Medicine and Health Sciences Commons^™

Antipsychotic Medication Administration In Oregon Assisted Living/Residential Care Settings: Analyzing An Action Situation, Sarah Dys

Dissertations and Theses

Antipsychotic medication use (APU) in assisted living and residential care (AL/RC) settings is an under-studied and controversial health policy issue. APU in older adults with dementia is associated with an increased risk of falls, hospitalizations, and early mortality. I operationalize the Institutional Analysis and Development Framework using a situational analysis approach, an extension of grounded theory methods, to explore the APU in Oregon AL/RC settings. Regulatory deficiency citations, Oregon AL/RC population data, and semi-structured interviews suggest that staff role clarity, organizational characteristics, and perceived agency influence decision-making around APU. AL/RC providers and caregivers are forced to simultaneously balance and prioritize …

Genomic Epidemiology Of Clostridium Difficile Colonization And Transmission In An Intensive Care Unit Cohort, Brianne Ciferri

Dissertations and Theses

Abstract

Genomic epidemiology of Clostridium difficile colonization and transmission in an intensive care unit cohort

by Brianne Ciferri, MPH

Advisor: C. Mary Schooling, PhD

Introduction: Clostridiodes difficile (C. difficile) is a leading cause of healthcare associated infections (HAI) in the United States and responsible for an estimated incidence of 223,900 cases and 12,800 deaths per year^1,2. C. difficile can cause gastrointestinal illness with symptoms ranging from mild diarrheal illness to a life-threatening condition. C. difficile is an opportunistic pathogen in which spores can live in an undisturbed dormant state within the intestinal tract and become …

Lower Extremity Power And Movement Velocity In Competitive Older Athletes, Becca D. Jordre

Dissertations and Theses

Older adults are a rapidly growing population which house a subset of older athletes who regularly engage in sport competition. The physical health and risk factors of this competitive older athlete population have been largely overlooked by healthcare providers and researchers and are poorly understood. Older athletes exhibit distinctly different measures of physical performance which require unique thresholds to identify health-related risk factors. While lower extremity power and movement velocity have been identified as valuable measures of physical performance and fall risk in community-dwelling older adults this relationship has not been explored in competitive older athletes. One method for analyzing …

(R)-2,5-Dimethoxy-4-Iodoamphetamine [(R)-Doi] Influences Coping Strategies To An Escapable Social Stress, Kevin Thomas Krupp

Dissertations and Theses

Depressive mood disorders are a leading cause of disability worldwide and pharmacological treatments for these disorders are inadequate, requiring new compounds with greater efficacy be investigated. The etiology of depression is heterogeneous; however, it is well established that stress exposure, and the proinflammatory effects of stress have a major role. Psychedelic compounds have rapid and long-lasting anxiolytic and antidepressive effects in humans and animal models of stress induced affective behavior. However, it is not completely understood how these compounds produce such rapid effects. We investigated whether the psychedelic compound (R)-2,5-dimethoxy-4-iodoamphetamine [(R)-DOI], a selective 5-HT2A partial agonist with potent anti-inflammatory properties, …

The Longitudinal Effects Of A Family And Sleep Supportive Intervention On Service Member Anger And Resilience, Shalene Joyce Allen

Dissertations and Theses

The vast majority of workplace intervention research on employee anger and resilience primarily focuses on individual-level strategies for mitigating employee anger and resilience outcomes in the workplace, with no studies having examined these outcomes with tangible occupational health interventions utilizing organizational-level techniques. Thus, the current study extends the literature on how to provide improvements in employee anger and resilience using higher system and organizational change mechanisms by providing evidence-based support for the effectiveness of a Total Worker Health® intervention, referred to as the Family and Sleep Supportive Intervention Training (FaSST). This approach employs both health protection and health promotion strategies …

School-Based Sex Education In The United States And Its Association With Sexual And Reproductive Health Outcomes, 2000-2020, Priscilla M. Lopez

Dissertations and Theses

Background: There are significant sexual and reproductive health disparities in the United States (US). A significant proportion of sexual health disparities among adolescents is likely due in-part to inadequate school-based sex education. Sex education encourages sustainable and informed sexual behavior and has the potential reach adolescents prior to sexual debut and throughout the years at highest risk for adverse sexual health outcomes. However, the way in which sex education is defined and operationalized, as described in the literature, varies substantially, which may lead to wide variation in implementation in schools and this might explain the disparities seen. State-level sex …

