Medicine and Health Sciences Commons^™

Stress And Depression During Pregnancy Among Hispanic Women: Risk For Adverse Birth Outcomes And The Role Of Physical Activity, Kathleen Szegda

Doctoral Dissertations

Preterm birth and low birth weight are among the leading causes of infant mortality and morbidity in the United States. Puerto Rican women are at increased risk for these adverse birth outcomes and elevated levels of depression and psychosocial stress during pregnancy when compared to non-Hispanic Whites. Therefore, it is important to understand whether these psychological factors increase risk for these adverse birth outcomes and mechanisms to prevent/reduce depression in this high-risk population. The first study of this dissertation examined associations between perceived stress during pregnancy and preterm birth, low birth weight, and birth of a small-for-gestational age infant (SGA) …

Nutritional, Hormonal, And Psychological Risk Factors For Breast Cancer, Susan Nicole Boyer Brown

Doctoral Dissertations

Over the course of a lifetime, one in eight women will develop breast cancer. To date, 30-40% of breast cancer cases can be attributed to established risk factors, which supports the need for identification of additional modifiable risk factors. Therefore, we conducted three epidemiologic studies to examine the associations between nutritional, hormonal, and psychological risk factors and breast cancer risk. In our first study, we examined the relationship between urinary melatonin levels and the risk of breast cancer in a nested-case control study within the Nurses’ Health Study II. While limited in some respects, experimental and epidemiologic evidence support the …

Psychosocial Factors Affecting Pregnant Hispanic Women, Marushka L. Silveira

Doctoral Dissertations

Prenatal psychosocial stress, anxiety, and depression are common, with higher rates among Hispanic women. While evidence supports an adverse effect of psychosocial factors on glucose intolerance and oral health, studies during pregnancy are sparse, particularly among Hispanic women. Therefore, we examined correlates of psychosocial factors and their associations with glucose intolerance and oral health among pregnant women. The first project examined correlates of high stress among 1,426 pregnant Hispanic participants in Proyecto Buena Salud, a prospective cohort study. Cohen’s Perceived Stress Scale was administered in early, mid- and late pregnancy. Using multivariable logistic regression, we found that increasing age, pre-pregnancy …

Development Of The Biostatistics And Clinical Epidemiology Skills Assessment For Medical Residents, Patrick Brian Barlow

Doctoral Dissertations

This study developed the Biostatics and Clinical Epidemiology Skills (BACES) assessment, and established its preliminary item characteristics and validity evidence. Unlike previous instruments, the BACES assessment was developed and tested using an item response theory (IRT) approach to measurement to create a new, adaptive biostatistics and clinical epidemiology knowledge assessment for graduate medical professionals. Thirty multiple-choice questions were written to focus on interpreting relevant examples of clinical epidemiology and statistical methods. A four person expert panel reviewed these items for content validity. After this review, the BACES assessment was administered to 147 medical residents across three academic medical centers. Results …

Associations Of Total Activity Counts And Physical Activity Intensity Levels With The Metabolic Syndrome: A Structural Equation Modeling Approach, Dana Lizbeth Wolff

Doctoral Dissertations

To clarify the protective benefits of physical activity (PA), epidemiologists and public health researchers continue to seek improved methods of assessing PA. In particular, accelerometers have gained acceptance with researchers as they provide reliable estimates of PA and can record both the amount and intensity of ambulatory movement. However, there is concern that accelerometer data reduction techniques may not provide quantitatively accurate measurements of time spent in various PA intensity categories. One way to circumvent these inaccuracies is to use the accelerometer-derived total activity counts (TAC), which is a more direct expression of what the monitor records.

In order to …

Dabigatran And Warfarin For Stroke Prevention In Atrial Fibrillation: Use, Switching, And Clinical Effects Following New Market Entry In Real-World Patients, Julie C. Lauffenburger '03

Doctoral Dissertations

Patients with atrial fibrillation frequently benefit from anticoagulation to prevent stroke and systemic embolism. For decades, warfarin was the primary oral anticoagulant option despite its narrow therapeutic index requiring monitoring and drug-drug interactions. Dabigatran’s recent availability provides practical advantages including no monitoring and fewer interactions; however, it lacks a convenient reversal agent for bleeding events. Currently, it is unclear what factors have driven anticoagulant utilization since dabigatran’s introduction, and little real-world evidence on the agents’ comparative effectiveness and safety is available. The objectives were to describe dabigatran and warfarin’s utilization and switching patterns and assess their comparative effectiveness and safety. …

Geographic And Temporal Epidemiology Of Campylobacteriosis, Jennifer Weisent

Doctoral Dissertations

Campylobacteriosis is a leading cause of gastroenteritis in the United States. The focus of this research was to (i) analyze and predict spatial and temporal patterns and associations for campylobacteriosis risk and (ii) compare the utility of advanced modeling methods. Laboratory-confirmed Campylobacter case data, obtained from the Foodborne Diseases Active Surveillance Network were used in all investigations.

We compared the accuracy of forecasting techniques for campylobacteriosis risk in Minnesota, Oregon and Georgia and found that time series regression, decomposition, and Box-Jenkins Autoregressive Integrated Moving Averages reliably predict monthly risk of infection for campylobacteriosis. Decomposition provided the fastest, most accurate, user-friendly …

Geographic Disparities Associated With Stroke And Myocardial Infarction In East Tennessee, Ashley Pedigo Golden

Doctoral Dissertations

Stroke and myocardial infarction (MI) are serious conditions whose burdens vary by socio-demographic and geographic factors. Although several studies have investigated and identified disparities in burdens of these conditions at the county and state levels, little is known regarding their geographic epidemiology at the neighborhood level. Both conditions require emergency treatments and therefore timely geographic accessibility to appropriate care is critical. Investigation of disparities in geographic accessibility to stroke and MI care and the role of Emergency Medical Services (EMS) in reducing treatment delays are vital in improving health outcomes. Therefore, the objectives of this work were to: (i) classify …