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Delaying First Pregnancies: Canadian Women's Knowledge And Perception Of The Consequences, Deborah Haynes

Walden Dissertations and Doctoral Studies

Many women aged 20-30 are postponing their first pregnancies until their mid 30s and beyond, which has resulted in compressed childbearing years and/or infertility. Little is known about the knowledge and understanding that Canadian women of advanced age (age 35-45) possess of their reproductive capacity. This phenomenological study sought to explore these women's knowledge and perception of their reproductive capacity in relation to the timing of first pregnancy. Research questions using the constructs of Ajzen's theory of planned behavior were developed to explore how the behavioral, normative, and control beliefs of women's childbearing behaviors were based on their perceptions of …

Disparities In Arkansas Mandated Immunization Coverage Among Natural Home And Foster-Care Adolescents, Jerome Essono Ngundue

Walden Dissertations and Doctoral Studies

Anecdotal evidence indicated vaccine coverage disparities among foster-care (FCA) and natural-home adolescents (NHA). Arkansas laws require 5 vaccines for school entry (FVSE) to prevent 9 common childhood diseases. The study problem was that Pulaski County, Arkansas adolescent birth cohort (PCABC) immunization rates were low compared to U.S. adolescents for these FVSE. This study examined the extent to which (1) PCABC immunization rates were significantly different from those estimated for U.S. adolescents in 2006–2008, (2) NHA and FCA immunization rates were different in 2003– 2008; (3) sociodemographic variables mediate associations between home of residence (HOR), NHA or FCA, and up to …

The Effect Of Federal Reporting Regulations On Hospital Investment In Community Building, Dorothy Magasis Escobar

Walden Dissertations and Doctoral Studies

The role of hospitals as partners in community health improvement is changing, especially for nonprofit hospitals receiving tax exemptions in exchange for providing benefits to the community. There are examples of reported health improvement activities funded through hospitals' charitable donations, but there's a gap in the literature on the effect of policy and legislation on hospitals' investments in community building activities that address the social determinants of health. Grounded in eco-social theory, this quantitative, correlational study compared secondary data from CA's nonprofit hospitals' annual 2009 and 2012 reports to determine what, if any, changes have occurred in the hospitals' investments …

Risk Factors For Hypertension Among African-Born Immigrants In The United States, John Ojih

Walden Dissertations and Doctoral Studies

Essential hypertension (HTN) has been and continues to be a serious public health problem across the globe, particularly among Black races, with an estimated morbidity rate of over 1 billion people and an estimated mortality rate of 9.4 million people worldwide. Essential HTN can lead to a host of chronic diseases including cardiovascular disease (CVD), stroke, myocardial infarction, brain damage, kidney failure, and retinopathy. The main purpose of this quantitative, descriptive, nonexperimental study was to investigate the association of physical inactivity, length of stay in the United States, immigrants' health status, and food security as risk indicators in the development …

Rural Obese African American Women And Depression, Food Culture, And Binge Eating, Tracee Tamiko Smith

Walden Dissertations and Doctoral Studies

The rural African American population has a high incidence of severe psychosocial problems and a skewed perception of obesity, despite obesity's extremely high prevalence rate in this population. Despite the acknowledgements of these problems, there is a gap in literature relative to the effective treatments for obese African Americans diagnosed with depression. This study measured correlations between obesity and depression, binge eating, and food culture amongst African American women residing in Jefferson County, MS. The health belief model was used to guide an assessment of beliefs, perceptions, susceptibility, cues to action, and self-efficacy. A cross-sectional design was used based on …

Chronic Pain Causal Attributions In An Interdisciplinary Primary Care Clinic: Patient-Provider And Provider-Provider Discrepancies, Bryan Jensen

Theses and Dissertations

The purpose of the present study was to investigate the influence of pain causal attributions on patient pain-related functioning, treatment engagement, and clinical outcomes. Additionally, the impact of discordant pain causal attributions between patients and their providers as well as between interdisciplinary providers was examined. Patients rated their pain functioning and causal pain attributions during a regular clinic visit. Following the patient’s visit both the behavioral medicine provider and internal medicine resident provided ratings of similar pain-related functioning domains and causal attributions. Follow-up data were collected from the electronic medical record three months following that clinic visit. Overall, results revealed …

