Medicine and Health Sciences Commons^™

Host-Pathogen Interactions In A Changing World: Microbes, Mucosal Defenses, And Multiple Hosts, Brandon C. Labumbard

Graduate Doctoral Dissertations

As fungal diseases continue to emerge, research increasingly focuses on host-microbiome interactions and links to disease. Certain skin-associated microbes may benefit hosts by protecting them from invading pathogens. Seasonal changes in the host environment can also result in shifts in the microbial community and pathogen virulence – potentially influencing disease dynamics. I investigated how cutaneous microbial communities differ across hosts, seasons, and Batrachochytrium dendrobatidis (Bd) infection status by sequencing the microbial communities of 1,100 leopard frogs at five locations across the US. Percent anti-Bd function varied seasonally and with Bd infection status. Bacterial communities also varied across locations and time. …

Neighborhood And Environmental Predictors Of At-Risk And Problem Gambling In Massachusetts, Kendra E. Pugh

Graduate Doctoral Dissertations

Despite the widespread impact and negative effects of problem gambling (PG), limited attention has been paid to the environment where PG occurs. This study investigated the relationship between gambling on lottery and the zip code where gambling occurs, as well as the influence of individual-level characteristics that predict at-risk or problem gambling (AR/PG), among Massachusetts residents. A GIS analysis was conducted to identify vulnerable areas based on neighborhood characteristics, lottery sales, and AR/PG. Overall, residents of disadvantaged areas did not spend more money on lottery or have more lottery agents than residents of less disadvantaged areas. Some indicators of disadvantage …

Examining Culturally Adapted, Values Based, Mental Health Stigma Reduction And Help-Seeking Messages For Asian Americans, Anna M. Ying

Graduate Doctoral Dissertations

Mental health stigma is a ubiquitous concern impacting help-seeking in the United States and worldwide, including in college students. Insufficient attention has been given to the cultural context of stigma and help-seeking in Asian Americans, constructs in which culture has inherent relevance. The current study was the first to develop and test the acceptability of an online culturally adapted, values-based stigma and help-seeking intervention for Asian American college students, intentionally framing the benefits of therapy and mental wellness as congruent with values-based behaviors, intending to reduce the social costs and stigma of impaired functioning. A sample of 115 East, South, …

Associations Between Concepts Of The Family Management Style Framework, And Measures Of Child Adherence To Treatment For Heterozygous Familial Hypercholesterolemia, Heather Harker Ryan

Graduate Doctoral Dissertations

Background: Heterozygous Familial Hypercholesterolemia (HeFH) is an underdiagnosed, autosomal dominant, monogenic condition affecting ~1:250 individuals in the United States (U.S.), resulting in cardiovascular events 10-20 years earlier than in unaffected peers.

Sample: Fifty-one parents of youth aged 2-18 years followed for HeFH in a pediatric specialty clinic.

Purpose: Assess parental perceptions of HeFH, child adherence to treatment, and parenting in HeFH-affected households.

Methods: A cross-sectional, descriptive, and correlational survey study congruent with elements of the Family Management Style Framework (FMSF). Pearson’s and Spearman’s correlations assessed linear relationships between parentally observed HeFH treatment adherence measures, parenting style, and parental perceptions of …

The Role Of Physical Activity And Gender As Moderators For The Relationship Between Insomnia And Depression, Claire E. Wickersham

Graduate Doctoral Dissertations

Objective: The aim of this study was to examine the association between insomnia and depressive symptoms among middle-aged and older adults and to investigate whether gender or physical activity moderates this relationship. Method: This study used nationally representative data from the 2016 and 2018 waves of the Health and Retirement Study (HRS) and binomial logistic regression was used to estimate models. Regression models for risk of depressive symptoms (2018) were based on a longitudinal model with time-lagged indicators of insomnia, levels of physical activity, and covariates (2016). Results: Analyses showed that participants who reported having insomnia in 2016 were more …

