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Full-Text Articles in Medicine and Health Sciences
Psychometric Evaluation Of A Perceived Barriers To Medication Adherence Instrument And Association Between Perceived Barriers And Patient Characteristics, Lynn Andreae
All ETDs from UAB
Medication adherence is an important component of diabetes management, yet nonadherence is common and has substantial patient and economic costs. In order to achieve meaningful improvements in medication adherence, clinicians and researchers need good ways of both identifying those at risk of nonadherence and ascertaining the specific reasons driving nonadherence in those patients. Current options for self-reported medication adherence are limited in their vulnerability to response bias, which may lead to overestimation of adherence. A measure that assesses perceived barriers to medication adherence may be a useful alternative, as it may identify patients at risk of nonadherence while reducing socially …
Understanding Disparities In Hypertension Treatment Cascade And Validating Blood Pressure Measurement Among Persons Living With Or At Risk For Hiv, Jessica Blair
All ETDs from UAB
In the United States, 44% of adult women >18 years have hypertension. Although non-Hispanic Black adults were more likely to be aware of and treated for hypertension compared to non-Hispanic White adults, Black individuals had the highest prevalence of uncontrolled hypertension. Persons living with HIV have a higher prevalence of hypertension, which is a major modifiable risk factor for cardiovascular disease. Similar to the geographic distribution of hypertension in the US, people living in the South have higher incidence of both hypertension and HIV diagnoses compared to other US regions. Furthermore, accurate diagnosis of hypertension and initiation of treatment is …
Predictive Modeling Using Clinical Data And Compositional Microbiome Data, Li Zhang
Predictive Modeling Using Clinical Data And Compositional Microbiome Data, Li Zhang
All ETDs from UAB
This dissertation focuses on developing predictive modeling using data from two areas: clinical data and microbiome data. Compositional data in real life are mainly represented by relative proportions. With the advancement of next-generation sequencing (NGS) technology, researchers can now collect a large volume of metagenomic sequencing data, which is valuable for investigating associations between the microbiome and host diseases. Current methods for dealing with such data are either constrained by generalization or limited by application. In the first part, to address this, we propose Bayesian compositional generalized linear models for analyzing microbiome data (BCGLM). This model incorporates a structured regularized …
Social Determinants Of Health And Blood Pressure Control In Black And White Us Adults, Oluwasegun Philip Akinyelure
Social Determinants Of Health And Blood Pressure Control In Black And White Us Adults, Oluwasegun Philip Akinyelure
All ETDs from UAB
Black adults in the US have 2 to 3 times higher rates of cardiovascular disease (CVD) mortality compared to White adults. Most of the excess CVD mortality in Black adults has been attributed to their higher prevalence of hypertension and uncontrolled blood pressure (BP). In October 2020, the US Surgeon General published a Call-to-Action to improve hypertension control and identified social determinants of health (SDOH) as a major contributor to Black:White disparities in hypertension control. Prior research has showed that SDOH are associated with excess hypertension risk among Black compared with White adults, but data on their association with BP …
Understanding How Multi-Level Factors Influence Cancer Clinical Trial Enrollment Decisions By Patients Living In Higher Disadvantaged Areas, Nicole Caston
All ETDs from UAB
Cancer clinical trials offer current patients with cancer new treatment and novel interventions to treat their cancer, while advancing the care of future patients. Clinical trials test new drugs against the standard of care to determine drug efficacy and safety. There are many groups of patients who are either unrepresented or underrepresented in cancer clinical trials and there is a plethora of reasons they are not represented. One underrepresented population of interest is patients with cancer who live in highly disadvantaged neighborhoods. Previous research found that when compared to patients who live in areas of lower disadvantage, patients living in …
Identifying The Factors Influencing Hiv Testing And Safe Sex Practices: An Ecological Approach, Shekwonya Evelyn Samuel