Exploring Obesity Risk Factors In Five Regions Of Virginia, Karen Toth Carpenter

Walden Dissertations and Doctoral Studies

Obesity continues to weaken our nation physiologically, psychologically and financially with an overall prevalence rate of 34.9% or 78.6 million Americans affected. Variance in obesity prevalence rates, in the state of Virginia, account for over a 15% difference from one health district to the next. The purpose of this research was to better explore the regional obesogenic factors that may exist among five health districts in the state of Virginia. The socio ecological theory provides the conceptual framework of the study to understand the variance in regional obesity rates, as a function of the contributing risk factors that a region …

Data Management And Data Facilitation In Multi-Center Large Cohort Health Care Studies, Wei Wang

Dissertations, Master's Theses and Master's Reports

Data management and data facilitation is the foundation and a critical part for scientific investigations, especially with large cohort studies on health care, which may have multiple components collected from different institutes or different areas due to efficiency, cost, enrollment considerations. In this thesis, I consider how to design and to implement data management with multi-center health care research data. The research project that I joined focuses mainly on environmental health science, and the primary goal is to investigate the impact of nutritional and toxicant exposures in environment during fetal and early postnatal life on individual’s health outcomes over the …

Progesterone-Only Oral Contraceptive Pill, Breast Cancer, Heart Disease, And Stroke, Marsha Ema Samson

Theses and Dissertations

There is evidence from earlier studies that oral contraceptive pills may be a risk factor for certain chronic diseases, including heart disease, stroke, and breast cancer. Previous studies mainly focus on the estrogen component of combined (estrogen+ progestin) oral contraceptives (COCs) due to their popularity. This focus limits our understanding of progestin-only contraceptives and its relationship to commonly occurring chronic diseases. To provide insight into alternative methods of oral contraception, this dissertation explores the relationship between progestin-only oral contraceptive (POC) pills and heart disease, stroke, and breast cancer. We hypothesize that women using POCs are less likely to have certain …

Enteric Fever: A Slow Response To An Old Plague, Carlos Franco- Paredes, M. Imran Khan, Esteban Gonzalez- Diaz, Jose I. Santos- Preciado, Alfonso J. Rodriguez Morales, Eduardo Gotuzzo

Centre of Excellence in Women and Child Health

Man is irremediably embedded in nature with complex interactions with all living organisms. Historically, the establishment of contemporary human societies has been influenced by our coexistence with other microorganisms living in highly interconnected habitats and ecologies. As a result, with the progression from unicellular to multicellular life, bacteria have coexisted with humans. In this biological journey, while there are important benefits provided by bacterial guests to the human host living in complex relationships and becoming part of their microbiome, some organisms are able to cause a wide spectrum of diseases. Among the large Enterobacteriaceae family, the genus Salmonella, a …

Status Of Paratyphoid Fever Vaccine Research And Development, Laura B. Martin, Raphael Simon, Calman A. Maclennan, Sharon M. Tennant, Sushant Sahastrabuddhe, M. Imran Khan

Centre of Excellence in Women and Child Health

Salmonella enterica serovars Typhi and Paratyphi (S. Paratyphi) A and B cause enteric fever in humans. Of the paratyphoid group, S. Paratyphi A is the most common serovar. In 2000, there were an estimated 5.4 million cases of S. Paratyphi A worldwide. More recently paratyphoid fever has accounted for an increasing fraction of all cases of enteric fever. Although vaccines for typhoid fever have been developed and in use for decades, vaccines for paratyphoid fever have not yet been licensed. Several S. Paratyphi A vaccines, however, are in development and based on either whole cell …

Nontyphoidal Salmonella Disease: Current Status Of Vaccine Research And Development, Sharon M. Tennant, Calman A. Maclennan, Raphael Simon, Laura B. Martin, M. Imran Khan

Centre of Excellence in Women and Child Health

Among more than 2500 nontyphoidal Salmonella enterica (NTS) serovars, S. enterica serovar Typhimurium and S. enterica serovar Enteritidis account for approximately fifty percent of all human isolates of NTS reported globally. The global incidence of NTS gastroenteritis in 2010 was estimated to be 93 million cases, approximately 80 million of which were contracted via food-borne transmission. It is estimated that 155,000 deaths resulted from NTS in 2010. NTS also causes severe, extra-intestinal, invasive bacteremia, referred to as invasive nontyphoidal Salmonella (iNTS) disease. iNTS disease usually presents as a febrile illness, frequently without gastrointestinal symptoms, in both adults and children. Symptoms …

