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Public Health Education and Promotion

Theses/Dissertations

2018

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Full-Text Articles in Medicine and Health Sciences

Video-Based Diabetes Education For A Culturally Diverse Population, Heather Harris Dec 2018

Video-Based Diabetes Education For A Culturally Diverse Population, Heather Harris

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Immigrants and refugees represent an underserved population in need of quality, accessible, and culturally appropriate healthcare and education. Diabetes is a chronic condition frequently seen in this population. The author utilized the Wagner Chronic Care Model (CCM) as a theoretical framework for planning diabetes education delivery in this diverse population. Studies report significant health disparities in diabetes care and subsequent poor diabetes quality indicators in refugees and immigrants. Research has found that culturally sensitive diabetes education can improve diabetes outcomes in ethnically diverse populations. The author implemented a translational project to develop and evaluate a video-based diabetes health education intervention …


Understanding Adolescent Physical Activity In The Early Nutrition Transitioning Country Of Haiti, Haley V. Becker Dec 2018

Understanding Adolescent Physical Activity In The Early Nutrition Transitioning Country Of Haiti, Haley V. Becker

Arts & Sciences Electronic Theses and Dissertations

The nutrition transition is underway in Haiti, giving rise to the dual burden of malnutrition. Physical activity (PA) plays an important role in mitigating the negative health consequences of nutrition transition and the dual burden, but heretofore this data has been unavailable for Haiti. This dissertation undertook an exploratory needs assessment providing baseline PA data for Haitian adolescents. It evaluated two different PA data collection methodologies: a cross-sectional survey adapted from the IPAQ long-form and objectively measured PA via Actigraph GT1M accelerometers. Next, it identified initial covariates of self-reported and objectively-assessed PA behaviors; data was operationalized as meeting the World …


Normalizing Masculinity: Explaining Processes, Factors, And Contexts That Influence How Rural Male Farmers Seek Health Information In Southwest Ontario, Bradley C. Hiebert Dec 2018

Normalizing Masculinity: Explaining Processes, Factors, And Contexts That Influence How Rural Male Farmers Seek Health Information In Southwest Ontario, Bradley C. Hiebert

Electronic Thesis and Dissertation Repository

Disproportionately high mortality and morbidity rates experienced by rural men are often related to the high prevalence of rural male farmers (RMFs) who are consistently exposed to chemicals, animal waste, and dust, or injured or killed while working. This dissertation aimed to explain processes by which RMFs seek health information (HI), and how these processes are influenced by rural social, cultural, political, and geographical factors.

Three studies were conducted as part of this dissertation. The first study was a literature review that explored the relationship between rural men’s health, health information seeking (HIS) theory, and masculinity theory. The second study …


Examining Barriers To Sexual And Reproductive Health Services For Adolescents And Young Adults In Nebraska, Marisa Rosen Dec 2018

Examining Barriers To Sexual And Reproductive Health Services For Adolescents And Young Adults In Nebraska, Marisa Rosen

Theses & Dissertations

Despite recent declines in unintended pregnancy rates among adolescent and young adult women, barriers to family planning services and contraception continue to exist for young women living in the United States. Various initiatives have been implemented over the years from programmatic interventions to enactment of policies around family planning, yet more work needs to be done to help adolescent and young adult women successfully prevent unintended pregnancy. The Contraceptive Access Project (CAP) is a multi-component initiative in Nebraska to reduce unintended pregnancy among women aged 15-24. This dissertation comprises three separate studies each of which contributes to the overall objective …


Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson Dec 2018

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …


Risky Business: Millennials’ Protection Motivation Factors For Norovirus Outbreaks On College Campuses, Dylan Conrad Martinez Dec 2018

Risky Business: Millennials’ Protection Motivation Factors For Norovirus Outbreaks On College Campuses, Dylan Conrad Martinez

Graduate Theses and Dissertations

The risk and severity of hNoV transmission is obscurely recognized to foodservice millennial customers. Most commonly associated with cruise ships, consumers are not aware of its full potential to strike at other locations, especially college campuses. For the foodservice industry and the university community, it is imperative that a proactive method for increasing millennials’ motivation to practice mitigation methods emerges to reduce future hNoV outbreaks on college campuses. Research has shown that students can play a major role in the spread of hNoV on college campuses. Therefore, the purpose of these studies is to examine motivations for health protective behaviors …


