Digital Commons Network^™

Addressing Gaps In Access: Examining Language Barrier Accommodations In Medicaid Member Handbooks, 2015-2019, Sanskruti Patel

Senior Theses

Objective: This study examines the linguistic accessibility of Medicaid Managed Care Organization (MCO) handbooks from 2015 to 2019 by analyzing the instructions provided to access interpreter and written translation services. Trends were compared over time, considering state and plan-level factors that impact equitable healthcare access for Limited English Proficiency (LEP) enrollees.

Methods: A systematic search using manual efforts and FOIA requests located all publicly available Medicaid handbooks from 2015-2019 (N=657) across 39 states with comprehensive MCO plans. These handbooks were coded by independent reviewers to assess the study outcome variables. Random mixed-effects logistic and linear regression models were conducted to …

Impacts On College-Aged Asian American Mental Health, Zahra Soherwardy

Senior Theses

This study explores the relationship between different forms of racial harassment and mental health issues in Asian American college students. Asian American mental health is a growing concern in the field of public health. Asian Americans have the lowest treatment rates and some of the highest stigma levels of any demographic. They are also impacted by the model minority myth and discrimination, further alienating them from getting help. The topics of subtle racism, blatant racism, and current racial discrimination were compared to depressive symptoms, anxiety, self-esteem, and four domains of aggression using survey data. Subtle racism was found to be …

Estimation Of Therapeutic Threshold For Tuberculosis Using Adapted Nominal Group Technique And Clinical Vignettes In Clinical And Community Settings In Southern Africa, Alfred Kipyegon Keter, Alastair Van Heerden, Tom Decroo, Tom Boyles, Shannon Bosman, Thandanani Madonsela, Lindani Innocent Msimango, Lenika Naiken, Carlos Kiyan, Mashaete Kamele

Population Health, East Africa

Background: When confronted with diagnostic uncertainty and a decision on whether to start treatment or not, clinicians consider the potential harm and benefit of offering versus withholding treatment. Treatment can be offered if the probability of tuberculosis (TB) in the patient is above the “therapeutic threshold” (ThT): the probability of disease at which the expected utility of treating and not treating is the same. We estimated ThT for TB in clinical and community settings in Southern Africa using two methods: an adapted nominal group technique (aNGT), and decisions made based on clinical vignettes (CVs).

Methods: We enrolled health …

Cell-Free Dna Results Indicating Mosaic Monosomy X Of Likely Maternal Origin: Impact On Genetic Counseling Practices And Patient Experiences, Audrey Mcbride, Ashley Cannon, Siddharth Prakash, Aaron W Roberts, Angela Seasely, Anna C E Hurst, Laura Hendon

Faculty, Staff and Student Publications

Objective: To investigate the current genetic counseling practices involving a cfDNA result indicating mosaic monosomy X of likely maternal origin, and to better understand the perspectives of patients who have received this result.

Method: A total of 60 prenatal genetic counselors completed surveys about their experiences with this result, cfDNA consenting practices, and management practices. In addition, qualitative interviews were conducted with 5 patients to gain insight into their experiences with result disclosure and follow-up care.

Results: 95% of genetic counselors reported feeling prepared to counsel on these results. However, responses to current practices varied. Of the genetic counselors surveyed, …

Selected Social And Lifestyle Correlates Of Brain Health Markers: The Cross-Cohort Collaboration Consortium, Leslie Grasset, Joshua C Bis, Stefan Frenzel, Daniel Kojis, Jeannette Simino, Amber Yaqub, Alexa Beiser, Claudine Berr, Jan Bressler, Robin Bülow, Charles S Decarli, Alison E Fohner, Laura B Harrington, Catherine Helmer, M Arfan Ikram, Rozenn N Lemaitre, Oscar L Lopez, W T Longstreth, Julia Neitzel, Michelle C Odden, Priya Palta, Carsten O Schmidt, Rajesh Talluri, Meike W Vernooij, Henry Völzke, Trudy Voortman, Quest Whalen, Katharina Wittfeld, Hans J Grabe, Thomas H Mosley, Bruce M Psaty, Frank J Wolters, Sudha Seshadri, Carole Dufouil

Faculty, Staff and Student Publications

Introduction: To investigate the associations of education level, marital status, and physical activity with dementia risk and brain MRI markers.