Association Between Biopsychosocial Factors And Physical Activity Among U.S. Stroke Survivors, Claire Johnson

Walden Dissertations and Doctoral Studies

Stroke causes substantial morbidity and mortality, and physical activity can reduce the risk of stroke occurrence. The purpose of this study was to test the association between biopsychosocial factors and levels of physical activity and to develop a model to predict inactivity for US stroke survivors. A quantitative, cross-sectional analysis was performed of the 2013 National Health Interview Survey (NHIS), which is a representative sample of US households. Association for 1,077 stroke survivors was tested with chi-square between physical activity and independent variables: biological factors (age, sex, race, body mass index, musculoskeletal conditions, and cardiovascular diseases), psychological factors (mental distress, …

Using Nutrition And Fitness Awareness To Reduce Overweight And Obesity In Adolescents, Allissa.Johnson Johnson

Walden Dissertations and Doctoral Studies

In the United States, adolescent obesity rates continue to increase unabated, yet there is a paucity of programs to address these conditions for this population. The current study evaluated an after-school program in California high schools that uses a mentoring model with youth to promote regular exercise and healthy food choices. It is grounded in Social Cognitive Theory which focuses on both the impact of the environment on shaping behaviors and the ability of an individual to construct his or her own suitable environment. A quantitative single-group pretest-posttest design using archived participant responses was utilized in order to determine whether …

Characteristics Of Adult Icu Patients With Device Associated Nosocomial Infections, Doramarie Arocha

Walden Dissertations and Doctoral Studies

Nosocomial infections are a cause of concern for hospital patients and the incidence rates of these infections are greater in intensive care units (ICUs) due to the invasive nature of treatments, additional risk factors and comorbidities, and therapies used. Invasive devices, such as vascular central lines, Foley catheters, and mechanical ventilators pose a risk for critically ill patients in the ICUs to develop device-related, healthcare-associated infections (HAI). The purpose of this study was to describe the epidemiological characteristics of patients who developed device-related HAIs within 3 ICU units (medical-surgical, cardiovascular, and neurosurgical) of an academic medical facility. The ecosocial theory …

Chronic Disease Management Of The Uninsured Patient At Ohio Free Clinics, James Benedict

Walden Dissertations and Doctoral Studies

Management of chronic disease requires a different service delivery model from that of acute illness. The uninsured population experience poorer health status and increased incidence of chronic disease than do the insured population. The purpose of this study was to identify the supports and barriers present in providing chronic disease management to patients at Ohio free clinics. Wagner's theory of chronic disease management served as the theoretical lens. The sequential, exploratory mixed methods study collected data from 13 free clinics belonging to the Ohio Association of Free Clinics (OAFC). Quantitative questions focused on processes in clinics with high and low …

Symptom Presentation Frequency And Severity Associated With Adult Lyme Disease By Ross Scale Review, Vicki A. Stanavitch

Walden Dissertations and Doctoral Studies

Although Lyme disease is the most frequently reported vector-borne illness in the United States, recent evidence from the CDC suggests that Lyme disease incidence in the United States may be much higher than reported. Lyme disease symptoms can be mistaken for a wide variety of diseases, which can complicate the diagnosis. To date, no diagnostic criteria analysis has been conducted examining the association between sociodemographic variables (sex and age) and seasonality of infection with the severity and symptomology found in Lyme disease cases. Using the CDC's outbreak investigation model, a primary case/control study was conducted using the ROSS Scale to …

Consistency In Clinical Preceptor Field Training For Sonography Students, Cathy Herring Daniels

Walden Dissertations and Doctoral Studies

Consistency in clinical preceptor training for sonography students is important in assuring equity in sonography student evaluation. Review of a local community college sonography program revealed a gap between expected roles and responsibilities of clinical preceptorship and what was actually done in the clinical setting. The purpose of this project study was to explore perceptions of graduates and preceptors regarding what constituted best practices in the evaluation of sonography students in the clinical setting. Knowles's theory of active learning provided a framework for understanding the student-preceptor relationship in the evaluation process. Research questions focused on sonography graduates' and clinical preceptors' …

