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The Silent Epidemic: Equipment Maintenance Failures And Patient Outcomes In Ghana's Healthcare System, Ramseyer Adekorang Asamoah, Celene Dzreke, Evans Dzreke, David Kanzin

Health & Biomedical Sciences Faculty Publications

Broken tools indicate a broken system. This new study reveals how medical equipment failures destroy Ghana's public hospitals, turning life-saving technologies into silent murderers that disproportionately affect rural areas. Moving beyond technical diagnostics, we study the cascading systemic failures, chronic underfunding, critical staff shortages, and fragmented supply chains that leave 40% of vital equipment, such as ventilators, MRI scanners, and dialysis machines, inoperable at any given time. We quantify the devastating human toll through rigorous mixed-methods analysis of equipment downtime records across ten regional hospitals (2018-2023) and profound narratives from 50 frontline stakeholders, doctors forced to improvise without working incubators, …

More Than A Feeling: A Mixed-Methods Examination Of Transgender Community Connectedness And Associations With Suicidality, Erin Rook

UNLV Theses, Dissertations, Professional Papers, and Capstones

Transgender adults experience significantly higher rates of suicidal ideation than the general population. A sense of transgender community connectedness (STCC) may reduce this risk, but predictors of STCC and its association with suicidal ideation are understudied. This cross-sectional mixed methods study examined STCC and past-year suicidal ideation in relation to dimensions of transgender community connectedness (TCC) at each level of the Social Ecological Model using data from a U.S. survey of transgender adults (n = 126). About half (52.4%) felt connected to the transgender community, and 27.0% reported past-year suicidal ideation. Hierarchical logistic regression models for both outcomes showed good …

Beyond The Bruise: Understanding Injury Risk Factors Among Livestock Workers In Cattle Feedyards And Animal Handling Farms And Ranches, Rishad Ahmed

Theses & Dissertations

Cattle feeding and livestock production are central to U.S. agriculture and represent some of the most hazardous occupational environments. Workers in feedyards and on cattle farms and ranches face elevated risks of injury due to physically demanding labor, frequent animal handling, and exposure to environmental and ergonomic hazards. Many feedyard workers are Hispanic/Latino immigrants who may experience additional barriers related to language, healthcare access, and job security. Similarly, injury risks among cattle producers are compounded by seasonal workload fluctuations, limited rest opportunities, and psychosocial stressors. Beyond individual impacts, agricultural injuries also pose a substantial economic burden. Recent estimates indicate that …

Symptom Clusters And Their Association With Health-Related Quality Of Life In Pediatric Cancer Survivors After Treatment Completion, Krishtee Napit

Theses & Dissertations

A critical area of cancer research, symptom management, has evolved from focusing on individual symptoms to recognizing the complexity of co-occurring symptoms, commonly referred to as symptom clusters. However, most studies on pediatric cancer symptom clusters have focused primarily on the treatment phase or long-term survivorship, overlooking the early post-treatment period. This dissertation examines the prevalence of multiple symptoms and symptom clusters in pediatric cancer survivors post-treatment; factors associated with the total number of symptoms and symptom clusters; and the association of the total number of symptoms and symptom clusters with health-related quality of life (HRQoL). We developed and tested …

Factors Associated With Discrimination-Related Distress Among Sexual And Gender Minority Individuals: A Predictive Analysis, Emylia Terry

UNLV Theses, Dissertations, Professional Papers, and Capstones

Sexual and gender minority (SGM) individuals face disparate rates of mental health outcomes, such as psychological distress, which contributes to suicidality. This may be attributable to minority stress, which posits that health inequities impacting this community are driven by increased exposure to stigma- and discrimination-related stressors. The negative physical and psychological health impacts of psychological distress and discrimination are well-documented in the literature. Structural stigma – in the form of harmful anti-LGBTQIA+ laws and policies – is associated with increased suicidality. However, little is known about factors associated with perceived discrimination occurrences and discrimination-related distress. First, a systematic review was …