Philosophia Soteria: How Occupational Safety And Health Professionals Influence Decision Makers, Daniel Jay Snyder Dec 2018

Philosophia Soteria: How Occupational Safety And Health Professionals Influence Decision Makers, Daniel Jay Snyder

Graduate Theses and Dissertations

The purpose of this study was to identify ideas about how occupational safety and health (OSH) professionals influence decision-makers on matters impacting occupational health and safety management systems. A modified nominal group technique was used that involved 67 participants in ten nominal groups and identified the most important ideas about how OSH professionals can influence workplace safety and health decision making. The research produced themes of communication, scientific, professionalism, leadership, adaptability, and business acumen that resulted in six domains of occupational safety and health professional influence.


Understanding The Essentials: A "Serenity House" Health Program, Tory E. Wilder Dec 2018

Understanding The Essentials: A "Serenity House" Health Program, Tory E. Wilder

Chancellor’s Honors Program Projects

No abstract provided.


Stress Management In The Kitchen, Haley Rosano Dec 2018

Stress Management In The Kitchen, Haley Rosano

Capstone Projects and Master's Theses

Catholic Charities - Diocese of Monterey has implemented Stress Management in the Kitchen though the Family Support Services department of the Seaside office. Stress Management in the Kitchen was implemented to address the knowledge gap between nutrition and healthy living.The purpose of the workshop series was to give clients a fun and digestible way to increase their knowledge on how their health and nutritional habits can or should be applied to how they deal with stress. These workshops were implemented through presentation and a series of activities.The measurement of these workshops will be obtained through an exit survey from participants. …


Promoting Healthy Beverage Consumption Habits Among Elementary School Children: Evaluating The Healthy Kids Community Challenge 'Water Does Wonders' Interventions In London, Ontario, Bridget R. Irwin Nov 2018

Promoting Healthy Beverage Consumption Habits Among Elementary School Children: Evaluating The Healthy Kids Community Challenge 'Water Does Wonders' Interventions In London, Ontario, Bridget R. Irwin

Electronic Thesis and Dissertation Repository

Childhood obesity is a major public health concern and has been attributed to poor diet, among other factors. Sugar-sweetened beverage (SSB) consumption, in particular, has been linked to excess weight gain in childhood, while water consumption is a protective factor. Taking advantage of the Water Does Wonders theme of the Healthy Kids Community Challenge, an initiative by the provincial government to promote water consumption, this thesis uses pre-post surveys of children aged 8-14 years to examine (a) the association between knowledge and beverage consumption habits, and (b) the effectiveness of a school- based education and environment intervention to reduce SSB …


An Examination Of The Relationship Between Health Literacy And Dietary Practices Among College Students: A Test Of The Integrated Model Of Health Literacy, Alison B. Oberne Oct 2018

An Examination Of The Relationship Between Health Literacy And Dietary Practices Among College Students: A Test Of The Integrated Model Of Health Literacy, Alison B. Oberne

USF Tampa Graduate Theses and Dissertations

Overweight and obesity continue to plague Americans and contribute to decreased quantity and quality of life. Americans of all ages experience overweight and obesity; however, increasing rates occur during young adulthood. Young adults develop dietary practice behaviors that persist into adulthood and can contribute to weight-related chronic diseases. Approximately half of all young adults are enrolled in college, and, approximately 38% of college students are either overweight or obese.

