Medicine and Health Sciences Commons^™

Genetic Risk Scores For Hypertension And Chronic Kidney Disease In African Americans., Aastha Kakar

Electronic Theses and Dissertations

Hypertension (HT) and chronic kidney diseases (CKD) are complex conditions, disproportionally prevalent among African Americans (AA) and are influenced by multiple genetic as well as environmental factors. Genetic risk scores (GRS) enable the analysis of the combined effects of multiple single nucleotide polymorphisms (SNPs). This study investigates the association of blood pressure (BP) and CKD GRS with BP, hypertension (HT) and CKD; early-onset HT and CKD; and investigates interactions of the GRSs with environmental measures in AA. We observed a significant association between the BP-GRS with HT, SBP and DBP. The odds of HT for one standard deviation (s.d.) increase …

Environmental Exposures And Aging., Daniel Chris Gomes

Electronic Theses and Dissertations

In recent years, research into air pollution has shown that exposure to certain components in air pollution, primarily PM2.5 can accelerate biological aging and thereby lead to increased susceptibility to multiple diseases. We hypothesize that prolonged exposure to air pollutants can result in premature aging leading to extensive tissue dysfunction and susceptibility to diseases. To examine this, we exposed mice to PM2.5 for 9, 15, and 21 days, then measured the telomere lengths, cellular senescence, and histone methylation patterns of multiple cell types. We found consistently increased telomere attrition, cellular senescence and advanced age-consistent histone methylation patterns in groups exposed …

Organizational Change In Saudi Healthcare Settings: Evaluating Organizational And Individual Readiness For Change, And The Mediating Role Of Readiness For Change Between Management Support And Commitment To Change., Sultan Alsaif

Electronic Theses and Dissertations

BACKGROUND: To respond to the constantly changing environment and developments of healthcare, leaders of healthcare organizations have been trying to introduce and implement transformations that allow their organizations to be able to operate effectively and efficiently to meet the shifts in healthcare demand and to deal with new patterns of health issues, comply with the new policies, and to enhance their present in the market. Thus, it is important for managers to determine the level of readiness for implementing organizational changes from to perspectives. These perspectives include organizational readiness for change and individual readiness for change. METHOD: This first manuscript …

Enhancing Adherence To Best Practice Guidelines Related To Pressure Injury Prevention In The Operating Room At A Children's Hospital During Comprehensive Dental Procedures., Alyce Bailey Seaver

Doctor of Nursing Practice Papers

Background: 1,600,000 patients develop a hospital-acquired pressure injury every year, and 23% of these originate during surgery. Research has demonstrated that the incidence of hospital-acquired pressure injuries developing during surgery has risen over the past 5 years. This rise has been attributed to nurse circulators exhibiting poor knowledge regarding best practices for intraoperative patient positioning and intraoperative documentation that does not follow standards of care.

Purpose: This quality improvement project aimed to enhance circulator knowledge on best practices for intraoperative patient positioning and improve documentation of intraoperative patient positioning in the electronic medical record to comply with standards of …

Food Insecurity And Residential Segregation Among Adults In The United States: The National Health And Nutrition Examination Survey 2017- March 2020 Pre-Pandemic Data., Chandre' L. Chaney

Electronic Theses and Dissertations

Food insecurity is when a household has insufficient food supply due to limited economic resources. It is a public health issue that continues to persist. The health, social, and economic impact affects millions of people nationwide. Residential segregation is a primary cause of inequities and health disparities. It shapes the differences in socio-economic conditions between Blacks and Whites living in the U.S. This country is segregated across racial lines in many of our most populated metropolitan cities. Americans worship in different churches, learn in disparate schools, and live in separate neighborhoods. Residential segregation has consequences that impact the economy, professional …

Clinical And Environmental Factors Affecting The Survival Outcomes Among Stage 1a Tn0m0 First Primary Non-Small Cell Lung Carcinoma Patients In The United States., Naiya Patel

Electronic Theses and Dissertations

Background: Lung cancer is the second leading cause of death in the United States (U.S.). The most prevalent histological type of lung cancer is Non-Small Cell Lung Cancer (NSCLC), which has an overall five years survival of 5% if left untreated. Therefore, early treatment of NSCLC is vital to improve overall survival (OS) outcomes. Several factors affect survival outcomes, which can be categorized as modifiable or non-modifiable. The difference in timely receipt of guideline-concordant treatment affects the survival outcomes of patients with stage 1A NSCLC. This dissertation explored factors that affect treatment and survival outcomes among stage 1A NSCLC patients …