Culturally Responsive Occupational Therapy Treatment Guide For African-American And Hispanic People With Eating Disorders, Desere N. Cooper

Student Capstone Papers

This capstone project addressed the critical need for a culturally responsive approach to occupational therapy in the treatment of African-American and Hispanic with eating disorders (EDs) in the United States. Although EDs impair physical, cognitive, and psychosocial functioning, these communities often encounter systemic barriers such as cultural stigma, food insecurity, and inadequate assessment tools rooted in Eurocentric norms—that contribute to underdiagnosis, limited access to care, and poorer outcomes. The central issue addressed was the absence of clear, culturally relevant guidance for occupational therapy practitioners working with these underserved populations. The project was informed by a comprehensive literature review and synthesis …

Disentangling The Effect Of Criminal Legal System Involvement On Mental Health In The United States, Pui Ying Chan

Dissertations and Theses

BACKGROUND: Interactions with the criminal legal system (CLS), such as through arrest or incarceration, are relatively common in the United States (US) and are increasingly recognized as social risk factors for poor mental health. Previous studies have reported a positive association between CLS involvement and poor mental health, with some theoretical frameworks, including the ecosocial theory and the stress process paradigm, supporting a plausible causal relationship. However, prior research has significant limitations in providing casual evidence given possible reverse causation in cross-sectional studies and insufficient consideration for the dynamics between CLS exposures, mental health status, and related confounders over time …

Role Of Perceived Social Support And Knowledge Of Postpartum Depression Among Women In Anambra State, Eastern Nigeria, Raphael Oluwasina Babatola Folorunsho

Walden Dissertations and Doctoral Studies

Postpartum depression (PPD) is an increasingly pressing public health issue, particularly in low-resource settings like Nigeria, where maternal mental health tends to receive limited attention. This study explored the relationship between maternal awareness of PPD, perceived social support, and prevalence of depressive symptoms among postpartum women in the Nnewi North Local Government Area (LGA) of Anambra State. Grounded in the social support theory, health belief model, and socioecological model, the study used a descriptive cross-sectional research design. A total of 406 postpartum women attending primary healthcare centers were surveyed using validated instruments, including the PHQ-9 and MSPSS. Statistical analyses included …

Increasing Implementation Of The Comfortable Cafeteria Program To Promote School-Age Children’S Mental Health And Well-Being, Reinecka Mondesir, Angela Labrie Blackwell Phd, Otr

Summer 2025 OTD Capstone Symposium

Every Moment Counts (EMC) is a positive mental health promotion initiative that offers several initiatives to create inclusive environments that support student participation and emotional well-being throughout the school day. Comfortable Cafeteria, part of EMC, fosters positive mealtime experiences supporting peer interaction, emotional regulation, and inclusion. Many SBOT practitioners lack the resources to implement Comfortable Cafeteria, despite its benefits. This capstone project addresses the need for practical tools to help school-based occupational therapy (SBOT) practitioners integrate the Comfortable Cafeteria program into daily practice. Using the Multi-Tiered System of Supports (MTSS) framework, the project developed and disseminated an interactive, evidence-based video …

Cardiometabolic Outcomes In The Obese African American Population With Rheumatoid Arthritis, Cecilia Jillo Walan

Walden Dissertations and Doctoral Studies

Rheumatoid arthritis (RA) disproportionately impacts African American adults, particularly those with obesity, due to overlapping cardiometabolic risks and health care disparities. The intersection of RA, obesity, and chronic conditions such as cardiovascular disease (CVD) and hypertension underscores the need for targeted public health interventions. This study investigated the association between RA and cardiometabolic outcomes among African American adults with obesity, aiming to identify significant predictors within this high-risk population. This quantitative study employed a cross-sectional design to analyze data from the 1999–2018 National Health and Nutrition Examination Survey undergirded by the social ecological change framework with N=23644 African American adults …

