Medicine and Health Sciences Commons^™

The Association Of Hospital Practices To Breastfeeding Behaviors In South Carolina: Analysis Of 2013-2015 Pregnancy Risk Assessment Monitoring System (Prams) Data, Larisa Donnette Bruner

Theses and Dissertations

Objective: The purpose of this study was to determine whether hospital practices are associated with breastfeeding initiation and breastfeeding duration for ≥10 weeks.

Methods: We analyzed the 2013-2015 South Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) data. The population of interest was mothers who delivered a single live birth in the hospital. The infant was alive and living with the mother at the time of the survey. Chi-square and logistic regression were used to examine breastfeeding initiation and duration among all women who delivered in a hospital and those who stated that they initiated breastfeeding while in the …

Physical Activity During Pregnancy And Birth Outcomes In South Carolina 2009-2015, Andrew Tyler Broadway

Theses and Dissertations

Physical activity is known to be beneficial to adults in general, including pregnant women, but the literature on physical activity and neonatal outcomes has been inconsistent. Few studies have differentiated between physical activity prior to pregnancy and during pregnancy to see whether the typical beneficial effect is not due to having a more active lifestyle in general. The Pregnancy Risk Assessment Monitoring System (PRAMS) is a national cross-sectional surveillance system. Our data from SC PRAMS included 6391 respondents and was weighted to be representative of population of pregnant women that delivered in the state. We excluded births that were not …

The Role Of Cdk8 In Metastatic Growth Of Colon Cancer, Jiaxin Liang

Theses and Dissertations

Unresectable hepatic metastases of colon cancer poorly respond to existing therapies and are a major cause of colon cancer lethality. Transcription- regulating Mediator kinase CDK8, an early clinical stage drug target, is amplified or overexpressed in many colon cancers and CDK8 expression correlates with shorter patient survival. Here we show that CDK8 inhibition does not generally suppress proliferation of CDK8-overexpressing colon cancer cells but nevertheless CDK8 knockdown by shRNA or CDK8 kinase inhibition by a selective small-molecule drug candidate suppresses metastatic growth of mouse and human colon cancer cells in the liver. This effect is due at least in part …

The Importance Of Person And Place In Predicting Prostate Cancer Incidence And Mortality Among United States Veterans Seeking Veterans Health Administration Care, Peter Georgantopoulos

Theses and Dissertations

T Introduction: There are several unique characteristics in the epidemiology of prostate cancer (PrCA) that make it an interesting and important cancer to study. The first is that while prostate cancer is the most common cancer that men develop, it is one of the least common cancers that men die from. This indolent nature of PrCA has led to the idiom among health scientists that “men are more likely to die with PrCA than due to PrCA”. Just like other cancers, several individual-level risk factors (e.g., family history of the disease, age, and race) are well established for both PrCA …

Kv7 Channels Of The Urinary Bladder Smooth Muscle: Functional Roles And Therapeutic Potential, Aaron Provence

Theses and Dissertations

Overactive bladder (OAB) is a pervasive and debilitating condition for which effective therapeutic modalities are lacking. As potential novel pharmacological targets for lower urinary tract dysfunction, our recent studies have demonstrated voltage-gated KV7 channels (KV7.1-KV7.5) to be functionally expressed in detrusor smooth muscle (DSM) of the urinary bladder. Nonetheless, the specific roles of individual KV7 channel subtypes remains poorly understood. Using Western blot, immunocytochemistry, isometric DSM tension recordings, ratiometric fluorescence Ca2+ imaging, and patch-clamp electrophysiology, we demonstrated expression and key physiologic roles for the KV7.2/KV7.3 channels in guinea pig DSM using the novel and selective KV7.2/KV7.3 channel opener N-(2-Chloro-5-pyrimidinyl)-3,4-difluorobenzamide (ICA-069673). …

Advanced Clearing Methods And Imaging Techniques For Optimized Three- Dimensional Reconstruction Of Dense Tissues, Caleb A. Padgett

Theses and Dissertations

Advances in tissue clearing have allowed biological and biomedical researchers to image entire segments of tissue and generate three-dimensional reconstructions, allowing for a better understanding of the structural and morphological characteristics of large tissues. This study compared three commonly utilized clearing methods and analyzed their effectiveness in increasing imaging depth for three-dimensional reconstruction of large tissue segments. Mouse heart, mouse brain, mouse colon, and embryonic chick tissues were cut into thick sections, cleared and immunolabeled with an antibody specific to each tissue type, and imaged using a confocal microscope. The results of this study concluded that most tissues cleared by …