On The Roles Of Trait Anxiety And Toll Like Receptor 4 In Amphetamine Sensitization In Adolescent Male Rats, Corey A. Calhoun

Graduate Doctoral Dissertations

Mammalian adolescence can be a difficult transition from childhood to adulthood, where increases in impulsivity and novelty- and risk-seeking are combined with heightened affect and elevated sensitivity to stress. Indeed, during adolescence, first drug use patterns emerge and in the continental United States, increasing misuse of amphetamines has been observed in adolescent youth. Myriad neural mechanisms underlie this shift in adolescence, including the dynamic remodeling of the mesocorticolimbic (MCL) pathway. Repeated drug administration affects neuroimmune substrates within the MCL circuit including toll-like receptor 4 (TLR4)Advances in addiction neuroscience indicate that drugs of abuse activate neural TLR4 and implicate glial TLR4 …

A Digitial Health Action Process Approach Intervention To Promote Resistance Training In Healthy Adult Novices, Justin M. Kompf

Graduate Doctoral Dissertations

Introduction: There is little research to date that has been conducted testing theory-based interventions to increase resistance training. We assessed the relative efficacy of Health Action Process Approach (HAPA) based digital intervention for performing resistance training (RT). Methods: The RTinHome study was a three-phase study which recruited adults aged 18-35 not meeting the strength training recommendations. In Phase I, all participants received two Zoom based training sessions over a one-week period. In Phase II, participants were randomized to a no contract control or to a 4-week, HAPA based digital coaching intervention. In Phase III (follow-up) there was no contact with …

The Relationship Between Participation In Recreational Therapy Physical Activity And Symptoms Of Mental Health Issues In Veterans, Krista F. Mcdonagh

Graduate Doctoral Dissertations

Background/Objective: The growing prevalence of mental health issues in veterans has triggered a wide-spread effort to identify and provide complementary intervention strategies to increase help-seeking behavior in this population. Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) have become two of the most common mental health issues as a result of the demanding environment of military life. This study looks specifically at therapeutic recreation-based physical activity opportunities as a complementary treatment option for veterans at an increased risk for mental health issues.

Method: A correlational survey research design was used to examine relationships between factors of participation in different …

Risk Factors Contributing To The Development Of Bronchopulmonary Dysplasia Among Preterm Infants, Caitlin E. Bradley

Graduate Doctoral Dissertations

Bronchopulmonary dysplasia (BPD) is a pulmonary disease that affects infants born < 32 weeks gestational age. Despite improved survival among preterm infants, the incidence and severity of BPD has not improved, rather the features and severity of BPD have evolved (Abman et al., 2017). BPD is a disease that has significant impact on the outcomes of preterm infants, including poor pulmonary and neurodevelopmental outcomes (Abman et al., 2017). Since its identification in 1967, and many iterations to its defining criteria, healthcare practitioners are unable to accurately predict infants’ risk of developing BPD. Further, there is significant family, social, and economic impacts from BPD. This dissertation research examined risk factors for BPD, as identified in a mid-range theory developed from a systematic review of the literature. This mid-range theory is framed using the Neuman Systems Model (NSM) (2011). The research utilized a secondary analysis of data from a database including a cohort of infants born at < 32 weeks’ gestation (n=455) treated at Boston Children’s Hospital. Findings from this research demonstrated that multiple intrapersonal risk factors are associated with development of BPD and the grades of BPD severity including gestational age, birth weight, surfactant administration, necrotizing enterocolitis, infections, mechanical ventilation duration, and patent ductus arteriosus. This research adds to the current body of research by demonstrating specific risks associated with BPD. Findings of this research could be used to identify maternal infant dyads that would benefit from early therapy(s) to reduce BPD risk.

