Medicine and Health Sciences Commons^™

Opioid-Related Mortality: Dynamic Temporal And Spatial Trends By Drug Type And Demographic Subpopulations, Massachusetts, 2005–2021, Thomas J Stopka, Marc R Larochelle, Xiaona Li, Dana Bernson, Wenjun Li, Leland K Ackerson, Ric Bayly, Olaf Dammann, Cici Bauer

Faculty, Staff and Student Publications

BACKGROUND: Fatal opioid-related overdoses (OOD) present significant public health challenges. Intuitive and replicable analytical approaches are needed to inform targeted public health responses.

METHODS: We obtained fatal OOD data for 2005-2021 from the Massachusetts Registry of Vital Records and Statistics. We conducted heatmap analyses to assess trends in fatal OOD rates per 100,000 residents, visualizing rates by death year and decedent age at one-year intervals, stratifying by race/ethnicity, sex, rurality, and involved substances. We calculated Getis-Ord Gi* statistics to identify spatial clusters of OOD rates.

RESULTS: Among 20,774 fatal OODs, rates were higher among males, and highly variable by race/ethnicity, …

Perceived Negative Political Climate Among Hispanic/Latino Adolescents Before And After The 2020 Us Presidential Election: Associations With Internalizing Symptoms And Substance Use, Pablo Montero-Zamora, Saskia R Vos, Jennifer B Unger, Ingrid Zeledon, Ryan Lee, Daniel W Soto, Eric C Brown, Maria Duque, Maria Fernanda Garcia, Carolina Scaramutti, Beyhan Ertanir, Seth J Schwartz

Faculty, Staff and Student Publications

The political climate often changes following the installment of a new president. This volatility presents opportunities for examining how elections might affect vulnerable subgroups such as Hispanic/Latino (HL) adolescents. The present study explored the perception of negative political climate among HL adolescents before and after the 2020 U.S. presidential election and its association with internalizing symptoms and substance use. We conducted the study in Los Angeles and Miami between 2020-2021, with a sample of 304 HL adolescents (Females = 60.8%), aged 15.3 years on average. Participants completed measures of negative political climate (pre- post-election) and measures of depressive symptoms, anxiety, …

Rated T For Therapy: How Video Games Portray Mental Illness And Their Effects On Social Stigmas, Christine Wendell

All Theses

Mental illness has always been a tricky subject for us to tackle as a society due to the social stigmas surrounding it. Historically, people with mental illness were seen as violent and unstable and would often need to be committed for public safety; however, a large majority of people with mental illness do not fit that bracket and often don’t reach out for help due to that fear of being “othered” by society. As time went on, these tropes faded to purely entertainment mediums but the stigmas still remain. Many video games specifically hold onto these tropes for shock value …

Chronic Overlapping Pain Conditions And Long-Term Opioid Treatment, Maria Ukhanova, Robert W Voss, Miguel Marino, Nathalie Huguet, Steffani R Bailey, Daniel M Hartung, Jean O'Malley, Irina Chamine, John Muench

Faculty, Staff and Student Publications

OBJECTIVES: One in 5 people in the United States lives with chronic pain. Many patients with chronic pain experience a subset of specific co-occurring pain conditions that may share a common pain mechanism and that have been designated as chronic overlapping pain conditions (COPCs). Little is known about chronic opioid prescribing patterns among patients with COPCs in primary care settings, especially among socioeconomically vulnerable patients. This study aims to evaluate opioid prescribing among patients with COPCs in US community health centers and to identify individual COPCs and their combinations that are associated with long-term opioid treatment (LOT).