Improving National Health Management Information Systems: Stakeholder Views In Selected Sub-Saharan African Countries, Marie Donaldson

Dissertations and Theses

Background

Reliable, quality health information is the foundation of measurement and decision making in the health sector. Effective health management information systems can help improve the quality and coverage of health services, aid in policy development, support program implementation, and increase the likelihood that a well-trained health work force with the infrastructure and resources needed to provide appropriate health services will be properly distributed and supplied. There is widespread global agreement that data is a powerful tool. Arming Ministry of Health officials with better access to higher quality data that they know how to use can help improve health services …

Affecting Absenteeism Through School-Based Health Services Delivery: A Configurational Comparative Methods Study Of Oregon's Public Secondary Schools, Kelly Elizabeth Coates

Dissertations and Theses

A student's ability to attend school regularly can be profoundly affected by poor health-related behaviors, illnesses, and chronic diseases that are left unaddressed and unattended. The delivery of health services in the school environment is uniquely positioned to interrupt the effects these health barriers to learning (HBLs) can have on subsequent diminished educational and health outcomes. The literature widely acknowledges the intersectionality between health and education, but no comprehensive overview exists of how different structures and processes within a school work (or do not work) together to lead to higher or lower student absenteeism. This research sought to fill that …

Ancillary Data For Refining Computer Adaptive Algorithms For The Assessment Of Anomia, Emily Kathryn Tudorache

Dissertations and Theses

Computer adaptive testing formats, based in item response theory (IRT), are becoming an increasingly popular approach to testing in healthcare because they offer numerous psychometric and practical advantages to assessment when compared to static tests that rely on classical test theory. Fergadiotis and colleagues (2015) have developed computer adaptive versions of the Philadelphia Naming Test (PNT) short-forms, which have demonstrated acceptable precision and standard error of measurement when compared to the static short-forms and original full-length assessment. This study sought to use synthetic data simulations using the catIrt R package (Nydik, 2014) to investigate possible advantages of the use of …

Incarceration And Suicide: Do The Risk Factors Differ For Civilians And Veterans?, Rheannon Gail Ramsey

Dissertations and Theses

Suicide is one of the leading causes of death in United States jails and prisons. Many researchers have looked at suicides in prisons and what can potentially cause suicidal ideation but there are conflicting findings among civilian incarcerated populations and United States military veteran incarcerated populations.

The intent of this study is to examine which risk factors are most prevalent among adults in custody, with a focus on mental health and substance use or abuse and how these risk factors differ between incarcerated civilians and incarcerated veterans. Using survey data from the 2002 Survey of Inmates in Local Jails conducted …

Allergy And Anaphylaxis From The Prehospital Perspective, Anthony E. Conrardy

Dissertations and Theses

Anaphylaxis is considered a severe, potentially fatal, systemic allergic reaction that occurs suddenly after contact with an allergy causing substance. It is estimated that up to 5% of the population has experienced anaphylaxis, with 1% of hospitalizations and 0.1% of emergency department patients having fatal outcomes. We characterized the population of patients encountered by the EMS agency (786 patients) that had a provider impression of “allergic reaction” and then utilized logistic regression models to estimate associations with the administration of epinephrine in the prehospital setting. Additionally, we used incident location data for all patient encounters of the EMS agency …

National Health Insurance Program In Nepal: Early Experiences And Its Effect On Health Service Utilization, Rajani Bharati

Dissertations and Theses

Introduction: Nepal initiated the Health Insurance program in 2016 to achieve Universal Health Coverage by 2030. However, the enrollment rate is low, and people are already starting to drop out. Therefore, this study aimed to explore the demand and supply side (service providers) experiences with Nepal's National Health Insurance Program and its effect on insurance enrollment and health service utilization.