Dietary practices are health behaviors that can either increase or decrease risk for overweight and obesity. Much research has explored predictors of dietary practices among college students; however, there is a …


Taking (Birth) Control: Empowerment Through Contraceptive Education, Meghan Saas Oct 2018

Taking (Birth) Control: Empowerment Through Contraceptive Education, Meghan Saas

LSU Master's Theses

TAKING (birth) CONTROL is a body of work that educates women on their options for contraceptives, and empowers them to claim their right to choose if—and when—to have a child. Utilizing graphic design and letterpress printing processes, I created a visual system consisting of carefully honed typographic, color, and graphic styles. The bulk of the materials make up an educational toolkit for use at Delta Clinic of Baton Rouge, one of only three remaining abortion providers in Louisiana. Delta Clinic was in need of comprehensive and affordable materials for their patients on the subject of contraception. The toolkit consists of …


Examining The Relationship Between Body Mass Index And Health-Related Quality Of Life Perception Among People With Mental Illness, Fatima Bukair Oct 2018

Examining The Relationship Between Body Mass Index And Health-Related Quality Of Life Perception Among People With Mental Illness, Fatima Bukair

Electronic Thesis and Dissertation Repository

People suffering from mental illness are three times more likely to die prematurely from ‘natural’ causes than those without mental disorders as a result of their physical condition. Their life expectancy is reduced by 12-19 years. Obesity is commonly associated with mental illness and accounts for increased risk of cardiovascular disease, diabetes mellitus, stroke, heart disease, some cancers and osteoarthritis. This paper examined the relationship between body mass index (BMI) and health-related quality of life perception using the Short-Form Health Survey 36 among people living with mental illness. A Multivariate Multiple Regression model was employed to estimate the variables that …


Wait Times, Resource Use And Patient-Reported Outcomes For Patients Referred For Total Knee Replacement Surgery, Kate Lebedeva Sep 2018

Wait Times, Resource Use And Patient-Reported Outcomes For Patients Referred For Total Knee Replacement Surgery, Kate Lebedeva

Electronic Thesis and Dissertation Repository

This prospective cohort study evaluated the usual care pathway for patients referred to total knee arthroplasty (TKA). We measured healthcare resource use, costs and health-related quality of life (HRQoL) over the continuum of care. We also determined the proportion of inappropriate referrals and estimated wait times for initial surgical consultation and TKA. We found that two in five patients referred to specialty care were deemed inappropriate surgical candidates. Prior to referral, few conservative treatment options were tried, and many imaging tests ordered by referring providers were unjustified. Overall, the greatest proportion of costs were borne by the patient or private …


Development, Validation, And Testing Of A Self-Determination Theory Instrument Called The Motivation To Prepare Healthy Foods Questionnaire, Ariana Delong Bailey Sep 2018

Development, Validation, And Testing Of A Self-Determination Theory Instrument Called The Motivation To Prepare Healthy Foods Questionnaire, Ariana Delong Bailey

LSU Doctoral Dissertations

The objectives of these studies were to validate and confirm the structure of a previously developed questionnaire that measures the psychosocial constructs defined by the Self-Determination Theory (SDT) and then test this questionnaire in a nutrition education setting. The instrument, titled the Motivation to Prepare Healthy Foods Questionnaire (MPHFQ), included items that measured intrinsic motivation, perceived competence, relatedness, autonomy, and autonomy support. These studies evaluated the questionnaire’s validity and ability to measure changes in the SDT construct scores.

The MPHFQ is a previously developed and reliable instrument intended to measure adults’ intrinsic motivation and perceived competence to prepare healthy foods, …


Reducing Sexual Victimization On College Campuses: The Impact Of A Collegiate-Level Human Sexual Behavior Course On Students’ Level Of Sexual Assertiveness, Ashlee D. Carter Sep 2018

Reducing Sexual Victimization On College Campuses: The Impact Of A Collegiate-Level Human Sexual Behavior Course On Students’ Level Of Sexual Assertiveness, Ashlee D. Carter

Seton Hall University Dissertations and Theses (ETDs)

As the national conversation around the perpetration of sexual violence continues, research around sexual assault on college campuses continues to grow. By collecting both quantitative and qualitative data, this dissertation investigated the effects on students’ levels of sexual assertiveness, sexual awareness, communication skills, and sexual refusal skills as a result of taking a college-level human sexual behavior course. Through a lens of cognitive development theory and social cognitive theory, this study adds to the framework of promotion of cognitive development, which can assist in strengthening a young woman’s sexual assertiveness.

