Medicine and Health Sciences Commons^™

Air Pollution Related Asthma Inpatient Hospital Admission In The Las Vegas Valley, Joshua Allen Jensen

UNLV Theses, Dissertations, Professional Papers, and Capstones

Asthma is a chronic respiratory condition characterized by inflammation in the lungs that causes airflow to be restricted. In Southern Nevada’s Las Vegas Valley, the natural basin geography causes air pollutants to accumulate. Research has linked air pollution with worsening asthma symptoms. The goal of this study was to determine the non-linear lagged relationship between Asthma Related Inpatient Hospital Admissions (ARIHA) and the Environmental Protection Agency’s (EPA) criteria air pollutants in the Las Vegas Valley using hospital and pollution monitoring station data. Overall, a statistically significant increased RR of ARIHA between 7 and 13 days after exposure to PM2.5 24-hour …

Epidemiological Studies Of Soybean Vein Necrosis Virus And Potential Resistance Mechanisms To Its Vector Neohydatothrips Variabilis (Beach), Jing Zhou

Graduate Theses and Dissertations

Soybean (Glycine max (L.) Merrill) is one the most important crops in global agriculture with annual production of over 260 million metric tons. As the dependence of a growing global population to soybean has increased, so does the importance of soybean diseases and pests. Over 200 pathogens attack soybean; among them, viruses pose a major threat to the soybean industries accounting for approximately 10% of the annual yield reduction caused by diseases in the past two decades. Soybean vein necrosis virus (SVNV) is a relatively newly discovered virus causing the homonymous disease. The widespread occurrence of the disease in major …

Factors Associated With Follow-Up Compliance Among Clients Referred By A Local Health Department For Hiv Pre-Exposure Prophylaxis, Lauren R. Cirrincione

Capstone Experience

Background: Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) is a public health strategy to limit HIV infection among at-risk populations. Local health departments (LHDs) promote PrEP initiation by referring patients to private and academic specialty care centers. However, low follow-up compliance remains a challenge in this setting. Between January 2016 and September 2018, Douglas County Health Department, a LHD in Omaha, Nebraska, externally referred 126 clients for PrEP at an academic specialty care center, and only 20 (15%) clients completed a PrEP initiation follow-up appointment. The purpose of this study is to describe the characteristics of clients referred by …

Trends In Childhood Elevated Blood Lead Levels In Nebraska, 2013 – 2017, Ellana Haakenstad

Capstone Experience

This project explored the exposure to lead among children in Nebraska. Using the Nebraska Department of Health and Human Services’ Blood Lead Level database, trends were investigated in screening; demographics; incidence; and prevalence of elevated blood lead levels, statewide and by census tract. The study further explored the geography of lead exposure and elevated blood lead level cases with maps. Based on these results, policy recommendations were made to the Nebraska Department of Health and Human Services’ Childhood Lead Poisoning Prevention Program, particularly about areas of Nebraska with high risk of lead incidence and exposure risk where testing should be …

Examining The Impact Of Hiv Medical And Social Case Management Program On Viral Load For Clients Living With Hiv/Aids In Nebraska, Abdulla Munir

Capstone Experience

Abstract

Case management (CM) is one of the standard practices that has been implemented since 1990 to help people living with HIV/AIDS (PLWHA) in the United States. The program is designed for low-income populations and it aims to address the barriers related to access to health care and improve the HIV outcomes. Previous studies identified a positive association with the provision of CM and improvement in viral outcomes. Increasing the viral suppression rates among HIV diagnosed individuals proved to reduce the risk of transmitting the infection, and disease incidence. Although CM program is provided to Nebraskans diagnosed with HIV, but …

Evaluation Of The Predictive Ability Of A Screening Instrument Used To Diagnose Co-Occurrence Of Anxiety In Children With High-Functioning Autism., Austin Zachary

Electronic Theses and Dissertations

Anxiety has shown to have a high co-occurrence in children with Autism Spectrum Disorder (ASD), but has been difficult to co-diagnose. This study analyzed the ability of the Screen for Child Anxiety-Related Emotional Disorders (SCARED) to predict positive ASD screenings of the Social Responsiveness Scale (SRS). Parents and children ages 8 to 18 years (N = 100) were screened for anxiety using the SCARED and autism using the SRS. Moderate correlation was found between parent-reported SCARED and positive screening of the SRS (r = .579), with weak correlation found in the child-reported SCARED (r = .105). LASSO regression was conducted …

Lead And Crime: An Ecological Study Between Lead Contaminated Topsoil And Violent Crime., Brian Guinn