Identifying The Factors Influencing Hiv Testing And Safe Sex Practices: An Ecological Approach, Shekwonya Evelyn Samuel
All ETDs from UAB
Introduction: HIV (Human Immunodeficiency Virus) is a sexually transmitted infection (STI) that is still a major health issue in the United States and the world. Emerging adults are more likely to engage in risky sexual behaviors such as multiple sexual partners and unprotected sex. HIV testing contributes to ending the HIV epidemic by identifying at-risk individuals and promoting early diagnosis.Methods: Secondary data analyses of the City Health II dataset were conducted to 1) identify the association between HIV testing and risky sexual behaviors among Black/African American emerging adults ages 18-25 years living in Birmingham metro area, 2) use social network …
Neighborhood Disadvantage, Sleep Quality, And Shift Work: The Reasons For Geographic And Racial Differences In Stroke (Regards) Study, Rebecca Williams
Neighborhood Disadvantage, Sleep Quality, And Shift Work: The Reasons For Geographic And Racial Differences In Stroke (Regards) Study, Rebecca Williams
All ETDs from UAB
The first study used data (n=14,609) from the REasons for Geographic and Racial Differences in Stroke (REGARDS) to test the associations among Area Deprivation Index (ADI) and self-reported total sleep time (TST), sleep efficiency (SE), and number of restless nights within the last week. The second study (n=12,496) tested the associations among ADI, shift work status, and restlessness.Regression models were fit to examine associations between ADI and SE or TST or restlessness, as well as assess the relation between ADI and SE in clinically meaningful categories. Moderation analyses indicated whether sex or race impact the association between ADI and sleep. …
Parenting Through A Pandemic: A Mixed Methods Analysis Of Covid-19’S Impact On Stress, Coping, Resiliency, And Mental Health Among University Student-Parents, Jordin Ann Lane
All ETDs from UAB
The COVID-19 pandemic has taken a toll on the mental health of university students and continues to have a profound impact to this day. The transition from in-person traditional courses to online courses and campus closures, coupled with feelings of isolation, fear of contracting COVID-19, and uncertainty of the future has further intensified the mental health of college students. The effects of federal and state regulations, such as stay-at-home orders, influenced the mental health and general well-being of many Americans, specifically those who take on a dual role as a student and a parent. Unfortunately, literature pertaining to the effects …
The Genetic Epidemiology Of Complex Lung Diseases, Ava Claire Wilson
The Genetic Epidemiology Of Complex Lung Diseases, Ava Claire Wilson
All ETDs from UAB
This research utilizes precision medicine techniques to advance our understanding of Chronic Obstructive Pulmonary Disease (COPD) and Idiopathic Pulmonary Fibrosis (IPF) with the overall goal of improving the etiology of and identifying molecular targets and pathways in COPD and IPF to help improve patient outcomes. We aimed to 1) identify novel drug targets and uncover potential mechanisms by which pirfenidone and nintedanib attenuate fibrosis by performing an integrative ‘omics analysis of transcriptomics and proteomic responses to TGFb1-stimulated lung fibroblasts; 2) define a skeletal muscle fiber shift phenotype in both males and females with COPD and begin to disentangle underlying mechanisms …
Perceptionf Of Multipurpose Prevention Technologies Aimed At Hiv/Sti/Unintended Pregnancy Among African American Women In The Deep South, Kristina Wilbekin Walker
Perceptionf Of Multipurpose Prevention Technologies Aimed At Hiv/Sti/Unintended Pregnancy Among African American Women In The Deep South, Kristina Wilbekin Walker
All ETDs from UAB
Sexual and reproductive health (SRH) needs for women are not being met globally. In addition to efforts towards providing widespread access to currently available contraceptives and sexually transmitted infection (STI) treatment or prevention products, another focus is the development of multipurpose prevention technologies (MPTs). These MPTs are combination methods that prevent pregnancy, and protect against HIV and/or additional STIs. The objective of this dissertation research was to assess factors related to sexual and reproductive decision-making that may influence interest in MPTs and inform MPT implementation strategies for African and African American (AA) women. The first aim of this research, I …
The Costly Performance Of Strength: An Exploration Of Mental Health Treatment Utilization Among Black Women In The Deep South, Amber N. Martin