Effect Of Resveratrol On The Development Of Eczema, Christopher Carlucci

Theses and Dissertations

Atopic dermatitis is a type of eczema characterized by chronic inflammation of the skin, affecting millions of people worldwide. Resveratrol, a naturally occurring stilbenoid, is widely believed to exhibit beneficial effects on a host of chronic diseases. Although some previous studies have aimed to evaluate the effects of resveratrol on the pathogenesis of atopic dermatitis, this relationship remains ill-defined. We have previously established that mast cell activation, remodeling, and cellular infiltration in the hypodermis all begin prior to the IgE-mediated immune response in an atopic dermatitis mouse model, and that this early pathogenesis is directly related to an increase in …

A Longitudinal Analysis Of Shiftwork And Self-Reported Depression In A Police Cohort, Meghan Holst

Theses and Dissertations

Background: Shiftwork is associated with many chronic diseases stemming from the disruption of circadian rhythms. Police officers have a high risk for many adverse conditions including depression. Abnormal bodily functions, such as increased stress and disturbed sleeping patterns, may play an important role in the development and severity of depression. This study was designed to assess the association between depressive symptoms and shiftwork in a police cohort from Buffalo, NY

Methods: This longitudinal analysis consists of 470 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study. Data were collected during visit 3 between 2004-2005 and visit …

Understanding Barriers To Genetic Testing For Sickle Cell Trait: The African-American Male Perspective, Shandrea Foster

Theses and Dissertations

Research has shown a reluctance in African-American males to pursue testing for sickle cell trait. Few studies have tried to discern what barriers are contributing to this issue within the African-American male community. Research suggests a lack of knowledge may be the biggest contributing factor. This study hypothesized there would be a significant difference in knowledge of sickle cell trait based on educational level, age, and health beliefs. African-America male participants (N=116), ages 18 and over, completed a questionnaire assessing knowledge, risk perception, health beliefs, barriers, and motivating factors within the context of sickle cell trait. One-way and two-way analysis …

Integrating Genetic Counseling And Testing In The Pediatric Oncology Setting: Parental Attitudes And Influencing Factors, Lauren Renee Desrosiers

Theses and Dissertations

Cancer predisposition syndromes (CPS), caused by germline pathogenic variants in tumor suppressor genes and oncogenes, are genetic conditions that put an individual at increased risk to develop cancer. It is estimated that 10-15% of children with cancer have an underlying CPS. Although genetic testing for these conditions has become routine in the adult setting, incorporation of germline genomic technologies into pediatric cancer care has not occurred as rapidly. The purpose of this study is to assess desire for genetic counseling and testing services among parents of children with cancer to provide parental insight in the incorporation of genomic technologies in …

Family Planning Decisions After A Child’S Diagnosis Of Rett Syndrome: A Pilot Study, Erin E. Huggins

Theses and Dissertations

Rett syndrome (RTT) is a rare neurodevelopmental disorder that primarily affects females. In 99% of cases, RTT is believed to occur sporadically, or de novo. However, in rare cases, RTT can be passed down from parent to child through gonadal mosaicism or asymptomatic carrier mothers. It is known that having a child with an inherited genetic condition can lead to changes in family planning; however, little research has investigated this phenomenon in sporadic genetic conditions, such as RTT. This present study used a questionnaire to assess family planning decisions of parents of children with RTT. Forty-three percent of respondents reported …

Role Of Cox2 In Cellular Senescence, Mingxiao Feng

Theses and Dissertations

The survivors of childhood cancers are often associated with adverse late effects including hypoplasia, fatigue, and infertility, which are characteristics of aging. However, the underlying mechanisms of the late effects of chemotherapy are still elusive. We have found that transgenic cyclooxygenase-2 (COX2) expression causes premature aging phenotypes. Since COX2 expression is highly induced by various chemotherapeutic agents, we further investigated the possible link between COX2 and the late effects of chemotherapy. Treatment of juvenile wild-type mice with doxorubicin (DOX), an anthracycline-based chemotherapeutic agent, resulted in premature aging phenotypes and escalated cellular senescence level in various tissues. We found that tissue …

