Medicine and Health Sciences Commons^™

Nutrition Care For The Transgender Population: A Retrospective Study To Investigate Relationships Between The Nutrition Care Process Model And Patient Outcomes, Alana Minnee Marrero Gonzalez

UNF Graduate Theses and Dissertations

One of the most important roles of the registered dietitian nutritionist is to provide medical nutrition therapy that is fitting to an individual’s culture, reality, ethnicity, and dietary preferences. A review of existing literature exposes the lack of information available on LGBTQ (lesbian, gay, bisexual, transgender, queer) health, for transgender communities. The purpose of this research was to generate knowledge of the nutrition-related problems and barriers to adequate nutrition and health, and their impact in nutrition assessment in a sample of Hispanic transgender adult patients living in San Juan, Puerto Rico. A retrospective observational study was conducted, data from 114 …

The Experiences Of Transgender And Gender Diverse Individuals Seeking Mental Health Treatment, Brice T. Marks

UNF Graduate Theses and Dissertations

Transgender and Gender Diverse (TGD) individuals are underserved in communities despite experiencing disproportionately higher rates of mental health distress. The cisheteronomativity of society creates chronic stressors that impact the mental health outcomes of TGD individuals. TGD individuals face the highest rates of discrimination in healthcare settings. Yet, little is known about the population's specific experiences seeking mental health care. Using a phenomenological approach, this study interviewed eight TGD individuals to understand the experience of seeking mental health care. There were six themes: facilitation of seeking behaviors, barriers, type of care, characteristics of providers, identity disclosure, and burden of advocacy and …

Association Between Objectively-Measured Sedentary Time And Self-Reported Prescription Medication Use Among Adults: A Pilot Study, Ciarra Ashley Boyne

UNF Graduate Theses and Dissertations

BACKGROUND: Prescription medication use and extended sedentary time are independently related to poor health outcomes (e.g., diabetes, metabolic syndrome, mortality). Historically, survey methods have been used to obtain estimates of total sedentary time (ST), however, recent use of accelerometers avoids self-report bias and affords more characteristics of ST that may be factors in health outcomes (e.g., frequency and duration of sedentary bouts). The aims of this pilot study were to 1) examine the association between objectively measured ST via accelerometers and self-reported prescription medication use in adults and 2) examine the independent association of sedentary bout length and frequency with …

Walking The Talk: A Qualitative Exploration Of Gatekeeping Staff Perceptions Surrounding Implementation Of Nutrition Policy In Florida Food Banks, Rachel Lynn Mccandless

UNF Graduate Theses and Dissertations

Food insecurity is an independent risk factor for adverse health outcomes; providing nutrient-dense food through the emergency food system to individuals who regularly seek assistance can impact population-level health disparities. This research explored the extrinsic and intrinsic barriers and facilitators surrounding formal nutrition policy implementation as seen by the logistical gatekeepers in a sample of Feeding Florida food banks. A secondary aim of this research was to explore the change readiness of these same logistical decision-makers in nutrition policy implementation. Research Questions included the following: What are the critical gatekeeping staff perceptions of the barriers and facilitators to implementing formal …

Illness Stigma, Social Connectedness, And Health In People Living With Chronic Illness: A Structural Equation Model, Abigail Brooke Crawford

UNF Graduate Theses and Dissertations

The complexity of chronic or unexplained conditions may lead to potential stigma for those suffering long-term symptoms as they do not follow the expected pattern of recovery following diagnosis and treatment. Experiencing such illness-related stigma has potential for leading to a belongingness identity of detachment with implications for health across physical, social, and psychological dimensions. This study aimed to examine the relationship between stigma, social connection, mental health, physical health, and social functioning in a group of 231 participants with ongoing symptoms of chronic illness through structural equation modeling. The fit indices all suggest that the model reasonably fits the …

Physiological Responses Regarding Stress And Trauma: The Freeze Response, Emma Arie Von Holten

UNF Graduate Theses and Dissertations

Fight-or-flight is a commonly known response to threatening situations, but the freeze response is another defensive mechanism that might arise in such situations. There is also evidence that exposure to trauma can impact physiological reactions when defensive mechanisms are not required, such as freezing in response to non-threatening situations. The current study aimed to replicate and expand upon a limited number of previous studies on the human freeze response by implementing measurements of postural sway, heart rate, and infrared thermography while valenced images were shown to participants. Ninety-two participants were recruited from the University of North Florida and participants were …

Virtual Supervised Practice During The Covid-19 Pandemic. Does Virtual Learning Affect The Quality Of Preparation For The Rd Exam Or Beginning Dietetics Practice?, Shaynee M. Roper

