Medicine and Health Sciences Commons^™

Older Women’S Stories Of Covid-19 Loss: Communicated Narrative Sense-Making Through Photography, Anne Walker

Electronic Theses and Dissertations

The diverse array of challenges associated with the COVID-19 pandemic make it difficult to assess the full impact of this global health crisis. More than 300,000 older Americans died, leaving a nation of grieving survivors in their absence. This profound loss of life will undoubtedly inform the field’s understanding of grief and grieving for many years to come. Pre-pandemic, older women in the United States understood grief to be part of their life stage; COVID-19 amplified the grief experience through both cumulative losses and the isolation particular to the novel coronavirus response. However, few qualitative studies explore older women’s grief, …

Protocol For The Promoting Resilience In Stress Management (Prism) Intervention: A Multi-Site Randomized Controlled Trial For Adolescents And Young Adults With Advanced Cancer, Alison O’Daffer, Liam Comiskey, Samantha R. Scott, Chuan Zhou, Miranda C. Bradford, Joyce P. Yi-Frazier, Abby R. Rosenberg

Psychology: Faculty Scholarship

Background

Adolescents and young adults (AYAs) with cancer are at high risk of poor psychosocial outcomes, and evidence-based interventions designed to meet their psychosocial and communication needs are lacking. The main objective of this project is to test the efficacy of a new adaptation of the Promoting Resilience in Stress Management intervention for AYAs with Advanced Cancer (PRISM-AC).

Methods/design

The PRISM-AC trial is a 2-arm, parallel, non-blinded, multisite, randomized controlled trial. 144 participants with advanced cancer will be enrolled and randomized to either usual, non-directive, supportive care without PRISM-AC (“control” arm) or with PRISM-AC (“experimental” arm). PRISM is a manualized, …

Environmental And Social Factors Associated With High Chronic Kidney Disease Mortality Rates In Municipalities Of Guatemala: An Ecological Study Of Municipal-Level Mortality Data, Alejandro Cerón

Anthropology: Faculty Scholarship

The purpose of this study was to determine the association between social and environmental indicators and high mortality rates from chronic kidney disease (CKD) in municipalities of Guatemala. An ecological study of municipal-level factors associated with CKD mortality in Guatemala was conducted. Crude mortality rates were calculated for the 2009–2019 period for each of the country’s 340 municipalities, by gender and age groups. Municipal-level social and environmental indicators were used as independent variables. Linear regression was used for bivariate and multivariate analysis. A total of 28,723 deaths from CKD were documented for the 2009–2019 period. Average crude mortality rate for …

Bringing People Back Into Public Health Data: Community Feedback On A Set Of Visualization Tools - Summary Report, Alejandro Cerón, Mia Glover, Quisi Rodriguez-Oregel, Dani Thompson, Tom Adams, Naomi Asakura, Kaela Belknap, Anna Block, Nicole Boehler, Hannah Boeve, Sarah Bomers, Sasha Borovok, Grace Bryan, Kate Buffington, Majesty Cain, Beth Carideo, Haley Chesno, Grace Connell, Jake Corbett, Camille Cruz, Chloe Dawkins, Anna Denniston, Lydia Dickens, Sophie Duplock, Samuel Dwinell, Avery Ess, Sam Ferman, Ellis Geis, Ethan Graupmann, Xander Hedrick, Angel Hernandez-Miramontes, Grant Huyghe, Sara Ibrahiem, Anna Jamieson, Ian Kang, Allie Kris, Erin Lawrence, Maddie Leake, Ryan Leary, Taylor Loh, Charlotte Monroe, Alexander Nguyen-Lopez, Henry O’Daffer, Cat Parish, Jaylee Recountre, Grace Rizzo, Noah Roseth, Grace Rothstein, Katie Sage, Marie Saltzmann, Stephen Shlain, Riley Shores, Mackenna Simson, Mark Teneza, Jack Weinmeister, Justin Weinzweig, Alison Wenman, Patch Whelan, Lea Zimmerman

Anthropology: Undergraduate Student Scholarship

This course-based study is a product of the University of Denver’s Spring 2022 The Social Determination of Health (ANTH 2424) class. The study aimed to understand how well a set of public health visualization tools tells the data stories about people in Colorado, and about important public health problems. For this, a team of almost sixty undergraduate students taking the class, coordinated by three graduate teaching assistants, and directed by the course instructor interviewed a total of fifty-six people from Colorado, qualitatively analyzed those interviews, and wrote reports that draw conclusions and recommendations.