Addressing Psychosocial Barriers To Participation In People Experiencing Homelessness: An Occupational Therapy Workshop, Preston Bender, Steven M. Gerardi, Lacey Spark

Summer 2025 OTD Capstone Symposium

Despite the occupational therapy (OT) profession's emphasis on holistic, person-centered care, many OT practitioners and students report feeling a lack of self-efficacy and preparedness to navigate the complex psychological, social, and systemic barriers that hinder occupational participation in people experiencing homelessness (PEH). This capstone project aimed to address the perceived unpreparedness among clinicians through the creation of an 8-hour interactive educational workshop aligned with Experiential Learning Theory. The content is grounded in the Model of Human Occupation (MOHO) and informed by the Bridging the Transition from Homelessness: A Social Justice Framework (BTTF), trauma-informed care (TIC), harm reduction, and diversity, equity, …

Changes In Mental Health Care Utilisation Before And During The Covid-19 Pandemic Among People Living With Hiv In The Usa: A Retrospective Cohort Study Using The All Of Us Dataset, Atena Pasha, Shan Qiao, Jiajia Zhang Ph.D., Ruilie Cai, Buwei He, Xueying Yang, Chen Liang Ph.D., Sharon Weissman, Xiaoming Li Ph.D.

Faculty Publications

Introduction Despite the profound impact of the COVID-19 pandemic on people living with HIV (PLWH) mental health, large-scale, real-world data on mental healthcare utilisation and associated factors among PLWH remain limited. This study explores mental healthcare utilisation and associated factors among PLWH during the COVID-19 pandemic.

Methods Using a retrospective cohort design, we identified and included 4575 PLWH through computational phenotyping based on relevant Observational Medical Outcomes Partnership Common Data Model concept sets from the All of Us programme between March 2018 and March 2022. Mental healthcare utilisation was measured using the yearly count of mental healthcare visits and compared …

Kind Kids, Healthy Teens: Child Prosociality And Fruit And Vegetable Intake, Farah Qureshi, Krista P. Woodward, Laura D. Kubzansky, Julia K. Boehm

Psychology Faculty Articles and Research

Introduction

Methods

Holistic Approach To Managing Grade 3 Vaginismus: An Obg Physiotherapy Perspective, Nagma Khan

Internet Journal of Allied Health Sciences and Practice

Background: Vaginismus is a condition characterized by involuntary pelvic floor muscle contractions, which can make vaginal penetration painful or impossible. This disorder has both physical and psychological components, often leading to significant emotional distress, anxiety, and relationship difficulties. Effective management requires a holistic, multidisciplinary approach, combining physical therapy with psychological support. This case report examines the treatment of a 29-year-old woman with grade 3 vaginismus, highlighting the role of Obstetrics & Gynaecology (OBG) physiotherapy in improving both physical symptoms and emotional well-being.

Case Presentation: A 29-year-old female presented with grade 3 vaginismus, with a history of severe pelvic floor tension …

The Lived Experience Of In-Home Social Distancing And Other Preventative Measures Among Covid-19-Positive Individuals And Other Household Members, Jimmette Naytwain Brooks

Walden Dissertations and Doctoral Studies

The novel Coronavirus Disease 2019 (COVID-19), first detected in Wuhan, China, is caused by a new virus strain: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On March 11, 2020, COVID-19 was classified as “the second pandemic of the 21st century” by the World Health Organization. To better control the spread of the virus, governments and communities adopted several established public health protocols to quell the spread of the disease and decrease the resulting morbidity and mortality. Specific measures included masking, hand hygiene, social distancing and disinfection. Though these are proven measures, not much was known about adherence in the home …

Eco-Emotions And Climate Activism In Adolescents, Julianna Sahoo

Master's Projects and Capstones

Background. Youth are especially vulnerable to climate change, both physically and psychologically. Combatting climate change will require a coordinated, global effort. Understanding the motivations and emotions behind climate activism is essential to coordinate efforts to combat climate change.