Methods: We employed a mixed-method design. Ethnographic methods were used to explore the rich holistic insights into people's views and actions. We conducted 14 focus group discussions and 20 key informant interviews, mainly in Kailali and Baglung districts. …

The Intersection Of Industry, Occupation, And Job Tasks With Hotel Room Cleaner Musculoskeletal Disorder Injuries: A Methods Approach To The Analysis Of California Workers’ Compensation Data, Pamela Vossenas

Dissertations and Theses

Abstract

Background

Hotel room cleaners are a high-risk occupation for musculoskeletal disorder (MSD) injuries among U.S. hotel workers. The Bureau of Labor Statistics (BLS) publishes occupational injury rate data for Maids and Housekeeping Cleaners, the Standard Occupation Classification closest to the job of a hotel room cleaner, and for the hotel industry, yet the BLS does not cross reference injury rate data by occupation and industry. This lack of occupational injury surveillance data limits MSD injury prevention and intervention efforts targeting this high-risk occupation in the hotel industry. Workers’ compensation (WC) data is another source of administrative data with potential …

The Association Of Psychosocial Stressors With Childhood Asthma: A Cross-Sectional Study Using The National Survey Of Children's Health 2018, Sharon Joseph

Dissertations and Theses

ABSTRACT

Background: Asthma is recognized as a major public health issue for US children. Evidence suggests that psychosocial stressors experienced by parents and caretakers of children and the children themselves can also be associated with childhood asthma prevalence. Psychosocial stressors such as parents’ perception of neighborhood safety/support, as well as experiencing bullying and/or racial/ethnic discrimination can cause physiologic changes in the body favorable for asthma symptoms. However, there is a paucity of evidence regarding associations of these specific psychosocial stressors with the prevalence of childhood asthma. The goals of this study were to investigate the association between three common psychosocial …

Can Racial Disparities In Poor Birth Outcomes Be Partially Attributed To Stress: A Mendellian Randomization Study, Madeline Travers

Dissertations and Theses

In the United States, low birth weight (LBW) is a leading cause of infant death overall, and the leading cause of death for Black infants. Understanding and preventing adverse birth outcomes is a major public health priority. Observationally, there is some evidence to support the hypothesis that maternal stress may be associated with LBW. To clarify the effect of maternal stress exposure on LBW, I conducted three separate-sample instrumental variable analyses with genetic instruments (Mendelian randomization) based on single nucleotide polymorphisms (SNP), from genome wide association studies, strongly (p-value < 5 × 10⁻⁶) and independently associated with neuroendocrine, vascular, and immune measures …

The Digital Divide And Health: Examining Digital Access As A Social Determinant Of Health, Elizabeth Melissa Withers

Dissertations and Theses

This dissertation is comprised of three papers that consider ways in which one's level of digital access may impact self-rated health. Data are from multiple years of three separate nationally representative cross-sectional surveys: National Health Interview Survey, General Social Survey, and Health Information National Trends Survey to address the primary overarching research question: Is there an association between digital access and health? The examination of the relationship between digital access and health is situated within a social determinants of health perspective and draws on van Dijk's (2005) causal and sequential model of digital access. Education, income, race and ethnicity, work …

Assessing Hiv Risk, Syndemics, Resilience And Engagement In Care In A Large National Cohort Of Gay, Bisexual And Other Men Who Have Sex With Men In The United States, Javier Lopez-Rios

Dissertations and Theses

Background: HIV continues to be a pervasive public health issue in the United States with more than 1.2 million people living with HIV (PLWHIV) across the nation. Gay, bisexual and other men who have sex with men (GBM) account for over two-thirds of all new HIV diagnoses with racial and ethnic minorities shouldering a large proportion of the burden of disease. Although HIV transmission is predominantly driven by sexual behaviors, there are underlying complex individual, behavioral, and structural factors that contribute to high rates of sexual behavior and subsequent HIV acquisition. Moreover, difficulties remain in maximizing linkage to care …

Exposure Characterization And Assessment Of Airborne Chemicals And Sars-Cov-2 Transmission In New York City Nail Salons, Amelia P. H. Watkins

Dissertations and Theses

Background: Currently, there are 156,000 people employed as manicurists or pedicurists in the United States. Employment in this sector is expected to grow by 10% over the next decade. Exposure assessments have revealed that salon workers are chronically exposed to a variety of substances that cause respiratory sensitization, developmental problems, contact dermatitis, blood, liver, and kidney issues, as well as nervous system impacts. Most recently, the SARS-Cov-2 pandemic has raised the issue of the vulnerability of nail salon workers to airborne infectious diseases as well. This dissertation aims to characterize and assess the chemical exposures that nail salon workers …

