Medicine and Health Sciences Commons^™

It's A Birth Not A Procedure: An Ethnographic Study Of Intrauterine Fetal Death In A Labor And Delivery Unit Of An American Hospital Setting, Catherine Mcleod Griffin

Wayne State University Dissertations

Life transitions such as birth and death constitute a significant area within anthropological studies of ritual. It is important to investigate how individuals, groups, and communities organize around these events. Birth and death can be considered as rites of passage that mark key life transitions (van Gennep 1909/1960). Thus birth and death related rituals need to be investigated within the social and cultural context of American hospital settings to better understand the social organization of life, death, and personhood. In the American hospital setting, a reproductive loss at any gestational age receives the medical diagnostic label of an intrauterine fetal …

An Examination Of The Effects Of Medicare Part D On Racial/Ethnic Disparities, Elham Mahmoudi

Wayne State University Dissertations

This dissertation seeks to evaluate whether Medicare Part D has reduced racial/ethnic disparities in prescription drug utilization and spending among Medicare seniors. Using nationally representative data on White, African-American, and Hispanic Medicare seniors from the 2002-2009 Medical Expenditure Panel Survey, this dissertation analyzes eight measures of access and utilization related to prescription medications. This dissertation applies the Institute of Medicine's definition of a racial/ethnic disparity, and adopts a difference-in-differences quasi-experimental design, using a multivariate regression framework. It finds strong evidence that Medicare Part D reduced ethnic disparities in prescription drug use, total prescription drug cost, out-of-pocket prescription drug cost, and …

Perceived And Functional Disability In Adults With Chronic Pain: What Accounts For Discrepancies?, Dana Catharine Nevedal

Wayne State University Dissertations

Disability among patients with chronic pain can be assessed functionally (behaviorally) or subjectively (self-report). However, discrepancies--including low or zero correlations--between these methods are commonly reported. Research suggests that subjective disability may be more influenced by psychosocial factors than disability measured during functional tasks, leading to under/over reporting, but further investigation is needed. This study sought to identify correlates of discrepancies between subjective and functional disability in two samples of patients with chronic pain.

Retrospective data was compiled from clinical records of 389 patients evaluated at a university multidisciplinary chronic spinal pain treatment program (52.7% men; 88.9% White, 9.8% Black; spinal …

Development And Initial Psychometric Evaluation Of A Culturally- Sensitive Beliefs About Personal Weight Survey, Stephanie Pickett

Wayne State University Dissertations

ABSTRACT

DEVELOPMENT AND INITIAL PSYCHOMETRIC EVALUATION OF

A CULTURALLY-SENSITIVE BELIEFS ABOUT PERSONAL WEIGHT SURVEY

by

STEPHANIE PICKETT

December 2012

Advisor: Dr. Rosalind Peters

Major: Nursing

Degree: Doctor of Philosophy

The purpose of this study was to develop and perform initial psychometric evaluation of an instrument that measures beliefs about personal weight in young African American women. Beliefs about personal weight were defined as a multidimensional concept consisting of the convictions regarding the descriptive characteristics, causal attributions, and consequences of one's personal weight. The theory of self-care (Orem, 2001) was used to conceptualize concepts and conceptual relationships.

The Beliefs about Personal …

Using The Protection Motivation Theory To Examine The Effects Of Obesity Fear Arousal On The Physical Activity Of Young Adult Female College Students, Bibia Renee Redd

Wayne State University Dissertations

The national rate of physical activity has been consistently declining while obesity and obesity-related illnesses are on the rise (French, Story, & Jeffrey, 2001; James, Leach, Kalamara, & Shayeghi, 2001; Malnick & Knobler, 2006). The current study employed a 2 (severity) x 2 (susceptibility) x 2 (intention implementation plan) x 3 (time) longitudinal within subject design examining the effects of the Protection Motivation Theory (Rogers, 1975, 1983) on the physical activity among 87 overweight young adult college females. A main effect was hypothesized for short-term severity, personal susceptibility, and the development of an intention implementation plan messages and an interaction …

Preterm Birth And The Perception Of Risk Among African Americans, Gwendolyn Simpson Norman