Cross-Age Peer Mentoring: A Meta-Analysis, Samantha Burton

Graduate Doctoral Dissertations

Youth mentoring programs are a promising intervention for youth, particularly those who experience or are at risk for developing a range of psychological, social, behavioral, and contextual difficulties. Cross-age peer mentoring is a form of formal peer mentoring that matches an older youth mentor with a younger youth mentee to promote positive youth outcomes. The current study used meta-analysis to explore the overall effectiveness of cross-age peer mentoring programs, as well as to explore moderators of cross-age peer mentoring program effectiveness. A comprehensive search of the literature published prior to April 2019 was conducted to identify evaluations of cross-age peer …

The Long-Term Multidimensional Impact Of Persistent Multisite Pain On Physical And Psychological Disability, And Mortality In Community-Dwelling Older Adults, Saurja Thapa

Graduate Doctoral Dissertations

Persistent multisite pain is highly prevalent, affecting 25-43% of community-dwelling older adults. Although existing evidence suggests that persistent multisite pain is associated with physical and psychological disability, studies use a cross-sectional assessment approach that overlooks pain duration or persistence. This study aimed to estimate the persistence of multisite pain and the proportion of incident multisite pain and examine the association between persistent multisite pain and physical (ADL and IADL) and psychological disability (depression and anxiety) at 18 months and six years. Also, the association between baseline persistent multisite pain and mortality was assessed.

Secondary data analysis of the MOBILIZE Boston …

The Relationship Between Physical Activity And Emotional Intelligence In Adolescents, Marie C. Gabour

Graduate Doctoral Dissertations

PURPOSE: We assessed the association of Physical Activity (PA) measures on overall Emotional Intelligence (EI) and domains of EI: Intrapersonal, Interpersonal, Adaptability, General Mood, and Stress Management in adolescents.

METHODS: Cross-sectional and two-year follow up analyses were conducted relating EI to PA measures using the National Longitudinal Survey of Children and Youth in adolescents between 10- 13 years. EI score was measured by using a validated the youth version of the Emotional Quotient Inventory; PA was self-reported. Regression analysis adjusted for age, gender, household annual income, and health status and was summarized using regression coefficients. A test of linear trend …

Employed Mothers’ Satisfaction With The Breastfeeding Provisions In The Patient Protection And Affordable Care Act, Rebecca A. Penders

Graduate Doctoral Dissertations

Objective: Guided by the Conceptual Model for Nursing and Health Policy (CMNHP), the purpose of this study was to determine the extent to which employed mothers perceived satisfaction in their breastfeeding experiences after enactment of the Patient Protection and Affordable Care Act (PPACA) breastfeeding provisions. Methods: The participants (N=507) were employed mothers who returned to work after the birth of their infants and reported hourly pay. Convenience sampling was used to recruit women via La Leche USA Facebook account (LLL USA). Participants completed the Penders Breastfeeding Survey in Research Electronic Data Capture (REDCap). The survey consisted of 39-items; including five …

The Impact Of The 2010 Affordable Care Act On Reducing Racial/Ethnic Disparties In Primary Care Acess And The Delivery Of Diabetes Preventive Care In The United States, Adrianna Nava

Graduate Doctoral Dissertations

A key focus of the 2010 Patient Protection and Affordable Care Act (ACA) was to improve access to healthcare services in the United States (U.S.) (Stolberg & Pear, 2010). The research purpose was to assess the impact of the ACA’s Medicaid expansion and insurance subsidies on reducing racial/ethnic disparities in coverage, access and the delivery of primary care services, specifically diabetes prevention. Diabetes disproportionately affects minority populations, with inequities reported in the delivery of diabetes care to minorities (Chow, Foster, Gonzalez & McIver, 2012). The Modified Quality Health Outcomes Model was used to guide this research. Statistical analyses were conducted …

Knowledge And Attitudes Regarding Cervical Cancer Screening Among Women Living With Hiv/Aids In Malawi: A Cross-Sectional Study, Jasintha Mtengezo