Identifying The Cost Of Preventable Chronic Disease In Prison: Can Illness Prevention Of Adults In Custody Save Money?, Molly Bineham

Dissertations and Theses

This study investigates the cost of preventable health problems and ailments when compared to other costs of incarceration. The purpose of this study is to examine the impact of imprisonment on the costliest chronic illness. The health of adults in custody related to the general population and the overall fiscal cost of the deadliest chronic illness among incarcerated adults is discussed. Linear regression is used to analyze the occurrence of heart disease and diabetes among adults in custody while controlling for other factors. The results of this analysis provide insight that chronic diseases like heart disease and diabetes should be …

Technology Management Maturity Assessment Model In Healthcare, Amir Shaygan

Dissertations and Theses

Significant gaps in the practical transformation of clinical knowledge into practices, increasing healthcare costs, costly medical errors, healthcare institutions' obligations towards improving safety, clinical outcomes, and efficacy of care from one side; and the rise of disruptive innovations, the adoption of electronic health records and novel diagnostic tools, and the plethora of data from the other side has made the need for a new approach in managing the U.S healthcare systems an imperative. Continuous learning has been utilized to mitigate some of these issues have been in healthcare organizations. Continuous learning is especially important in the research centers that act …

Returning To Rejection: Outcomes And Boundary Conditions Of Mental Illness Stereotypes, Stefanie Fox

Dissertations and Theses

Mental illness is a common condition in the United States, with over 20% of working age adults managing a mental illness condition in a given year. Disclosure of mental illness is often required for workers to take advantage of employer-provided resources (e.g., accommodations), yet use of resources is exceedingly low (less than 10%). Negative stigma-related outcomes are a top reason for which individuals delay the use of resources. Using an experimental design in an online data collection of 242 participants over two time points, the current study builds on existing organizational diversity literature to examine the stereotypes associated with mental …

Exploring "What Works" In Veterans Affairs Home-Based Primary Care, Elizabeth Catherine Hulen

Dissertations and Theses

Home Based Primary Care (HBPC) is an interdisciplinary care model involving comprehensive primary care services for patients with chronic illness who are unable to access clinic-based care. The largest HBPC program in the United States is run by the Department of Veterans Affairs (VA) and provides team-based primary care service to Veterans with complex, chronic conditions. The VA HBPC model includes primary care visits from a physician, nurse practitioner, or physician assistant, nurse care management, service coordination by a social worker, mental health services from a social worker or psychologist, nutrition counseling from a dietician, and help with medication management. …

Get Your Model Out There: Advancing Methods For Developing And Using Causal-Loop Diagrams, Erin Suzanne Kenzie

Dissertations and Theses

As simple visual diagrams of key dynamics in complex systems, causal-loop diagrams could meet known needs in settings such as theory-based program evaluation and qualitative research. Methods for developing and using causal-loop diagrams, however, are underdeveloped. This dissertation comprises three articles that advance these methods. The first paper describes a systematic review of evaluation studies utilizing causal-loop diagramming to illustrate program theory. The second paper pilots an improved method for systematically generating causal-loop diagrams from qualitative data. The third paper presents a protocol for an interview-based approach to mapping mental models. Together, this research contributes to recognizing the modeler as …

Assessment Of The Blockchain Technology Adoption For The Management Of The Electronic Health Record Systems, Saeed Mohammed Alzahrani

Dissertations and Theses

Blockchain is an emerging technology that holds great promises in healthcare despite slow adoption and previous unsuccessful implementation projects. Blockchain adoption in healthcare has been slow, partly because healthcare is a heavily regulated and complex industry. Blockchain applications span various areas of healthcare such as patient data management, health information exchange, health supply chain management, financial and insurance claims, clinical trial, biomedical devices tracking, and pharmaceutical counterfeit. The main challenges with blockchain technology in healthcare are: scarcity of real applications, the high level of failing projects, and the need for various parties to function together. There is, however, a lack …

Decolonizing Healthcare: A Black Feminist Analysis Of Sisters Informing Sisters On Topics Of Aids (Sista), Joy Mutare Fashu Kanu