Results of this mixed methods analysis suggest that there is …


Using The Theory Of Planned Behavior To Understand Student Compliance To Tobacco-Free Policies In California Universities, Harit Agroia Sep 2018

Using The Theory Of Planned Behavior To Understand Student Compliance To Tobacco-Free Policies In California Universities, Harit Agroia

Loma Linda University Electronic Theses, Dissertations & Projects

Background: In California, the mortality rate associated with smoking ranks as the sixth highest among all states in the nation (CDPH, 2016). To reduce this rate, many universities in California have adopted tobacco-free policies in recent years (Mamudu, Veeranki, Kioko, Boghozian & Littleton, 2016). Due to the recent adoption of such policies, there is limited research available which aim to assess the effectiveness of these on tobacco use behavior on campus among university students.

Purpose: The purpose of this study was to understand student compliance to tobacco-free policies within select universities in California, specifically those that implemented their …


Determining The Adoption And Implementation Of Nutrition Policies At Food Pantries Across The United States, Meagan Helmick Aug 2018

Determining The Adoption And Implementation Of Nutrition Policies At Food Pantries Across The United States, Meagan Helmick

Theses & Dissertations

Food insecurity occurs when there is a lack of access to enough food to live an active, healthy life. Current efforts to address food insecurity include developing and implementing policies, programs, and practices at the federal, state, and local levels. Specifically, local efforts target decreasing food insecurity through emergency food networks including food banks and food pantries. Over the last several years, many food banks and food pantries have worked to improve the nutritional quality of the foods they offer. However, food pantries are smaller and less formal organizations than food banks. Thus, they have limited resources to develop and …


Active And Safe Routes To School: Evaluating School Travel Planning To Support Children's Active Travel, Adrian Nicholas Buttazzoni Aug 2018

Active And Safe Routes To School: Evaluating School Travel Planning To Support Children's Active Travel, Adrian Nicholas Buttazzoni

Electronic Thesis and Dissertation Repository

Most Canadian children are not achieving their daily recommended physical activity (PA) levels despite the many emotional, psychological, and physical benefits of PA. Walking or wheeling to/from school, or active school travel (AST), is a viable method for improving children’s daily participation in PA. In Canada, the Active and Safe Routes to School initiative promotes AST through its comprehensive School Travel Planning (STP) program. Utilizing a mixed-methods approach, broadly, this thesis investigates the i) implementation and ii) effectiveness of a regional, two-year STP program supporting AST. This thesis includes a systematic review of AST intervention models implemented in North America, …


Creating A More Collaborative Tomorrow: Development Of A Patient Engagement Curriculum For A School Of Nursing And Health Professions, Alicia Digiammarino Aug 2018

Creating A More Collaborative Tomorrow: Development Of A Patient Engagement Curriculum For A School Of Nursing And Health Professions, Alicia Digiammarino

Master's Projects and Capstones

Background: Healthcare has been moving steadily toward a patient-centered paradigm that seeks to involve patients more in their own care. Teaching communication skills to future health professionals can increase such patient participation. Despite the shift to patient-centered care, there is almost no training in patient engagement techniques provided to students at the University of San Francisco School of Nursing and Health Professions. Purpose: This project aimed to design and develop a sustainable patient engagement curriculum that meets the unique needs of faculty and students at the University. Methods: Interviews were conducted with eight faculty members to understand …


Examining Geographic Variation In Children's Perceived Barriers To Physical Activity And The Implications On Behaviour, Leah Gabrielle Taylor Aug 2018

Examining Geographic Variation In Children's Perceived Barriers To Physical Activity And The Implications On Behaviour, Leah Gabrielle Taylor

Electronic Thesis and Dissertation Repository

Low levels of physical activity among Canadian children has become a national public health issue. Recent research has suggested that children’s physical activity levels are associated with their perceptions of their everyday environments. A better understanding of the formation of these perceptions within different contexts is needed to explain the extent of the relationship. Using a multi-tool quantitative protocol, this thesis examines geographic variation in socio-ecological factors influencing children’s perceptions of barriers to PA, and the extent to which perceptions mediate the relationship of the environment and PA. Results indicate that perceptions form within contexts, and have an influence on …


A Characterization Of The Medical-Legal Partnership (Mlp) Of Nebraska Medicine, Jordan Pieper Aug 2018

A Characterization Of The Medical-Legal Partnership (Mlp) Of Nebraska Medicine, Jordan Pieper