Methods: Data from six community-based samples from the Cross-Cohort Collaboration Consortium were analyzed. Self-reported education level, marital status, and physical activity at age 60 to 75 years were harmonized. Subsamples of participants with brain MRI markers at time of exposure were selected. Associations with dementia risk and cross-sectional MRI markers were meta-analyzed.

Results: Higher education level was associated with lower dementia risk (hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.59; 0.72 vs low level) but not significantly …

Brain Candy: Wayne State University School Of Medicine Journal Of Arts And Culture, 12th Edition, Wayne State University School Of Medicine Gold Humanism Honor Society

Gold Humanism Honor Society

Brain Candy incorporates paintings, written pieces, and poetry from all the medical classes at Wayne State University School of Medicine to shed light on the creative process in medicine, the city of Detroit, and the experiences of health care providers. This year, the journal is organized into four sections, each of which denotes a particular time period within medical school. The first edition of Brain Candy was published online and in print in 2009, produced by a generous grant by the Gold Humanism Honor Society (GHHS). The edition featured poetry, nonfiction, short fiction, and different types of artwork. With generous …

Adolescent Sleep Health, Mental Health, And Cardiovascular Disease Risk In Adulthood, Prince Nii Ossah Addo

Theses and Dissertations

Background: Insufficient sleep and poor sleep quality are major public health issues among adolescents in the United States (U.S.). Mental health and substance use challenges are also common among adolescents, particularly those with sleep problems. Although exposures in adolescence have been evidenced to significantly impact future health, little is known about how adolescent sleep health, mental health, and substance use influence future cardiovascular disease (CVD) risk. We, therefore, examined the association between sleep health in adolescence and CVD risk in adulthood and assessed whether the association is mediated by depressive symptoms and substance use in adolescents. Further, we explored the …

Advancing Pandemic Response: Integrated Strategies For Testing, Prediction, And Bias Mitigation, Tianshu Gu

Theses and Dissertations (ETD)

The COVID-19 pandemic, along with prior outbreaks such as SARS and Ebola, has revealed critical gaps in global pandemic preparedness, emphasizing the need for integrated approaches to infectious disease management. This dissertation addresses three key areas of pandemic response: developing scalable screening strategies, constructing reliable predictive models, and mitigating demographic biases in artificial intelligence (AI) models used for healthcare decision-making.

The first study introduces a global screening strategy designed to optimize resource use and increase testing capacity, particularly in low- and middle-income countries (LMICs) where resources are limited. This study leverages pooled testing methods, where multiple samples are combined into …

The Impact Of Hyperglycemia On Post-Reperfusion Outcomes In Patients With Hyperacute Ischemic Stroke, Nicole Schumacher

Theses and Dissertations (ETD)

Stroke is a major contributor to disability in the United States, with ischemic stroke accounting for approximately 87% of all cases. The use of approved reperfusion therapies, including intravenous thrombolysis with tissue plasminogen activator (tPA) and mechanical thrombectomy, has significantly improved functional outcomes for ischemic stroke patients. However, hyperglycemia at the time of hospital arrival is associated with worse outcomes, including increased infarct growth, higher rates of disability, and elevated mortality. Despite this, current stroke guidelines neither exclude hyperglycemic patients from receiving reperfusion therapy nor recommend glucose management during the hyperacute phase of care. While recent studies suggest that mild …

The Lived Experience Of Acute Stroke Advanced Practice Registered Nurses (Aprn) Working In Expanded Roles: A Mixed Methods Study, Terri-Ellen Kiernan

Theses and Dissertations (ETD)