Incidence And Determinants Of Hypertensive Disorders Of Pregnancy In The Us: Hospitalization Discharge Rate For Preeclampsia, Eclampsia, And Gestational Hypertensions, 2016-2018., Kahir S. Jawad

Electronic Theses and Dissertations

Background: Hypertension remains one of the most prevalent medical issues in pregnancy. It contributes considerably to maternal and fetal morbidity and mortality, making it one of the most significant public health problems. Although various epidemiological studies have been conducted over the past decades to assess the disease incidence and key risk factors associated with hypertensive disorders of pregnancy, current incidence rates and trends are lacking. This is a novel and significant study because there are no current population-based incidence estimates of hypertensive disorders of pregnancy and their subtypes and very few studies with the power to explore a wide range …

The Role Of E-Liquid Constituents In E-Cigarette-Induced Cardiac Arrhythmia And Autonomic Imbalance., Cory Kucera

Electronic Theses and Dissertations

Introduction. Accumulating evidence indicates that exposure to electronic cigarettes (e-cigs) promotes sympathetic dominance and electrophysiologic instability in the heart, potentially culminating in arrhythmogenesis. E-liquids contain various formulations of nicotine and flavorings, but the effects of specific e-liquid constituents and their concentrations on e-cig-induced autonomic imbalance and electrical dysfunction are unresolved. To that end, we tested the hypothesis that e-cigs modify cardiac autonomic balance and ventricular arrhythmogenesis in mice dependent on e-liquid constituent type and concentration. Methods. Using a crossover design and a serial exposure regimen, ECG-telemetered male C57BL/6J mice underwent whole-body exposure to e-cig aerosols generated from e-liquids containing different …

Postpartum Depression In Jamaica: Exploring The Lived Experiences., Shakeyrah Elmore

Electronic Theses and Dissertations

The purpose of this study was to explore the lived experiences of Jamaican women with postpartum depression (PPD). It is estimated globally, postpartum depression impacts 10-20% of women. In Jamaica, rates exceed global averages, with 26-60% of women experiencing PPD. Untreated maternal depression poses a significant physical, social, and economic threat to Jamaican women, children, and society as a whole. This study affirms that maternal mental health and postpartum depression are global public health concerns. There are limited studies that have examined PPD in Jamaican women, especially qualitatively. This research study utilized a qualitative descriptive approach to examine PPD experiences …

An Analysis Of The Effects Of Certified Electronic Health Records On Organizations And Patients., Picandra Elzie

Electronic Theses and Dissertations

The growing technological advancement of electronic health records can become an issue with quality and electronic patient information exchange if hospitals do not adhere to federal guidelines. It is recommended that hospitals utilize certified electronic health records (EHRs) to receive financial incentives. This certification is supposedly also associated with the quality of the EHR itself. The certification process is criticized for allowing EHR vendors to meet a set of limited functions known in advance. EHRs can affect healthcare quality and electronic health information exchange. This dissertation explored what is known about the effects of certified EHRs on length of stay …

An Evaluation Of Hospital-Based Health Technology Assessment Processes In The United States., Scott Skinner

Electronic Theses and Dissertations

This research study explored the practices of hospital-based health technology assessment (HTA) in the U.S., as experienced by healthcare technology management (HTM) professionals. HTA can play an important role in helping to evaluate health technologies at both the macro (e.g., policy) level as well as at the micro (e.g., institutional) level of the public health ecosystem (C. S. Goodman, 2004). HTA seeks to broadly evaluate the effects, properties, and other impacts of various health technologies (C. S. Goodman, 2004). Common goals of HTA are to evaluate the safety, effectiveness, and cost-benefit of health technologies. A primarily phenomenological approach was used …

Factors Associated With Skin Cancer Prevention: Primary And Secondary Behaviors., Jeanne Ward

Electronic Theses and Dissertations

Skin cancer, seemingly more innocuous than other cancers, maintains the highest incidence among cancers in the United States. While it is treatable early, metastasized melanoma or other carcinomas present severe illness with high mortality rates and disproportionate 5-year survival rates among ethnic/racial groups. Fortunately, most skin cancer is highly treatable when found in the early stages. However, this necessitates prevention tactics to avoid the causative agent, ultraviolet radiation, and regular skin screening to catch the disease in earlier stages. Unfortunately, these tactics are not widely conducted by adults, despite substantial skin cancer awareness. Therefore, motivating people to perform these health …