Socioeconomic Status Mobility And Lifetime Exposure To Discrimination On Cardiovascular Disease Events, Nkenge H. Jones-Jack

Walden Dissertations and Doctoral Studies

Blacks in the United States have the highest rates of hypertension in the world, and their cardiovascular disease mortality rates are higher than for any other population group as a result of traditional risk factors such as obesity and stronger family history. However, additional underlying factors, such as social determinants of health (e.g., socioeconomic status [SES]) and macrosocial factors (e.g., racism), also correlate with adverse health outcomes. This study investigated whether the interaction between SES mobility over the lifecourse and lifetime racial discrimination influenced the extent to which hypertension contributed to the cardiovascular disease health disparities observed among Blacks in …

Impact Of Pneumococcal Conjugate Vaccine Thirteen Valent On The Reduction Of Invasive Pneumococcal Disease, Aissata Coulibaly

Walden Dissertations and Doctoral Studies

Many children under the age of 5 die each year of invasive pneumococcal disease. Childhood vaccination against this disease reduces morbidity and mortality. Despite the introduction of a pneumococcal conjugate vaccine (PCV13) in a central African country in 2011, all provinces have not yet been vaccinated. The purpose of this quantitative quasi-experimental study was to determine whether there was an association between the introduction of PCV13 and new cases of pneumococcal disease in 2 provinces in central Africa. The sample size for the study was 380. The theoretical framework for this study was the epidemic model supported by the concept …

Comparing African- And U.S.-Born Blacks At Stage Of Diagnosis And Treatment For Nonsmall Cell Lung Cancer, Relindis K. Fofung

Walden Dissertations and Doctoral Studies

Lung cancer is a disease with a high mortality rate for the U.S. Black population. There had been considerable research done on different population demographics, necessary to achieve the Healthy People 2020 overarching goals to eliminate health disparities, gain health equity and maintain quality health. Yet, the African-born Black (AFBB) population has been understudied for nonsmall cell lung cancer (NSCLC). This study sought to determine whether within race differences in stage at diagnosis and treatment of NSCLC exists between AFBB and American-born Blacks (AMBB) populations in the United States. The study data is secondary data collected as part of the …

Healthy Weight Maintenance: Narrative Analysis Of Weight Cycling In The Formerly Obese, Cheri Renee Lewis

Walden Dissertations and Doctoral Studies

Medical and economic costs for obesity are estimated at $147 billion per year, yet less than 1/3 of overweight individuals successfully maintain weight loss. The literature is replete with descriptions of the problem and research on treatments, yet demonstrations of effective loss and maintenance are lacking. Missing is an understanding of the experiences of individuals who successfully maintained healthy weight loss, which could provide insights regarding effective psycho-social interventions. The purpose of this qualitative narrative study was to explore key events and experiences in the lives of former weight cyclers. The primary phenomena of interest included weight cycling and sustained …

Life Events, Initial Sexual Behaviors, And Teenage Pregnancy Among African American Females, Yonzetta Brook Tillman

Walden Dissertations and Doctoral Studies

Teenage pregnancy is disproportionate between African American and Caucasian females. This disproportion is notable because African American teenagers are 3 times more likely to become pregnant than their Caucasian counterparts are. The purpose of this study was to determine whether a relationship exists among major life events, sexual behaviors, and resultant teenage pregnancy among African American females in the United States. The theoretical framework for this study was social learning theory. Three key research questions focused on relationships among (a) major life events and initial sexual behavior, (b) ethnicity, and (c) teenage pregnancy. Independent variables were life event and ethnicity, …

Factors Associated With Late Stage Diagnosis Of Cervical Cancer In The United States, Marianne S. Pelletier

Walden Dissertations and Doctoral Studies

Cervical cancer represents a significant public health problem in the United States. According to the Centers for Disease Control and Prevention, the prognosis is related to stage at diagnosis, with the 5-year survival rate being 91.2% for early stage disease and only 17.0% for those with late stage disease. There is a gap in the literature examining the association of insurance status with late stage cervical cancer diagnosis across a large segment of the United States population. There is also a gap in the literature examining women residing in the United States with late stage cervical cancer diagnosis and identifying …

An Evaluation Of The Screening And Management Of Childhood Overweight And Obesity In The Primary Care Setting, Diane L. Crutcher

DNP Projects

Background: Worldwide, the World Health Organization (2016) estimates that forty-two million children from two to five years of age are overweight or obese. In the United States, Kentucky ranks sixth for the highest rate of overweight youth in the nation (Partnership for Fit Kentucky, 2009). The long term consequences of overweight and obesity are early onset of adult chronic diseases as well as social and psychological issues in childhood and adulthood.