Wayne State University Dissertations

Background: African American women deliver preterm at a rate that is two to three times that of their white counterparts, and after decades of research, this disparity in birth outcomes still remains unexplained. While factors including income, education, neighborhood conditions, infection and stress have all been associated with prematurity, no combination of these factors has explained why the disparity persists. Recently, however, racism-specific stress has emerged as a possible factor contributing to this disparity. This study was designed to learn how preterm birth was explained by African Americans directly impacted by prematurity. Methods: Interviews were conducted with African American women …

Functional Correlates Of Verbal Working Memory In Healthy Aging And Early Alzheimer's Disease, Michael Adam Sugarman

Wayne State University Theses

Deficits in the working memory system are common in patients diagnosed with Alzheimer's disease (AD). However, little is known regarding the neurobiological basis of this impairment. The current study examined the neurobiological functional correlates of the working memory system in early AD patients and cognitively intact control participants using a word list repetition task performed during positron emission tomography (PET). Compared to a reading control task, both the AD and control groups utilized a network of parietal, frontal, and cerebellar regions while completing the word rehearsal task. However, control participants displayed greater activation in all regions, especially in the parietal …

The Relationship Of Rehabilitation Counselors' Knowledge Of The Americans With Disabilities Act 1990, Attitudes Toward Reasonable Accommodation, And Job Development Efficacy, Joy Elizabeth Inniss-Johnson

Wayne State University Dissertations

The purpose of this research was to evaluate the relationship between the rehabilitation counselors' level of knowledge, attitudes towards reasonable accommodations and job development efficacy. The more knowledgeable rehabilitation counselors are about ADA, reasonable accommodations, and their attitude toward job development, the less likely their attitudes will be expected to fluctuate. In addition, there has been very little research in terms of evaluating rehabilitation counselor's level of job placement efficacy. A survey-based design was utilized to create both a quantitative description of knowledge of the ADA, beliefs about reasonable accommodations and job placement efficacy and qualitative information concerning the barriers …

Motivating Adolescents To Chat For Health (Match): Improving Nutrition And Physical Activity In Urban Youth, Jaclyn Beth Issner

Wayne State University Dissertations

Adolescence represents a unique period of development that is filled with both opportunities and challenges. Choices and health patterns, such as sedentary activity or poor dietary intake, which are established during adolescence can set the stage for adulthood. Obesity in youth has emerged as a major health problem in the United States and across the globe (American Academy of Child and Adolescent Psychiatry, 2012). One way to help prevent obesity is by incorporating preventive intervention services into primary care health systems. The current study, therefore, evaluated the effects of a brief 1-session intervention delivered in a primary care setting in …

"Still Here, Trying To Find My Way": Understanding The Experiences Of Hiv Disruption And Reorganization Among Older African Americans In Detroit, Andrea Nevedal

Wayne State University Dissertations

Adults aged fifty and older are the fastest growing age group with HIV/AIDS. Research on older adults with HIV has focused primarily on health status and physiological changes that occur as people age with HIV. However, little is known about the socio-cultural consequences that occur when older adults are diagnosed with HIV and as they age with HIV. Drawing from an anthropological approach to the life course and Becker's (1997) framework of life disruption, this dissertation research explored to what extent people experienced disruption from living with HIV and reorganized their lives after experiencing disruption.

The specific aims included identifying …

Improving Blood Pressure Control In Esrd Through A Supportive Educative Nursing Intervention, Zorica Kauric-Klein

Wayne State University Dissertations

ABSTRACT

IMPROVING BLOOD PRESSURE CONTROL IN ESRD THROUGH A

SUPPORTIVE EDUCATIVE NURSING INTERVENTION

by

ZORICA KAURIC-KLEIN

May 2011

Advisor: Dr. Nancy T. Artinian

Major: Nursing

Degree: Doctor of Philosophy

Problem: Hypertension in chronic hemodialysis (HD) patients contributes significantly to their morbidity and mortality. Statistics indicate the hypertension rate amongst HD patients ranges from 75 to 100 %. Studies have indicated that adherence rates to self-care behaviors related to salt and fluid intake and medication regimens are very poor in the HD population. Traditional hypertension management strategies have been found to be largely ineffective. There is modest evidence indicating that interventions …