Spiritual Care In Cancer Genetic Counseling: Patient Perceptions Of Methods, Christopher Michael Spencer

Theses and Dissertations

The integration of spirituality into medical care is a growing area of debate among professionals, involving a delicate balance between serving patients who may benefit from this without alienating those who would not. To date, little research has targeted spirituality in cancer genetic counseling, particularly concerning the various methods a genetic counselor can use to address spirituality with their patients. A paper questionnaire was created and distributed to patients following their cancer genetic counseling appointments to gain insight on their perception of these methods. Fifty-two participants completed this questionnaire. The eight different spiritual integration methods presented each showed positive responses …

Minimal Hearing Loss In School-Age Children: Prevalence And Relationship To Reading Impairment, Laura Peek

Theses and Dissertations

Purpose: The two-fold purpose of this study was to determine if a) students with reading impairments fail hearing screenings at higher rates than students without reading impairments and b) if the pattern of simple view of reading classification differs across hearing screening results.

Method: This project included 19 students with reading impairments and 17 students with typically reading skills in grades 2 through 11. Each participant completed a hearing screening and a complete battery of language and literacy tests to determine their hearing screen status and simple view classification.

Results: Results of a chi square test comparing reading status and …

The Effect Of Neighborhood Characteristics And Acculturation On Vegetable Intake Among U.S. Hispanics, Anna Victoria Mesa

Theses and Dissertations

The growing prevalence of chronic disease among the U.S. Hispanic population has drawn increasing attention to modifiable behaviors such as diet in an effort to curb the burden of disease among this population. While factors affecting dietary intake among U.S. Hispanics have been largely studied, this study broadens the scope of existing analyses from examining the role of individual-level factors, including acculturation, to also include environmental factors such as neighborhood ethnic composition. Multilevel mixed modeling was employed to test the interaction of individual acculturation with neighborhood ethnic composition to predict vegetable intake among a sample of U.S. Hispanics. Individuals who …

Residential Mobility And Enrollment Churn In A Medicaid Population, John E. Stewart

Theses and Dissertations

Previous investigations show high rates of enrollment discontinuity, or churn, among Medicaid participants. Discontinuity of coverage can limit appropriate use of health care, increase emergency department utilization and in-patient hospitalization, negatively affect self-reported health, increase health care spending, and compound Medicaid administrative costs. Efforts to more fully understand and ultimately reduce enrollment churn thus are vital to Medicaid agencies and beneficiaries. Residential moves are life transitions, often marking other significant life events (e.g., changes in employment or family structure) that can alter eligibility for Medicaid benefits. Few studies have examined residential moves among Medicaid members, or considered residential mobility as …

Comparative Effectiveness Of Conventional And Novel Sampling Methods For The Recruitment Of Sexual Minority Identified Women, Sarah M. Piperato

Theses and Dissertations

Sexual minority identified (SMI) women have an amplified risk for risky health behaviors and chronic health conditions. Current research on mechanisms related to health disparities in SMI women is limited. Research targeting SMI women has relied on small, convenience samples to address health disparities. Due to the nature of this population, probability sampling methods are ineffective and inefficient and cost prohibitive. The purpose of this dissertation was threefold. First, we examined the current state of literature to gain insight on prevalent sampling strategies used to access SMI women for health-related research. Second, we compared the efficacy of two sampling strategies, …

The Effects Of The Affordable Care Act On The Receipt Of Colonoscopies Among Insured Elderly, Min Jee Lee

Theses and Dissertations

Background: The Affordable Care Act (ACA) waived deductibles and eliminated coinsurance for colonoscopies for Medicare beneficiaries beginning on January 1, 2011. This study investigated the effect of the ACA’s removing of financial barriers on the receipt of colonoscopies among insured elderly, who are predominantly covered by Medicare. Moreover, this study examined how income-related disparities in colonoscopy use have changed over the past decade and attempted to quantify various contributions to income-related disparity in the use of colonoscopies among insured elderly. Methods: Five cycles (2008, 2010, 2012, 2014, and 2016) of the Behavioral Risk Factor Surveillance System (BRFSS) were utilized to …

Sleep, Shiftwork Adaptation, Autonomic Dysfunction, And Metabolic Syndrome, Torrance Torrance

Theses and Dissertations

Background: Sleep is considered a physiological necessity and its disruption is associated with a wide variety of adverse mental and physical health outcomes including increased incidence of obesity, cancer, hypertension, cardiovascular disease, type 2 diabetes mellitus, stroke, depression, post-traumatic stress disorder (PTSD), work-related and vehicle accidents, and aberration of the autonomic nervous system.