Indicadores De Desigualdad Y Mortalidad Por Enfermedades Cardiometabólicas En Guatemala / Inequality Indicators And Cardiometabolic Diseases Mortality In Guatemala, Alejandro Cerón, Gila Y. Goldstein

Anthropology: Faculty Scholarship

La medición de las desigualdades en salud al interior de los países de ingresos bajos y medios es necesaria para la planificación, monitoreo y evaluación de intervenciones de salud pública, especialmente para problemas que contribuyen altamente a la carga de enfermedad, como las enfermedades cardiometabólicas. El objetivo de este estudio fue caracterizar los patrones de desigualdad de las tasas de mortalidad para las principales causas cardiometabólicas en Guatemala. Se usó datos del Censo Nacional de Población, y estadísticas oficiales de defunción de 2018 para calcular tasas crudas de mortalidad para diabetes (DM), infarto agudo de miocardio (IAM), y accidente cerebrovascular …

Mortalidad Por Accidente Cerebrovascular En Guatemala 2018: Patrones E Inequidades, Alejandro Cerón, Gila Goldstein

Anthropology: Faculty Scholarship

El presente estudio busca analizar la mortalidad por accidente cerebrovascular (ACV) en Guatemala con el propósito de identificar posibles criterios epidemiológicos que orienten la priorización de acciones de salud pública. El riesgo de morir de ACV en Guatemala muestra marcadas desigualdades por departamento, las que son aún más marcadas al comparar por municipio. El riesgo de morir es también más alto en personas mestizas o ladinas, en niveles educativos bajos, y en personas que se dedican a ocupaciones elementales. Deberían implementarse medidas de salud pública orientadas a los municipios y grupos en mayor riesgo de morir de ACV. Este estudio …

Factors Associated With Chronic Kidney Disease Of Non-Traditional Causes Among Children In Guatemala, Alejandro Cerón, Brooke M. Ramay, Luis Pablo Méndez-Alburez, Randall Lou-Meda

Anthropology: Faculty Scholarship

Objective. To identify factors associated with chronic kidney disease of non-traditional causes among children in Guatemala. Methods. A cross-sectional survey was conducted. The study population was all pediatric patients with stage 5 chronic kidney disease active in FUNDANIER’s pediatric nephrology unit (N = 156). Simple random sampling led to a total of 100 participants. Data collection consisted of a questionnaire addressing individual and household characteristics, access and utilization of health care, and place of residence when the disease began. Chronic kidney disease etiology was obtained from medical records. Municipality-level secondary data were collected. Descriptive statistics were estimated. Logistic regression was …

Mortalidad Por Infarto Agudo De Miocardio En Guatemala 2018: Patrones E Inequidades, Alejandro Cerón, Gila Goldstein

Anthropology: Faculty Scholarship

El presente estudio busca analizar la mortalidad por infarto agudo de miocardio (IAM) en Guatemala con el propósito de identificar posibles criterios epidemiológicos que orienten la priorización de acciones de salud pública. El riesgo de morir de IAM en Guatemala muestra marcadas desigualdades por departamento, las que son aún más marcadas al comparar por municipio. El riesgo de morir es también más alto en personas mestizas o ladinas, en niveles educativos bajos, y en personas que se dedican a ocupaciones elementales. Deberían implementarse medidas de salud pública orientadas a los municipios y grupos en mayor riesgo de morir de IAM. …

Maternal Hpa Axis Function During Parenting Is Associated With Reduced Brain Activation To Infant Cry And More Intrusive Parenting Behavior, Andrew Erhart