UNF Graduate Theses and Dissertations

The Covid-19 pandemic has seemingly altered the practice of Dietetics, and its essential supervised practice component of the Dietetic Internship programs. Telehealth, in particular telenutrition, became a necessity of practice for the entire United States and many parts of the world. Medicare and many private insurance companies amended policies for the expansion, inclusion, and provision of MNT via telephone.¹ In addition, numerous Dietetic Interns were forced to complete the supervised practice (SPE) components of ACEND (Accreditation Council for Education in Nutrition and Dietetics) accredited programs virtually. The practice of telehealth is not a new concept. Indeed, this area of …

A Two-Day Virtual Workshop On The Micronutrient-Directed Nutrition-Focused Physical Exam For Ghanaian Nutrition Professionals: Examining Perceived Self-Efficacy And Innovation, Leah Anne Qubty

UNF Graduate Theses and Dissertations

Micronutrients are key components of various physiological processes. Therefore, in the setting of deficiency, poor health outcomes ensue. In Ghana, micronutrient deficiencies are common and medical resources are limited. The Ghanaian dietetics profession is growing, and this growth is propitiously timed to address micronutrient deficiencies. Biochemical markers of nutrition status are considered the gold standard to detect micronutrient deficiencies, but are costly and require specialized medical equipment. In the absence of available biochemical markers of nutrition status, the micronutrient-directed nutrition-focused physical exam is a viable tool. Nutrition professionals such as Registered Dietitians are qualified to conduct this exam, but feel …

Implementation Of A Transitions Of Care Nutrition Intervention For Malnourished Patients, Nina Rocca

UNF Graduate Theses and Dissertations

The topic of Transitions of Care (TOC) has been investigated by physician and nursing professions for years, while only more recently by nutrition professionals. Registered Dietitians are not always involved in TOC planning. RDs can play an important role in TOC by communicating patients’ nutrition information across health care settings, especially for patients with malnutrition. The primary aim was to use a CDC based process evaluation to evaluate if a case management, nursing focused care transitions framework, adapted for a TOC nutrition intervention, can result in a successful intervention implementation. The secondary aim was to use a CDC outcomes evaluation, …

Nutrition Perception, Dietary Intake, And Anthropometric Correlations Between Autism Spectrum Disorder And Typically Developing Adolescents., Kristin M. Berg

UNF Graduate Theses and Dissertations

The adolescent’s nutrition perception is reflected in dietary intake and body composition. Obesity is prevalent among adolescents with Autism Spectrum Disorder (ASD). Dietary habits of children with ASD are affected by sensory issues, gastrointestinal factors, and parental provision of diet. This cross-sectional study identifies the relationships among variables for dietary intake, nutrition perception of intake, and anthropometric measurements for adiposity for 19 adolescents, ages 11 to 17, with ASD. Twenty-four children who are typically developing (TD) were assessed to compare all variables for significant differences. Measurements of variables of interest were obtained from the adolescent subjects: a 24-hour recall of …

Interprofessional Education Activities And New Practitioner Competence: Implications For Practice In Nutrition And Dietetics Education, Stephanie N. Petrosky

UNF Graduate Theses and Dissertations

Interprofessional education (IPE) and interprofessional collaborative practice (IPCP) are associated with improved perception, values, attitudes towards collaborative practice, and therefore benefits patients, practitioners, and health care systems. Notable organizations have long promoted standardized guidelines for best practices in interdisciplinary team-based learning to improve patient safety and health outcomes. The state of IPE in nutrition and dietetics practice was recently addressed by the Nutrition and Dietetic Educators and Preceptors (NDEP) practice group of the Academy of Nutrition and Dietetics. The authors generated a call to action to engage in IPCP while pushing the boundaries of leadership in teaching, research, and practice. …

The Potential Mediating Effects Of Social Support Network Size And Physical Activity On Cognitive Function And Mortality Risk, Madeline Zipperer

UNF Graduate Theses and Dissertations

BACKGROUND: Low cognitive function has been shown to be an independent predictor of all-cause and cardiovascular disease (CVD)-related mortality. Social support network size and total physical activity volume (TPAV) are two modifiable factors which have been shown to be independently associated with cognitive function and mortality risk. Therefore, the purpose of this study was to examine the potential mediating effects of social support network size and TPAV on cognitive function and all-cause and CVD-related mortality risk in a large, nationally representative sample of U.S. adults.

