Medicine and Health Sciences Commons^™

Mining High Impact Combinations Of Conditions From The Medical Expenditure Panel Survey, Arjun Mohan

Masters Theses

The condition of multimorbidity — the presence of two or more medical conditions in an individual — is a growing phenomenon worldwide. In the United States, multimorbid patients represent more than a third of the population and the trend is steadily increasing in an already aging population. There is thus a pressing need to understand the patterns in which multimorbidity occurs, and to better understand the nature of the care that is required to be provided to such patients.

In this thesis, we use data from the Medical Expenditure Panel Survey (MEPS) from the years 2011 to 2015 to identify …

Association Of Birth Weight And Preterm Birth With Subsequent Risk For Hypertension In Women From The Women’S Health Initiative, Christian P. Daniele

Masters Theses

Hypertension is a chronic disease with an estimated prevalence of nearly 50% in US adults. In addition to sociodemographic and lifestyle factors, evidence suggests that in utero and early life exposures may contribute to life-long risk of hypertension. This study aimed to investigate the potential associations between an individual’s birthweight and preterm birth status with their risk for hypertension in the Women’s Health Initiative (WHI) cohort. WHI is a large, multi-racial cohort of postmenopausal women. At study entry, birthweight and preterm birth status were self-reported by category (< 6 lbs., 6-7 lbs. 15 oz., 8-9 lbs. 15 oz., or ≥ 10 lbs.; ≥ 4 weeks premature or full term). Baseline and incident hypertension status were self-reported; mean systolic blood pressure, diastolic blood pressure, and 30-second pulse were also recorded at baseline by trained study staff. Linear, logistic, and Cox-proportional hazards regression models were used to generate crude and adjusted beta estimates, odds ratios, and hazards ratios, respectively. After adjusting for demographic and lifestyle factors, we found that participants born at a low birthweight had a higher mean systolic blood pressure than participants born at a normal birthweight and were at increased risk for both baseline and incident hypertension. Women born at a higher birthweight had a lower mean systolic blood pressure and were at lower risk for baseline and incident hypertension. When compared to participants born full term, participants born preterm were at increased risk for baseline and incident hypertension. These results support current research on early life exposures and health risks later in life. Long term follow-up or targeted counseling may be required for individuals born prematurely or at low birthweights to prevent and treat hypertension and associated cardiovascular outcomes.

Sexual Orientation Differences In The Association Between Cancer Diagnosis And Mental Health Outcomes, Pablo Fernandez

Masters Theses

Background: Since the early 1960s, survival rates among cancer survivors have been increasing. Surviving cancer can be a stressful experience due to the multifaceted changes that come with diagnosis, treatment, and recovery. Therefore, studying the mental health of cancer survivors is vital for their well-being. Among queer groups (including those identifying as gay, lesbian, or bisexual), poor mental health is more prevalent than among heterosexuals. However, cancer survivorship among queer populations is not well studied. This study examines the association between cancer survivorship and poor mental health, focusing on potential sexual orientation differences.

Methods: Data are from the 2019-2021 National …

Sexual Orientation Differences In The Association Between Physical Activity And Allostatic Load: Results From The National Health And Nutrition Examination Study, Natalia I. Putnam

Masters Theses

Higher levels of allostatic load (AL), a composite measure of the impact of chronic stress on the body, are found among socially marginalized groups compared to privileged groups. AL is associated with premature aging and death, as well as a variety of chronic health conditions that impact quality of life. Effects of AL may be offset by physical activity (PA). Queer populations (including those who identify as lesbian, gay, or bisexual) may be at risk for elevated AL due to repeated exposure to discrimination in the form of sexual minority stress. There is mixed literature on sexual orientation differences in …

Forecasting Covid-19 With Temporal Hierarchies And Ensemble Methods, Li Shandross

Masters Theses

Infectious disease forecasting efforts underwent rapid growth during the COVID-19 pandemic, providing guidance for pandemic response and about potential future trends. Yet despite their importance, short-term forecasting models often struggled to produce accurate real-time predictions of this complex and rapidly changing system. This gap in accuracy persisted into the pandemic and warrants the exploration and testing of new methods to glean fresh insights.