Introduction. Nurse practitioners have made credible gains through the six decades since inception to cover the growing need for outpatient family care. Nurse practitioners are now working in all aspects of medicine by continuing to fill gaps with healthcare needs that persist due to physician shortages. Stroke neurology is a medical specialty plagued by a shortage of physician specialists in hospital acute care which can limit acute stroke diagnosis and treatment capabilities. Stroke nurse practitioners (SNP) are vascular neurology trained specialists who fill relatively new hospital roles to assume traditionally physician-based responsibilities in an expanded role. This study aims to …

Addressing Informal Caregiver Burnout In The United States: Policies, Interventions, And Recommendations, Michael Blampye

Master's Projects and Capstones

Informal caregiver burnout has been and will continue to be a significant public health concern in the United States, necessitating a comprehensive analysis of initiatives and policies to reduce its negative impacts. This paper provides an overview of existing approaches to address caregiver burnout at the individual, community, and national level, identifying critical gaps in policies and programs. By highlighting successful approaches in other developed countries, this paper presents comprehensive program and policy recommendations to strengthen informal caregiver support systems in the United States. Prioritizing these proposals can guide policymakers in creating a more supportive environment that values the crucial …

Revisions To The Safety Assurance Factors For Electronic Health Record Resilience (Safer) Guides To Update National Recommendations For Safe Use Of Electronic Health Records, Dean F Sittig, Trisha Flanagan, Patricia Sengstack, Rosann T Cholankeril, Sara Ehsan, Amanda Heidemann, Daniel R Murphy, Hojjat Salmasian, Jason S Adelman, Hardeep Singh

Faculty, Staff and Student Publications

The Safety Assurance Factors for Electronic Health Record (EHR) Resilience (SAFER) Guides provide recommendations to healthcare organizations for conducting proactive self-assessments of the safety and effectiveness of their EHR implementation and use. Originally released in 2014, they were last updated in 2016. In 2022, the Centers for Medicare and Medicaid Services required their annual attestation by US hospitals.

Objectives: This case study describes how SAFER Guide recommendations were updated to align with current evidence and clinical practice.

Materials and methods: Over nine months, a multidisciplinary team updated SAFER Guides through literature reviews, iterative feedback, and online meetings.

Results: We reduced …

Soluble Mesothelin-Related Peptide As A Prognosticator In Pleural Mesothelioma Patients Receiving Checkpoint Immunotherapy, Sonali Mitra, Hee-Jin Jang, Allen Kuncheria, Sung Wook Kang, Jong Min Choi, Ji Seon Shim, Claire Lee, Priyanka Ranchod, Peter Jindra, Maheshwari Ramineni, Meera Patel, R Taylor Ripley, Shawn S Groth, Shanda H Blackmon, Bryan M Burt, Hyun-Sung Lee

Faculty, Staff and Students Publications

Background: Immune checkpoint therapy (ICT) has significantly impacted the treatment of malignant pleural mesothelioma (MPM). Despite some promising results from combination therapies, nearly half of MPM patients do not benefit, underscoring the urgent need for reliable predictive biomarkers. This study assesses the prognostic value of serum soluble mesothelin-related peptide (SMRP) and PD-L1 levels in MPM patients receiving ICT.

Methods: We conducted a retrospective analysis of 125 MPM patients treated with ICT by measuring pre-ICT serum levels of SMRP and PD-L1. We also examined the correlation of these serum levels with tumor mRNA expressions of mesothelin and PD-L1. Both univariable and …

Rapid Diagnostic Sequencing Of Stool Dna Using Targeted Nanopore Sequencing In Patients With A Pulmonary Tuberculosis Diagnosis, Tara Ness, Nontobeko Maphalala, Wethusonkhe Khumalo, Doctor Sibandze, Abigail Seeger, Maia Madison, Anca Vasiliu, Durbin Mulengwa, Clement Gascua, Mangaliso Ziyane, Sindisiwe Dlamini, Gugu Maphalala, Eric Bortz, Alexander Kay, Christoph Lange, Viola Dreyer, Tanja Niemann, Stefan Niemann, Andrew Dinardo, Anna Mandalakas, Stool4tb Global Partnership