Electronic Theses and Dissertations

Previous research indicated that maternal cortisol function and maternal brain response to infant stimuli are separately related to differences in parenting behavior. Evidence from animal models have demonstrated that chronically high cortisol concentration alters brain structure and function, suggesting that studying these two mechanisms together may further improve understanding of parental behavior in human mothers. First time mothers of infants aged 1-7 months old (M age = 3 months) were recruited to participate. Mother’s cortisol concentration was measured during a naturalistic interaction with their infant and their behavior was coded for maternal sensitivity and nonintrusiveness. In a separate session using …

The Place And Role Of Pharmacy Benefit Management (Pbm) Companies In Us Healthcare System, George Mattis Ii

Electronic Theses and Dissertations

On average, prescription drugs cost US consumers more than any other developed country in the world. US drug makers claim that intermediaries in the prescription drug supply chain, companies called pharmacy benefit managers (PBM), are forcing them to increase their drug prices. PBMs counter that the discounts they receive from drug makers are channeled to insurers. This thesis will examine the role that PBMs play in the prescription drug supply chain and determine what effect they have on drug prices. This thesis will utilize a comparative static model, Structure, Conduct, Performance (SCP) framework to analyze the pharmaceutical manufacturing and the …

Mortalidad Por Diabetes En Guatemala 2018: Patrones E Inequidades, Alejandro Cerón, Gila Goldstein

Anthropology: Faculty Scholarship

El presente estudio busca analizar la mortalidad por diabetes en Guatemala con el propósito de identificar posibles criterios epidemiológicos que orienten la priorización de acciones de salud pública. El riesgo de morir de diabetes en Guatemala muestra marcadas desigualdades por departamento, las que son aún más marcadas al comparar por municipio. El riesgo de morir es también más alto en mujeres, en personas mestizas o ladinas, en niveles educativos bajos, y en personas que se dedican a ocupaciones elementales. Deberían implementarse medidas de salud pública orientadas a los municipios y grupos en mayor riesgo de morir de diabetes. Este estudio …

Availability Of Over-The-Counter Antibiotics In Guatemalan Corner Stores, Purificación Moreno, Alejandro Cerón, Karen Sosa, Marinees Morales, Laura M. Grajeda, Maria Renee Lopez, John P. Mccraken, Celia Cordón-Rosales, Guy H. Palmer, Douglas R. Call, Brooke M. Ramay

Anthropology: Faculty Scholarship

Widespread availability of antibiotics without prescription potentially facilitates overuse and contributes to selection pressure for antimicrobial resistant bacteria. Prior to this study, anecdotal observations in Guatemala identified corner stores as primary antibiotic dispensaries, where people purchase antibiotics without prescriptions. We carried out a cross sectional study to document the number and types of antibiotics available in corner stores, in four study areas in Guatemala. A total of 443 corner stores were surveyed, of which 295 (67%) sold antibiotics. The most commonly available antibiotics were amoxicillin, found in 246/295 (83%) stores, and tetracycline, found in 195/295 (66%) stores. Over the counter …

The Colored Pill: A History Film Performance Exposing Race Based Medicines, Wanda Lakota

Electronic Theses and Dissertations

Of the 32 pharmaceuticals approved by the FDA in 2005, one medicine stood out. That medicine, BiDil®, was a heart failure medication that set a precedent for being the first approved race based drug for African Americans. Though BiDil®, was the first race specific medicine, racialized bodies have been used all throughout history to advance medical knowledge. The framework for race, history, and racialized drugs was so multi-tiered; it could not be conceptualized from a single perspective. For this reason, this study examines racialized medicine through performance, history, and discourse analysis.

The focus of this work aimed …

Fostering Trauma-Informed Schools By Considering The Experiences Of Teachers In Working With Trauma-Exposed Students, Allison A. Stiles

Electronic Theses and Dissertations

High rates of trauma exposure among youth in the United States and the detrimental effects of trauma on students’ psychosocial and academic outcomes are well-established. Such findings have engendered the emergence of trauma-informed schools across the nation. While research regarding trauma-informed schools has understandably focused on the needs of students, shockingly little is known about teachers’ experiences in working with trauma-exposed students. In particular, very few studies have examined the relationship between teachers’ indirect exposure to student trauma and related symptoms of secondary traumatic stress (STS), as well as factors that may predict STS levels or explain variation in the …