Methods. This research uses survey data collected from first and second year undergraduates (n=521) at a private, urban university in California in the Fall of 2022. Youth were surveyed on emotions related to climate change, activism, compassion, eco-anxiety, and well-being.

Results. Experiencing positive emotions had a stronger relationship with environmental activism compared to negative emotions.

Conclusion. Results suggest climate change communications should …

Effects Of Mode And Transitioning To A Mixed-Mode (Web/Phone) Design On Categorical Survey Estimates: Do Question Characteristics Matter?, Mengyao Hu, Vicki A Freedman, Justin Kamens

Faculty, Staff and Student Publications

An increasing number of telephone surveys are introducing a web option. Limited experimental research has explored the implications of such design changes and how they vary by question characteristics. Using an experimental design and propensity score matching techniques, this study examines the effects of mode (web vs. telephone) and transitioning to a mixed-mode design (from telephone-only to the choice of web or telephone) on survey estimates and how effects differ by question characteristics. We draw upon an experiment embedded in the National Study of Caregiving (NSOC), in which half of NSOC-eligible caregivers were randomized to a telephone-only design and the …

A Comprehensive Evidence-Based Educational Initiative For Improving Hand Hygiene, Lyanna L. Chan

Master's Projects and Capstones

Abstract

Problem: Healthcare-associated infections (HAIs) are a persistent concern in assisted living facilities, often resulting from inconsistent hand hygiene practices. Although national guidelines exist, adherence remains suboptimal, especially where staff training and compliance monitoring are limited.

Context: This project took place in a 53-bed assisted living facility without a formal system to track or reinforce hand hygiene. The aim was to improve staff knowledge and promote infection prevention through education.

Interventions: A Clinical Nurse Leader (CNL) led an evidence-based hand hygiene education program. The intervention included interactive training, visual reminders, personal sanitizers, and leadership support during clinical huddles.

Measures: Pre- …

Chlamydia And Gonorrhea Infections In Genital And Extragenital Samples Among Men And Women, Kristal J. Aaron, Charlotte A. Gaydos, Edward W. Hook, Max Chernesky, Jeanne Moncada, Stephanie N. Taylor, Harold C. Wiesenfeld, Kenneth H. Mayer, Matthew R. Golden, Alexander Boutwell, Barbara Van Der Pol

School of Medicine Faculty Publications

Background For people who have anal and/or oral sex, many programs recommend genital and extragenital (defined here as anorectal and oropharyngeal) screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) to identify all potential sites of infection. Methods We assessed genital and extragenital CT and NG prevalence among people reporting extragenital sexual exposure. Results Among 343 gay and bisexual men who reported sex with men (GBMSM), 42 (12.2%) had CT with positivity of 3.5%, 9.3% and 1.8% in the genital, anal, and oral samples, respectively. In this same group, 55 (16.0%) had NG with positivity of 5.2%, 8.5%, and 7.6% …

Amputation Trends Among People Who Use Drugs In The Context Of Philadelphia’S Increasingly Xylazine Adulterated Drug Supply, Rose Laurano, Monika Pogorzelska-Maziarz, Traci C. Green, Sara Beachy, Kristin L. Rising, Jeffrey K. Hom, Megan K. Reed

Jefferson Center for Connected Care Faculty Papers

BACKGROUND: Xylazine-adulterated fentanyl has rapidly spread across the United States and has been increasingly detected in overdose deaths in Philadelphia, PA through medical examiner reports, clinical testing, and widescale drug checking. Xylazine use has been associated with wounds which may lead to amputation, but the extent of this outcome has not been explored.