Chemotherapy For Lung Cancer: Determinants Of Guideline Adherence And Associated Patient Outcomes, Ramzi George Salloum

Wayne State University Dissertations

Evidence-based guidelines recommend chemotherapy for medically fit patients with stage II-IV non-small cell lung cancer (NSCLC). Adherence to chemotherapy guidelines has rarely been studied among large populations, mainly because performance status (PS), a key component in assessing chemotherapy appropriateness, is missing from claims-based datasets. Among a large cohort of patients with known PS, this dissertation describes chemotherapy use relative to guideline recommendations and identifies patient factors and outcomes associated with guideline concordant use. Among these patients 29% do not receive guideline recommended chemotherapy treatment, missing opportunities for cure or receiving chemotherapy with more risk of harm than benefit, thereby likely …

Examining The Relationship Among Physical And Psychological Health, Parent And Peer Attachment, And Cyberbullying In Adolescents In Urban And Suburban Environments, Jemica Monique Carter

Wayne State University Dissertations

Cyberbullying is a new phenomenon that has received substantial attention via media. An extensive review of the literature revealed limited nursing research on this topic. The purpose of this study was to examine the impact of cyberbullying on adolescents' physical (e.g., headache, stomachache, etc.) and psychosocial (e.g., self-esteem, depression, post traumatic stress syndrome, etc.) outcomes. Individuals who experience repeated traditional bullying are at increased risk for experiencing repeated incidents of cyberbullying. Research has shown that effects of cyberbullying may be more traumatic than traditional bullying because victims can be bullied 24 hours and 7 days a week, on and off …

The Effects Of Racially-Motivated Emotional Arousal On The Eating Behaviors Of African American Women, Lenwood W. Hayman

Wayne State University Dissertations

Disparities between African Americans and Caucasians remain vast across a wide variety of health indicators. Chronic stress has been identified as a risk factor for a variety of chronic illnesses and poor health outcomes. One type of chronic stress that has been linked to health disparities is the stress associated with experiences of racial discrimination. The stress African Americans encounter as a result of their racist experiences contributes to a chronic elevation of their physiological stress response. In addition to stress, a major risk factor for coronary heart disease and diabetes is obesity, which has been established as a major …

Hospital Quality And Medicare Payment: A Theoretical And Empirical Investigation, Jinghua Huang

Wayne State University Dissertations

Does Medicare's payment rate for a hospital stay influence the quality of care received by a patient? We examine this question, theoretically and empirically. First, a model is developed which generates the key hypothesis -- that Medicare's payment rate per admission should be positively related to care quality. We then test this hypothesis by estimating the relationship between Medicare's DRG payment for pneumonia, heart failure and heart attacks and care quality, using clinically-recognized measures of the quality of pneumonia care, heart failure care and heart attack care. Newly available data on acute hospitals in 2007 from "Hospital Compare" (maintained by …

Social Workers' Knowledge And Attitudes About Treating Children With Attention Deficit Hyperactivity Disorder, Angelah Dawn Gomez

Wayne State University Theses

The current research seeks to understand how social work students and social work professionals increase their knowledge about AD/HD and how they formulate their attitudes about the disorder. The literature provided illustrates the many components of AD/HD risks, etiology, treatments, and professional opinions about the disorder. AD/HD is one of the most studied childhood mental health disorders in the nation. However, there is little research providing insight to social workers' knowledge and attitudes about the disorder. This is especially alarming because social workers are one of the largest professional populations to provide mental health services to children and their families. …

Work-Family Boundary Management Strategies: Examining Outcomes, And The Role Of Fit, Madhura Chakrabarti

Wayne State University Dissertations

As more and more people attempt to effectively manage the simultaneous demands of work and family, researchers are now trying to investigate the various ways by which people choose to do so. The present study investigated the concept of boundary management strategies that describes the work-family interface in terms of cognitive, physical, and behavioral boundaries between work and family domains that individuals actively try to manage in order to balance the two worlds. Research in boundary management strategies has been minimal due to the the novelty of the construct. In this study, specific individual and organizational outcomes like work-family conflict, …

Effects Of Two Group Approaches On Life Satisfaction And Mood Of Older Females In Nursing Homes, Bede Redpath Ryan