Social Aspects Of Food-Sensitive Adults, Jean Elizabeth Duane

Electronic Theses and Dissertations

People living with food-related illnesses find themselves subjugated by commonly held ideologies causing awkwardness in social situations. The current study is a qualitative analysis addressing how people with celiac disease (CD) navigate social situations in light of dominant beliefs that influence behaviors. Initially, I identify macro-level patriarchal, religious, sexist, ableist and etiquette-related commensality ideologies that disadvantage those with CD. Drawing from the communication narrative sense making (CNSM) theory that supports storytelling and memorable messages as a sense-making tool for individuals diagnosed with chronic illness and their family members, this work highlights retrospective stories and memorable messages from 20 randomly selected …

Social Determinants Of Health Theory: Policy Entry Points For Healthcare Providers, Kiah R. Vandergrift

Electronic Theses and Dissertations

This thesis examines a shifting paradigm in the U.S. healthcare system that will re-define the role that the healthcare provider plays in the production of health. It does this by first acknowledging two differing economic theories on the production of health: Human Capital Theory and Social Determinants of Health theory, and how both schools of thought have contributed to the paradigm that healthcare providers only play a role in the end stages of health production - to heal those who are already ill. However, policy, payment, and delivery system reforms have begun to force healthcare providers to re-think how they …

How Informational Imperfections Lead To Sub-Optimal Solutions In Health Savings Plan And Potential Remedies In A Competitive Marketplace, Jacob Gene Dengg

Electronic Theses and Dissertations

In the growing trend of consumer-driven health insurance, more consumers than ever have access to a high-deductible health plan paired with a health savings account, where consumers can save pre-tax income for healthcare but also face higher out-of-pocket prices, in hopes that consumers will become smarter shoppers. The Health Savings Plan is successful at lowering costs, but at the expense of consumers lowering their adherence to healthcare, raising health risk. Even in a competitive market, HSP plan designs require smart shoppers and more active healthcare self-management, but without dealing with the informational imperfections that need to be overcome to encourage …

Stigma In The Post Crisis Age: External Barriers To Accessing Hiv Treatment, Internalized Trauma, And Strategies Of Support In Orlando, Florida, Julian Cerrell Nilsson

Electronic Theses and Dissertations

In 2017, The CDC (center for disease control and prevention) released a memo confirming popular medical opinion that an HIV positive person with an undetectable viral load was unable to transmit the HIV virus. While treatment and prevention options are advancing, this advancement may not translate directly into reduced stigma, which is produced and reproduced by external barriers to accessing healthcare, and internalized by HIV positive people as emotional trauma. This research explores the relationship between the availability of contemporary resources for the treatment and prevention of HIV/AIDS, and the environment of stigma experienced by positive gay and bisexual men …

Vmpfc Activation During A Stressor Predicts Positive Emotions During Stress Recovery, Xi Yang, Katelyn M. Garcia, Youngkyoo Jung, Christopher T. Whitlow, Kateri Mcrae, Christian E. Waugh

Psychology: Faculty Scholarship

Despite accruing evidence showing that positive emotions facilitate stress recovery, the neural basis for this effect remains unclear. To identify the underlying mechanism, we compared stress recovery for people reflecting on a stressor while in a positive emotional context with that for people in a neutral context. While blood–oxygen-level dependent data were being collected, participants (N = 43) performed a stressful anagram task, which was followed by a recovery period during which they reflected on the stressor while watching a positive or neutral video. Participants also reported positive and negative emotions throughout the task as well as retrospective thoughts …

Recent Advances In The Understanding Of Relationship Communication During Military Deployment, Steven L. Sayers, Galena K. Rhoades

Psychology: Faculty Scholarship

In recent decades, there has been a dramatic increase in the ability of service members and their intimate partners to communicate while the service member is deployed to a combat zone. Communication among partners is a crucial aspect of intimate relationships that has been demonstrated to be highly associated with couples’ satisfaction. In addition, it is often cited by unhappy partners as a primary relationship problem. This special section of the Journal of Family Psychology presents five articles investigating deployment communication among service members and their intimate partners. The studies address the content and goals of deployment communication, the relations …