Electronic Theses and Dissertations

Lead is a known neurotoxicant. Human exposure to lead comes primarily through environmental exposures, including remnant lead paint, lead contaminated topsoil and lead contaminated water. Prenatal and early life lead exposure has been associated with numerous neurocognitive and neuropsychiatric disorders. This dissertation presents findings from an ecological study which evaluated the geospatial association between topsoil lead content and the incidence of FBI designated violent crime in Jefferson County, Kentucky. A total of 412 topsoil samples were collected along roadways (n=300) and from Louisville Metro Parks (n=112). Jefferson County crime data was obtained from the Louisville Metro Police Department – Crime …

Association Between Cigarette Smoking And Ovarian Reserve Among Women Seeking Fertility Treatment With Effect Modification By Race And Nat2 Genotype., Islamiat A. Oladipupo

Electronic Theses and Dissertations

Cigarette smoking in women has been associated with adverse reproductive outcomes such as reduced ovarian reserve, poorer in vitro fertilization (IVF) outcomes and increased adverse pregnancy outcomes. This study examined the association of smoking with ovarian reserve in a cross-sectional study of women seeking fertility treatment, and potential effect modification by race and NAT2 acetylator phenotype. Data from 265 women from the Louisville Tobacco Smoke, Genetic Susceptibility, and Infertility (LOUSSI) Study were analyzed. A total of 265 women were recruited through a single infertility clinic between September 2016 and June 2018. Information on current smoking status was assessed using a …

Adolescent Sexual And Reproductive Health In The Gambia., Sandhya Lohani

Electronic Theses and Dissertations

Adolescence is a crucial period in human development. Knowledge and awareness about when to have children, when to have sex, and use of contraceptives impacts the chances of teenage pregnancy and risk of sexually transmitted diseases. The objective of this study is to determine the prevalence and associated risk factors related to age of sexual debut, teenage pregnancy, and use of contraceptives in the Gambia. This study also compares the data with 2014 survey research conducted in the Gambia. The total study population were 50 adolescents aged 13-21 years from Bafuluto and surrounding communities in the Gambia. Among 50 respondents, …

Is Macrolide And Beta-Lactam Combination Therapy Associated With Early Clinical Stability Or 30 Day Mortality In Hospitalized Patients With Pneumonia? An Assessment Of Confounding By Indication., Evangeline Pierce

Electronic Theses and Dissertations

Pneumonia and influenza are one of the leading causes of infectious disease-related deaths worldwide. Current guidelines for the treatment of hospitalized patients with community acquired pneumonia (CAP) include empiric antimicrobial therapy with a macrolide and a beta-lactam. There is little consensus among studies as to which antimicrobial regimen is best. The confusing results seen may very well be due to lack of assessment of confounding by indication (CBI). This analysis was a secondary analysis from Hospitalized Adults with Pneumococcal Pneumonia: Incidence Study (HAPPI). The study participants were those in HAPPI who had received either macrolide and beta-lactam combination therapy or …

Prognostic Predictive Model To Estimate The Risk Of Multiple Chronic Diseases: Constructing Copulas Using Electronic Medical Record Data, Jason E. Black

Electronic Thesis and Dissertation Repository

Introduction: Multimorbidity, the presence of two or more chronic diseases in an individual, is a pressing medical condition. Novel prevention methods are required to reduce the incidence of multimorbidity. Prognostic predictive models estimate a patient’s risk of developing chronic disease. This thesis developed a single predictive model for three diseases associated with multimorbidity: diabetes, hypertension, and osteoarthritis.

Methods: Univariate logistic regression models were constructed, followed by an analysis of the dependence that existed using copulas. All analyses were based on data from the Canadian Primary Care Sentinel Surveillance Network.

Results: All univariate models were highly predictive, as demonstrated by their …

Social Determinants Of Cardiometabolic Disease Control: An Ecosocial Approach, Cristina Huebner Torres

Doctoral Dissertations

Cardiovascular disease (CVD) is the leading cause of death in the United States. Diabetes mellitus, hypertension, and dyslipidemia are three primary risk factors for CVD. Each is disproportionately distributed in the population by race/ethnicity. Social determinants of health (SDoH) research indicate that social and environmental factors upstream of individual behaviors can impede an individual’s chronic disease control. Guided by Michael Marmot’s SDoH theoretical framework and by an ecosocial approach, this study used data from a cross-sectional mixed methods study conducted in Western Massachusetts at a federally qualified health center from 2014 to 2018 (RxHL) to examine the association between SDoH—food …