The Costly Performance Of Strength: An Exploration Of Mental Health Treatment Utilization Among Black Women In The Deep South, Amber N. Martin
All ETDs from UAB
Introduction: Strength is indoctrinated into the cultural tapestry of Black women, dating back to slavery, and passed down through intergenerational socialization. The incessant need for Black women to be strong diminishes their psychological health leading to poorer quality of life. Further, historical injustices and unethical practices in mental healthcare continue to perpetuate the need for Black women to perform in strength. The performance of strength is one explanation for the grave mental health disparities among Black women offering an opportunity to better understand their mental health needs. This project aims to center Black women within the cultural contextualization of the …
Mediation Analysis Using Marginalized Zero-Inflated Poisson Model, Andrew Sims
Mediation Analysis Using Marginalized Zero-Inflated Poisson Model, Andrew Sims
All ETDs from UAB
Mediation analysis has become exponentially more popular over the last decade as researchers are interested in establishing mechanistic pathways for intervention. Standard statistical methods emphasize quantifying and testing whether a specific exposure impacts a particular health outcome. Mediation analysis addresses the question ‘How is the exposure causing the outcome?’ by examining the extent to which an intermediate variable, called a mediator, influences the relationship between an exposure and an outcome. While multiple mediation strategies exist, the counterfactual approach to mediation allows for mediation effects to be estimated directly with nonlinearities and interactions. The counterfactual approach allows for the effect of …
The Impact Of Diabetes On At-Fault Motor Vehicle Collisions In Older Adults: Visual Function, Medication, And Crash Characteristics, Thomas A. Swain
The Impact Of Diabetes On At-Fault Motor Vehicle Collisions In Older Adults: Visual Function, Medication, And Crash Characteristics, Thomas A. Swain
All ETDs from UAB
Older drivers represent one of the fastest growing age groups of drivers in the United States. Crash risk among older adults, who have the highest prevalence of vision impairment, has been shown to be related to worse visual function. Diabetes mellitus is a chronic health condition affecting more than 23.1 million Americans, and one in three have pre-diabetes. Persons with diabetes are at increased risk of conditions which cause vision loss. Research indicates those with diabetes have higher rates of MVCs. Despite the increased MVC risk among each of these groups, work has yet to evaluate if diabetes modifies the …
Social Vulnerability And Trust Associated With African American Secondary Syphilis Cases Reported In Alabama, United States, 2020-2022, Givanta Tribit
Social Vulnerability And Trust Associated With African American Secondary Syphilis Cases Reported In Alabama, United States, 2020-2022, Givanta Tribit
All ETDs from UAB
Introduction: Syphilis is a sexually transmitted infection (STI) that can cause serious health problems, including neurological disorders, blindness, and fetal abnormalities. Routine STI screenings can help prevent its spread. Despite effective treatments, syphilis cases have risen sharply in the last decade, particularly among marginalized communities. Understanding the ecological and contextual factors contributing to syphilis incidence could inform prevention efforts and improve healthcare outcomes for all. Methods: Retrospective secondary data analyses, at the county level, from 2020 to 2022, were conducted to assess for mean differences among social vulnerability index (SVI) scores, SVI scores by four primary categories, Black Belt regional …
Modifiable Risk Factors And Subsequent All-Cause And Cause-Specific Late Mortality After Blood Or Marrow Transplanta-Tion (Bmt), Nora Balas
All ETDs from UAB
The objective of this dissertation was to examine the association between modifiable risk factors and subsequent all-cause and cause-specific late mortality among blood or marrow transplantation (BMT) recipients. I analyzed data for participants who were ≥18 years (y) at study participation from the BMT Survivor Study (BMTSS). BMTSS (U01 CA213140, PI: Bhatia) is a cohort study designed to examine the long-term outcome of individuals who survived ≥2y after undergoing BMT between 1974 and 2014, at the University of Alabama at Birmingham, City of Hope, or University of Minnesota. BMTSS also examines outcomes in an unaffected comparison group drawn from the …