Capstone Experience

This research study was completed at Legal Aid of Nebraska’s Health, Education, and Law Project through the partnership it has formed working with Nebraska Medicine and Iowa Legal Aid. Traditionally, health and disease have always been viewed exclusively as "healthcare" issues. But with healthcare consistently growing towards holistic approaches to help patients, we now know there are deeper, structural conditions of society that can act as strong driving forces of a person's poor daily living conditions that can negatively impact health. The importance of a Medical-Legal Partnership is that it considers a patient's social determinants of health (SDHs). The goal …


Exploring The Influence Of Childcare Type On Physical Activity And Sedentary Time Of A Nationally Representative Sample Of Canadian Preschoolers, Julie Statler Jul 2018

Exploring The Influence Of Childcare Type On Physical Activity And Sedentary Time Of A Nationally Representative Sample Of Canadian Preschoolers, Julie Statler

Electronic Thesis and Dissertation Repository

A large number of Canadian children are enrolled in childcare, and they spend substantial time there. Capturing a national picture of the relationship between childcare type and physical activity (PA; i.e., light, moderate- to-vigorous, and total) and sedentary time (ST) in young children is needed. Using a nationally representative sample of preschoolers (aged 3-5 years), this cross-sectional study used cycles 3 and 4 of the Canadian Health Measures Survey. Childcare type (e.g., centre-, home-based childcare, home with parent, kindergarten) was reported by parents. Preschoolers wore an accelerometer for 7 consecutive days. Device and population-specific cut-points were applied to delineate PA …


Exploring The Physical Activity And Screen Viewing-Related Knowledge, Training, And Self-Efficacy Of Early Childhood Education Candidates, Brianne Bruijns Jul 2018

Exploring The Physical Activity And Screen Viewing-Related Knowledge, Training, And Self-Efficacy Of Early Childhood Education Candidates, Brianne Bruijns

Electronic Thesis and Dissertation Repository

Early childhood educators (ECEs) greatly influence young children’s physical activity (PA) and screen viewing (SV) behaviours. This study explored the PA and SV-related knowledge (i.e., of important PA/SV concepts), training (i.e., PA/SV courses/content received), and self-efficacy (i.e., to facilitate PA and limit SV in childcare) of early childhood education students. A sample of 1,292 students from 61 Canadian colleges/universities completed the online survey. In general, students exhibited the least amount of knowledge regarding the link between SV and health. Further, 67.8% and 73.3% of students had not completed PA or SV courses during their post-secondary training, respectively, and students who …


Consumer Behaviors, Added Sugar Intake, Diet Quality, Inflammation And Metabolic Syndrome Risks Among Adults From The National Health And Nutrition Examination Survey 2007-2010, Shanshan Chen Jul 2018

Consumer Behaviors, Added Sugar Intake, Diet Quality, Inflammation And Metabolic Syndrome Risks Among Adults From The National Health And Nutrition Examination Survey 2007-2010, Shanshan Chen

Doctoral Dissertations

We carried out a secondary data analysis of adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES) 2007-2010. All analyses were weighted using NHANES sample weights to account for the complex survey design, survey non-response, and post-stratification. Overall, the majority of our population (60.4%) exceeded the USDA/HHS recommendation on added sugar consumption. In the first study, soft drink availability at home was positively associated with added sugar intake (p In the second study, added sugar intake was negatively associated with diet quality determined by Healthy Eating Index (HEI) 2015, after adjusting for covariates. With regards …


Implementing The Cdcs Core Elements Of Outpatient Antibiotic Stewardship Program Into The Urgent Care, Deanna Powelson Jul 2018

Implementing The Cdcs Core Elements Of Outpatient Antibiotic Stewardship Program Into The Urgent Care, Deanna Powelson

Dissertations

Purpose: The inappropriate use of antibiotics has led to the development of antimicrobial

resistance which is a severe threat to the public and an increasing global problem. The

Centers for Disease Control and Prevention (CDC) estimates at least two million illnesses

and 23,000 deaths are caused by antibiotic-resistant bacteria in the United States (CDC,

2014). The purpose of this quality improvement (QI) project was to evaluate the

effectiveness of an antibiotic stewardship program (ASP) on urgent care providers'

prescribing on viral respiratory tract infections (RTIs) including the common cold,

pharyngitis, and bronchitis.