Risk Indicators Of Non-Severe Hypoglycemia In Type 2 Diabetes: An Analysis Of Real World Data, Natalie Hon Man Au

Electronic Thesis and Dissertation Repository

Non-severe hypoglycemia (NSH) is a common, adverse event arising from the use of insulin/secretagogues to treat type 2 diabetes mellitus (T2DM). This thesis explored risk indicators for the frequency of any NSH, daytime NSH, and nocturnal NSH where outcomes were regarded as event counts and ordinal categories. Real-world data used in this thesis was provided by a population-based sample of Canadian adults with T2DM on insulin and/or secretagogues from the InHypo-DM Study. Count and ordinal outcomes were analyzed using negative binomial regression models and a proportional odds model, respectively. Backward selection was applied to both modelling approaches. Younger age, lower …

Child Abuse As A Determinant Of Barriers To Hiv Status Disclosure Among Women In Canada, Siobhan M. Churchill

Electronic Thesis and Dissertation Repository

Introduction: In Canada, people with HIV are legally required to disclose their HIV status to their sexual partners prior to having sex that presents a “realistic possibility of HIV transmission”. This policy has been criticized for failing to consider the safety and autonomy of women with HIV, which can be compromised following disclosure.

Objectives: To investigate whether experiences of childhood physical or sexual abuse (CPSA) affect barriers to HIV disclosure to partners in adulthood, which include: later physical or sexual abuse, sexual agency, HIV stigma, and perceived social support.

Methods: Propensity scores and inverse probability of treatment weights were used …

Physical Activity During Pregnancy And Birth Outcomes In South Carolina 2009-2015, Andrew Tyler Broadway

Theses and Dissertations

Physical activity is known to be beneficial to adults in general, including pregnant women, but the literature on physical activity and neonatal outcomes has been inconsistent. Few studies have differentiated between physical activity prior to pregnancy and during pregnancy to see whether the typical beneficial effect is not due to having a more active lifestyle in general. The Pregnancy Risk Assessment Monitoring System (PRAMS) is a national cross-sectional surveillance system. Our data from SC PRAMS included 6391 respondents and was weighted to be representative of population of pregnant women that delivered in the state. We excluded births that were not …

Burden Of Lipohypertrophy Among Insulin Dependent Diabetes Mellitus Patients In China: An Analysis Of Outcomes And Impact Of Pen Needle Reimbursement Policy, Arthi Chandran

Dissertations and Theses

Background

Diabetes is a global epidemic and with an aging population accompanied by rapid urbanization China ranks highest in disease prevalence and associated burden. Independent of diabetes type, insulin is an eventual and costly requirement for disease management. The consequences of insulin administration however are poorly understood. Lipohypertrophy (LH) is one such consequence. It is hypothesized that method of insulin delivery and poor delivery technique are significant risk factors for this condition which is believed to alter insulin pharmacodynamics. Subsequently, insulin pen needles are a critical component of care however access to pen needles varies across China.

Objective

The objective …

The Effects Of Child Restraint System Use And Motor Vehicle Collision Severity On Injury Patterns And Severity In Children 8 Years Old And Younger., Peyton A. Schroeder

Electronic Thesis and Dissertation Repository

Motor vehicle collisions (MVCs) are a leading cause of injury and death for children under the age of 14 years in North America. Children, eight years old or younger, are required to use a child restraint system (CRS) when travelling in a vehicle in Canada. In the present study, the hypothesis that head injury severity of children in this age group, seated in rear rows of vehicles in MVCs, will be influenced by the types of restraint systems used was not supported by the data; however, other secondary aspects of collision data were explored. There were injury patterns that involved …

Viral Etiology Of Rheumatoid Arthritis, Fatima Kudaeva

Electronic Thesis and Dissertation Repository

Viruses can trigger rheumatoid arthritis (RA) or inflammatory arthritis (IA). Our study provides insight into etiology of RA/IA. We analyzed the evidence relating to the risk of RA after viral infections; estimated the distribution of IA onsets over time; quantified the effect of influenza on the risk of IA.

Results of systematic review and meta-analysis showed that the risk of RA/IA is increased after parvovirus B19 and chikungunya virus. There seems to be a risk of RA after chronic hepatitis C (HCV), but whether it is a true RA or HCV-associated arthritis is not clear.