Graduate Doctoral Dissertations

Cervical cancer is the third most frequent cancer among women worldwide and about 265,672 women die from the disease annually. Abnormal cervical cells caused by human papillomavirus are more common in HIV-positive women than in HIV-negative women due to their compromised immune system. Malawi, in Sub-Saharan Africa, is one of the countries with the highest rates of cervical cancer and HIV in the world. The incidence of cervical cancer and deaths can be reduced by 80% if women go for screening. There are limited studies about cervical cancer screening behavior, level of knowledge and attitudes regarding cervical cancer and screening …

Familial Aggregation Of Ideal Cardiovascular Health And Cardiovascular Disease Disability-Adjusted Life Years In Parent-Offspring Dyads: Analysis Of The Framingham Heart Study, James M. Muchira

Graduate Doctoral Dissertations

Background: Ideal cardiovascular health (iCVH) is defined as the simultaneous presence of seven health metrics-physical activity, not-smoking, healthy diet, healthy body weight, and blood cholesterol, blood pressure, and blood glucose levels as defined by evidence-based guidelines. Evidence suggests familial aggregation of single cardiovascular disease (CVD) risk factors but research on clustering of seven iCVH metrics and CVD disability-adjusted life years (CVD DALYs) within families is lacking.

Purpose: To examine trends and relationship of parental iCVH and offspring iCVH and CVD DALYs at similar age across the lifespan.

Methods: A secondary data analysis of the Framingham Heart Study (FHS) Dataset-Original and …

Do Race And Ethnicity Influence Turnover Intention In Newly Licensed Registered Nurses?, Mary Susan L. Howlett

Graduate Doctoral Dissertations

Background: Demand for health care services is rising while newly licensed nurses vacate employment positions at alarming rates. Healthcare leadership has called for an increased diversification of the healthcare workforce, but the workplace experience of nonwhite nurses in the first years has not been assessed.

Methods: This study utilized a quantitative cross-sectional survey design. The sample was limited to newly licensed nurses with no prior experience as a nurse. Linear regression models were constructed to determine which personal and structural attributes are associated with turnover intention, stratified by race and ethnicity. Hierarchical, backwards stepwise selection was used to build the …

Intergenerational Financial Exchange And Cognitive Well-Being Among Older Adults In China, Ping Xu

Graduate Doctoral Dissertations

Although cognitive loss is part of normal aging, it has unfavorable consequences for older individuals, their family, as well as society. The prevalence of mild cognition impairment is expected to go up in China. How to maintain normal cognition for a longer period of time and to delay impair process is an emerging concern for older Chinese adults. Unlike Western countries, China lacks of formal support system. Intergenerational support between older parents and adult children is a predominant resource when they are in need. This study examines how intergenerational financial exchanges between older parents and their adult children is related …

Evaluation Of Extracellular Matrix Composition And Rheology As Determinants Of Growth, Invasion, And Response To Photodynamic Therapy In 3d Cell Culture Models Of Pancreatic Ductal Adenocarcinoma, Gwendolyn M. Cramer

Graduate Doctoral Dissertations

Pancreatic ductal adenocarcinoma (PDAC) is a notoriously lethal disease characterized by prominent stromal involvement, which plays complex roles in regulating tumor growth and therapeutic response. The extracellular matrix (ECM)-rich stroma has been implicated as a barrier to drug penetration, although stromal depletion strategies have had mixed clinical success. It remains less clear how biophysical interactions with the ECM regulate invasive progression and susceptibilities to specific therapies. Here, an integrative approach combining 3D cell culture and quantitative imaging techniques is used to evaluate invasive behavior and motility as determinants of response to classical chemotherapy and photodynamic therapy (PDT), in which light …

School Nurses' Awareness And Attitudes Towards Commercial Sexual Exploitation Of Children: A Mixed Methods Study, Hannah E. Fraley