Wayne State University Dissertations

The purpose of this study was to examine the effects of two group counseling therapy interventions on levels of life satisfaction and mood disturbance of older women, age 65+, living in two Detroit-based skilled nursing home facilities. This quasi-experimental, two-treatment group design examined the pretest-posttest data of two group counseling therapy interventions, Group Art Therapy (GAT) and Group Life Stories Narrative Therapy (GLSNT). Seventeen participants completed the bi-weekly, 90-minute sessions, over a four-week period. A univariate ANCOVA with group membership as fixed independent variable was used to compare life satisfaction post scores with pre scores as covariates. Mean scores were …

A Study Of The Associations Between Childhood Obesity And Three Forms Of Social Capital, Cynthia Bala-Brusilow

Wayne State University Dissertations

Purpose: The purpose of the study was to expand the understanding of childhood obesity in American children by examining the associations between obesity in children and measures of social capital.

Context: Persons between 2 and 20 years of age are categorized as "obese" if their BMI is in 95th percentile or above for their age and sex using the Center for Disease Control and Prevention (CDC) BMI-for-age growth charts. Obesity prevalence has more than quadrupled in the last 40 years in the United States for children. Social capital, in the study of health, can be defined as resources accrued and/or …

The Effects Of Gestalt And Cognitive-Behavioral Therapy Group Interventions On The Assertiveness And Self-Esteem Of Women With Physical Disabilities Facing Abuse, Cilene Susan Adam Rita

Wayne State University Dissertations

The purpose of this study was to examine the differential effects of Gestalt and Cognitive-Behavioral group therapy interventions on assertiveness and self-esteem among women with physical disabilities facing abuse. The eleven women, who met the study criteria, were randomly assigned to one of two experimental conditions, Gestalt Therapy (GT) and Cognitive-Behavioral Therapy (CBT) group interventions. The Demographic Questionnaire (Adam Rita, 2009) documented personal characteristics of the participants. The criterion instruments were: a) RAS (Rathus, 1973), and b) CFSEI-2 (Form AD, Battle, 1992) measuring assertiveness and self-esteem respectively and were administered pre-and-post treatment. The research was conducted over a period of …

The Role Of Employment Status, Work Disruption, Leisure, And Resources In The Mental Health Of Demenita Caregiving Daughters, Lisa Jones Ficker

Wayne State University Dissertations

Employment has been consistently identified as a role strain among dementia caregivers. This study sought to examine the patterns and context of employment and work disruption among dementia caregiving daughters and learn the extent to which work disruption influences mental health through hypothesized reductions in financial resources and leisure activities. This study was a cross-sectional design that extracted data of 486 daughter caregivers from a dataset that gathered information from Caucasian, African American, and Latina dementia caregivers at six research sites across the nation.

Results indicated that caregiving daughters who were employed reported the lowest number of depressive symptoms and …

The Contribution Of Nmda Receptors Within The Central Nucleus Of The Amygdala To The Suppression Of Pain Affect, Catherine Ann Spuz

Wayne State University Dissertations

The amygdala processes stimuli that threaten an individual and organizes the execution of affective behaviors designed to cope with the threat. The prototypical threat to an individual is exposure to a noxious stimulus. The central nucleus of the amygdala (CeA) receives nociceptive afferents and exhibits neuronal activation in response to noxious peripheral stimulation. NMDA receptors within CeA mediate this noxious-evoked neural excitation, and previous studies in the laboratory have shown that blockade of CeA NMDA receptors via the antagonist APV elevates the threshold for noxious tail-shock-induced vocalization afterdischarges (VADs), a validated measure of pain affect in the rat. The present …

The Influence Of Religion And Spirituality On Rehabilitation Outcomes Among Traumatic Brain Injury Survivors, Brigid Waldron-Perrine

Wayne State University Dissertations

The long-term consequences of traumatic brain injury affect millions of Americans, many of whom report using religion and spirituality to cope. Little research, however, has investigated how various elements of the religious and spiritual belief systems affect rehabilitation outcomes. The present study sought to assess the use of specifically defined elements of religion and spirituality as coping resources in a sample of traumatically brain injured adults. Furthermore, various mechanisms by which religion and spirituality may affect outcome were explored.