In this work, we examined the application of the temporal hierarchical forecasting (THieF) methodology to probabilistic forecasts of COVID-19 incident hospital admissions in the United States. THieF is an innovative forecasting technique that aggregates time-series data into …

Enhancing Wellbeing In Public Landscape Through Light, Ruiqing Miao

Masters Theses

Close to half of Americans living in the U.S. Northeast and Midwest say they do not get enough sunshine throughout the year. That’s compared to less than a third of those living in the South or the West.

During the winter months, the days are shorter, with the sun rising later and setting earlier than during the summer months. This means there is less daylight for people to enjoy, and the reduced exposure to natural light can have a negative impact on mood and energy levels.

Public Health’s research demonstrates that constant stimuli of body senses plays an important role …

Leptospira Seroprevalence In Companion Animals In Tennessee, Kellie Anne Mccreight

Masters Theses

Leptospirosis is a re-emerging zoonotic disease in humans and animals. The bacteria Leptospira spp. causing this disease is maintained in the kidneys of animals such as rodents and cattle as well as in the environment. Animals harboring Leptospira spp. in the kidneys frequently shed the bacteria in their urine, contaminating the environment. Contact with contaminated soil and water may result in infection. Animals and humans may develop serious life threatening disease from Leptospira infection. Approximately 1 million new human cases and over 50,000 deaths are reported worldwide. Numerous animal species including rodents, cattle, and dogs may serve as reservoir …

A Machine Learning Approach For Predicting Clinical Trial Patient Enrollment In Drug Development Portfolio Demand Planning, Ahmed Shoieb

Masters Theses

One of the biggest challenges the clinical research industry currently faces is the accurate forecasting of patient enrollment (namely if and when a clinical trial will achieve full enrollment), as the stochastic behavior of enrollment can significantly contribute to delays in the development of new drugs, increases in duration and costs of clinical trials, and the over- or under- estimation of clinical supply. This study proposes a Machine Learning model using a Fully Convolutional Network (FCN) that is trained on a dataset of 100,000 patient enrollment data points including patient age, patient gender, patient disease, investigational product, study phase, blinded …

Differential Toxicity Of Pm2.5 Components And Modified Health Effects Modeling: A Case Study In Nepal, Jeremy Brownholtz

Masters Theses

During the latter part of the 20^th century, a transition away from coal as a major energy source in developed countries was accompanied by a notable decrease in air pollution-related deaths in those countries. Currently the same phenomenon is being observed in developing nations like China and India. However, many areas that do still rely on coal for their energy production or industrial needs also reflect a gap in research on the effects of those specific processes on local populations. Located in Nepal at the foot of the Himalayan Plateau, Kathmandu represents one such location. The local economy of …

Feasibility, Acceptability And Process Evaluation Of A Physical Activity Intervention In Toddler Aged Children: The Tap-A-Long Study, Luke M. Sudarsky

Masters Theses

Recent literature has suggested the importance of physical activity in early childhood such as during the toddler years (12 months - 3 years.) Despite this, most toddlers are not physically active. There is a need to determine the types of physical activity programs that would interest toddlers within the settings they spend a significant amount of time in (e.g., childcare center). Currently, data on the feasibility, implementation, and process evaluation of physical activity interventions in toddler age children attending childcare centers is lacking within the literature. Therefore, the purpose of the Toddler Activity Pilot (TAP-A-LONG) study was to examine the …

The Use Of Occupational Therapy Services In Outpatient Mental Health, Kelsey A. Wasik, Matt T. Valois, Kaylee M. Essenberg, Kelcie P. Beck

Masters Theses

The purpose of this study is aimed to explore the structure and utilization details of occupational therapy in outpatient behavioral health settings. Two occupational therapists participated in qualitative phenomenological interviews which were transcribed and analyzed using the thematic approach. A total of two themes emerged: billing and coverage, and education and advocacy. Participants identified there are necessary factors for reimbursement of services, in addition to the need for education and advocacy for occupational therapists to practice in outpatient behavioral health settings. Future research should be aimed at recruiting more participants, occupational therapists, and from other roles in these clinics such …

Development Of A Predictive Model For Frailty Utilizing Electronic Health Records, Kye Poronsky

