Medicine and Health Sciences Commons^™

Implementation Of A Decision Aid To Increase The Rate Of Routine Breast Cancer Screening Among Women Between 50 To 74 Years Old At A Federally Qualified Health Center, Dana Mars

Doctor of Nursing Practice Scholarly Projects

Background: Breast cancer is the most prevalent form of cancer in the U.S. Cancer screenings can result in prompt treatments and positive health outcomes. Disparities in screening rates are prevalent among vulnerable populations. At a Federally Qualified Health Center (FQHC), where the project occurred, the rate of breast cancer screening in 2021 (64%) was lower than the target set by the Healthy People 2030 (77%). This quality improvement project aimed to increase the rate of routine breast cancer screening among women aged 50-74 years old in the FQHC.

Methods: Previous studies have reported that decision aids on breast cancer screening …

Introduction Of Hiv Point-Of-Care Testing In Adolescent Primary Care: A Quality Improvement Project, Jennifer Quinn Belfry

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: HIV, first identified in 1981, remains a persistent public health problem affecting 1.1 million Americans today. Detection is a critical first step to ending the HIV epidemic and the CDC recommends universal HIV screening for all patients 13-64 years of age regardless of risk factors. HIV screening rates are suboptimal especially in adolescent and young adult populations who face unique barriers to screening. The aim of this project was to improve HIV screening rates in adolescent and young adult patients at a large, urban FQHC.

LOCAL PROBLEM: In the state of Rhode Island, 1 in 10 persons living with …

Building An Infrastructure For Down Syndrome Care, Kate E. Martin

Instructional Design Capstones Collection

People with intellectual disabilities experience greater obstacles in attaining their full health potential. The most common identifiable cause of intellectual disability is Down syndrome. Established in September 2021, the Down Syndrome Program at The Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (UNLV) aims to meet the healthcare needs of members of the Southern Nevada community with Down syndrome and their families. However, there is currently no infrastructure in place in Southern Nevada to provide Down syndrome care, or clinical services dedicated to individuals with the condition. This work discusses options that were explored to develop …

Neighborhood And Environmental Predictors Of At-Risk And Problem Gambling In Massachusetts, Kendra E. Pugh

Graduate Doctoral Dissertations

Despite the widespread impact and negative effects of problem gambling (PG), limited attention has been paid to the environment where PG occurs. This study investigated the relationship between gambling on lottery and the zip code where gambling occurs, as well as the influence of individual-level characteristics that predict at-risk or problem gambling (AR/PG), among Massachusetts residents. A GIS analysis was conducted to identify vulnerable areas based on neighborhood characteristics, lottery sales, and AR/PG. Overall, residents of disadvantaged areas did not spend more money on lottery or have more lottery agents than residents of less disadvantaged areas. Some indicators of disadvantage …

The Role Of Physical Activity And Gender As Moderators For The Relationship Between Insomnia And Depression, Claire E. Wickersham

Graduate Doctoral Dissertations

Objective: The aim of this study was to examine the association between insomnia and depressive symptoms among middle-aged and older adults and to investigate whether gender or physical activity moderates this relationship. Method: This study used nationally representative data from the 2016 and 2018 waves of the Health and Retirement Study (HRS) and binomial logistic regression was used to estimate models. Regression models for risk of depressive symptoms (2018) were based on a longitudinal model with time-lagged indicators of insomnia, levels of physical activity, and covariates (2016). Results: Analyses showed that participants who reported having insomnia in 2016 were more …

Health Equity & Obesity Management: An Improvement Project In A Federally Qualified Healthcare Center In Central Harlem, Brianna Bouchez

Doctor of Nursing Practice Scholarly Projects

Description of the problem: Obesity is a growing healthcare problem worldwide with extraordinary costs to the individual's health and the healthcare system. Individuals most affected by obesity include socioeconomically disadvantaged individuals, often with limited resources to seek specialized care.

Available knowledge: Various weight-loss interventions exist but access and success rates vary. Weight loss is often modest and additional factors such as social determinants of health, health literacy, and patient motivation are all factors important to the success of an intervention.

