Medicine and Health Sciences Commons^™

Individual- And Community- Level Associations With Healthcare Utilization Among A Health System, Emergency Department Population, Carlene A. Mayfield

Theses and Dissertations

AIM: The primary aim of this study was to examine individual-level and community- level characteristics associated with ambulatory or primary care utilization, emergency department (ED) utilization, and ED charges among a sample of ED patients.

DESIGN AND SAMPLE: Data for this cross-sectional study were obtained from three distinct sources: (i) electronic medical records (EMR); (ii) billing records; and (iii) the 2013-2017 American Community Survey (ACS). The individual-level EMR and billing sample included all adults residing in Mecklenburg County, North Carolina who visited an Atrium Health ED in 2017. The ACS sample included population and demographic estimates from Mecklenburg County’s 27 …

Dietary Advanced Glycation End-Products (Ages) And Breast Cancer Risk And Survival, Omonefe Opeyemi Omofuma

Theses and Dissertations

Introduction: Advanced glycation end-products (AGEs) are implicated in the pathogenesis of chronic diseases including cancer. AGEs are produced endogenously and are also consumed from foods. High amounts of AGEs are found in animal products and processed foods, and AGE formation is accelerated during cooking at high temperatures. Using data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), we assigned and quantified NƐ-carboxymethyl-lysine (CML)-AGE content in food and investigated the association between dietary AGE intake and breast cancer (BrCa) risk. We assessed whether the risk was modified by race/ethnicity, obesity status, fruit and vegetable intake, BrCa invasiveness …

Longitudinal Trajectories Of Depressive Symptoms Among Youth And Young Adults With Type 1 Diabetes: Predictors And Health Outcomes, Melanie Whitmire Sutherland

Theses and Dissertations

Type 1 diabetes (T1D) is one of the most frequently diagnosed chronic illnesses among youth, and has many long-term complications, including retinopathy, neuropathy, and cardiovascular disease. The risk of these complications may be reduced through maintaining glycemic control and one potential risk factor for failure to achieve optimal glycemic control is elevated depressive symptoms among youth and young adults (YYA) with T1D. YYA with T1D are at increased risk of depression, which has been associated with adverse outcomes such as poor adherence to self-management and poor glycemic control. Although a robust body of research exists on the association between comorbid …

An Evidence Based Rationale For Making Tick - Borne Relapsing Fever A Nationally Notifiable Disease, Kyle M. Hatcher

Theses and Dissertations

Tick – borne relapsing fever (TBRF) is globally dispersed, and within the United States is found primarily in the mid – west, south - west, and north – west portions of the country. TBRF is a disease which causes patients to experience flu – like symptoms and is distinguished by multiple relapses of high fever which can cause individuals to be hospitalized multiple times over months. TBRF is caused by Borrelia spp. spirochetes and spread by Onthidoros spp. soft – shelled ticks. First diagnosed in the early 20th century, the disease has gone underdiagnosed and has attracted little attention for …

The Association Of Cardiorespiratory Fitness With Advancing Age Among Those With And Without Type Ii Diabetes, Amber Kathlyn Watson

Theses and Dissertations

OBJECTIVE: This study examined the relationship between cardiorespiratory fitness (CRF) and age to determine if the decrease in CRF associated with advancing age is greater among those with type 2 diabetes mellitus (T2DM) as compared to those without T2DM. This study also assessed if differences in CRF between persons with T2DM and those without are consistent across CRF percentiles.

METHODS: Data from the Aerobics Center Longitudinal Study (ACLS, Dallas, Texas, 1970-2006) were utilized in the current study. CRF was measured by maximal treadmill exercise testing using the Balke protocol and T2DM status was determined by self-report of previous diagnosis by …

Disparities In Non-Small Cell Lung Cancer In The United States: An Examination Of Treatment, Survival, And Access To Care, Cassie Lewis Odahowski

Theses and Dissertations

Lung cancer is the leading cause of cancer-related deaths in the United States with a 5-year survival rate of only 18%. Differences in access to care and treatment utilization may play a role in observed survival disparities among rural patient populations. This dissertation aimed to examine rural disparities in all-cause and lung-cancer specific survival, time to treatment initiation, and utilization of surgical treatment among non-small cell lung cancer cases.

We utilized comprehensive cancer registry data from the Surveillance, Epidemiology, and End Results program linked with Medicare billing claims (SEER-Medicare) for non-small cell lung cancer (NSCLC) patients diagnosed between 2003-2011. We …

Association Between Snps In The Vitamin D Binding Protein, Vitamin D Status, And Aggressive Prostate Cancer By Race, Diana Diaz

Theses and Dissertations

Prostate cancer incidence and mortality have been decreasing in recent years, but it remains the most commonly diagnosed cancer among men. Racial disparities exist in prostate cancer with African Americans (AAs) having notably higher rates of incidence and mortality, lower survival rates, and are more likely to be diagnosed with a highergrade cancer compared to European Americans (EAs). Genome-wide association studies have revealed several single nucleotide polymorphisms (SNPs) within the vitamin Drelated GC gene that may be associated with prostate cancer aggressiveness. In addition to SNPs, previous research has suggested that low levels of 25-hydroxyvitamin D (25(OH)D) may be related …