Graduate Doctoral Dissertations

Human trafficking is a global problem and a multi-billion dollar industry. Most victims are women and girls and more than half are children. In the United States, many at risk youth continue to attend school with school nurses on the frontlines. Using the Peace and Power Conceptual Model, a mixed methods study was conducted to explore their awareness, attitudes, and role perceptions in prevention of commercial sexual exploitation of children (CSEC). Two factors related to increased awareness, and positive attitudes and role perceptions to prevent of CSEC included prior exposure to working with vulnerable students, and prior education about CSEC. …

Determined Wellness: The Influence Of Mental Illness Models Upon Treatment Outcome Expectancies And Treatment Engagement, Francisco I. Surace

Graduate Doctoral Dissertations

Multiple campaigns geared towards reducing public and self-stigma associated with depression, and increasing help-seeking behaviors have been launched in the past two decades. There has been an increase in promoting psychoeducation on the biological bases of mental illness. Recent international studies have documented that this increase in public knowledge has not reduced stigma. Indeed, growing evidence suggests that biological models, in comparison to other causal models of mental illness, decrease people’s sense of self-efficacy and self-control, and decrease positive expectancies of treatments and prognosis–among those with and without mental illness. Individuals who have come in contact with health services, however, …

External Validation And Cost Effectiveness Analysis Of The Non-Lb Framingham Cardiovascular Disease Risk Assessment Algorithm In The Atherosclerosis Risk In Communities Dataset, Jacob K. Kariuki

Graduate Doctoral Dissertations

Background: In recent years, non-Laboratory based (non-LB) risk assessment algorithms have been developed to facilitate absolute cardiovascular disease (CVD) risk assessment in resource constrained primary care settings. The non-LB Framingham algorithm, which substitutes body mass index (BMI) for lipids, has the best discrimination and calibration among the published algorithms, but its external validity and cost-effectiveness have not been determined.

Purpose: External validation and comparative effectiveness analysis of the non-LB versus laboratory based (LB) Framingham algorithm in a racially diverse population, and simulated cost-effectiveness analysis focusing on a black sample.

Methods: Secondary data analysis was performed using the Atherosclerosis Risk in …

Identification And Use Of Indicator Data To Develop Models For Marine-Sourced Risks In Massachusetts Bay, Marin M. Kress

Graduate Doctoral Dissertations

The coastal watersheds around Massachusetts Bay are home to millions of people, many of whom recreate in coastal waters and consume locally harvested shellfish. Epidemiological data on food-borne illness and illnesses associated with recreational water exposure are known to be incomplete. Of major food categories, seafood has the highest recorded rate of associated foodborne illness. In total, the health impacts from these marine-sourced risks are estimated to cost millions of dollars each year in medical expenses or lost productivity. When recorded epidemiological data is incomplete it may be possible to estimate abundance or prevalence of specific pathogens or toxins in …

Impact Of Parental Stress On Asthma Management Behaviors And Health Outcomes: A Longitudinal Analysis Of Inner City School-Aged Children, Amanda Constance Green

Graduate Doctoral Dissertations

Background. Asthma is a prevalent chronic condition with excess disease burden in school-aged, minority children from low income inner-city communities. Conceptualized within a nursing and socio-ecological framework, the purpose of this secondary analysis of a prospective study of inner-city school-aged children with asthma (School Inner-City Asthma Study [SICAS]) was to examine associations between characteristics of children and parents, parents stress, parent asthma management behaviors (AMB) and child asthma outcomes, including emergency (ED) visits for asthma, missed school and asthma control.

Methods. The sample included 351 school-aged children (7.9 years old, SD= 1.9 years; 53.0% male; 95.7% minority). Parents reported their …

The Impact Of Nursing Hours And Hospital And Patient Characteristics On Medicare Hospital Acquired Conditions: A National Pooled Cross-Sectional Secondary Data Model And Analysis, Terry Kahlert Eng

Graduate Doctoral Dissertations

Background: Previous research and quality improvement initiatives have underscored the prevalence of healthcare acquired conditions (HACs) and their associated costs in American hospitals. In response to these findings, in 2008, The Centers for Medicare and Medicaid Services identified 10 condition categories that they would no longer pay for if acquired during hospitalization. The conditions were selected based on high cost, high volume, or both, assigned to a higher paying medical severity diagnostic related group (MS-DRG), and were deemed preventable through application of evidence-based guidelines. The Health Quality Outcomes Model and a Path Model guided the study.