We estimated the distribution of …

Examining The Relationships Between School Engagement, Physical Activity, And Attention-Deficit Hyperactivity Disorder In Children Using The Ecological Model, Minh Nguyen

Theses & Dissertations

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with onset usually occurring in childhood and adolescence. During these developmental stages, social interactions and external environments can have significant impact on children’s growth and development. Few studies previously used a theoretical model to examine the effects of social and external environments on ADHD. The goal of this dissertation is to apply an ecological perspective to examine the roles of school and community in the development of childhood ADHD through school engagement and physical activity. Three studies were implemented to carry out this goal. Study 1 examined the associations of neighborhood, school, and …

Improving Prediction Of Systemic Statin Exposure Using Concomitant Medications, Non-Linear Modelling And Novel Snp Discovery, Rhiannon Rose

Electronic Thesis and Dissertation Repository

Introduction: Statin drugs are a highly efficacious treatment for hypercholesterolemia and adherent treatment with statins reduces the risk of cardiovascular disease. Although statins are generally well tolerated, myalgia (muscle pain) is a common side effect and can lead to non-compliance with treatment. Increased systemic exposure may contribute to the development of myalgia. Drug-drug interactions inhibiting statin metabolism and impaired drug transporter function may lead to decreased statin clearance. Establishing accurate predictive models is an important step towards preventing adverse drug events by titrating statin dosing to limit systemic exposure.

Objectives: 1) To develop an algorithm to select concomitant medications for …

Coal Ash Exposure And Behavioral Impairments Among Children In Louisville, Kentucky., Chisom Nmesoma Odoh

Electronic Theses and Dissertations

Introduction: Coal ash, generated from the combustion of coal is principally made up of fly ash, which consists of small particles and metals that can affect the development of children. Coal ash is predominately stored in landfills and surface impoundments, of which many are in proximity to residential areas. According to the Environmental Protection Agency, 25% of residents in proximity to electric power plants are children. Few studies have reported a positive association between coal ash and its by-products and neurobehavioral disorders. The purpose of this study was to explore the relationship between coal ash and its components and …

Post-Diagnosis Quality Of Life And Mortality In Non-Hispanic White And Hispanic Women Diagnosed With Invasive Breast Cancer., Delvon T. Mattingly

Electronic Theses and Dissertations

The prevalence of breast cancer is increasing, and the health-related quality of life (HRQOL) of breast cancer survivors may help to further understand survivorship. This study evaluated HRQOL as a potential prognostic factor for mortality among Non-Hispanic White (NHW) and Hispanic women diagnosed with invasive breast cancer. Data were used from the Health, Eating, Activity, and Lifestyle (HEAL) Study. Data for 351 participants were analyzed for associations between HRQOL scores (subscale, component) and mortality. Cox proportional hazards regression was conducted to assess the relationship between HRQOL and mortality outcomes (all-cause, breast cancer-specific, non-cancer). Median follow-up time from HRQOL assessment (approximately …

Phthalates, Embryo Development, And Sperm Dna Methylation, Haotian Wu

Doctoral Dissertations

Infertility affects 15% of all couples and presents a major public health issue. Animal and human data indicate that epigenetic dysregulation in sperm is associated with poor male reproductive health and extensive epigenetic reprogramming during spermatogenesis presents a window of vulnerability for environmentally-induced epigenetic dysregulation. Phthalates is a class of ubiquitous environmental contaminant and global health concern. Phthalate exposure in humans has been associated with diminished male fertility, adverse birth outcomes, and altered offspring development. In order to facilitate additional research on this topic, we aimed to developing a higher throughput method of sperm nucleic acid extraction. In addition, this …

Vitamin D, Calcium, And Dairy Consumption And Risk Of Early Menopause, Alexandra C. Purdue-Smithe

Doctoral Dissertations

Early menopause, defined as the cessation of ovarian function before the age of 45, affects roughly 10% of women in Western populations. Current research suggests that women who experience early menopause are at increased risk for cardiovascular disease and other adverse health outcomes. Early menopause may also have substantial financial and psychological consequences for family planning, particularly as women increasingly delay childbearing into the later reproductive years. Emerging research suggests that modifiable lifestyle factors such as diet may play an important role in ovarian aging. According to our review of the current biologic and epidemiologic literature in Chapter 1, vitamin …

Hormonal Contraceptive Use Among Active Duty Army Servicewomen. Trends And Implications For Risk Of Musculoskeletal Injury., Melanie K. Hosker