STUDY DESIGN: Retrospective …

Program Evaluation: Utilizing Health Department’S Community Health Needs Assessment Data To Improve Emergency Preparedness Plans, Kathleen Gottschalk

Capstone Experience: Master of Public Health

Public health officials conducting emergency response plans must know how to easily identify the vulnerable populations in their community or jurisdiction. It is beneficial for access and functional needs appendices to include information and resources directed at the identified vulnerable groups before an emergency event to improve health outcomes. Community Health Needs Assessments (CHNA) can provide population-level statistics and information needed to easily identify vulnerable or at-risk groups. This report aims to evaluate the use of the CHNA data to guide the development of inclusive emergency response plans that account for vulnerable populations in local health department jurisdictions. The 2021 …

Surviving The Stigma: Incorporating Mental Health Literacy To Increase Help-Seeking In California First Responders, Yvonne C. Newson

Master's Projects and Capstones

First responders are at risk of developing mental health problems due to repeated exposure to traumatic incidents, increasing their chance of developing Post Traumatic Stress Disorder, substance abuse, suicidal ideation, and suicide. Unfortunately, first responders do not recognize that they may have a mental illness and are reluctant to seek help. This paper will discuss the prevalence of mental health problems among first responders and the barriers to their help-seeking. These barriers include the stigma around mental illness within the culture, the assessability of professional help, and the lack of mental health literacy regarding their well-being. Further discussion will focus …

One Immune System Plays Many Parts: The Dynamic Role Of The Immune System In Chronic Pain And Opioid Pharmacology, Sanam Mustafa, Juliana E Bajic, Benjamin Barry, Samuel Evans, Kariel R Siemens, Mark R Hutchinson, Peter M Grace

Faculty, Staff and Student Publications

The transition from acute to chronic pain is an ongoing major problem for individuals, society and healthcare systems around the world. It is clear chronic pain is a complex multidimensional biological challenge plagued with difficulties in pain management, specifically opioid use. In recent years the role of the immune system in chronic pain and opioid pharmacology has come to the forefront. As a highly dynamic and versatile network of cells, tissues and organs, the immune system is perfectly positioned at the microscale level to alter nociception and drive structural adaptations that underpin chronic pain and opioid use. In this review, …

An Examination Of The Association Of Religiosity, Purity Culture, And Religious Trauma With Symptoms Of Depression And Anxiety, Kaelyn R. Griffin

UNLV Theses, Dissertations, Professional Papers, and Capstones

While no consistent definition yet exists for religious trauma, religious abuse is typically defined as a misuse of authority by a spiritual leader to coerce, control, or exploit those under their leadership, which may in turn lead to the experience of religious trauma. Numerous studies suggest that experiencing abuse within a religious environment is a both global phenomenon and common experience. The impact of religious abuse has recently gained greater media attention, specifically related to the social and psychological impact of leaving high-cost religious groups (i.e., those with rigid rules or groups from which departure leads to isolation and rejection …

Depression, Stress And Regional Cerebral Blood Flow, Joshua Chiappelli, Bhim M Adhikari, Mark D Kvarta, Heather A Bruce, Eric L Goldwaser, Yizhou Ma, Shuo Chen, Seth Ament, Alan R Shuldiner, Braxton D Mitchell, Peter Kochunov, Danny Jj Wang, L Elliot Hong

Faculty, Staff and Student Publications

Decreased cerebral blood flow (CBF) may be an important mechanism associated with depression. In this study we aimed to determine if the association of CBF and depression is dependent on current level of depression or the tendency to experience depression over time (trait depression), and if CBF is influenced by depression-related factors such as stressful life experiences and antidepressant medication use. CBF was measured in 254 participants from the Amish Connectome Project (age 18-76, 99 men and 154 women) using arterial spin labeling. All participants underwent assessment of symptoms of depression measured with the Beck Depression Inventory and Maryland Trait …

Association Between The Epigenetic Lifespan Predictor Grimage And History Of Suicide Attempt In Bipolar Disorder, Camila N C Lima, Emese H C Kovács, Salahudeen Mirza, Alexandra Del Favero-Campbell, Alexandre Paim Diaz, Joao Quevedo, Benney M R Argue, Jenny Gringer Richards, Aislinn Williams, John A Wemmie, Vincent A Magnotta, Jess G Fiedorowicz, Jair C Soares, Marie E Gaine, Gabriel R Fries

Faculty, Staff and Student Publications

Bipolar disorder (BD) has been previously associated with premature mortality and aging, including acceleration of epigenetic aging. Suicide attempts (SA) are greatly elevated in BD and are associated with decreased lifespan, biological aging, and poorer clinical outcomes. We investigated the relationship between GrimAge, an epigenetic clock trained on time-to-death and associated with mortality and lifespan, and SA in two independent cohorts of BD individuals (discovery cohort - controls (n = 50), BD individuals with (n = 77, BD/SA) and without (n = 67, BD/non-SA) lifetime history of SA; replication cohort - BD/SA (n = 48) and BD/non-SA (n = 47)). …

Patient With Genital Lymphedema, Pain, And Rash, Resa G Magill, Dylan Supak, Rachel Pham, Dustin Luse, Cooper R Benson

Faculty, Staff and Student Publications

No abstract provided.