Masters Theses

Frailty is a multifaceted, geriatric syndrome that is associated with age-related declines in functional reserves resulting in increased risks of in-hospital death, readmissions and discharge to nursing homes. The risks associated with frailty highlights the need for providers to be able to quickly, and accurately, assess someone’s frailty level. Previous studies have shown that bedside clinician assessment is not a reliable or valid way to determine frailty, meaning that a more reliable, valid and concise method is needed. We developed a prediction model using discharge ICD-9/ICD-10 diagnostic codes and other demographic variables to predict Reported Edmonton Frail Scale scores. Participants …

Preterm Birth And Subsequent Risk Of Type 2 Diabetes Among Postmenopausal Women In The Women’S Health Initiative, Aaron Holman-Vittone

Masters Theses

Type 2 diabetes (T2D) is increasing in the United States, currently affecting 11.3% of the nation. The Developmental Origins of Health and Disease Hypothesis suggests that environmental stresses in utero and in early stages of life, such as preterm birth (age), can lead to development of adulthood diseases, including T2D. However, research on the association between preterm birth and T2D is sparse and predominantly based on European ancestry populations. We examined this association in postmenopausal women (N = 85,356) from the Women’s Health Initiative, a nationwide prospective cohort. Logistic regression models were used to examine the association between self-reported preterm …

The Relationship Between Pm2.5 And Chronic Respiratory Disease In Senegal, Bailey Glenn

Masters Theses

Chronic respiratory diseases such as asthma and chronic bronchitis have significantly increased in prevalence in Africa over the past 10 years. Recent studies have demonstrated that exposure to air pollution may be associated with an increased risk of chronic respiratory diseases. However, such studies have predominantly been conducted in western societies or often used urbanicity as a proxy for exposure to air pollution. Therefore, we evaluated the association between PM_2.5 exposure and asthma/chronic bronchitis in Senegal. A cross-sectional study was conducted for the time period of 3 October 2010 to 28 April 2011 using annual concentrations of PM_{2.5 …}

Three Dimensional Spatio-Temporal Cluster Analysis Of Sars-Cov-2 Infections, Keith W. Allison

Masters Theses

The COVID-19 pandemic has heightened the need for fine-scale analysis of the clustering of cases of infectious disease in order to better understand and prevent the localized spread of infection. The students living on the University of Massachusetts, Amherst campus provided a unique opportunity to do so, due to frequent mandatory testing during the 2020-2021 academic year, and dense living conditions. The South-West dormitory area is of particular interest due to its extremely high population density, housing around half of students living on campus during normal conditions. Using data gathered by the Public Health Promotion Center (PHPC), we analyzed the …

Accelerometer-Determined Physical Behavior Metrics And Their Associations With Sarcopenia Among Oldest-Old Adults, Eric M. Eberl

Masters Theses

INTRODUCTION: Sarcopenia is a loss of muscle function and muscle mass which frequently occurs among the oldest-old adult population (aged 85+ years). The analysis of accelerometer-determined physical behavior volumes and patterns of oldest-old adults might provide novel insights into the associations with sarcopenia and its components. METHODS: A total of 145 participants in the primary sample and 87 participants in the subsample with a mean age of 88.2 (2.5) years from the Health, Aging, and Body Composition study cohort provided cross-sectional data of handgrip strength, appendicular lean mass, gait speed, and accelerometry. Probable, confirmed, and severe sarcopenia were assessed based …

Evaluating Public Masking Mandates On Covid-19 Growth Rates In U.S. States, Angus K. Wong

Masters Theses

U.S. state governments have implemented numerous policies to help mitigate the spread of COVID-19. While there is strong biological evidence supporting the wearing of face masks or coverings in public spaces, the impact of public masking policies remains unclear. We aimed to evaluate how early versus delayed implementation of state-level public masking orders impacted subsequent COVID-19 growth rates. We defined “early” implementation as having a state-level mandate in place before September 1, 2020, the approximate start of the school-year. We defined COVID-19 growth rates as the relative increase in confirmed cases 7, 14, 21, 30, 45, 60-days after September 1. …