Photothermal Desorption Of Volatile Organic Compounds From Buckypaper Sorbents, For Occupational Exposure Assessment, Jacob S. Shedd
Photothermal Desorption Of Volatile Organic Compounds From Buckypaper Sorbents, For Occupational Exposure Assessment, Jacob S. Shedd
All ETDs from UAB
Volatile organic compounds (VOCs) are a common source of occupational exposures. To prevent adverse health effects in employees, industrial hygienists must regularly conduct occupational air sampling to ensure exposures remain below regulatory limits. As such, the need for sensitive and reliable exposure assessment methodologies becomes apparent. Currently, diffusive sampling is popular and well-established exposure assessment method amongst professionals. However, its reliance on diffusion-driven mass uptake and chemical extraction, results in limited analytical sensitivity. In response to this, a pre-analytical technology, known as photothermal desorption (PTD), has been in development over the past decade. PTD uses pulses of high-energy light to …
Filtration And Adsorption Performance Of Activated Carbon Fiber: Applications For Respiratory Protection, Margaret C. Summers
Filtration And Adsorption Performance Of Activated Carbon Fiber: Applications For Respiratory Protection, Margaret C. Summers
All ETDs from UAB
Activated Carbon Fiber (ACF) is an adsorbent material that can be used to re-move volatile organic compounds (VOCs) from the air. Unlike granular adsorbents that are currently used in organic vapor respirators, ACF is a self-supporting fiber structure that can be tailored into non-woven forms and can potentially be used to support particu-late filtration. While ACF-containing respirators first appear in patent literature in the 1980s, the use of ACF in respiratory protection has not been widely considered in the PPE market in the intervening years. To develop the concept of an ACF-containing N95 that offers particulate filtration in addition to …
Non-Mean Ambulatory Blood Pressure Monitoring Parameters And Left Ventricular Hypertrophy: Analysis Of Pooled Population- And Community-Based Studies, Swati Sakhuja
All ETDs from UAB
High mean blood pressure (BP) on ambulatory BP monitoring (ABPM) is a strong risk factor for left ventricular hypertrophy (LVH), an early manifestation of hypertension-related cardiovascular disease (CVD). Typically, 48-72 systolic and diastolic BP (SBP and DBP) readings are obtained on a 24-hour ABPM recording. The large number of readings from ABPM allows for the estimation of parameters beyond mean BP that capture level and fluctuation in BP over 24-hours, which may be useful for identifying individuals at high risk for CVD. The measures of BP level other than mean BP obtained from ABPM recording include BP load (percentage of …
Power And Sample Size Calculations For Linear Mixed Models Of Longitudinal Data Using The Kenward-Roger Adjusted Wald Test, Tarrant Oliver Mcpherson
Power And Sample Size Calculations For Linear Mixed Models Of Longitudinal Data Using The Kenward-Roger Adjusted Wald Test, Tarrant Oliver Mcpherson
All ETDs from UAB
The linear mixed model has become a popular technique for the analysis of longitudinal data, but Wald test statistics of fixed effects for these models frequently lack well defined distributions. A common approach to this problem uses the Kenward-Roger adjustment, which attempts to approximate the distribution of the Wald statistic by matching its moments obtained via Taylor expansion to those of an F distribution. However, this approach only matches moments obtained under the null hypothesis of no effect and cannot currently be used to approximate the distribution of the test statistic under some alternative hypothesis. This limitation prevents a straightforward …
Spike-And-Slab Additive Models And Scalable Algorithms For High Dimensional Data Analysis, Boyi Guo
Spike-And-Slab Additive Models And Scalable Algorithms For High Dimensional Data Analysis, Boyi Guo
All ETDs from UAB
There are proposals that extend classical additive models (AMs) to accommodate high-dimensional data (p >> n) using group sparse regularization. However, the sparse regularization may induce excess shrinkage when estimating smooth functions, damaging predictive performance. Moreover, most of these AMs consider an “all-in-allout” approach for functional selection, rendering them difficult to answer if nonlinear effects are necessary. While some Bayesian models can address these shortcomings, model fitting can create a new challenge, scalability. In this dissertation, we propose Bayesian hierarchical additive models to address the previous shortcomings: we consider the smoothing penalty for proper shrinkage of curve interpolation via reparameterization. A …