Objective: To quantify the …

Examining The Toxicity, Exposure, And Regulatory Approach To Potential Human Health Risks Of The Algal Toxin Domoic Acid, Thomas H. Angus

Graduate Doctoral Dissertations

Domoic acid is a neurotoxin produced by the marine diatom genus Pseudo-nitzschia and causes cell death primarily in the area of the brain responsible for long-term memory. The resulting severe illness has been termed amnesic shellfish poisoning. Domoic acid accumulates in shellfish and planktivorous fish that consume Pseudo-nitzschia, resulting in exposure to humans through consumption of planktivorous seafood. A regulatory standard in seafood was developed shortly after its discovery in 1987 to protect against acute effects. This regulatory standard has not been revised despite significant recent data in the scientific literature.

This dissertation is divided into four sections: (1) …

Individual, Disease, And Work-Related Factors Associated With Work Patterns, Presenteeism And Sick Pay Policy Of The Colorectal Cancer Survivor After Treatment, Kristin A. Roper

Graduate Doctoral Dissertations

Participation of colorectal cancer survivors (CRC) in the workforce has been described by clinicians, survivors, and researchers as a way to improve mood, quality of life (QOL), and survival. Maintaining self-esteem and financial independence have also been attributed to continued employment of the CRC survivor. The purpose of this cross-sectional survey was to describe patterns of employment of the CRC survivor and to examine the individual, disease, and work-related factors that influence presenteeism and perceived adequacy of sick pay (ASP) policy. The Conceptual Model of Nursing and Health Policy and the Pathways to Work Life Recovery guided the design, selection …

The Associations Of The Level Of School Wellness Policy Implementation And School Nurse Activities To Weight Status Of School Children In Massachusetts, Mary Jane F. O'Brien

Graduate Doctoral Dissertations

The increase in prevalence of childhood obesity has prompted child health authorities to propose mandates focusing on population health efforts that may be implemented in public schools. In 2010, the federal government passed the Healthy, Hunger-Free Kids Act, reinforcing the 2004 regulations to guide school districts in development and implementation of school wellness policies.

The purpose of this secondary data analysis was an examination of the association between implementation of the school wellness policy and school nurse activities to the absolute change in percent of students with body mass index in the obese weight category between the school years 2005-2006 …

Influences Of Health Insurance And Primary Care On Breast And Cervical Cancer Screening Among Black Women In Boston, Gail Barlow Gall

Graduate Doctoral Dissertations

Healthy People 2010 promoted breast and cervical cancer screening to reduce cancer among all women and reduce disparities in cancer deaths between Black and White women. The REACH 2010 program targeted improving screening rates among Black women and funded a demonstration project to provide outreach, screening, patient navigation and case management for Black women in Boston. The purpose of this study was to describe associations between health insurance and primary care (having a primary care provider [PCP], quality of communications and relationship with PCP) on differences in breast and cervical cancer screening reported by Black women born in the United …

Diffusion Of The Egfr Assay: The Underutilization And The Urban/Rural Divide, Julie Ann Lynch

Graduate Doctoral Dissertations

Purpose - The EGFR assay is a molecular diagnostic test which identifies a targetable mutation in lung tumors. Guidelines call for EGFR testing for non-small cell lung cancer patients to direct first line treatment. We explored institutional and regional factors predicting the likelihood acute care hospitals ordered the assay. Methods: This was a retrospective study which analyzed US acute care hospitals (n=4780). We linked proprietary industry data for orders of the EGFR assay to public datasets that provided hospital and regional characteristics. We conducted logistic regression to identify significant characteristics that predict likelihood a hospital ordered the assay. Results - …