Specific Aims: The purpose of this quality improvement project was to improve self-regulatory weight loss behaviors and increase weight loss …

Senior Center Response To Covid-19: Mid-Year Operations 2021, Ceara Somerville, Caitlin Coyle, Jan Mutchler

Center for Social and Demographic Research on Aging Publications

Senior centers/COAs in Massachusetts remained largely operational through the height of the COVID-19 pandemic, and continued to assist older adults in the community. With the introduction of a vaccine, return to ‘normal’ operations has become more feasible. By mid-2021, senior centers were returning to some in-person operations and continued adaptations for safety, including mask-wearing, limiting capacity, fewer walk-ins, and increased hand sanitization availability.

Senior Center Response To Covid-19: Involvement With Vaccine Distribution, Ceara Somerville, Caitlin Coyle, Jan Mutchler

Center for Social and Demographic Research on Aging Publications

In early 2021, access to a COVID-19 vaccine was prioritized for older adults and people with multiple co-morbidities. Between high demand and emerging supply, and new systems for booking a vaccine appointment, many people had challenges getting an appointment. Senior centers across the state became a crucial resource for access to the vaccine and additional information about its efficacy and safety.

Rapid Cycle Quality Improvement (Rcqi) Approaches For Developing The Capacity Of Community- Based Organizations To Address Covid-19 And Cancer Disparities In Latinx Communities, Lorna Rivera, Jarvis Chen, Jaime Vallejos

Gastón Institute Publications

No abstract provided.

It's The Little Things: A Community Resource For Strengthening Social Connections, Caitlin Coyle, Shayna Gleason, Cindy Bui

Center for Social and Demographic Research on Aging Publications

Now, more than ever, it is imperative that we prioritize connection for ourselves and the people around us. The global COVID-19 pandemic and the national reckoning with systemic racism has made people more aware and appreciative of their relationships and has made some painfully aware of how distant and disconnected they are. While the evidence is clear that social isolation is bad for health and well-being, the evidence base of solutions is far less so. Thus, this report sought to harness the energy, creativity, and progressive thinking of cities and towns in Massachusetts by documenting their efforts to keep people …

Critical And Creative Thinking Practices And Principles To Improve Audiovisual Production, Paula Andrea Avila Jimenez

Critical and Creative Thinking Capstones Collection

The purpose of capstone is to address the application of Critical and Creative Thinking practices and principles to improve audiovisual production that intends to communicate complicated health information. This paper synthetized the application of the principles of the Habits of Mind (HOM) as Critical and Creative Thinking tool to improve audio-visual (AV) production. The project that spurred this specific question was my experience working as a Research Assistant (RA) at the Dana Farber Cancer Institute (DF) where I developed videos and booklets to help Latino patients to understand the purposes of chemotherapy in advanced cancer. Five principles of Habits of …

Responding To Covid-19: How Massachusetts Senior Centers Are Adapting, Ceara Somerville, Caitlin Coyle, Jan Mutchler

Center for Social and Demographic Research on Aging Publications

The COVID-19 pandemic has swept the United States with force and speed. Massachusetts is one of the hardest hit states in nation, with over 120,000 cases and over 8,500 deaths to date. Local governments across the Commonwealth have had to work quickly to meet the needs of their constituents in a constantly changing environment. With older adults being at high risk of contracting COVID-19, having more severe symptoms, and at higher risk of dying from the disease, special efforts are warranted to ensure that they are supported in their efforts to maintain physical distance while meeting needs for food and …

The Relationship Between Physical Activity And Emotional Intelligence In Adolescents, Marie C. Gabour

Graduate Doctoral Dissertations

PURPOSE: We assessed the association of Physical Activity (PA) measures on overall Emotional Intelligence (EI) and domains of EI: Intrapersonal, Interpersonal, Adaptability, General Mood, and Stress Management in adolescents.