Psychotropic Medications And Children: Perceptions Of Mental Health Professionals, Elinor Jane Brereton

Electronic Theses and Dissertations

This project explores mental health professionals' perspectives on the prescription of psychotropic medications to children. It emphasizes the placement of biomedicine within its larger social, economic, and political context, and the influence these structures have on the way mental illness is conceptualized and treated in children. Eight semi-structured interviews were conducted in Denver, Colorado with psychiatrists, psychologists, social workers, and a pharmaceutical board member to capture multiple perspectives from different positionalities within the field. Participants discussed factors that they believe influence prescribing practices including: professional role changes, issues of access, limited evidence, cost, and institutional pressures to practice within a …

Validation Of Minimally-Invasive Sample Collection Methods For Measurement Of Telomere Length, Stephanie A. Stout, Jue Lin, Natalie Hernandez, Elysia Poggi Davis, Elizabeth Blackburn, Judith E. Carroll, Laura M. Glynn

Psychology: Faculty Scholarship

Objective: The discovery of telomere length (TL) as a biomarker of cellular aging and correlate of age-related disease has generated a new field of research in the biology of healthy aging. Although the most common method of sample collection for TL is venous blood draw, less-invasive DNA collection methods are becoming more widely used. However, how TL relates across tissues derived from these sample collection methods is poorly understood. The current study is the first to characterize the associations in TL across three sample collection methods: venous whole blood, finger prick dried blood spot and saliva.

Methods: TL …

Family Income, Cumulative Risk Exposure, And White Matter Structure In Middle Childhood, Alexander J. Dufford, Pilyoung Kim

Psychology: Faculty Scholarship

Family income is associated with gray matter morphometry in children, but little is known about the relationship between family income and white matter structure. In this paper, using Tract-Based Spatial Statistics, a whole brain, voxel-wise approach, we examined the relationship between family income (assessed by income-to-needs ratio) and white matter organization in middle childhood (N = 27, M = 8.66 years). Results from a non-parametric, voxel-wise, multiple regression (threshold-free cluster enhancement, p < 0.05 FWE corrected) indicated that lower family income was associated with lower white matter organization [assessed by fractional anisotropy (FA)] for several clusters in white matter tracts involved in cognitive and emotional functions including fronto-limbic circuitry (uncinate fasciculus and cingulum bundle), association fibers (inferior longitudinal fasciculus, superior longitudinal fasciculus), and corticospinal tracts. Further, we examined the possibility that cumulative risk (CR) exposure might function as one of the potential pathways by which family income influences neural outcomes. Using multiple regressions, we found lower FA in portions of these tracts, including those found in the left cingulum bundle and left superior longitudinal fasciculus, was significantly related to greater exposure to CR (β = -0.47, p < 0.05 and β = -0.45, p < 0.05).

Distinct Patterns Of Reduced Prefrontal And Limbic Gray Matter Volume In Childhood General And Internalizing Psychopathology, Hannah R. Snyder, Benjamin L. Hankin, Curt A. Sandman, Kevin Head, Elysia Poggi Davis

Psychology: Faculty Scholarship

Reduced gray matter volume (GMV) is widely implicated in psychopathology, but scholars have found mostly overlapping areas of GMV reduction across disorders rather than unique neural signatures, potentially due to pervasive comorbidity. GMV reductions may be associated with broader psychopathology dimensions rather than specific disorders. We used an empirically supported bifactor model consisting of common psychopathology and internalizing- and externalizing-specific factors to evaluate whether latent psychopathology dimensions yield a clearer, more parsimonious pattern of GMV reduction in prefrontal and limbic/paralimbic areas implicated in individual disorders. A community sample of children (N = 254, ages 6–10) was used to evaluate …

General And Emotion-Specific Alterations To Cognitive Control In Women With A History Of Childhood Abuse, Kristen L. Mackiewicz Seghete, Roselinde H. Kaiser, Anne P. Deprince, Marie T. Banich

Psychology: Faculty Scholarship

Background

Although limited, the literature suggests alterations in activation of cognitive control regions in adults and adolescents with a history of childhood abuse. The current study examined whether such alterations are increased in the face of emotionally-distracting as compared to emotionally neutral information, and whether such alterations occur in brain regions that exert cognitive control in a more top-down sustained manner or a more bottom-up transient manner.