The sample included 88 adults with brain injury from 1 to 20 years post injury and their knowledgeable significant others (SOs). …

Is Private Long-Term Care Insurance Affordable For Older Adults?, Nayoung Kim

Wayne State University Dissertations

Nationwide there are fewer than 7 million long-term care (LTC) insurance policies in force. Why do so few Americans buy private long-term care (LTC) insurance? Several theories have been offered as possible explanations, including the availability of Medicaid, misperceptions that Medicare or other policies cover LTC, beliefs that one's own risk of needing LTC services is small, or desires to simply rely on children and spouses for LTC. This study examines another possible explanation - that private LTC insurance is simply "unaffordable" for most older Americans, which may be why they don't buy it.

This study begins by investigating the …

Comparison Of Affective Analgesia And Conditioned Place Preference Following Cholinergic Activation Of, Elena Schifirnet

Wayne State University Dissertations

Activation of the dopaminergic mesolimbic reward circuitry that originates in the ventral tegmental area (VTA) is postulated to preferentially suppress affective reactions to noxious stimuli (affective analgesia, AA). VTA dopamine neurons are activated via cholinergic inputs, and we have observed that microinjections of the acetylcholine agonist carbachol suppressed vocalizations of rats that occur following administration of brief (1 sec) tail-shocks (vocalization afterdischarges = VAD). VADs are a validated rodent model of pain affect. In addition, the capacity of carbachol to support reinforcement appears to be regionally dependent within VTA. Ikemoto and Wise (2002) reported that carbachol was self-administered in the …

A Vignette Study Examining The Accuracy Of Diagnosis: The Role Of Patient And Practitioner Gender And Race Match, Kevin Johnson

Wayne State University Dissertations

ABSTRACT

DIAGNOSING MENTAL ILLNESS

By

KEVIN JOHNSON

2010

Advisor: Dr. Janet R. Hankin

Major: Medical Sociology

Degree: Doctor of Philosophy in Sociology

A convenience snowball sample of 228 mental health practitioners were surveyed and administered two vignettes of persons with mental illness and a 12-question survey that included occupational background and attitudinal questions about diagnosing mental illness. The gender and race of the patients were randomly altered, while the symptoms and characteristics of mental illness remained constant for each vignette. Each practitioner assigned a DSM-IV diagnostic label for axis I and axis II on both vignettes. The surveys were coded …

Communicative Competence In Persons With Aphasia: The Impact Of Executive Function, Judy Marie Mikola

Wayne State University Dissertations

The purpose of this study was to examine the relationship between executive function and performance on selected linguistic tasks in persons with aphasia secondary to left frontal lesions.

A group of 15 persons with aphasia (PWA) completed three communication board tasks of varying levels of complexity and structure. The subject's functional use of the picture/word communication board was tested during a Story Retelling task. In addition, the PWA's executive function skills were examined using six nonverbal tests. The PWA group performance scores were compared to that of the neurologically healthy control group.

Results demonstrated that the control group performed significantly …

The Lived Experiences Of Older African Americans Residing In Urban Nursing Homes, Marilynn Gail Byrd Knall

Wayne State University Theses

As huge numbers of baby boomers reach old age, an increased need for nursing home care in the future is inevitable. Older people face more complex health issues that often lead to debilitation or disability and thus the need for long-term care. The numbers of consumers needing long-term care services will more than triple during the next 30 years.

African Americans compose less than 10% of nursing home residents and even at age 84 and older, when the likelihood of nursing home placement is higher, proportionately fewer African Americans live in nursing homes. The underrepresentation of ethnic minorities groups in …

2001 Michigan Hospital Cqi/Tqm Study, Colleen L. Croxall

Wayne State University Dissertations

In recent years, there has been significant interest in the application of total quality management/continuous quality improvement (TQM/CQI) within health care organizations. The health care industry, in its quest to improve outcomes with fewer resources, began to look at CQI/TQM as a possible solution. To date, the most comprehensive and enthusiastic response to efforts to improve quality while containing or lowering costs is reflected in hospitals' commitment to continuous quality improvement/total quality management (CQI/TQM). The health care industry, particularly hospitals, has embraced the concepts of CQI/TQM with the belief that adoption will lead to an improvement in both the quality …