Methods: Three studies were conducted from three separate populations. The first study examined the latent trajectories of self-reported sleep quality in active duty Army soldiers over a 3-year period using data from the Global Assessment 2.0 survey and Repeated Measures Latent Class Analysis (RMCLA) procedures. Generalized Estimating …

Effect Modification By Stroke To The Relationship Between Tooth Loss And Cognitive Decline, Amanda Collins

Theses and Dissertations

Background: A decline in cognitive functioning is one of the greatest burdens that older adults face. Studies indicate that periodontal disease is positively associated with cognitive decline. The link between stroke and cognitive decline is well-established, and literature supports that tooth loss and stroke are associated as well, but the role that stroke plays in the relationship between tooth loss and decline in cognitive functioning is, as of yet, unclear. This study uses data from the REGARDS cohort to examine the effect of stroke on the relationship between periodontal disease and cognitive function.

Methods: The REGARDS cohort is comprised of …

Healthy Motivations For Moms-To-Be (Healthy Mom2b) Study: A Mobile Health Intervention Targeting Gestational Weight Gain Among U.S. Women, Alicia Anne Dahl

Theses and Dissertations

INTRODUCTION: Almost one-half of all pregnant women in the U.S. exceed the Institute of Medicine’s (IOM) gestational weight gain (GWG) guidelines. Healthy GWG is critical for reducing adverse health outcomes associated with excessive GWG for the mother and infant. Electronic health (e-health) interventions delivered through mobile apps and websites hold potential as readily available resources for targeting health behaviors and monitoring GWG during pregnancy. The development of the Healthy Motivations for Moms-To-Be (HM2B) intervention was informed by health behavior theories, a systematic review of existing in-person and technology mediated interventions (Aim 1 of this dissertation), and results of an online …

Food Insecurity And Hypertension Prevalence, Awareness, Treatment And Control, Alexandra N. Luttrell

Theses and Dissertations

Objective: To examine the association between food insecurity and the prevalence of pre-hypertension and hypertension among U.S. adults. Additionally, this project will examine the association between food insecurity and the awareness, treatment and control (ATC) of hypertension.

Design: A cross-sectional study using data from the National Health and Nutritional Examination Survey (NHANES) 2011-2012 and 2013-2014 waves was deployed to examine the association between food insecurity and the prevalence and ATC of hypertension. Food security was measured by the cumulative number of affirmative responses to the 10-item U.S. Household Food Security Survey Module (HFSSM) questionnaire which were graded into four categories; …

How Do Health System Employees With Established Musculoskeletal Complaints Decide On Their Treatment Pathway? A Qualitative Approach, Noor Alshareef

Theses and Dissertations

Purpose: Non-pharmacologic treatment such as physical therapy (PT) are advocated for musculoskeletal pain for decreasing opioid use. Early access to PT has been shown to decrease costs and improve outcomes through direct access via self-referral. Although self-referral to PT is permitted in the majority of U.S states, health insurance coverage has been identified as a barrier preventing some patients with musculoskeletal complaints from using it. There are few studies examining patient factors related to early access to physical therapy via self-referral. The purpose of this study was to identify the factors outside of insurance that influence the choice to access …

Assessment Of An Educational Intervention To Increase Knowledge And Intention To Take Hpv Vaccine And Cervical Cancer Screening In Nigeria, Chigozie Anastacia Nkwonta

Theses and Dissertations

Nigeria has some of the highest rates of cervical cancer morbidity and mortality in sub-Saharan Africa. Both the human papillomavirus vaccine (HPV) and cervical screening are effective prevention strategies against both HPV infection and cervical cancer. Lack of awareness, limited knowledge, limited decision-making agency, lack of spousal support and stigma are barriers to uptake of these preventive measures. Given patriarchal structures and norms through which men control family resources and dominate decisions, male involvement in initiatives aimed at improving sexual and reproductive health is necessary. Community-based health education is an effective intervention to improve knowledge and reduce stigma. The aim …