New-R Intervention For Clients With Severe Mental Illness And Obesity: Grant Writing For Implementation Funds Supporting Occupational Therapy Interventions, Kaitlyn Hoffman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Increasing numbers of people suffer from obesity and severe mental illness co-morbidly. If these conditions remain untreated, they can harm an individual's health and well-being. Unfortunately, there are very few programs currently available that target both management and improvement of these conditions simultaneously. Even so, despite the lack of programming options, it must be noted that the NEW-R program strives to reach those goals, although there hasn't been an abundance of literature supporting the effectiveness of this program. This poses a concern for occupational therapy practitioners who hope to assist their clients in managing these conditions as occupational therapy treatments …

Neuroendocrine Tumor Of The Ampulla Of Vater: A Case Report, Mohammad S Aman, Bidhan C Das, Aminul Islam, Murshidul Arefin, Satya N Gupta

Faculty, Staff and Student Publications

Neuroendocrine tumors (NETs) of the ampulla of Vater are extremely rare. Here, we discuss the clinical presentation, diagnostic challenges, and treatment options of a recently experienced case of NET of the ampulla of Vater in light of the literature. A 56-year-old woman presented with recurrent upper abdominal pain. Ultrasonography (USG) of the whole abdomen showed multiple gallstones along with a dilated common bile duct (CBD). For evaluating the dilated CBD, a magnetic resonance cholangiopancreatography was performed, which revealed the double-duct sign. Subsequently, an upper gastrointestinal endoscopy showed a bulged-out ampulla of the Vater. Biopsy and histopathological examination of the growth …

Assessment Of Corticosteroid Therapy And Death Or Disability According To Pretreatment Risk Of Death Or Bronchopulmonary Dysplasia In Extremely Preterm Infants, Erik A Jensen, Laura Elizabeth Wiener, Matthew A Rysavy, Kevin C Dysart, Marie G Gantz, Eric C Eichenwald, Rachel G Greenberg, Heidi M Harmon, Matthew M Laughon, Kristi L Watterberg, Michele C Walsh, Bradley A Yoder, Scott A Lorch, Sara B Demauro

Faculty, Staff and Student Publications

IMPORTANCE: Meta-analyses suggest that corticosteroids may be associated with increased survival without cerebral palsy in infants at high risk of bronchopulmonary dysplasia (BPD) but are associated with adverse neurologic outcomes in low-risk infants. Whether this association exists in contemporary practice is uncertain because most randomized clinical trials administered corticosteroids earlier and at higher doses than currently recommended.

OBJECTIVE: To evaluate whether the pretreatment risk of death or grade 2 or 3 BPD at 36 weeks' postmenstrual age modified the association between postnatal corticosteroid therapy and death or disability at 2 years' corrected age in extremely preterm infants.

DESIGN, SETTING, AND …

Rural Appalachia And The Opioid Epidemic: Overcoming Current Barriers With New Solutions, Olivia Croft

Undergraduate Theses and Capstone Projects

The opioid epidemic has damaged the lives of many Americans since the early 2000’s. As America continues to look for ways to fight the opioid epidemic and save this country, the idea of providing the rescue drug, naloxone, to the general public has been discussed and implemented in some areas. An overdose from opioids causes a person to have respiratory depression and eventually stop breathing. Without intervention, this quickly leads to death. Although the opioid epidemic is nationwide, some of the most significantly affected populations are the rural communities tucked away in the Appalachian Mountains. In rural areas of America, …

Increasing College Students Awareness Of Technologies Impacts In Their Daily Lives, Melissa Gutierrez

Capstone Projects and Master's Theses

Many college students today may spend an excessive amount of time on technology. Excessive technology may leave an impact on their mental and physical health leading to poor eating habits or obesity, anxiety and can even have an impact on their academics. When college students learn about how to manage their technology use, it is likely they will focus more on the negative impacts to benefit their health and wellbeing. To address the overuse of technology, I created a one-day workshop for Theta Alpha Sigma sorority college students at Cal State Monterey Bay.