METHODS: Study sample (N =2,550) included older adult (≥ 60 years of age) participants …

Estimation Of 24-Hour Urinary Creatinine Excretion Through The Development Of A Model And Its Relationship To Outcomes In Hospitalized Critically Ill Veterans, Lynn Diane Hiller

UNF Graduate Theses and Dissertations

Background: Muscle mass is highly correlated with patient outcomes. Techniques to identify patients with low muscularity include computed tomography (CT) and bioelectrical impendence analysis (BIA) however disadvantages of cost, exposure to radiation and access make these measurements unavailable to the average dietitian. Urinary creatinine excretion (UCE) and estimation of creatinine height index (CHI) are strongly associated with muscularity and outcomes, however, require a 24-hour urine collection. The postulation that UCE may be predicted from patient variables, through mathematical modeling, would avoid the need for a 24-hour urine collection and may be clinically useful.

Methods: Input variables of age, …

Childhood Food Insecurity: A Program Impact And Evaluation Study Of The Meals On Wheels For Kids Program, Claudia Rivero

UNF Graduate Theses and Dissertations

In America, millions of families and children face hunger and food insecurity every day. According to the United States Department of Agriculture, more than thirty-eight million people experienced hunger in 2020. As many as 13 million children in the United States live in food-insecure homes. Many households that experience food insecurity do not qualify for federal nutrition programs. While valuable, barriers to these programs can block food-insecure households with children and prevent access to healthy food. The impact of adverse health and nutritional consequences, of a food-insecure household, will continue to plague our communities until efficient programming connects to those …

Exploring The Health Outcomes And Patient’S Viewpoint Of Pediatric Patients Receiving Medical Nutrition Therapy Visits With In-Person, Telephonic, And Tele-Video Modalities At A Rural Community Health Center, Valerie L. Muehleman

UNF Graduate Theses and Dissertations

The Covid-19 pandemic advanced telephonic (TP) and tele-video (TV) visits for medical nutrition therapy (MNT). This study explored the health outcomes and patient’s viewpoints of MNT by modalities in a community health center (CHC). Participants ranged in age from 1-18 years, diagnosed with overweight/obesity, and received MNT from a registered dietitian nutritionist (RDN) from January 1, 2019 to August 31, 2021. Health outcomes measured were health goal achievement, BMI percentile, pre/post lipid panel, and A1C%. Show/no-show rates and demographic characteristics of gender, age, race, insurance, county, language, and ethnicity were also compared by the visit modality. Ten interviews in the …

Identification And Characterization Of The Tssk6 Activating Co-Chaperone (Tsacc) Gene In Skeletal Muscle, Tala Shourbagi Tello

UNF Graduate Theses and Dissertations

Skeletal muscle atrophy is defined as a decrease in muscle size and occurs due to disparate physiological conditions, including aging, immobilization, and corticosteroid exposure. TSSK6 activating co-chaperone (TSACC) was identified as a gene that is significantly upregulated in skeletal muscle in response to denervation. To confirm Tsacc expression in skeletal muscle, the Tsacc cDNA was cloned from cultured myoblast cells leading to the discovery of a novel alternative splice-variant that is 49 amino acids shorter than the known full-length transcript. Quantitative PCR (qPCR) confirmed that Tsacc is expressed in skeletal muscle with expression increasing as muscle cells undergo differentiation. Characterization …

Total Brachial Artery Reactivity And Incident Heart Failure And Heart Failure Sub-Types: Multi-Ethnic Study Of Atherosclerosis, Daniela Charry Segura

UNF Graduate Theses and Dissertations

Purpose: The aim of this study was to evaluate the association between total brachial artery reactivity (TBAR) and the cumulative risk of incident heart failure (HF), HF with reduced ejection fraction (HFrEF), and HF with preserved ejection fraction (HFpEF) in a community-based study. Methods: Sample included 5,499 participants (45-84 years of age) from the Multi-Ethnic Study of Atherosclerosis who were free of cardiovascular disease at baseline. Brachial artery ultrasound was performed after five minutes of cuff occlusion at the right forearm. TBAR was calculated as the difference between maximum and minimum brachial artery diameters following cuff release, divided by the …

Physician Knowledge, Attitudes, And Behaviors Towards Registered Dietitian Nutritionists, Amy Motley Jones

UNF Graduate Theses and Dissertations

Diet is increasingly linked with overall quality of life, and a healthy diet is now being considered one of the cornerstones of preventative care. Physicians rely on Registered Dietitian Nutritionists (RDNs) as most doctors lack the nutrition knowledge to properly treat their patients, especially during their residency. Little published information exists on the specific collaboration of RDNs and resident physicians. This study aimed to determine whether mentoring with an RDN increased physician nutrition knowledge, increased consults to RDNs, and whether physician attitudes improved regarding their understanding of the role of the RDN in healthcare. Knowledge or attitude alone are not …

The Effects Of Fermented Vegetable Consumption On The Composition Of The Intestinal Microflora And Levels Of Inflammatory Markers In Women: A Pilot And Feasibility Study, Amy Galena

UNF Graduate Theses and Dissertations

Background: The gut microbiome plays a key role in metabolic disease development. Diet is a modifiable factor that significantly influences gut microbial composition, and fermented foods are a reliable source of probiotic microorganisms that can contribute to gut homeostasis. The primary objective of this study was to explore the feasibility of fermented vegetable consumption for six weeks on markers of inflammation and gut microflora profiles in women.