METHODS: Utilizing the 10th revision of the International Classification of Diseases (ICD-10) codes, we conducted a de-identified retrospective analysis of data for patients identified with opioid related disorders (ICD-10 code F11) admitted to four different hospitals in Philadelphia, PA between 2018 and 2023. Exposure to xylazine use …

Partnership, Collaboration, And Co-Production To Improve Patient Experience Beyond Conducting Surveys – Lessons From The Quebec Model, Canada, Marie-Pascale Pomey, Catherine Wilhelmy, Myriam Fournier-Tombs, Vincent Dumez, Cécile Vialaron, Monica Nelea Iliescu, Karina Prevost, Simon Courtemanche, Louise Normandin, Geneviève David

Patient Experience Journal

Objective: The objectives of this article are to present how, in the province of Quebec (Canada), healthcare and service partnerships have been implemented, to take stock of the current situation and to suggest ways to continue strengthening the model over the coming years, in Quebec and elsewhere in the world. Methods: Three methods were mobilized: (1) a review of the literature and reports published in recent years on implementations of partnerships in Quebec; (2) a survey sent to the persons responsible for partnerships in Quebec’s health and social services establishments; and (3) a working committee comprised of patient experts, partnership …

Peer Mentoring, Camaraderie, And Support (Pmcs) Of Southern New Jersey: Suicide Prevention Using Human Experience And Social Determinants Of Health, Ali A. Poorani, Matthew Jacobs, Patrick Carney, Jaclyn Tomasetti

Patient Experience Journal

Suicide prevention is a high priority for Veterans Health Administration (VHA). Recent data show an increase in suicide rates, especially among Veterans that had not used VHA health services and nor had received any VHA benefits. Meanwhile, data collected for the past two decades reveals a decline in suicide rates among Veterans who were recent VHA users with mental health or substance use disorders. The objective of the Peer Mentoring, Camaraderie, and Support (PMCS) Program was to explore novel ways to reengage and reintegrate Veterans into their earned VA healthcare benefits, and examine the effectiveness of this new initiative by …

“All Together”: A Case Study Demystifying Patient And Public Involvement (Ppi) In Brief Psychological Interventions Within A Community Mental Health Service For Adults In The Uk, Molly H. Nadel, Katherine Parkin, Stephanie Casey, Rachel Maciag, Alice Xie, Mu-Yin Chang, Youngsuk Kim

Patient Experience Journal

The importance and value of involving patients and the public in the decision-making processes within services designed to support them, and research projects aimed at understanding and improving those services, have long been established. This is often referred to as Patient and Public Involvement (PPI). However, establishing good quality involvement work in practical terms is often less well understood and therefore, the uncertainty surrounding this can lead to hesitation by clinicians in practice. In this paper, we will share our lessons learned and the practical outcomes of PPI when applied in an NHS community mental health service for adults. We …

Understanding Online Reviews Of Geriatricians: Correlations Within A Dataset Of 53,210 Physician Reviews, Yizhong Wu, Eric Reuben Smith, Nick Shaffer, Hanh Dieu Trinh, Becky Powers

Patient Experience Journal

Introduction: Online reviews are increasingly influential in how patients find and choose physicians. Patients appreciate the transparency of online reviews, and they offer an avenue for physicians to receive feedback. This cross-sectional study aims to provide insight into correlations between provider level information such as wait times or physician demographics, and the reviews patients submit online for geriatricians.

Methods: ParseHub software was used to extract and pool data from 6,631 provider profiles categorized under “geriatric medicine” on the popular open-source physician review website Healthgrades.com. Physician race or ethnicity was modeled by profile last name based on 2010 US census data. …

Family-Centered Care In Pediatric And Neonatal Intensive Care Units: A Systematic Review Of Effects On Parental Satisfaction And Length Of Stay, Vincenzo Andretta, Valentina Cerrone, Veronica Strini, Angela Prendin

Patient Experience Journal

Background: Family-centered care (FCC) is essential in pediatric and neonatal intensive care units (PICUs), potentially increasing parent satisfaction and reducing length of hospital stay, but evidence of its effectiveness is inconsistent. Objective: To assess the effects of FCC interventions on parent satisfaction and length of hospital stay in PICUs. Methods: A systematic review was conducted, with 17 studies meeting the established inclusion criteria. The McMaster tool was used to assess the methodological quality of studies, along with an assessment of risk of bias. Results: The review identified a wide range of FCC interventions, including promoting parental …