Faculty, Staff and Students Publications

Background: Approximately 1.25 million individuals died of tuberculosis in 2023, in part due to ineffective treatment. In patients with paucibacillary tuberculosis, microbiologic confirmation and drug resistance testing via respiratory specimens is challenging; hence, stool samples are increasingly used for microbiologic confirmation. Targeted next-generation sequencing (tNGS) of stool DNA may improve detection of drug-resistant (DR) tuberculosis, helping patients receive appropriate treatments.

Methods: We assessed the ability of a nanopore tNGS approach using stool to detect drug resistance in a prospective, nested cohort of consecutive participants in Eswatini with pulmonary tuberculosis confirmed via sputum culture or sputum GeneXpert Ultra from 2020 to …

Women’S Health Considerations In Traumatic Brain Injury, Sindhoori Nalla

Department of Rehabilitation Medicine Faculty Papers

Purpose of Review: Biological sex differences are an important factor to consider when treating TBI, as there can be a disproportionate manifestation of symptoms and recovery process when comparing females to males. Historically, these differences have not been well studied, and there is still much to be understood as to why these differences exist. Recent Findings: A number of factors are thought to contribute to disparities with women who have a TBI, including lack of well-designed research studies focused on women, hormonal fluctuations at the time of and as a result of a TBI, psychosocial comorbidities, and societal norms/expectations. While …

Harnessing Sociodemographic And Anthropometric Insights To Predict Type 2 Diabetes Risk: A Machine Learning Approach, Rico Kurniawan, Rezki Yunanda, Okky Assetya Pratiwi

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

The complexity of diabetes makes early diagnosis and effective management challenging for healthcare settings. This study developed and evaluated models using machine learning algorithms to predict the risk of diabetes. The data were primarily sourced from the Indonesia Family Life Survey (IFLS). Diabetes status was identified using A1c whole blood sample values (A1c WBS ³5.7%). Sociodemographic and anthropometric factors were set as predictors, most of which were significantly correlated with diabetes status. Discrete machine learning algorithms such as decision tree, k-nearest neighbors (KNN), random forest (RF), naïve Bayer, support vector machine (SVM), and neural network (MLP) were applied to construct …

Analisis Kepuasan Pengguna Simrs Pada Klaim Jkn Di Rsud Khidmat Sehat Afiat, Kota Depok Tahun 2023, Robiatul Adawiyah, R Sutiawan

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Keberlangsungan klaim JKN di RSUD Khidmat Sehat Afiat Kota Depok sekurang-kurangnya harus didukung oleh SIMRS yang dapat diintegrasikan dengan E-Klaim INA-CBG’s dan V-Claim. Maka pada tahun 2019 SIMRS dilakukan integrasi dengan kedua sistem informasi tersebut guna meningkatkan keberhasilan klaim JKN. Namun, sejak SIMRS diintegrasi, hingga saat ini belum pernah dilakukan analisis. Padahal, E-Klaim INA-CBG’s dan V-Claim terus mengalami perubahan yang menjadikan banyaknya fitur yang belum tersedia pada SIMRS yang berujung membuat proses pengajuan klaim JKN menjadi terhambat. Desain penelitian ini menggunakan teori Delone dan McLean dengan jenis penelitian kuantitatif dan pendekatan cross-sectional. Pengambilan sampel menggunakan proportional stratified random sampling …

Peran Tempat Persalinan Dalam Inisiasi Menyusu Dini: Analisis Survei Demografi Dan Kesehatan Indonesia Tahun 2017, Siti Sunya Kumala, Besral Besral