Dissertations and Theses

This mixed methods project combines the conceptual insights offered by institutional ethnography, the deductive and inductive attributes of content analysis, semi structured interviews, and quantitative data analysis to study Sisters Informing Sisters on Topics of AIDS (SISTA), a social skills training program designed for sexually active, heterosexual African American women. This progressive program serves as a site to examine the complex relationship the U.S. state has had, and continues to have, with marginalized populations, particularly African Americans. The program reveals how the state, through the public health service, partners with scholars, researchers, and community-based organizations to produce, reproduce and perpetuate …

Restoration Of Bone Material And Microstructural Properties After Long-Term Remodeling Suppression, Abigail A. Coffman

Dissertations and Theses

Anti-resorptive drugs, principally bisphosphonates (BPs), are the mainstay of osteoporosis treatment. They work by inhibiting bone resorption/remodeling, thus preventing bone loss. However, long-term suppression of bone resorption adversely affects bone tissue mechanical properties, even while conserving bone mass. Lack of remodeling leads to accumulation of fatigue-induced microdamage, altered matrix mineralization and reduction in normal bone tissue heterogeneity, causing impaired strength and fracture toughness. The most severe consequence to patients, while rare, is Atypical Femur Fractures (i.e., complete fatigue fractures of the femoral shaft). To counteract the effects of long-term remodeling suppression, a temporary break in BP treatment (a "drug holiday) …

Readiness To Change In Rural Adults At High Risk For Diabetes, Katherine A. Wagner

Dissertations and Theses

Type II diabetes is one of the most devastating chronic diseases in the United States and is associated with decreased lifespan and serious comorbidities. While evidence-based prevention strategies of nutrition and physical activity exist, behavior change is an essential component. Researchers use readiness to change to predict clinical outcomes of chronic disease prevention programs, however, this has not been well studied in rural populations. The purpose of this research was to study the relationship between readiness to change and attrition rates and clinical outcomes among rural dwellers enrolled in a nutrition and physical activity intervention. Article one of this three-article …

Osteocyte Activity And Skeletal Muscle Relative Gene Expression Profiling After Short-Term Muscle Paralysis, Michelle Gelbs

Dissertations and Theses

Mechanical loading is essential for maintaining bone tissue. Reduced mechanical loading has been shown to have a negative effect on bone, and can result in the development of disuse osteoporosis. Disuse models of muscle inactivity and immobilization, like the Botox model used in this study, result in changes in the bone microarchitecture, the mechanisms behind which are not fully understood. In a previous four-week Botox disuse study, skeletally mature 20- week-old rats experienced degradation of intracortical bone, increased vascular porosity, and decreased osteocyte lacunar density in the tibiae. The focus of this study was to explicate a potential source of …

Development Of Light Actuated Chemical Delivery Platform On A 2-D Array Of Micropore Structure, Hojjat Rostami Azmand, Hojjat Rostami Azmand

Dissertations and Theses

Localized chemical delivery plays an essential role in the fundamental information transfers within biological systems. Thus, the ability to mimic the natural chemical signal modulation would provide significant contributions to understand the functional signaling pathway of biological cells and develop new prosthetic devices for neurological disorders. In this paper, we demonstrate a light-controlled hydrogel platform that can be used for localized chemical delivery in a high spatial resolution. By utilizing the photothermal behavior of graphene-hydrogel composites confined within micron-sized fluidic channels, patterned light illumination creates the parallel and independent actuation of chemical release in a group of fluidic ports. The …

Development Of An Injectable Methylcellulose Hydrogel System For Nucleus Pulposus Repair And Regeneration, Nada A. Haq-Siddiqi

Dissertations and Theses

Low back pain is the most common cause of disability in the world and is often caused by degeneration or injury of the intervertebral disc (IVD). The IVD is a complex, fibrocartilaginous tissue that allows for the wide range of spinal mobility. Disc degeneration is a progressive condition believed to begin in the central, gelatinous nucleus pulposus (NP) region of the tissue, for which there are few preventative therapies. Current therapeutic strategies include pain management and exercise, or surgical intervention such as spinal fusion, none of which address the underlying cause of degeneration. With an increasingly aging population, the socioeconomic …