Purpose: The objective of this gap analysis was to assess BMI screening and weight management of children ages two to five who presented for a well-child check …

Job Stress, Inflammation, And Atherosclerosis: A Reflection, Renzo Bianchi, Irvin Sam Schonfeld

Publications and Research

Stress in general has been associated with inflammation and atherosclerosis (Sapolsky, 2004; Slavich and Irwin, 2014). The accumulation of inadequately controlled studies has become a concern (Bianchi, 2016; Schonfeld & Bianchi, 2016). Stronger efforts should be made to take into account both empirically identified and theoretically likely confounders in this research field. Assessing the contribution of job-related factors to given outcomes without simultaneously considering the role of relevant non-job factors is unwarranted. Results from inadequately controlled studies can lead to our making ineffective, or even counter-productive, decisions in terms of public health policies.

Implementation And Evaluation Of An Analytical Method For A Novel Derivatizing Agent To Measure 4,4'-Methylene Diphenyl Diisocyanate Atmospheres, Silvia Puscasu, Simon Aubin, Mark Spence, Sébastien Gagné

Études primaires

Accurate measurement of 4,4'-methylene diphenyl diisocyanate (MDI) atmospheres is a challenge since the molecule is both chemically reactive and likely to be present in aerosol form when heated and sprayed because of its low vapor pressure. Meeting this challenge requires optimizing both the sampling device used and the derivatization agent employed to stabilize the isocyanate functional group. This study describes the use of a novel derivatization reagent for isocyanate sampling to address the challenge of MDI aerosol exposure sampling. Like most conventional derivatizing agents for isocyanates, 1,8-diaminonapthalene (DAN) reacts with isocyanate functional groups to form a urea. However, unlike other …

Methods For Analysis Of Genetic Differences In Sex And Ethnicity For Complex Human Traits, Yogasudha Veturi Veturi

All ETDs from UAB

In the last two decades, thousands of genome-wide association (GWA) analyses have been published. These studies have been primarily conducted using data from Caucasians and many of the reported findings have not been replicated in other populations, perhaps reflecting that the underlying architecture of effects may vary across ethnically diverse groups. Similarly, the possibility that the genetic architecture of traits may vary between males and females has also been overlooked. We propose a methodology for estimation and testing of effect heterogeneity between groups such as sex or ethnicity that involves modeling genotype-by-group random interactions. Using simulations, we show that the …

Influence Of Maternal Age On The Effects Of Organic Selenium In The Animal Model Daphnia Pulex, Jordan E. Roberts

All ETDs from UAB

As a necessary micronutrient, seleno-L-methionine (SeMet) exhibits a U-shaped dose-response with deficiency and toxicity leading to adverse health outcomes. Some studies suggest dietary selenium may offer protection against toxicity from other metals, but excessive dietary levels can also lead to toxicity. In addition, increased maternal age has been shown to increase the risk of adverse developmental outcomes. We hypothesize that older maternal age will increase susceptibility in offspring exposed to toxic concentrations of SeMet. The goal of this project was to evaluate the effects of SeMet treatment on lifespan and determine if the effects are altered by maternal age using …

Political, Economic, And Health Determinants Of Tuberculosis Incidence, Ashley Rutherford

Electronic Theses and Dissertations

The epidemiologic transition has shifted major causes of mortality from infectious disease to chronic disease; however, infectious diseases are again re-emerging as a major global concern (Diamond, 1997; Karlen, 1995; McNeil, 1976). This research aimed to identify potential areas of infectious disease influence that are not health-related in order to help governments and policymakers establish new policies, correct current policies, or further address these issues in order to effectively prevent and combat infectious disease. This study employed a retrospective, cross-sectional, non-experimental design via structural equation modeling (SEM) and examined tuberculosis incidence rates at the country-level. Secondary data from open-source, international …