Methods

Participants were young adult women (ages 23–30): one group with a history of childhood physical or sexual abuse (N = 15) and one with no trauma exposure (N = 17), as assessed …

Abnormal Dendritic Maturation Of Developing Cortical Neurons Exposed To Corticotropin Releasing Hormone (Crh): Insights Into Effects Of Prenatal Adversity?, Megan M. Curran, Curt A. Sandman, Elysia Poggi Davis, Laura M. Glynn, Tallie Z. Baram

Psychology: Faculty Scholarship

Corticotropin releasing hormone (CRH) produced by the hypothalamus initiates the hypothalamic-pituitary-adrenal (HPA) axis, which regulates the body’s stress response. CRH levels typically are undetectable in human plasma, but during pregnancy the primate placenta synthesizes and releases large amounts of CRH into both maternal and fetal circulations. Notably, placental CRH synthesis increases in response to maternal stress signals. There is evidence that human fetal exposure to high concentrations of placental CRH is associated with behavioral consequences during infancy and into childhood, however the direct effects on of the peptide on the human brain are unknown. In this study, we used a …

“That’S Enough Patients For Everyone!”: Local Stakeholders’ Views On Attracting Patients Into Barbados And Guatemala’S Emerging Medical Tourism Sectors, Jeremy Snyder, Valorie A. Crooks, Rory Johnston, Alejandro Cerón, Ronald Labonte

Anthropology: Faculty Scholarship

Background

Medical tourism has attracted considerable interest within the Latin American and Caribbean (LAC) region. Governments in the region tout the economic potential of treating foreign patients while several new private hospitals primarily target international patients. This analysis explores the perspectives of a range of medical tourism sector stakeholders in two LAC countries, Guatemala and Barbados, which are beginning to develop their medical tourism sectors. These perspectives provide insights into how beliefs about international patients are shaping the expanding regional interest in medical tourism.

Methods

Structured around the comparative case study methodology, semi-structured interviews were conducted with 50 medical tourism …

The Caregiver–Child Relationship, Youth Mental Health, And Placement Stability In A Child Welfare Sample, Laura A. Rindlaub

Electronic Theses and Dissertations

Objective: Healthy relationships between adolescents and their caregivers have been robustly associated with better youth outcomes in a variety of domains. Youth in contact with the child welfare system are at higher risk for worse outcomes including mental health problems and home placement instability. A growing body of literature points to youth mental health problems as both a predictor and a consequence of home placement instability in this population; the present study aimed to expand our understanding of these phenomena by examining the interplay among the caregiver-child relationship, youth mental health symptoms, and placement change over time. Method: The sample …

Social Support And Affectionate Communication In Animal-Assisted Interventions: Toward A Typology And Rating Scheme Of Handler/Dog Messages, Amy Mccullough

Electronic Theses and Dissertations

Animal-assisted interventions (AAIs) are a treatment modality that incorporates a trained animal into a person's healing and learning process in order to benefit the person physically, emotionally and/or socially (Delta Society, 1996). From an interactional perspective, two mechanisms that may contribute to these health benefits are social support and affection exchange. Although there is growing evidence of the health and well-being benefits of AAIs, there remains a need for scientific research to understand more precisely the communicative and behavioral components that constitute a therapeutic intervention involving an animal (Kazdin, 2010). Additionally, there is a need to develop a means of …

The Case For Extending Patent Terms For Drugs That Treat Rare Diseases, Joanna Louise Thompson

Electronic Theses and Dissertations

This paper seeks to determine if extended patent terms can positively effect the production of drugs that treat rare diseases. It reviews the structure of the modern pharmaceutical company and considers the regulatory history that lead to this structure. The paper applies historically significant economic research in the field of patents and considers patent alternatives to establish the best method for incentivizing the development of these drugs. The paper finds that while there are numerous pitfalls and issues with the patent method, there are no viable alternatives. It also concludes that extending patent terms for drugs that treat rare diseases …