Neuroanatomical Correlates Of Speech And Melody Repetition In Chronic Stroke, Sarah Elizabeth Bradford

Theses and Dissertations

The ability to repeat speech is impaired in most individuals with aphasia. Recent evidence suggests damage to area Spt (boundary of the parietal and temporal lobes at the Sylvian fissure) may cause the repetition difficulties commonly seen in aphasia. This study examined if such repetition impairments are specific to speech or reflect a more general repetition deficit, and determined how regional and network brain damage predict repetition impairments. Participants in the chronic phase of stroke (N=47) listened to a series of ten five-second melodies that consisted of six tones and repeated the melody (by humming) following its presentation. The participants’ …

Interpersonal Communication About Cigarette Warning Labels Among U.S. Smokers: Differences Between Latinos And Whites, Victoria Catherine Lambert

Theses and Dissertations

Pictorial health warning labels (HWLs) on cigarette packs are used worldwide to curb cigarette smoking, the leading preventable cause of death in the United States While individual-level mediators of HWLs’ effects on cessation have been thoroughly studied, interpersonal communication about HWLs has received less attention in HWL research. However, results from one study demonstrated the importance of interpersonal communication, finding that conversations about HWLs predicted quit attempts in Australia, Canada, and Mexico. That study also found that smokers in Mexico, where most smokers are Latino, reported more conversations than smokers in Australia and Canada, where most smokers are non-Latino White. …

The Impact Of The Medicaid Coverage Expansion And The Removal Of Cost-Sharing Under The Affordable Care Act On Mammography And Pap Tests, Abeer Alharbi

Theses and Dissertations

Background: The Affordable Care Act (ACA) aimed at making health care affordable and accessible including the use of preventive care services. To achieve these aims, the ACA expanded Medicaid coverage to population with income below 138% of FPL and removed cost-sharing when using preventive care services recommended by the USPSTF. This study tried to assess the impact of these provisions on the rate of mammography and Pap tests among women. Methods: Data was obtained from the Medical Expenditure Panel Survey - Household Component MEPS-HC. A difference-indifference design was used to determine the effect of Medicaid eligibility expansion on the outcomes …

Investigating Drug-Related Violence In Indian Country: The Lumbee Tribe Of North Carolina, Asa Alena Revels

Theses and Dissertations

Drug-related violence (DRV) impacts the over-all wellbeing of communities, with disparate health outcomes observable in many poor, minority communities. The purpose of this study was to better understand the multi-level social and environmental factors influencing elevated rates and prevention of DRV within the Lumbee, a southeastern American Indian Tribe. This was accomplished via in-depth, one-on-one interviews with 37 Lumbee Tribal Members and Key Leaders. The findings align with existing research, revealing the influence of such factors as poor socioeconomic conditions, coping strategies, broken family structures, and the influence of federal policy. Of interest was the substantial influence of the local …

Patient Characteristics, Discharge Disposition, And Hospital Factors Associated With All Cause 30-Day Hospital Readmission For Total Joint Arthroplasty In 2014, Hamad Yahya Alzamanan

Theses and Dissertations

Objective: Recent improvements in hospital care have come from a growing knowledge of factors that contribute to readmission. The objective of this work is to identify and describe the national readmission rate after Total Joint Arthroplasty, and to evaluate selected hospitals’ and patients’ factors for their association with the all-cause 30-day readmission rate after TJA in the United States in 2014. Method: Retrospective analysis of 938,504 TJA acute care hospital discharge records was performed, using a nationally representative database that is dedicated to the study of hospital readmissions, and accounts for 51% of total US hospitalizations. Logistic regression models were …

Factors Affecting Patient Satisfaction With Healthcare System Of Turkey, Serdar Aydin

Theses and Dissertations

The World Health Organization (WHO) defines health system as comprising of all the organizations, resources, and institutions dedicated to improving health. Health systems have a responsibility not just to improve the health of the population they serve but to provide financial protection against the costs of illness and to respond to people’s expectation with dignity. Besides, healthcare satisfaction and consumer satisfaction have become the latest trend in measuring quality to have a competitive advantage or best practice in the healthcare industry. Over the past 30 years, consumer satisfaction has gained widespread recognition as a measure of quality in many services …