Methods: This QI project implemented the CDCs Core …


What's So Bad About Hooking Up? : Factors Predictive Of More Positive Perceptions Following A Hookup, Jade A. M. Spaulding Jul 2018

What's So Bad About Hooking Up? : Factors Predictive Of More Positive Perceptions Following A Hookup, Jade A. M. Spaulding

Theses and Dissertations

The purpose of the study was to examine factors predictive of a more positive perceptions following a hookup. The participants included 188 students from Illinois State University. Participants completed a demographics questionnaire, the Hookup Scale, the Rosenberg Self-Esteem Scale, the Sexual Self-Esteem Inventory, religiosity questions, attitudes toward hooking up questionnaire, emotional reactions to hooking up questionnaire, and the Social Academic, Romantic, and Sexual Hooking Up Reactions Scale. The current study found that participants who reported high global self-esteem, high sexual self-esteem, and positive attitudes toward hooking up reported less regret, more positive reactions, and fewer negative reactions following a hookup.


The Health Of Migrant Farmworkers In The Pacific Northwest: Access, Quality, And Health Disparities, Marleny Silva Jun 2018

The Health Of Migrant Farmworkers In The Pacific Northwest: Access, Quality, And Health Disparities, Marleny Silva

Global Honors Theses

The health and well-being of migrant farmworkers have been neglected in the U.S. despite the prevalent reliance on undocumented foreign labor to fill the needs of the agricultural industry. In 1942, the U.S. signed a bilateral agreement with Mexico which allowed the recruitment of Mexican workers for temporary work in U.S. fields until the end of the program in 1964. This program contributed to the increase of Mexican migration even after its termination and reaffirmed our nation’s dependence on migrant farm workers, both documented and undocumented. Due to their undocumented status, undocumented migrant farmworkers experience neglect, dehumanization, and criminalization that …


Pink And Dude Chefs: Effectiveness Of An After-School Nutrition Knowledge And Culinary Skills Program For Middle School Students To Increase Fruit And Vegetable Consumption, Alyssa S. Vaziri Jun 2018

Pink And Dude Chefs: Effectiveness Of An After-School Nutrition Knowledge And Culinary Skills Program For Middle School Students To Increase Fruit And Vegetable Consumption, Alyssa S. Vaziri

Master's Theses

The rate of overweight and obesity among adolescents aged 12-19 years has more than tripled since 1980, and disproportionately impacts low-income and marginalized populations. Reduction in adolescent obesity rates may result in decreased health risks, decrease healthcare costs, and increased quality of life. Effective intervention methods for adolescent participants have incorporated nutrition knowledge and culinary skill building into afterschool programs. This study examines whether building knowledge, skills, and confidence through a culinary intervention can improve adolescent participants’ choices of healthful foods through increased fruit and vegetable intake.

Pink and Dude Chefs (PDC) is an afterschool nutrition education and culinary skills …


Increasing Follow-Up In College Students With Latent Tuberculosis Infection, Emily Middleton, Dnp, Aprn, Ccrn, Kathy James, Dnsc, Aprn, Faan, Kimberly Woodruff, Md, Mph May 2018

Increasing Follow-Up In College Students With Latent Tuberculosis Infection, Emily Middleton, Dnp, Aprn, Ccrn, Kathy James, Dnsc, Aprn, Faan, Kimberly Woodruff, Md, Mph

Doctor of Nursing Practice Final Manuscripts

Around 13 million people in the United States have latent tuberculosis infection (LTBI) with a 5-10% chance of developing active tuberculosis (TB) in their lifetime if not treated (Center for Disease Control, 2015). At a University Student Health Center (SHC), there is a matriculation requirement for TB testing for students that screen as high risk. Many students have these testing requirements performed at outside clinics, including foreign clinics, and follow-up regarding education about LTBI and treatment recommendations was often missing. The purpose of this evidence-based practice (EBP) project was to increase follow-up, education, and treatment options after diagnosis of LTBI. …