Understanding Patient Experiences: A Qualitative Study On Communication And Cultural Competence In Multiple Sclerosis Care, Vaishnavi Sridharan, Charee Thompson, Rola Mahmoud, Minnatallah N. E. Eltinay, Chungyi Chiu

Patient Experience Journal

Objective: Effective communication is crucial in multiple sclerosis (MS) care, influencing patient satisfaction, self-management, and health outcomes. This study explores the experiences of people with MS (PwMS) regarding communication with healthcare providers and between providers within healthcare systems. Methods: This qualitative study analyzed open-ended responses from 590 participants in a national cross-sectional survey. Thematic content analysis was conducted to explore MS patients’ experiences with healthcare communication and care delivery. Results: Three major themes emerged: (1) Patient-provider communication, where 62.9% of participants reported positive experiences, citing responsiveness and empathy, while 37.1% noted issues such as inattentiveness and rushed consultations. (2) …

“Why Should Anyone Want To Make Things Better For Me Particularly?” – A Qualitative Exploration Of Care Opinion And Nhs Care Improvements, Emma Berry, Zoe Skea, Marion K. Campbell, Louise Locock

Patient Experience Journal

Care Opinion is an online platform which enables people to share anonymous feedback (known as “stories”) about their experiences of UK healthcare. In Scotland, this platform has official government backing, though healthcare organisations are not obliged to use it. Care Opinion staff review and edit these stories, acting as moderators. Healthcare staff are invited to respond to stories and are encouraged to use it for healthcare improvement. However, the number of changes made and registered on the platform is relatively small. This paper brings together findings from interviews with story authors (those sharing experiences), NHS staff and Care Opinion moderators …

Psychosocial Dimensions Of Living With Hep B: Notes From The Field: The Lived Experience Of A Mother Raising A Daughter With Hepatitis B, Julie Gerhardt

Patient Experience Journal

What follows is based on the interweaving of three points of view each of which contributes to an understanding of the experience of living with Hepatitis B: (i) as the mother of a daughter who was diagnosed with HBV at 5 months and who still, at age 22, carries traces of the surface antigen in her blood; (ii) as a participant in the Hepatitis B Foundation’s (HBF) “Storytellers” program in which those impacted by the disease meet with others to share experiences and narrate a short video posted on the HBF website; and (iii) as a PhD research psychologist-turned-psychoanalyst interested …

Holding Space: An Effective Intervention For When Hope Wanes, Annette Lane, Marlette Reed, Rose Schroeder

Patient Experience Journal

Holding space is a person-centered, non-judgmental approach to working with clients. This approach goes beyond listening to client concerns; it entails deep listening and being present, developing trust with clients, and helping them connect goals with values. Within this brief account, the concept of holding space is described. What it is and is not is explained. Examples of holding space are woven throughout in order illustrate this concept. Finally, implications for professionals are provided.

“Those Boxes Do Not Hold Me”: Using Narrative Health Experiences Research To Learn From Patients And Care Partners Beyond Surveys, Rachel Grob, Barbara Warren, Erika Cottrell, Njeri Grevious, Sara Knight, Mark Schlesinger, Kate Clegg Smith, Nancy Pandhi

Patient Experience Journal

Stories are fundamental to how we understand individual beliefs and experiences, as well as collective mindsets and institutional practices. Volunteered narratives are abundant, especially on the interweb. We in the health experiences research community, however, are challenged to develop effective, equitable approaches to moving beyond surveys by hearing and responding to not just dominant voices, but also those whom research has historically ignored, silenced, or objectified. In this commentary, we describe one such approach: the Database of Individual Patient Experiences (DIPEx) methodology as adapted by the Health Experiences Research Network (HERN) for use in the U.S. context since 2015. We …