Examining The Co-Infection Effects Of Helminths And Malaria In An Indonesian Community, Andrea Rodríguez-Sánchez

Masters Theses

Malaria is one of the most prevalent vector-borne infectious diseases with major morbidity and mortality in sub-Saharan Africa and Southeast Asia. Recent epidemiological studies have shown that co-occurrence of soil-transmitted helminth (STH) infections, or infection caused by parasitic worms, are associated with increased risk of malaria infection. However, studies of the association between STH and malaria, and the effect of antihelminth (deworming) treatments that are more commonly used in areas with high STH infection rates, are sparse. Therefore, we explored the relationship between STH and malaria infection in an Indonesian community (N=1997) with high prevalence of both STH and malaria …

Birthweight And Risk Of Autoimmune And Thyroid Conditions Within The Women’S Health Initiative, Brian C. Monahan

Masters Theses

Autoimmune and thyroid conditions account for a substantial proportion of the morbidity and mortality experienced in the United States, affecting >40 million Americans combined. Co-occurrence of both an autoimmune and thyroid condition is also likely, particularly among women. Epidemiologic studies on both sets of conditions have examined many risk factors, including demographic, lifestyle, genetic, and environmental risk factors. However, one area which has been neglected is the effect of early life exposures on the development of autoimmune and thyroid conditions. To investigate the potential association between an individual’s birth weight (by category;in uteroand early childhood, extending the hypothesis to include …

Subnational Analysis Of Birth Weight In Ghana Using Bayesian Spatial Regression Models, Barbara E. Mottey

Masters Theses

Child mortality in sub-Saharan Africa is reducing but the levels remain high with subnational within-country variations. Birth weight is a key predictor of child survival and monitoring birth weight outcomes, in particular, prevalence of low birth weights, is important for resource allocation to improve child survival outcomes.

Past research in sub-Saharan Africa has found that different individual-level factors are associated with birth weight including BMI of mother, sex of baby, educational level of mother, and wealth index of household. Some environmental factors are found to be associated with birth outcomes. However, past findings regarding the association of birth weight with …

Assessing Basic Needs Insecurity Prevalence And Associated Factors Among College Students Enrolled At A Large, Public University In The Southeastern U.S., Mary Kathleen Robbins

Masters Theses

Abstract

Background: Basic needs insecurity (BNI), defined as having both food and housing insecurity, is an emerging issue on college campuses. Students experiencing basic needs insecurity may be more likely to have poorer academic performance, as well as poorer physical and mental health compared to other students. This research assesses the prevalence of food, housing, and basic needs insecurity among college students enrolled at a large, public university and identifies factors associated with experiencing food, housing, and basic needs insecurity.

Methods: A cross-sectional online survey was conducted at a large, public university in the Southeast U.S. Eligible, enrolled students (n=23,444) …

The Role Of Vegetative Cover In Enhancing Resilience To Climate Change And Improving Public Health, Anastasia D. Ivanova

Masters Theses

Changing temperature and precipitation patterns are causing degraded soil, water, and air quality which is negatively affecting the safety and health of people, and the productivity of urban and rural communities. However, research shows that implementing urban forests and cover crops into urban and rural landscapes, respectively, can mitigate these effects by providing ecosystem services. As extreme precipitation and heat events continue to intensify, there is a need for comprehensively assessing these ecosystem services under changing climates and for this information to be easily accessible by communities for rapid land-use decision making. Therefore, I investigated the role of urban forests …

Mitigation Of Teratogenic Agents: Is There Promise In Ion Modulating Drugs?, Aastha Pokharel

Masters Theses

As reported by the CDC, birth defects remain a common occurrence in the United States, with malformations originating in many places in the developing organism. Furthermore, the etiology of many of these defects remain unknown, with some factors consisting of genetics, environmental pollutants and teratogens. In our study, we examined whether insults by teratogenic agents, ethanol in particular, can be mitigated by hyperpolarizing agents acting to restore the cell’s potential. We first evaluated whether three hyperpolarizing drugs (Lamotrigine, Gabapentin, and Ivermectin) induced teratogenic effects on CD-1 mice and found that Ivermectin induced craniofacial malformations, and exposure to Lamotrigine and Gabpentin …

