected Conditions On Emergency Department Utilization, John K. Amoh

Walden Dissertations and Doctoral Studies

Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) are conditions that represent significant and ongoing medical costs, including frequent emergency department (ED) visits, hospitalizations, work absences, and disability. This retrospective cross-sectional study, examined the effects of the frequent ED visits due to COPD and CHF on the beneficiaries of Medicare and Medicaid in Maryland. The goal was to identify the factors that led these patients to visit the ED, the impact of these visits on Medicare utilization and costs across Maryland, and preventative intervention strategies to control this population's costs of care. Secondary data were analyzed from 2010-2012 …

Effect Of Reduced-Fee Dental Hygiene Treatment And Oral Health Perceptions Among Socioeconomically Deprived Persons, Janeime Necole Asbury

Walden Dissertations and Doctoral Studies

Access to oral health care remains problematic for millions of Americans. Factors such as socioeconomic status, age, race, and lack of dental insurance benefits inhibit the ability of many to obtain preventative oral health care. The aim of this study was to explore the effect of preventive oral health treatment and education at reduced-fee dental hygiene facilities on the oral health behaviors and perceptions of socioeconomically deprived persons within the state of Georgia. This study was based on the health belief model constructs. A convenience sample of 102 participants was recruited from the individuals who visited two dental hygiene colleges …

Gestational Age, Birth Weight, And Incidence Of Adult Type 2 Diabetes Among Southeast Alaska Natives, Renee Elaine Crawford

Walden Dissertations and Doctoral Studies

American Indian and Alaska Native adults are 2.6 times more likely to have adult onset diabetes resulting from higher weight at birth. Pregnant women, providers, and Indian Health Service administrators may benefit from timely information during pregnancy to intervene and prevent Type 2 diabetes. The purpose of this study was to examine the role of birth weight in the development of Type 2 diabetes among Southeast Alaska (SEA) Natives. Guided by the socioecological model, this study examined the extent to which birth weight and gestational age predict the incidence of Type 2 diabetes. The study used a quantitative research design …

Effect Of Genetic Background Combined With Excessive Media Screen Time On Markers Of Cardiovascular Risk In United States Youth Aged Newborn To 20 Years, Maria Moroni

Walden Dissertations and Doctoral Studies

Time with media screens (television, computers, videogames, cell phones, and tablets) is the primary activity of youth, second only to sleeping, and represents a major risk factor for cardiovascular diseases (CVD). Additionally, the populations with highest rates of screen time are also those most at risk of CVD from genetic predisposition (i.e., Blacks, Hispanics). The purpose of this descriptive, correlational study, based on cross-sectional analysis of archived data from the 2009 - 2010 NHANES for United States youth, newborn to 20 years old, was to determine whether the combination of media screen time with genetic background is a better predictor …

Experiences Of Chronic Disease Self-Management Program Leaders, Laketa Monique Hillman

Walden Dissertations and Doctoral Studies

Chronic conditions are public health threats. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based disease management program that addresses personal self-management of chronic conditions. The CDSMP involves peer trainers who instruct and assist with chronic disease preventive measures. Although disease management demonstrates promise to improving patient self-maintenance, previous researchers have not evaluated how the program affects program leaders. The purpose of this study was to discover how self-help leaders feel about the CDSM program. The overarching research question asked about perspectives that self-help leaders had toward the program. Through a narrative qualitative approach, the perceptions of peer leaders were …