METHODS: Cross-sectional and two-year follow up analyses were conducted relating EI to PA measures using the National Longitudinal Survey of Children and Youth in adolescents between 10- 13 years. EI score was measured by using a validated the youth version of the Emotional Quotient Inventory; PA was self-reported. Regression analysis adjusted for age, gender, household annual income, and health status and was summarized using regression coefficients. A test of linear trend …

Measuring The Impact Of Covid-19 On Older Adults In Massachusetts, Ceara Somerville, Jan Mutchler, Caitlin Coyle

Center for Social and Demographic Research on Aging Publications

The spread of COVID-19 across the United States has affected every facet of life since early 2020. According to the Centers for Disease Control and Prevention (CDC), there are currently over 4 million cases across the nation and over 146,000 deaths from the virus. Massachusetts has been one of the states hit hardest, with over 100,000 confirmed cases and more than 8,000 deaths to date. The Commonwealth currently trails only New York and New Jersey in number of deaths. While cases surge around the country, Massachusetts has seen some leveling out of positive cases since the beginning of July. Though …

Covid-19 And Latinos In Massachusetts, Lorna Rivera, Phillip Granberry, Lorena Estrada-Martínez, Miren Uriarte, Eduardo Siqueira, Ana Rosa Linde-Arias, Gonzalo Bacigalupe

Gastón Institute Publications

This report focuses on the Latino population of Massachusetts and uses 2014–2018 American Community Survey (ACS) demographic data to explore both Latinos’ vulnerability to COVID-19 infection and the key predictive factors. We explore what is known about the social determinants of health previously identified as critical to understanding the spread and differential infection rates of COVID-19 across populations—for example, opportunities for infection due to employment and housing conditions—and how these apply to the Latino population in Massachusetts. We also briefly explore those factors that lead to COVID-19 severe illness and possibly death from the disease, including the age of the …

Food And Health: Promoting The Importance Of Maintaining A Healthy Diet To Minimize Disease In Individuals At Greatest Risk, Nadjia Edwards

Critical and Creative Thinking Capstones Collection

Diets high in calories, saturated fats, sodium, and added sugars can lead to adverse health events such as; heart disease, diabetes, obesity, high blood pressure, stroke, osteoporosis, and certain cancers. Maintaining a healthy diet can help decrease this potential, but those experiencing food insecurity remain at risk as they may have challenges accessing and affording healthier items. Quality may be sacrificed for quantity leading to the purchasing of food that increases these health risks. Initiatives have been developed to address these obstacles, but aren’t widely utilized. This underuse can be due to a lack of emphasis on the importance of …

Climate Change And Human Rights: Shaping The Narrative For Reflexive Responses From Civilization’S Leadership To Counter And Abate Climate Change And Enhance The Role Of Human Rights In The Rule Of Law, Michael Donlan

New England Journal of Public Policy

This article offers a bold new legal process for enhancing and upgrading the rule of law to enable civilization to cope with and counter the mounting damage and injustice caused by climate change. Climate change, once an unimaginable threat, is now a brutal, ubiquitous game changer that is leading inexorably to the demise of all humanity. Only by enhancing the rule of law and melding international law with domestic law can civilization fashion a coherent, global action plan for survival.

For almost three centuries greenhouse gases have been emitted around the world by the burning of fossil fuel, and—most alarming—these …

Por Ahí Dicen: Sexual Health Promotion Campaign In A Puerto Rican Community, Isabella M. Antenucci, Yessica Guzman, Phillip Granberry, Maria Idali Torres

Gastón Institute Publications

The purpose of this study was to assess Puerto Rican mother’s levels of exposure to the Spanish media campaign launched by Por Ahi Dicen, and to assess the identification mothers had with these stories. The methodology consisted of in-person survey interviews of 210 Puerto Rican mothers residing in the city of Springfield, Massachusetts. The study used a sub-set of data taken from these interviews and analyzed using Microsoft Excel and Stata15. The major finding of this study showed that the mothers who regularly watched television in the 90-day campaign time frame were more exposed to the campaign than they were …

“I Don’T Know If I Have The Courage”: Reproductive Choices In Times Of Zika, Ana Rosa Linde Arias, Elisa Tristan-Cheever, Grace Furtado, Eduardo Siqueira