The Kynurenine Pathway In Major Depressive Disorder, Bipolar Disorder, And Schizophrenia: A Systematic Review And Meta-Analysis Of Cerebrospinal Fluid Studies, Mehmet Enes Inam, Brisa S Fernandes, Estela Salagre, Iria Grande, Eduard Vieta, João Quevedo, Zhongming Zhao

Faculty, Staff and Student Publications

INTRODUCTION: The kynurenine pathway has been attracting attention as a relevant pathway in schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MDD). We conducted a systematic review and meta-analysis of the kynurenine pathway metabolites from cerebrospinal fluid (CSF) samples in SZ, BD, and MDD.

METHODS: PubMed and Scopus databases were systematically searched to identify peer-reviewed case-control studies until April 2022 that assessed kynurenine metabolites, namely, tryptophan (TRP), kynurenine (KYN), kynurenic acid (KA), quinolinic acid (QA), and 3- hydroxykynurenine (3-HK) in SZ, BD, or MDD subjects compared with healthy controls (HC). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses …

Inviting The Outside In: Nature's Contribution To Counselor Wellness, Naomi Medina

Dissertations

The positive influence of nature on client wellness and psychological health (BonhamCorcoran et al., 2022) is well reflected in the emergence of nature-based counseling interventions such as wilderness therapy, walk talk therapy, and horticulture therapy, among other counseling modalities that involve aspects of the natural world (Lewis et al., 2022). This suggests that the inclusion of nature within the counseling session could also contribute to the wellness of the counselor. The purpose of this research was to determine the extent to which presence of nature contributes to counselor wellness and which of the five senses may play a greater role …

Lived Experiences Of School Counselors Working In Conjoint Roles In A Multisystem Framework To Address The Mental Health Needs Of Students, Angela Cano Sampson

Dissertations

The purpose of this phenomenological qualitative study was to explore the lived experiences of school counselors working in conjoint roles as social–emotional leaders and mental health professionals (MHPs) to address the mental health needs of students through multisystem collaboratives (MSCs) and school-based systems of mental health care (SBSMHC).

The role of the school counselor has expanded into becoming a social–emotional leader and school MHP advocating for comprehensive social–emotional learning and the “school-linked” movement that coalesced their exclusive professional proficiency with both school-based and community resources working to enhance initiatives for student psychosocial development in ways that would increase student assets …

Feasibility Of The Every Moment Counts Initiative At A Southern Nevada Elementary School, Amber Lee Eddy

UNLV Theses, Dissertations, Professional Papers, and Capstones

Over the past 20 years, multiple legislative acts have been passed mandating support and services for the mental health needs of children and youth in schools; however, Nevada continues to rank last for the provision of such services. Children and youth who are mentally healthy are more likely to be successful in their homes, schools, and communities (Arbesman et al., 2013). Those who have increased mental health needs are more at risk for developmental and long-term consequences that jeopardize overall health and wellness, not to mention the immense effects that the COVID-19 pandemic has had on children and youth. With …

County Characteristics And Opioid Mortality Rates In The United States, Baksun Sung

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Opioid overdose deaths are not equally distributed across the United States. While some areas have a less severe problem with opioid abuse, others face serious challenges, which are affected by various social factors. To address that question, in Chapter 1, I investigate how opioid mortality trends differ according to opioid types, race, and region to identify susceptible populations and areas. In Chapter 1, I contend that synthetic opioid is a main trigger for the current opioid epidemic and that the epidemic is concentrated among blacks and in the Eastern United States. Next, the following studies examine how varying social vulnerabilities …

One-Year Outcomes Following Intravenous Ketamine Plus Digital Training Among Patients With Treatment-Resistant Depression: A Secondary Analysis Of A Randomized Clinical Trial, Rebecca B Price, Meredith L Wallace, Sanjay J Mathew, Robert H Howland

Staff and Researcher Publications

This secondary analysis of a randomized clinical trial examines whether automated self-association training can prolong the antidepressant effect of a single infusion of ketamine beyond 1 month in patients with treatment-resistant depression.