Doctoral Dissertations

Almost 40% of servicewomen use hormonal contraception every year, and 60% will use a contraceptive method in their military career. Rates of contraceptive use and musculoskeletal injury are higher among servicewomen as compared to civilians. Gender differences in rates of musculoskeletal injury have led investigators to question the role of sex hormones, including contraception. Recent studies suggest that hormonal contraceptives may decreased risk of anterior cruciate ligament (ACL) injury, potentially decreasing early onset osteoarthritis (OA). We utilized the Total Army Injury and Health Outcome Database, which prospectively captured demographics, clinical and pharmacy records on over 5.6 million Army soldiers since …

Investigations Of The Role Of Acculturation In Cancer Screening And Phthalates In Breast Cancer Risk And Weight And Body Mass Index Change, Mary V. Diaz Santana

Doctoral Dissertations

INVESTIGATIONS OF THE ROLE OF ACCULTURATION IN CANCER SCREENING AND PHTHALATES IN BREAST CANCER RISK AND WEIGHT AND BODY MASS INDEX CHANGE MAY 2018 MARY V. DIAZ SANTANA, B.S., UNIVERSITY OF PUERTO RICO RIO PIEDRAS CAMPUS M.S., UNIVERSITY OF PUERTO RICO MEDICAL SCIENCE CAMPUS Ph.D., UNIVERSITY OF MASSACHUSETTS AMHERST Directed by: Professor Katherine Reeves Phthalates, endocrine-disrupting chemicals, are hypothesized to increase obesity and, as a result, risk of obesity-related cancers, such as breast cancer. However, findings are not consistent across studies. Identifying whether phthalates impact obesity is critical for understanding the pathways by which phthalates may affect cancer risk. Experimental …

Impacts Of Casino Gambling Availability In Plainville, Massachusetts: A Repeated Cross-Sectional Analysis, Danielle M. Venne

Masters Theses

The impacts of the introduction of casino gambling in Plainville, MA and surrounding communities are of interest in developing informed policy. Problem gambling is a public health issue as associated harms include physical and mental illness, impaired relationships with one’s close social network, impacts on school or work, financial difficulties and illegal behavior. The results of surveys prior to and after the introduction of the casino were used to evaluate potential differences in the prevalence of at-risk and problem gambling, associations amongst health and gambling behavior covariates with at-risk and problem gambling status by year, and changes of covariate relationships …

Association Of Follicle-Stimulating Hormone And Depression And Depressive Symptoms In Older Postmenopausal Women, Dana Fritz

Masters Theses

Worldwide, between 5 and 18% of postmenopausal women experience depression. While the associations of estrogens with depression have been researched extensively, relations with other postmenopausal hormones remain unclear. We evaluated the association of follicle stimulating hormone (FSH) levels with prevalent depression the Kuopio Ischaemic Heart Disease Risk Factor Study (n = 588). Study participants were postmenopausal women aged 53 to 73 years and not using hormone therapy at enrollment (1998-2001). FSH was measured by radioimmuno-assays. Depression symptoms were measured using a scale based on DSM-III criteria (score range = 0-12), with a score ≥5 indicative of probable depression. We assessed …

Understanding Relationships Between Early Life Toxic Stress, Childhood Socioeconomic Disadvantage, And Allostatic Load In Adolescence, Amanda King

Dissertations (1934 -)

Chronic disease prevalence among children and adolescents is rising, which is thought to result in part from elevations in allostatic load (AL). AL is the cumulative physiological dysregulation that results from exposure to biological, social and environmental stressors over time. Socioeconomic disparities in chronic disease and AL have been well-documented in adult populations, including links between childhood socioeconomic disadvantage (CSD) and AL, yet little is known as to whether CSD may begin to impact AL earlier in life. Differential exposure and vulnerability to stress among racial/ethnic minorities may increase risk for elevated AL among those experiencing CSD. Framed by the …

The Indigenous Determinants Of Health As Predictors For Diabetes And Unmet Health Needs Among Urban Indigenous People: A Respondent-Driven Sampling Study In Toronto, Ontario, Stephanie Rachael Mcconkey

Electronic Thesis and Dissertation Repository

National statistics commonly present Indigenous peoples as a falsely homogenous group of people experiencing disproportionate ill health when compared to non-Indigenous peoples. There are significant gaps in statistical information regarding the health services access barriers experienced by Indigenous people that disrupts the quality of care they receive or prevents them from accessing care altogether. Our Health Counts Toronto is a community-based study that employed respondent-driven sampling (RDS) methodologies to sample 917 urban Indigenous adults. Prevalence estimates and prevalence ratios were calculated using RDS-II weights and adjusting for clustering by shared recruiter in SAS 9.4 and SAS-callable SUDAAN 11.0 software. This …