Adverse Birth Outcomes: Investigating The Role Of Nativity And Perceived Racial Discrimination Among Black Mothers Enrolled In Des Moines, Iowa Healthy Start., Kendria Kelly-Taylor

Electronic Theses and Dissertations

Birth outcomes for Black women in the United States (US) are disproportionately worse in comparison to non-Black women, even when controlling for potential confounders. Existing studies suggest foreign-born (FB) Black women present better birth outcomes in comparison to US-born (USB) Black women. Also, the longer FB Black women live in the US, the more their perinatal health advantage diminishes. Racial discrimination has been hypothesized as a potential reason for this decline. This dissertation investigates the relationship between nativity and adverse birth outcomes while also exploring how the reporting of racial discrimination impacts birth outcomes among FB and USB Black mothers …

Our Story, Our Song: Assessing And Addressing Black Women's Healthcare Experiences., Jason Deakings

Electronic Theses and Dissertations

Despite advancements in medicine and health sciences, health disparities and declining life expectancy persists among Black women in the United States. Researchers and non-traditional healthcare providers suggest alternative healing (e.g., music and Sister Circles) and research methodologies to achieve a culturally conscious, traumainformed, quality, and holistic care and practice. The intersecting identities and cultural responsibility of Black women highly influences the barriers and facilitators on the uptake of healthcare services. Utilizing a community engaged research approach, this qualitative study assessed the healthcare experiences, as well as the role of music in the lived and retold experiences of Black women navigating …

The Association Of Long Working Hours And The Use Of Prescription Sedatives Among U.S. Workers., Emmanuel Ezekekwu

Electronic Theses and Dissertations

BACKGROUND: Meeting the needs of a round-the-clock and globalized society has led to an increase in long working hours. This trend has been accompanied by a corresponding rise in sleep disorders and subsequent use of sedating medications. Overtime hours have been associated with adverse health outcomes such as cardiovascular diseases, symptoms of psychological distress, and health behaviors, including risky intake of alcohol and smoking. Hence, the main objectives of this three-paper dissertation were to examine the multi-faceted relationship between working hours, the use of prescription sleep aids, the onset of psychological distress, and the use of health care services. METHODS: …

The Role Of Mmp-3 In Copper Oxide Nanoparticle-Induced Pulmonary Inflammation And Fibrosis., Yuanbao Zhang

Electronic Theses and Dissertations

Copper oxide nanoparticles (Nano-CuO) are wildly used in medical and industrial fields and our daily necessities. However, the biosafety assessment of Nano-CuO is far behind their rapid development. This study was to investigate the potential mechanisms underlying Nano-CuO-induced pulmonary inflammation and fibrosis, especially to determine whether Nano-CuO exposure could dysregulate MMP-3, an important mediator in pulmonary fibrosis, and its roles in Nano-CuO-induced pulmonary inflammation and fibrosis. Aim 1 was to investigate whether exposure to Nano-CuO caused MMP-3 dysregulation in lung epithelial cells and the role of MMP-3 in Nano-CuO-induced alteration of cell junction-associated proteins. The potential mechanisms that might be …

The Impact Of Volatile Organic Compound Exposure On Subclinical Biomarkers Of Cardiovascular Injury., Breandon Taylor

Electronic Theses and Dissertations

Pollution has been identified as the leading environmental cause of non-communicable disease and premature deaths globally. Volatile organic compounds (VOCs) are gaseous chemical constituents of pollution derived from a variety of sources, including industrial solvents and byproducts, automobile exhaust, tobacco smoke, cleaning supplies, and personal care products. VOCs are also abundant at various Superfund and Hazardous Waste Sites. Emerging data suggest that VOC exposure is associated with several adverse health outcomes, including cardiovascular disease (CVD). VOCs and their metabolites can potentially damage the endothelial lining of blood vessels, resulting in perturbed vascular function and vascular inflammation. We hypothesize that VOC …

Bayesian Methods For Graphical Models With Neighborhood Selection., Sagnik Bhadury