Methods: Thirty-one women consumed 100 g/day of fermented vegetables (group A), non-fermented vegetables (group B), or no vegetables (group C) for six weeks. Dietary intake was assessed twice during the intervention by a …

Factors Associated With Overall Experience In Advanced-Practice Doctoral Programs, Kristi Chipman

UNF Graduate Theses and Dissertations

Advanced-Practice Doctoral (APD) students are working professionals who are often returning to school after several years of practice. Multiple areas and concerns may affect overall experience as well as retention rates in doctoral programs.

This mixed-methods research study utilized both qualitative (interview) and quantitative (survey) methods. Students from three different APD programs (Doctorate in Clinical Nutrition, Doctor of Education, and Doctor of Nursing) were asked to participate in a semi-structured interview. The interview was used to help guide the development of a survey. Students from the three groups (n=65) were asked to participate in a one-time, non-incentivized, survey. The survey …

Parents' Attitudes And Beliefs Towards Dietary Behaviors Of Children With Autism Aged 5-13 Years, Subashree Narayanan

UNF Graduate Theses and Dissertations

Autism is a neurodevelopmental disability that may affect nutritional management of children with autism. Parent’s attitudes and their behavior towards healthy eating reflects on the child’s eating habits and thus, their nutritional health. This study aimed to describe the diet quality of children with autism using the Healthy Eating Index (HEI) scores. It also aimed to assess the relationship between parent’s perceived barriers and self-efficacy and children’s dietary behavior and dietary intake (age 5-13 years). The relationship was assessed using 2 questionnaires, Nutrition and Health Awareness and BAMBI questionnaire for parent’s attitudes and beliefs and dietary behavior, respectively. Dietary intake …

Investigation Of The Multidimensional Determinants Of Nutritionally Risky Coping Strategies And Tradeoffs In Adults, Cheryl Marsland

UNF Graduate Theses and Dissertations

Multidimensional determinants influence use of negative nutrition coping strategies and tradeoffs in households accessing food relief. The objective of this study is to examine negative nutrition coping strategies and tradeoffs at different levels of food insecurity in households accessing food relief and investigate how these behaviors relate to experience-based food insecurity dimensions and populations at risk. This secondary data analysis is from the cross-sectional Sunshine State Hunger Survey (SSHS) conducted June 2018 to August 2018. Over 600 adults were surveyed capturing households of Floridians who accessed 18 direct service charities and community groups that provide food relief across the Tampa …

A Mixed Methods Study Examining The Barriers And Facilitators To Research Utilization And Evidence-Based Practice In Adult Weight Management, Kevin B. Metcalf

UNF Graduate Theses and Dissertations

Background

Obesity is a disease with many associated comorbidities and its prevalence in the U.S. continues to increase despite the majority of people with obesity attempting weight loss. Dietitians are responsible for using evidence-based practice to mitigate the effects of obesity, however, differences in practice philosophies, opinion leaders, misinformation, a sense of competence, and the complexity of nutrition research have been identified as barriers to implementing practice guidelines into daily practice. It is unclear how dietitians strike a balance between empirical evidence, anecdotal evidence, and patient-centered practice.

Aims

The primary aim of this mixed-methods study was to identify the barriers …

Validation Of An Evidence-Based Dietetic Practice Instrument And The Association Between Level Of Education And Use Of Evidence-Based Dietetic Practices Among Registered Dietitian Nutritionists, Leslie Thompson Van Horn

UNF Graduate Theses and Dissertations

Evidence-based practice (EBP) is associated with improved and consistent patient care and reduced healthcare costs. While dietetic didactic and practice requirements emphasize EBP, there is a lack of a valid and reliable instrument that measures both objective and subjective knowledge of EBP among registered dietitian nutritionists (RDNs). Content validity was conducted with 11 experts and resulted in a 38-item survey that included ten items assessing objective knowledge of EBP. Items were deemed clear and appropriate for the survey goals and intended audience based on a face validity review among 16 RDNs with varying backgrounds. A pilot evaluation (n = …