Multidrug-Resistance, Antibiotic-Associated Acute Kidney Injury, And Poor Disease Prognosis In Community-Acquired Bacterial Pneumonia, Adeniyi J. Idigo
Multidrug-Resistance, Antibiotic-Associated Acute Kidney Injury, And Poor Disease Prognosis In Community-Acquired Bacterial Pneumonia, Adeniyi J. Idigo
All ETDs from UAB
In this dissertation research, I examined the challenges of treating patients with bacterial community-acquired pneumonia (CAP) with the purpose of identifying risk factors linked with multidrug-resistant (MDR) Pseudomonas, treatment toxicity, and poor disease prognosis. I used a retrospective cohort study design to explore a clinical cohort of patients admitted to the University of Alabama at Birmingham hospital network who had bacterial pneumonia diagnosis assessed to be from community transmission between January 2013-December 2019. Electronic medical records were accessed for socio-demographic and clinical information. First, I examined the local prevalence/incidence of Pseudomonas CAP and MDR Pseudomonas CAP, and the relationship between …
Likelihood Based Inferential Methods To Analyze Trials Incorporating Patient's Treatment Choice, Rouba A. Chahine
Likelihood Based Inferential Methods To Analyze Trials Incorporating Patient's Treatment Choice, Rouba A. Chahine
All ETDs from UAB
Randomized clinical trials (RCT) are the gold standards for clinical trials as they reduce bias and minimize variability between different arms of a study. One of the drawbacks of these designs is their lack of flexibility to incorporate patient’s preference, which may reduce recruitment rates and/or reduce patient’s tolerance if they receive a non-preferred treatment. Designs incorporating choice allow a subset of participants to choose a preferred treatment. Some of these designs are Zelen’s (1979), Brewin’s (1989), and Rucker’s (Two-Stage RCT, 1989). Current methods to analyze two-stage RCT are based on an analysis of variance (ANOVA) approach that do not …
Cognitive Progression And Care Patterns In All-Cause Dementia By Prior Cancer Diagnosis, Mackenzie Elisha Fowler
Cognitive Progression And Care Patterns In All-Cause Dementia By Prior Cancer Diagnosis, Mackenzie Elisha Fowler
All ETDs from UAB
Cancer and dementia are common aging-related diseases. Cancer and itstreatments are associated with cognitive impairment referred to as cancer-related cognitive impairment (CRCI). Dementias demonstrate similar impairment. Only one study has examined the longitudinal association between cancer and dementia. This dissertation goes beyond limitations of the prior study and has three aims: 1.) to evaluate dementia progression by prior cancer diagnosis, 2.) to evaluate progression of all-cause dementia by cancer treatments, and 3.) to evaluate patterns and predictors of care among dementia patients by cancer history. This study uses EHR data to evaluate cognitive progression by cancer history /cancer treatment characteristics, …
The Role Of Race, Sex, And Place In The Association Of Diabetes And Cardiovascular Disease, Gargya Malla
The Role Of Race, Sex, And Place In The Association Of Diabetes And Cardiovascular Disease, Gargya Malla
All ETDs from UAB
Cardiovascular disease risk is higher among adult with diabetes than those without diabetes. This increase in risk may vary by race, sex, and neighborhood characteristics. Recent US data showed a resurgence in stroke and coronary heart disease (CHD) among adults with diabetes, and an increase in heart failure (HF) mortality. Therefore, this dissertation investigated how cardiovascular disease risk may vary by race, sex, and neighborhood characteristics for adults across the glycemic spectrum.Data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, an ongoing prospective cohort of 30,239 Black and White adults age 45 years at baseline (2003-07) …
Attitudes, Beliefs, And Perceived Self-Efficacy Pre- And Post- Suicide Prevention Training, Angela Marie Sullivan
Attitudes, Beliefs, And Perceived Self-Efficacy Pre- And Post- Suicide Prevention Training, Angela Marie Sullivan
All ETDs from UAB
A 2017 World Health Organization (WHO) data brief included suicide in the top 20 causes of death worldwide. The WHO also listed suicide as the second leading cause of death for those aged 15 – 29 worldwide. In the US, suicide is the leading cause of violent death and has been consistently ranked as the 10th leading cause of death among all age groups in the US since 2008. In Alabama, the CDC reports suicide as the 11th leading cause of death in the state and the second leading cause of death for those aged 15 – 34. This study …