Electronic Theses and Dissertations

Graphical models determine associations between variables through the notion of conditional independence. Gaussian graphical models are a widely used class of such models, where the relationships are formalized by non-null entries of the precision matrix. However, in high-dimensional cases, covariance estimates are typically unstable. Moreover, it is natural to expect only a few significant associations to be present in many realistic applications. This necessitates the injection of sparsity techniques into the estimation method. Classical frequentist methods, like GLASSO, use penalization techniques for this purpose. Fully Bayesian methods, on the contrary, are slow because they require iteratively sampling over a quadratic …

A Mixed Methods Assessment Of Menstrual Hygiene Management And School Attendance Among Schoolgirls In Edo State, Nigeria., Madeline Tomlinson

Electronic Theses and Dissertations

Menstrual hygiene in lower-middle-income countries (LMICs) is limited and has been linked to many health, educational and social effects. However, the prevalence, details, and impact of menstrual hygiene management have not been well characterized in rural and peri-urban settings across Nigeria. The overall purpose of this research was to investigate menstrual hygiene management (MHM) among adolescent schoolgirls in peri-urban areas of Edo State, Nigeria; and to determine the educational consequences associated with poor MHM. MHM was measured using previously validated questions that were adapted after a formative assessment of MHM within the Edo State community. We used a mixed methods …

Models And Algorithms For Trauma Network Design., Sagarkumar Dhirubhai Hirpara

Electronic Theses and Dissertations

Trauma continues to be the leading cause of death and disability in the US for people aged 44 and under, making it a major public health problem. The geographical maldistribution of Trauma Centers (TCs), and the resulting higher access time to the nearest TC, has been shown to impact trauma patient safety and increase disability or mortality. State governments often design a trauma network to provide prompt and definitive care to their citizens. However, this process is mainly manual and experience-based and often leads to a suboptimal network in terms of patient safety and resource utilization. This dissertation fills important …

Quality Improvement: Piloting A Pediatric Obesity Prevention Screening Tool And Intervention In A Family Practice Setting., Erin Shaye Semeyn

Doctor of Nursing Practice Papers

Background: In the United States today, nearly one third of children fall into the category of overweight or obese. Because it is extremely difficult to treat childhood obesity once it occurs, prevention is the optimal approach to childhood overweight and obesity (Brown & Perrin, 2018; Cooper & Mandel, 2020). An ideal time to address obesity prevention health behaviors is during pediatric primary care visits. Since the COVID-19 pandemic began in the United States in 2019, visits to primary care offices, including visits to an urban university-based family practice clinic in Kentucky, dropped as some pediatric patients and their caregivers worried …

A Policy Project: Implementing Safe Firearm Storage Legislation In Kentucky., Maggie M. Wiser

Doctor of Nursing Practice Papers

Ensuring the safe storage of firearms in the home is a research-supported method of reducing the incidence of firearm injury and death, specifically unintentional injury and self-harm in the pediatric population. The American Academy of Pediatrics recommends keeping all firearms stored locked, unloaded, and separate from ammunition. While evidence shows that implementing laws regulating the storage of firearms can be effective to reduce morbidity and mortality, the state of Kentucky currently has no such regulations. For this DNP project, John Kingdon’s Multiple Streams Framework was used as a guideline for policy analysis with the intention of identifying opportunities to advocate …

Ecological Differences In The Associations Between Air Pollution, Greenness, And Risk Of Stroke: The Regards Study., Daniel W. Riggs

Electronic Theses and Dissertations

The adverse health effects of air pollution have long been recognized, with the majority of morbidity and mortality due to its effects on the cardiovascular system. Alternatively, living in areas with higher greenness has been found to be beneficial to a wide range of health outcomes. However, few studies have considered that these relationships may vary depending on the surrounding ecosystem. The purpose of this dissertation was to examine the effects of long-term exposure to air pollution and greenness on incidence of stroke, and how these relationships vary with the major ecological regions of the United States. We utilized the …

Environmental Noise Exposure And Its Association With Elementary Standardized Testing Scores And Adult Mental Ill-Health In Louisville, Kentucky., Lindsey Adelle Wood

Electronic Theses and Dissertations

Background and Aim: The current body of literature on the associations of environmental noise exposure with varying psychological outcomes is inconclusive, with many conflicting findings. Limitations include exposure measurement error and lack of investigation of effect modification by important factors. This dissertation aims to expand on the current understanding of these relationships by limiting exposure measurement error and by assessing effect modification. Methods: We estimated the distribution of total environmental noise in Louisville, Kentucky for several time-periods using land use regression (LUR) methodologies. Additionally, through multiple regression models, we estimated the association of environmental noise during relevant time-periods with childhood …