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Cakupan inisiasi menyusu dini (IMD) di Indonesia lebih rendah dibandingkan rata-rata ASEAN. Padahal cakupan persalinan di fasilitas kesehatan dan dibantu oleh tenaga kesehatan telah melampaui 70%. Penyedia layanan kesehatan menjadi faktor pendukung ibu untuk melakukan IMD. Penelitian ini bertujuan untuk mengetahui peran tempat persalinan dalam IMD di Indonesia. Penelitian dilakukan dengan desain potong lintang, dan menggunakan data Survei Demografi Kesehatan Indonesia tahun 2017. Sampel penelitian adalah wanita usia 15-49 tahun dari seluruh provinsi di Indonesia. Regresi logistik ganda dilakukan untuk menganalisis IMD dari berbagai tempat persalinan. Proporsi IMD pada tahun 2017 adalah 60,7%. Proporsi IMD paling banyak di poskesdes/polindes (72,8%), …

Vaccination As A Protective Factor Against Hospitalization For Sars-Cov-2 Infections: An Observational Study Using Surveillance Data, Chandrayani Simanjorang, Kristin Mutiara Tarigan, Diva Anita Churiana Sudrajat, Rana Zahra Raniyah Wangsawinangun, Asy Syifa Anwari Zahra

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Death due to SARS-CoV-2 generally occurs in patients requiring hospital care (hospitalization). However, it is still unclear whether vaccination acts as a protective factor against hospitalization in SARS-CoV-2 patients in Indonesia. This study examines the association between vaccination and hospitalization among SARS-CoV-2 patients. It employs a quantitative, cross-sectional design using secondary data from SARS-CoV-2 surveillance records at the Jakarta Health Agency (January–August 2021). Findings show that patients who received the 1st vaccine dose had a 0.34 times lower risk of hospitalization compared to unvaccinated individuals (aPOR=0.34; 95% CI=0.31–0.38). Those who received the 2nd dose had an even lower risk (aPOR=0.16; …

Dampak Tradisi Pemberian Nasi Papahan Terhadap Kesehatan Bayi Usia 6-24 Bulan: Literature Review, Sakinah Hadirama, Tri Krianto Karjoso

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Praktik pemberian nasi papahan seringkali dianggap sebagai bentuk kasih sayang antara ibu kepada bayi dan bertujuan untuk memudahkan bayi dalam mengonsumsi makanan, padahal hal tersebut tidak baik bagi kesehatan karena dapat menjadi media penularan penyakit apabila ibu menderita penyakit menular tertentu sehingga mengakibatkan gangguan kesehatan pada bayi, terutama saat berusia 6-24 bulan karena saat itu adalah masa golden age (periode keemasan) pada bayi yang menjadi proses penting dalam tumbuh kembang anak. Tujuan penelitian ini adalah untuk mengetahui dampak kesehatan yang ditimbulkan akibat tradisi pemberian nasi papahan kepada bayi usia 6-24 bulan. Metode yang dilakukan adalah kajian literatur melalui database publikasi …

Quantifying Patient Preferences For Treatments For Refractory Chronic Spontaneous Urticaria, Olufemi Babalola, Richard W. Hass, John F Mcana, Manav Segal, Juan Marcos Gonzalez, Olajumoke Fadugba

College of Population Health Faculty Papers

BACKGROUND: In recent years, it has become increasingly common to incorporate the patient perspective into drug development and regulatory decision making.

OBJECTIVE: This study aimed to measure and quantify patient preferences (priorities and trade-offs) for attributes that characterize current and emerging refractory chronic spontaneous urticaria (rCSU) treatments.