The Clinical Characterization Of Blocking Tics In Patients With Tourette Syndrome, José Fidel Baizabal-Carvallo, Joseph Jankovic

Faculty, Staff and Students Publications

OBJECTIVE: Tourette syndrome (TS) is a neurodevelopmental disorder characterized by the presence of motor and phonic tics. Blocking phenomena, characterized by arrests in motor activity causing interruptions in movements or speech, have also been described in patients with TS. In this study, we aimed to characterize the frequency and features of blocking tics in patients with TS.

METHODS: We studied a cohort of 201 patients with TS evaluated at our movement disorders clinic.

RESULTS: We identified 12 (6%) patients with blocking phenomena. Phonic tic intrusion causing speech arrest was the most common (n = 8, 4%), followed by sustained isometric …

Covid19-Associated New-Onset Movement Disorders: A Follow-Up Study, Susanne A Schneider, Soaham Desai, Onanong Phokaewvarangkul, Elena Cecilia Rosca, Jirada Sringean, Pria Anand, Gary Álvarez Bravo, Francisco Cardoso, Anna M Cervantes-Arslanian, Harshad Chovatiya, David Crosiers, Femke Dijkstra, Conor Fearon, Francisco Grandas, Eric Guedj, Antonio Méndez-Guerrero, Muhammad Hassan, Joseph Jankovic, Anthony E Lang, Karim Makhoul, Lorenzo Muccioli, Sarah A O'Shea, Vahid Reza Ostovan, Javier Ricardo Perez-Sanchez, Ritesh Ramdhani, Victoria Ros-Castelló, Christina Schulte, Priyank Shah, Lars Wojtecki, Pramod Kumar Pal

Faculty, Staff and Students Publications

BACKGROUND: Neurological symptoms are common manifestation in acute COVID-19. This includes hyper- and hypokinetic movement disorders. Data on their outcome, however, is limited.

METHODS: Cases with new-onset COVID-19-associated movement disorders were identified by searching the literature. Authors were contacted for outcome data which were reviewed and analyzed.

RESULTS: Movement disorders began 12.6 days on average after the initial onset of COVID-19. 92% of patients required hospital admission (mean duration 23 days). In a fraction of patients (6 of 27; 22%; 4 males/2 females, mean age 66.8 years) the movement disorder (ataxia, myoclonus, tremor, parkinsonism) was still present after a follow-up …

Aspirin And Immunotherapy: A Faustian Bargain?, Eric A Goethe, Amy B Heimberger, Ganesh Rao

Faculty, Staff and Students Publications

Fibrinogen-like protein 1 (FGL1) has been associated with improved survival in hepatocellular carcinoma (HCC). However, recent evidence suggests that FGL1 may bind to surface receptors on lymphocytes and induce immune senescence. In this issue of the JCI, Lin and co-authors show that FGL1 may be acetylated by aspirin and targeted for degradation, which is associated with increased antitumor immunity and improved survival. Similar findings were obtained with inhibitors of sirtuin 2 (SIRT2), a histone deacetylase. These findings expand our current understanding of the role of FGL1 in cancer and provide an impetus for the evaluation of alternative immunotherapy combinations in …

Effect Of Quality Of Life On Radiation Adherence For Patients With Cervical Cancer In An Urban Safety Net Health System, Alison K Yoder, Elizabeth Dong, Xiaoman Yu, Alfredo Echeverria, Shelly Sharma, Jane Montealegre, Michelle S Ludwig

Faculty, Staff and Students Publications

PURPOSE: Outcomes for patients undergoing chemoradiation for cervical cancer are dependent on adherence to radiation therapy (RT). In other diseases, quality of life (QoL) is associated with treatment adherence, but the association between QoL and RT adherence for patients with cervical cancer remains unclear.