A Hopeless Illness Representation Style: Examining Chronic Illness And Depression With Coping As A Mediator, Dana Arnold

UNF Graduate Theses and Dissertations

The self-regulation theory of illness representations (Leventhal et al., 2003) and the hopelessness theory of depression (Abramson et al., 1989) were used to observe how hopeless illness representations, depression, and coping styles interact. 238 participants with a chronic illness lasting three months or more were observed through the VOICE (Verification of Illness and Coping Experience) survey. Mediation was used to analyze the relationship between hopeless illness representations and depression, with passive coping as the mediator. All regressions in the mediation analysis were significant, and partial mediation was found. Patients with hopeless illness representations were more likely to use passive coping …

Impacts Of Meals On Wings (Mow) Program On Volunteers' Perceptions And Motives, Juan Diego Salcedo

UNF Graduate Theses and Dissertations

INTRODUCTION: Food insecurity is a problem in the subpopulation of older adults and the elderly. The following study aimed to explore the perceptions and motives such as career benefits, impacts experienced through volunteering, skills in dietetics, comfort level with seniors, social responsibility, peer modeling, and empathy of student volunteers participating in a food recovery-meal delivery program known as Meals on Wings (MOW) on a college campus in the Southeast.

METHODOLOGY: The study was conducted during July 2021. Semi-structured interviews were administered over the video conference program Zoom to 10 (n=10) student volunteers who volunteered with MOW for at least one …

The Nutrition Care Process In Diabetes Medical Nutrition Therapy, Casey R. Colin

UNF Graduate Theses and Dissertations

The purpose of this study was to examine documentation quality and outcomes in a sample (n = 564 patient cases) of Diabetes Registry data from ANDHII, and to determine the validity and reliability of a revised NCP quality audit tool. RDNs have struggled to objectively demonstrate the value of MNT, which has limited MNT reimbursement and RDN recognition amongst allied healthcare providers. Development of a standardized process (the NCP), standardized language (the NCPT), and ANDHII have provided a means through which RDNs can improve MNT documentation and capture outcomes data, but gaps in adequate utilization exist. The most common …

An Examination Of The Impact Of The Covid-19 Health Threat, Stress, And Social Isolation On Lifestyle Habits As Analyzed Through The Protection Motivation Theory, Luciana Adib Soares

UNF Graduate Theses and Dissertations

The COVID-19 emerged in China in 2019 and quickly spread to other countries, leading to mandated lockdowns and social isolation. This cross-sectional study examined the impact of the COVID-19-generated stress, health threat, and social isolation on dietary, physical activity, and self-care habits of adults in Florida, utilizing the PMT as a framework. Participants (n = 478) completed online surveys about demographics, perceived stress, and changes in lifestyle habits. Significant positive changes were reported in cooking at home (p < .001) frequency, sweets (p < .001), and breakfast (p = .009) consumption, outdoors physical activity (p = .005), self-care (p < .001), relaxation (p < .001), and rest (p < .001) habits. Significant negative changes were reported in fast food (p = .004) and snack (p < .001) consumption. A significant relationship existed between self-reported stress, perceived threat, (r = .33, p < .001), and perceived efficacy, (r = -.15, p = .002). Perceived threat was the most important predictor of changes …

Safety Analysis Of Battery-Powered Adaptive Ride-On Toys For Children With Disabilities, Abbey Fraser

UNF Graduate Theses and Dissertations

Modified battery-powered ride-on toy cars, or adaptive ride-on toys, represent novel rehabilitation tools and developmental aids for children with disabilities. Studies have shown that children are benefiting socially and developmentally from their use. However, the use of these toys by children with disabilities potentially poses a risk of injury and it is vitally important to ensure the safe use of these toys, particularly for the benefit of those with developmental challenges.

Within this context, the purpose of the first study was to determine whether modifications to ride-on toys are sufficient to prevent common modes of injury such as falls, passenger …

Exploring The Impact Of A Nutrition Support Workshop For Ghanaian Nutrition Professionals, Sarah D. Zeola

UNF Graduate Theses and Dissertations

Ghana, a middle-income country in West Africa, has long experienced high rates of malnutrition and is increasingly struggling with nutritional challenges from non-communicable diseases including overweight, obesity, hypertension and stroke. There is an inadequate number of trained Ghanaian nutrition professionals to meet the demands of providing nutrition care for the citizens of Ghana and those professionals providing nutrition care have limited opportunities for continuing education. This quasi-experimental prospective, single cohort pre-test/post-test research was conducted in Accra, Ghana in September 2019 to determine if providing a nutrition support workshop to Ghanaian nutrition professionals (dietitians, dietetic interns, dietetic students and nutritionists) would …