METHODS: Adult patients with self-reported rCSU symptoms completed an online discrete choice experiment survey. The survey included 10 questions that asked respondents to choose between 2 hypothetical rCSU treatment profiles having similar attributes with varying levels. The attributes included the following: chance of control of symptoms, time to symptom control, return of symptoms …

Limosilactobacillus Reuteri Promotes The Expression And Secretion Of Enteroendocrine- And Enterocyte-Derived Hormones, Sara C Di Rienzi, Heather A Danhof, Micah D Forshee, Ari Roberts, Robert A Britton

Faculty, Staff and Students Publications

Intestinal microbes can beneficially impact host physiology, prompting investigations into the therapeutic usage of such microbes in a range of diseases. For example, human intestinal microbe Limosilactobacillus reuteri strains ATCC PTA 6475 and DSM 17938 are being considered for use for intestinal ailments, including colic, infection, and inflammation, as well as for non-intestinal ailments, including osteoporosis, wound healing, and autism spectrum disorder. While many of their beneficial properties are attributed to suppressing inflammatory responses, we postulated that L. reuteri may also regulate intestinal hormones to affect physiology within and outside of the gut. To determine if L. reuteri secreted factors …

Uterine Pgrmc2 Deficiency Attenuates Endometrial Hyperplasia And Cancer And Prolongs Lifespan In A Pten Loss-Of-Function-Induced Cancer Model, Nicole C Kelp, Cindy A Pru, Sandeep Paudel, John P Lydon, J Julie Kim, John J Peluso, James K Pru

Faculty, Staff and Students Publications

The expression of members of the progesterone receptor membrane component (PGRMC) family, particularly PGRMC1, is elevated in diverse types of cancers, particularly those of the female reproductive system. While xenograft tumor studies using human transformed cell lines in immunocompromised mice have suggested that PGRMC1 enhances tumor growth and chemoresistance, the exact role of members of the PGRMC family in cancer development in vivo remains unclear. In this study, we examined the effect of deleting Pgrmc2 on the development of endometrial hyperplasia and cancer using a murine phosphatase and tensin homologue (Pten) conditional loss-of-function model. We previously established that …

The Relationship Between Climate And Dengue Hemorrhagic Fever Incidence Rate In Malang Regency In 2022-2024, Aticobhita C. Pramono, Suprijandani Suprijandani, Marlik Marlik, Pratiwi Hermiyanti

Jurnal Epidemiologi Kesehatan Indonesia

Dengue Hemorrhagic Fever (DHF) is an infectious disease that poses a public health problem in tropical regions and is influenced by climatic factors such as temperature, rainfall, humidity, and wind speed. In 2023, Malang Regency recorded 1,018 cases with an incidence rate (IR) of 38.2 per 100,000 population. This study aims to analyze the relationship between climatic factors and the DF IR for the 2022–2024 period using an ecological design and Spearman’s correlation analysis. Climate data were obtained from the BMKG, while DF data were obtained from the Health Office. The results showed that only air temperature was significantly associated …

Addressing Diabetic Retinopathy Prevalence In Low-Income Communities: Barriers To Quality Healthcare And Strategies For Equitable Treatment Access, Morkeia A. Mutchelknaus

Honors Thesis

Studies have shown a strong correlation between diabetes and individuals in low-income communities, which often lack access to equitable healthcare for a variety of reasons. This honors thesis will focus on diabetic retinopathy, its prevalence, prevention, and treatment strategies in both low- and high-income communities. A comprehensive literature review was conducted to define diabetic retinopathy, assess its prevalence, and review past and present approaches to its treatment and prevention. This paper aims to identify strategies to improve healthcare accessibility in low-income communities by analyzing current strategies in place to prevent and treat diabetic retinopathy and proposing potential solutions that will …

The Intensity Of 10-Minute Classroom Physical Activity Breaks In Elementary School Children, Jeffery J. Honas, Amanda N. Szabo-Reed, Joe Sherman, Anna Rice, Robert Montgomery, Ken Murfay, Richard A. Washburn, Joseph E. Donnelly