Gastón Institute Publications

Neste estudo transnacional, pretendemos fornecer informações sobre as opiniões e atitudes das mulheres em relação aos seus direitos reprodutivos durante a epidemia do Zika. Mulheres de diferentes nacionalidades e etnias foram recrutadas em vários locais do Brasil, Porto Rico e Estados Unidos. Foram realizadas entrevistas semiestruturadas que sugerem que as decisões reprodutivas dos participantes estavam intimamente relacionadas às convicções pessoais e crenças culturais, e suas ações e pensamentos foram incorporados em suas normas socioculturais. A maioria das mulheres entrevistadas comunicou que é preciso coragem para tomar a decisão extrema, emocional e esmagadora de fazer um aborto. Os achados deste estudo …

Knowledge And Attitudes Regarding Cervical Cancer Screening Among Women Living With Hiv/Aids In Malawi: A Cross-Sectional Study, Jasintha Mtengezo

Graduate Doctoral Dissertations

Cervical cancer is the third most frequent cancer among women worldwide and about 265,672 women die from the disease annually. Abnormal cervical cells caused by human papillomavirus are more common in HIV-positive women than in HIV-negative women due to their compromised immune system. Malawi, in Sub-Saharan Africa, is one of the countries with the highest rates of cervical cancer and HIV in the world. The incidence of cervical cancer and deaths can be reduced by 80% if women go for screening. There are limited studies about cervical cancer screening behavior, level of knowledge and attitudes regarding cervical cancer and screening …

Women’S Lives In Times Of Zika: Mosquito-Controlled Lives?, Ana Rosa Linde, C. Eduardo Siqueira

Gastón Institute Publications

Zika virus infection during pregnancy is a cause of congenital brain abnormalities. Its consequences to pregnancies has made governments, national and international agencies issue advices and recommendations to women. There is a clear need to investigate how the Zika outbreak affects the decisions that women take concerning their lives and the life of their families, as well as how women are psychologically and emotionally dealing with the outbreak. We conducted a qualitative study to address the impact of the Zika epidemic on the family life of women living in Brazil, Puerto Rico, and the US, who were affected by it …

Intergenerational Financial Exchange And Cognitive Well-Being Among Older Adults In China, Ping Xu

Graduate Doctoral Dissertations

Although cognitive loss is part of normal aging, it has unfavorable consequences for older individuals, their family, as well as society. The prevalence of mild cognition impairment is expected to go up in China. How to maintain normal cognition for a longer period of time and to delay impair process is an emerging concern for older Chinese adults. Unlike Western countries, China lacks of formal support system. Intergenerational support between older parents and adult children is a predominant resource when they are in need. This study examines how intergenerational financial exchanges between older parents and their adult children is related …

Teaching For Epidemiological Literacy: Description, Prescription, And Critical Thinking, Peter J. Taylor

Working Papers on Science in a Changing World

This working paper describes contrasting ideas for a sequence of topics as presented to students in a graduate course on epidemiological literacy. The premise of the pedagogical approach is that researchers develop their epidemiological thinking and practice over time through interactions with other researchers who have a variety of in-practice commitments, such as to kinds of cases and methods of analysis, and not simply to a philosophical framework for explanation. In descriptively teasing out what epidemiologists do in practice through a topic-by-topic presentation, I am prescriptively encouraging discussants to draw purposefully from across the range of topics and contrasting …

School Nurses' Awareness And Attitudes Towards Commercial Sexual Exploitation Of Children: A Mixed Methods Study, Hannah E. Fraley

Graduate Doctoral Dissertations

Human trafficking is a global problem and a multi-billion dollar industry. Most victims are women and girls and more than half are children. In the United States, many at risk youth continue to attend school with school nurses on the frontlines. Using the Peace and Power Conceptual Model, a mixed methods study was conducted to explore their awareness, attitudes, and role perceptions in prevention of commercial sexual exploitation of children (CSEC). Two factors related to increased awareness, and positive attitudes and role perceptions to prevent of CSEC included prior exposure to working with vulnerable students, and prior education about CSEC. …

Improving Patient Outcomes: Early Mobilization Of Intensive Care Patients, Casey Teves