METHODS AND MATERIALS: This prospective study included patients undergoing RT for cervical cancer from 2017 to 2021 at an urban safety net hospital. The Functional Assessment of Cancer Therapy-Cervical Cancer Version 4 was used to assess QoL based on 5 subscales (physical, functional, social and emotional, and cervical-cancer specific). The survey was administered at radiation consult, …

Vortioxetine Improves Physical And Cognitive Symptoms In Patients With Post-Covid-19 Major Depressive Episodes, Marco Di Nicola, Maria Pepe, Silvia Montanari, Maria Chiara Spera, Isabella Panaccione, Alessio Simonetti, Gabriele Sani

Faculty, Staff and Students Publications

Major Depressive Episodes (MDE) following COVID-19 are frequent, can have a characteristic clinical picture, and are associated with immune-inflammatory changes. Vortioxetine is known to improve physical and cognitive performance in patients with depression and shows anti-inflammatory and anti-oxidative activities. This study aimed to retrospectively evaluate the effects of vortioxetine after 1 and 3 months of treatment in 80 patients (44.4% males, 54±17.2 years) with post-COVID-19 MDE. The primary outcome was improvement in physical and cognitive symptoms measured by specific items of Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS), Short Form-36 Health Survey Questionnaire (SF-36), Digit Symbol …

Gender Bias In Antidepressant Direct-To-Consumer Pharmaceutical Advertising, Leila K Asadi, Asim A Shah

Faculty, Staff and Students Publications

Background: Direct to consumer pharmaceutical advertising (DTCPA) may have significant impacts on public perception of diseases and treatments. Our objective was to examine whether DTCPA for antidepressants disproportionately portray and hence target women in the United States.

Methods: DTCPA for branded medications for depression, psoriasis and diabetes were analyzed to determine the gender of the main "patient" portrayed, as well as the content of the disease depiction.

Results: DTCPA for antidepressants included only women in 82% of ads, only men in 10.1% of ads, and both genders in 7.8% of ads. There were significantly higher representations of women versus men …

Effect Of Quality Of Life On Radiation Adherence For Patients With Cervical Cancer In An Urban Safety Net Health System, Alison K Yoder, Elizabeth Dong, Xiaoman Yu, Alfredo Echeverria, Shelly Sharma, Jane Montealegre, Michelle S Ludwig

Faculty, Staff and Students Publications

PURPOSE: Outcomes for patients undergoing chemoradiation for cervical cancer are dependent on adherence to radiation therapy (RT). In other diseases, quality of life (QoL) is associated with treatment adherence, but the association between QoL and RT adherence for patients with cervical cancer remains unclear.

METHODS AND MATERIALS: This prospective study included patients undergoing RT for cervical cancer from 2017 to 2021 at an urban safety net hospital. The Functional Assessment of Cancer Therapy-Cervical Cancer Version 4 was used to assess QoL based on 5 subscales (physical, functional, social and emotional, and cervical-cancer specific). The survey was administered at radiation consult, …

Adapting Elements Of Cleft Care Protocols In Low- And Middle-Income Countries During And After Covid-19: A Process-Driven Review With Recommendations, Matthew Fell, Michael Goldwasser, B S Jayanth, Rui Manuel Rodrigues Pereira, Christian Tshisuz Nawej, Rachel Winer, Neeti Daftari, Hugh Brewster, Karen Goldschmied, Collaborators Fernando Almas, Mekonen Eshete, George W Galiwango, Larry H Hollier, Akhter Hussain, Lun-Jou Lo, Paul Salins, Debbie Sell, Amanuel Tafase, Ronald M Zuker

Faculty, Staff and Students Publications

A consortium of global cleft professionals, predominantly from low- and middle-income countries, identified adaptations to cleft care protocols during and after COVID-19 as a priority learning area of need. A multidisciplinary international working group met on a videoconferencing platform in a multi-staged process to make consensus recommendations for adaptations to cleft protocols within resource-constrained settings. Feedback was sought from a roundtable discussion forum and global organizations involved in comprehensive cleft care. Foundational principles were agreed to enable recommendations to be globally relevant and two areas of focus within the specified topic were identified. First the safety aspects of cleft surgery …