“…You Can't Unknow It, It's A New Reality": A Case Study Exploring A Social Justice Public Health Intervention's Impact On Critical Consciousness Development In Youth., Monique Williams

Electronic Theses and Dissertations

Even though public health purports to be rooted in social justice, it is not clear how social justice frameworks are integrated in public health research and intervention. The discipline focuses on groups/populations on the margins, without integrating the social and political factors that cause marginalization into the intervention. Seeing communities, and individuals, as assets and experts in their own experiences is key to population-level health improvement. Particularly for public health youth intervention, how youth are labeled and engaged in social change is critical to their healthy development. While public health lags in practically applying asset-based approaches to youth intervention, research …

Multicomponent Approach To Delirium Prevention In The Acute Care Setting: An Evidence-Based Quality Improvement Project., Kelley James

Doctor of Nursing Practice Papers

Background: Acutely ill, hospitalized individuals are at an increased likelihood of developing delirium. Between 30-35% of those patients admitted to the hospital will develop delirium, and as a result, these individuals will face an increased risk of mortality, adverse medical events, restraint usage, and incur a more extended hospitalization. The literature supports early screening utilizing the Confusion Assessment Method (CAM) tool and nurse-driven, multicomponent interventions to aid in preventing its development.

Environment: This project was implemented in a long-term, acute care facility specializing in patients requiring long-term mechanical ventilation, advanced wound care, pulmonary and respiratory care, and the rehabilitation of …

An Evaluation Of Covid-19 Vaccination Rates Of The Patients At The Kentucky Racing Health Services Center., Aditya Mehta

College of Arts & Sciences Senior Honors Theses

COVID-19 vaccines have been widely available to the U.S. public since early 2021. However, vaccination rates still vary considerably across geographical areas and different populations. The objective of this study was to research overall vaccination rates against COVID-19 for Latinx patients at the Kentucky Racing Health Services Center (KRHSC). Vaccination and booster data was collected from June to December 2021 for all unique patients visiting the center. It was initially hypothesized that these rates of vaccination and booster doses for the KRHSC patients would be lower than the data reported by Kentucky and Jefferson County. After a retrospective review, the …

Hiv And The African American Church: Millennial Faith Leader's Perspectives., Kelsey Leann Burton

Electronic Theses and Dissertations

African Americans are disproportionately impacted by HIV compared to other racial groups. Stigma surrounding HIV has created challenges for effective HIV prevention and stigma reduction programs. The African American church has been criticized for its slow and stigmatizing response to the HIV epidemic. Despite this, African American faith leaders play significant roles in guiding the perspective of the community. Numerous studies examine African American pastors’, faith leaders’, and ministers’ perspective about HIV and other HIV-related topics. However, there is no research that specifically examines young African American pastors’ perspectives of addressing HIV, stigma, and prevention. The purpose of this dissertation …

Public Health Contagion Of White Supremacy: Examining The Pipeline Of Attitudes About Racism And Racial History Education Among High School Students., Trinidad Jackson

Electronic Theses and Dissertations

We are living in compounded states of upheaval. Violence and exemption from it across socioecological levels have shaped how humans survive, thrive, and die. While different violence typologies exist, the U.S., prioritizes interpersonal violence as its primary target of intervention, often through structural means that foster and reinforce interpersonal violence. The omission of structural and cultural agents and outcomes of violence allows perpetrators to infiltrate and reproduce savage, dehumanizing ideologies in perpetuity. Instead of sustaining societal pillars that oppress and destroy, we must fertilize public health research, practice, and sociopolitical activism with pillars that both inform and activate liberatory consciousness …

Understanding Public Emergency Preparedness Before And During The Coronavirus Outbreak: Implications For Effective Public Health And Risk Communication., Raphael Adjetey Fumey

Electronic Theses and Dissertations

The COVID-19 pandemic has resulted in a dramatic loss of human lives globally and presents an unprecedented challenge to public health, the world of work, and our food systems. The social and economic disruption caused by the COVID-19 pandemic is devastating, putting several millions of people at risk of falling into extreme poverty, with over 500 million people being undernourished. It is evident from the data on COVID-19 cases, deaths, and hospitalizations that the United States is the worse hit country, which can be attributed to the lack of preparedness at the individual, environmental, and government levels. This study applied …