International Journal of Physical Activity and Health

This study examined the intensity of different physical activity (PA) breaks for elementary school children in a simulated classroom setting. Researchers compared the energy expenditure (Kcals/min, METs) of PA breaks developed for the Physical Activity Across the Curriculum (PAAC-3) program, delivered via video or in-person, to commercially available GoNoodle^© videos. 71 children (age 9.0 ± 1.1 yrs., 47 males, 24 females, 18% minority) participated in 10-minute PA breaks. The intensity of activity breaks was assessed using a COSMED® K5 portable indirect calorimeter (weight ~ 1 kg) (COSMED®, Rome, Italy) and and portable accelerometer (ActiGraph GT3X+; ActiGraph LLC, Pensacola, FL) …

Fogarty-Funded Research Ethics Education In Latin America And The Caribbean: Progress Despite Ongoing Challenges, Timothy Daly, Ignacio Mastroleo, Luis L García Valiña, Irene Melamed, María Florencia Santi, Theresa J Ochoa, Manuela Fernández Pinto, Paul J Cummins, Bernardo García Camino, Cheryl Macpherson, Elizabeth Heitman, Florencia Luna

Faculty, Staff and Student Publications

Ten years have passed since the last regional assessment of the state of Fogarty International Center-funded research ethics education and challenges facing research ethics in Latin America and the Caribbean basin. Program directors and faculty from four international research ethics education programs met in Spring 2024 to discuss their progress, challenges, and future priorities. The themes that emerged from these discussions were the structural difficulties faced by regional ethicists, the use of pedagogical innovations to mitigate different barriers faced by fellows, and the need to anticipate future challenges for the region including climate change.

Mothers’ Characteristics And Children's Diarrhea Between 2010-2020 In Rwanda, Amans Ntakarutimana Dr., Patrick A. Tschida Dr.

Journal of Social, Behavioral, and Health Sciences

Mothers’ characteristics influence children’s health and development. We conducted a cross-sectional study to assess the influence of mothers’ education level, employment status, and exposure to domestic violence on diarrhea among children under 5 years old using secondary data from 2010, 2015, and 2020 Rwanda Demographic Health Surveys. We used stratified descriptive statistics, pairwise comparisons, and logistic regression designs to assess (a) the prevalence of mothers per education level, employment status, and exposure to domestic violence; (b) their variation over time; and (c) their influence on diarrhea among children under 5 years old between 2010 and 2020 in Rwanda. According to …

Walking Interventions And Cognitive Health In Older Adults: A Systematic Review Of Randomized Controlled Trials, Jongwon Lee, Delia West, Christine Pellegrini, Jingkai Wei, Sara Wilcox, Jean Neils-Strunjas, A Caroline Rudisill, Daniela B Friedman, David X Marquez, Jenna Dzwierzynski, Joyce Balls-Berry, Rachelle Gajadhar, Chih-Hsiang Yang

Faculty, Staff and Student Publications

ObjectiveThis systematic review summarizes the effectiveness and the dose of walking interventions on specific cognition domains in older adults, including executive function, memory, attention, processing speed, and global cognition.Data sourcePublished randomized controlled trials in PubMed, Embase, and Web of Science until 10 May 2023.Study Inclusion and Exclusion CriteriaStudies include older adults without Alzheimer's or related dementias, involving a walking intervention and performance-based neuropsychological assessments for executive function, memory, processing speed, attention, or global cognition.Data ExtractionTwo independent research assistants reviewed 8424 studies and included 17 studies.Data SynthesisParticipant demographics, intervention features (type, intensity, time, frequency, duration, format, and context), cognitive assessment tools, …

Managing The Cost Of Services For People With Disabilities: International Approach. Part Ii: Ohio, United States, Dana Pugh, Jaroslaw Richard Romaniuk

Faculty Scholarship

Introduction: Four years of managing a housing network for people with disabilities prompted a rethinking of the financial management of the services offered. Clients with different needs require diverse professional staff for their home care. Emergency situations require that professionals offering assistance maintain the highest level of education possible. Financial resources often limit the quality of care for people with disabilities. Method: This paper is based on a literature search and on professional experience (Dana Pugh) in the management of a housing program for people with disabilities in Cleveland, Ohio (USA). Findings: In Poland, people with disabilities usually live with …