Applications Of Longitudinal Machine Learning Methods In Multi-Study Alzheimer's Disease Datasets, Charles F. Murchison
Applications Of Longitudinal Machine Learning Methods In Multi-Study Alzheimer's Disease Datasets, Charles F. Murchison
All ETDs from UAB
Advances in statistical learning models for prediction have led to broader application across a variety of disciplines, granting generalizations and adaptations that were previ-ously intractable even with advanced computational techniques. Among these is the al-lowance of correlated data with inherent paneled structure such as longitudinal or clus-tered data; adjustments which have already begun to be applied to a variety of supervised and unsupervised machine learning methods which had previously focused on cross-sec-tional data. These modifications have seen rudimentary testing in a number of applied disciplines where correlated data is commonly observed, including medical and clinical research. One field in particular …
Statistical Methodology For Mendelian Randomiztion Analysis, Phillip Hunter Allman
Statistical Methodology For Mendelian Randomiztion Analysis, Phillip Hunter Allman
All ETDs from UAB
Instrumental variable (IV) methods are causal analysis techniques used on observational data to address confounding, provided that certain assumptions are met. In the usual observational setting, some exposure of interest �� is associated with some outcome of interest ��, but confounders �� could distort the measure of the association between �� and ��. A valid IV is a proxy of sorts for �� which behaves in a very specific way, in that the IV operates analogously to the treatment group assignment seen in randomized trials. Finding a valid IV is no trivial task, but if one exists and we identify …
Cardiovascular Disease Risk In Head Neck Squamous Cell Carcinoma Patients: Using Electronic Medical Records Data, Amrita Mukherjee
Cardiovascular Disease Risk In Head Neck Squamous Cell Carcinoma Patients: Using Electronic Medical Records Data, Amrita Mukherjee
All ETDs from UAB
The objective of my dissertation research was to assess burden of cardiovascular disease (CVD) risk factors in Head Neck Squamous Cell Carcinoma (HNSCC) patients and to determine the association of traditional CVD risk factors and HNSCC-related factors with incident CVD outcomes. For this clinical cohort study, I analyzed electronic medical records (EMR) and tumor registry data on HNSCC patients diagnosed between January 2012 and December 2018 at UAB hospital and O’Neal Comprehensive Cancer Center. First, I assessed prevalence and incidence of traditional CVD risk factors at HNSCC diagnosis (baseline) and at one-year post HNSCC diagnosis, respectively. Then I determined the …
Role Of Partnership In Hiv-Related Outcomes In Heterosexual Individuals Newly Diagnosed With Hiv, Maira Sohail
Role Of Partnership In Hiv-Related Outcomes In Heterosexual Individuals Newly Diagnosed With Hiv, Maira Sohail
All ETDs from UAB
A supportive intimate partner has shown to be helpful in HIV care of men who have sex with men, and in some African heterosexual couples; however, knowledge on this phenomenon among heterosexual people with HIV (PWH) is limited in the United States context. This project included two quantitative studies and one qualitative study to examine the role of intimate partnership in HIV care among heterosexual, newly diagnosed PWH. Both quantitative studies were conducted among heterosexual, newly diagnosed (2013-2017) individuals at the University of Alabama at Birmingham (UAB) 1917 Clinic. The first study examined the role of partnership (un-partnered, unmarried-partnered, and …
An Investigation Of Strain And Support Needs Of Caregivers Of Older Adults With Delirium And Allied Health Promotion Interventions, Jasmine Vickers
An Investigation Of Strain And Support Needs Of Caregivers Of Older Adults With Delirium And Allied Health Promotion Interventions, Jasmine Vickers
All ETDs from UAB
Delirium, or the sudden onset of confusion, is common, highly distressing, debilitating, and deadly among hospitalized older adults and is associated with adverse outcomes for their family caregivers. As people are living longer with more complex conditions, more people will face the task of caregiving for older adults with delirium. Family caregivers can make meaningful contributions to delirium care, but high distress, insufficient knowledge, and lack of skills often seen in caregivers can lead to maladaptation and negative health outcomes. A few studies have focused on distress in caregivers from witnessing delirium episodes; however more research is needed to understand …