Effect Of Heart Rate Variability Biofeedback On Sleep, Joshua Mercadel

Theses and Dissertations

Healthy amounts of sleep is vital for normal human functions such as daily learning, memory, emotional state and cardiovascular function. Studies conducted previously have shown sleep deprivation to be associated with increases in sympathetic activity contributing to autonomic nervous system (ANS) dysregulation. HRV biofeedback (HRVB) training induces HRV coherence, a condition that maximizes HRV and facilitates autonomic and cardiorespiratory homeostasis. This randomized, controlled, intervention trial will test the hypothesis that HRVB can improve HRV coherence and increase overall sleep quality. Patients are randomized to previously established HRVB or sham protocols (n=40 each, total planned enrollment N=80). Each participant completes a …

Exploring Breast Cancer Care Variation In Coc-Accredited Facilities, Sarah Grace Barron

Theses and Dissertations

INTRODUCTION: While improvements have been made in reducing breast cancer incidence and mortality over the past twenty years, disparities in breast cancer mortality remain. Understanding systematic differences in breast cancer treatment and quality of care remain at the epicenter of understanding breast cancer disparities. Needle biopsy is a less invasive and less expensive diagnostic test for breast cancer (as compared to excisional biopsy) and permits diagnosis while avoiding unnecessary surgery. This study was conducted to 1) examine how the National Quality Forum (NQF)-endorsed needle biopsy utilization measure varies geographically (i.e. state and region) and 2) determine the patient- and/or health …

Prevalence Trends Of Victimization Among High School Students By Race, Ethnicity, And Gender – Yrbss 2009-2017, Carlos Avalos

Theses and Dissertations

Introduction: Students who are victimized at school are more likely to report mental health, behavioral, and academic problems. Bullying and electronic bullying are types of victimization that are prevalent in US schools, with prevalence varying by race and ethnicity, gender, and age. Additionally, due to increases in bias-based harassment (such as being targeted due to race, ethnicity, or religious beliefs) in the country over the last few years, it is of interest to see how victimization behaviors in schools may have changed from 2015 to 2017.

Objective: To analyze trends of overall bullying, school bullying, electronic bullying, and other forms …

Disparities In Colorectal Cancer: Measuring Spatial Accessibility, Screening, And Surveillance Outcomes In South Carolina, Michele J. Josey

Theses and Dissertations

The purpose of this dissertation project is to add to the growing literature about the multi-faceted aspects of colorectal cancer (CRC) prevention and related disparities. We focused on the spatial distribution of facilities performing screening services to identify areas that underutilize colonoscopy screening. Next, we examined how the food and physical activity environment affects precursors of CRC by considering plausible pathways. Finally, we explored if access to health insurance reduced the racial disparity of receiving a timely surveillance colonoscopy after a CRC diagnosis.

We utilized the SC Ambulatory Surgery Discharge Database, an all-payer, population-based outpatient dataset with colonoscopy records from …

Role Of Heart Rate Variability Biofeedback In Cognitive Performance, Chronic Pain, And Related Symptoms, James P. Winstead

Theses and Dissertations

Over-modulation of the sympathetic nervous system and reduced heart rate variability (HRV) are commonly overlooked components of pain, poor cognition (decreased attention, recall, and cognitive processing), depression, stress, and fatigue. HRV Biofeedback (HRVB) training induces HRV coherence to balance the autonomic system. Paced breathing (~6 breaths/minute) increases HRV coherence. This randomized, controlled intervention trial tested the hypothesis that HRVB would improve HRV coherence, pain (severity, interference, and catastrophizing), cognitive performance, and reduce depressive, stress, and fatigue symptoms and pain medication use in veterans. Participants were randomized to previously established HRVB or control protocols. Each participant completed a Baseline Assessment, 6 …

Identifying Predictors Of Racial Disparity In Treatment And Mortality Among Patients Diagnosed With Breast Cancer In South Carolina, Oluwole Adeyemi Babatunde

Theses and Dissertations

Introduction: Despite a lower incidence of breast cancer (BrCA) among Black women in the U.S. compared to White women, Black women experience consistently higher mortality rates. The aims of this study were 1) to assess the relationship between race and diagnosis-to-treatment times 2) to assess racial disparity in mortality among Black and White BrCA patients in SC and 3) assessment of the validity of the Mortality-to- incidence ration (MIR) as a proxy for survival and geospatial investigation of racial disparity among breast cancer (BrCA) patients.

Methods: Breast cancer cases diagnosed between 2002-2010 were obtained retrospectively from the SC Central Cancer …

Adverse Birth Outcomes Among Women With Physical Disabilities: A Retrospective Cohort Study In South Carolina, Iffat Nahar

Theses and Dissertations

Motherhood is precious in women’s lives. Among women, ages 21-64, 12.5% are living with a disabling condition, according to the Disability Status report: SC 2008. Although childbearing among women with disabilities is increasing, there are limited publications about the pregnancy outcomes. The objective of this study is to document the adverse neonatal outcomes of the pregnancies and to evaluate if early prenatal care is a protective factor for low birthweight and prematurity among the women with physical disabilities. This study used a retrospective cohort study design, with data from linked hospital discharge records and vital records (birth certificates) for all …