Honors College Theses

Early mobilization of intensive care patients has gained the interest of researchers within the last few years due to its safe and practical application and numerous benefits it can provide. Reviewing the literature on this topic reveals the substantial benefits of early mobilization and the detrimental effects of prolonged bed-rest. Despite recent evidence proving that this practice will increase quality of care, many intensive care units still utilize bed-rest as a standard. Understanding the barriers and facilitators of this change can help transform this research into practice and improve patient care outcomes. Nurses are the key facilitators in the initiative …

How We Care: Provider Perspectives On Services For Vietnamese Elderly In Boston’S Dorchester Neighborhood, Loan Thi Dao

Institute for Asian American Studies Publications

The need for culturally competent care for the elderly is of growing concern for Asian American and Pacific Islander (AAPI) communities and health providers. In 2012, a preliminary study was conducted to ascertain the perspectives of service providers about the cultural competency of services for elderly Vietnamese Americans in Boston, Massachusetts. The study includes interviews with key informants representing the five major community health centers (CHC) programs in Boston’s Vietnamese enclave in the Dorchester neighborhood. Secondary data collection from field observations and informal communications with other staff and elderly clients also inform the findings. While the study recognizes the value …

External Validation And Cost Effectiveness Analysis Of The Non-Lb Framingham Cardiovascular Disease Risk Assessment Algorithm In The Atherosclerosis Risk In Communities Dataset, Jacob K. Kariuki

Graduate Doctoral Dissertations

Background: In recent years, non-Laboratory based (non-LB) risk assessment algorithms have been developed to facilitate absolute cardiovascular disease (CVD) risk assessment in resource constrained primary care settings. The non-LB Framingham algorithm, which substitutes body mass index (BMI) for lipids, has the best discrimination and calibration among the published algorithms, but its external validity and cost-effectiveness have not been determined.

Purpose: External validation and comparative effectiveness analysis of the non-LB versus laboratory based (LB) Framingham algorithm in a racially diverse population, and simulated cost-effectiveness analysis focusing on a black sample.

Methods: Secondary data analysis was performed using the Atherosclerosis Risk in …

Identification And Use Of Indicator Data To Develop Models For Marine-Sourced Risks In Massachusetts Bay, Marin M. Kress

Graduate Doctoral Dissertations

The coastal watersheds around Massachusetts Bay are home to millions of people, many of whom recreate in coastal waters and consume locally harvested shellfish. Epidemiological data on food-borne illness and illnesses associated with recreational water exposure are known to be incomplete. Of major food categories, seafood has the highest recorded rate of associated foodborne illness. In total, the health impacts from these marine-sourced risks are estimated to cost millions of dollars each year in medical expenses or lost productivity. When recorded epidemiological data is incomplete it may be possible to estimate abundance or prevalence of specific pathogens or toxins in …

‘They Can’T Report Abuse, They Can’T Move Out. They Are At The Mercy Of These Men’: Exploring Connections Between Intimate Partner Violence, Gender And Hiv In South African Clinical Settings, Courtenay Sprague

Conflict Resolution, Human Security, and Global Governance Faculty Publication Series

This qualitative study captured South African female health provider perspectives of intimate partner violence in female patients, gender norms and consequences for patients’ health. Findings indicated female patients’ health behaviours were predicated on sociocultural norms of submission to men’s authority and economic dependence on their partners. Respondents described how men’s preferences and health decision-making in clinics affected their patients’ health. Adverse gender norms and gender inequalities affected women’s opportunities to be healthy, contributing to HIV risk and undermining effective HIV management in this context. Some providers, seeking to deliver a standard of quality healthcare to their female patients, demonstrated a …

Correlates Of Awareness And Use Of The Hubway Bike Share Program And The Association With Weight Status, Lawrence H. Stahley

Graduate Masters Theses

Objective: The purpose of this study was to examine the correlates of awareness and use of the Hubway bike share program and assess the relationship between use and rates of overweight or obesity. Methods: Two-hundred, fifty-six students, faculty, and staff from the University of Massachusetts Boston (UMB) participated in this cross-sectional study. Participants completed an on-line survey during the fall of 2014 that assessed socio-demographics, behavioral and physical activity characteristics, Hubway awareness, and use of Hubway and personal bikes. Multivariable regression models were conducted to evaluate associations between socio-demographic and behavioral factors, and Hubway awareness, use, and the relationship with …