Validity Parameters For Step Counting Wearable Technologies During Treadmill Walking In Young People 6-20 Years Of Age, Zachary Gould

Masters Theses

Introduction: Wearable technologies play an important contemporary role in the measurement of physical activity (PA) and promotion of human health across the lifespan, including for young people (i.e., children, adolescents, and young adults). As new objective wearable technologies continue to develop, standardized approaches to documenting validation parameters (i.e., measures of accuracy, precision, and bias) are needed to ensure confidence and comparability in step-defined PA. Purpose: To produce validity parameters for step counting wearable technologies during treadmill walking in young people 6-20 years of age Methods: 120 participants completed 5-minute treadmill bouts from13.4 to 134.1 m·min^-1. Participants wore eight …

Sperm Mitochondrial Dna Biomarkers As A Measure Of Male Fecundity And Overall Sperm Quality, Allyson Rosati

Masters Theses

Introduction. Sperm parameter analysis is the standard method of male fecundity testing; however, minimal evidence supports associations between individual sperm parameters and reproductive outcomes. Our previous work shows strong associations between sperm mitochondrial DNA copy number (mtDNAcn) and time-to-pregnancy (TTP) in general populations, and between mtDNAcn and fertilization outcomes in clinical populations. Thus it is possible for sperm mtDNA biomarkers to act as summary measures of semen quality. In this study, we developed a sperm quality index (SQI) from semen parameters and compared its ability to measure fecundity to sperm mtDNAcn.

Methods. We received 384 semen samples from the Longitudinal …

Sexual Experiences And Association With Depression And Anxiety Among Sexual Minority Women, Brie Engelbrecht

Masters Theses

Depression and anxiety are among the most prevalent forms of mental illness in the U.S, affecting an estimated 18% of the population. Recent studies have shown that sexual minority women may undergo sexual experiences that affect their risk of anxiety and depression. However, prior studies of this association are sparse and have largely been conducted among sexual majorities and have yet to examine differences between vulnerable sexual orientation groups. Therefore, we evaluated the relationship between sexual experiences (i.e., sexual assertiveness, sexual self-efficacy, and outness) and anxiety and depression among young sexual minority women in a cross-sectional study (N=328) from the …

The Association Between Dengue Virus Infection And Liver And Kidney Function Among Cambodian Children, Ashley Moineau

Masters Theses

Severe liver and kidney dysfunction are prevalent in 10%-30% of the Southeast Asian population. Dengue virus infection has been reported as a modifiable risk factor for liver and kidney dysfunction, especially among children in Southeast Asia. Epidemiologic studies assessing this relationship are sparse, often failed to include children, and did not adjust for important covariates. Therefore, we evaluated the relationship between dengue virus infection and liver and kidney dysfunction among hospitalized children in Cambodia (n=551). Participants with a serologically confirmed dengue virus infection were categorized according to increasing severity of infection (i.e. dengue fever, dengue hemorrhagic fever, or dengue shock …

A Cross-Sectional Study Of Phthalate Exposure And Inflammation Biomarker Levels Among Postmenopausal Women, Avery Trim

Masters Theses

Phthalates are industrial chemicals added to plastics found in products such as children’s toys, cosmetics, and household items, and some laboratory studies suggest phthalates may increase levels of inflammation. Chronic inflammation is associated with many chronic health conditions, such as diabetes and rheumatoid arthritis. Although research is limited, recent studies suggest a strong positive relationship between mono-butyl phthalate (MBP), mono-isobutyl phthalate (MiBP), and monocarboxynonyl phthalate (MCNP) and c-reactive protein (CRP), as well as monoethyl phthalate (MEP) and mono-3-carboxypropyl phthalate (MCPP) and interleukin-6 (IL-6). Additionally, this relationship has not been examined among postmenopausal women, a population that is at higher risk …

Reproductive Factors And Postmenopausal Fsh Levels, Rebecca Costa

Masters Theses

Recent studies have shown that postmenopausal follicle stimulating hormone (FSH) levels may be predictive of future cardiovascular disease risk. However, little is known about postmenopausal FSH levels, including the level of variation between women and factors associated with this variation. We assessed the relationship of multiple reproductive factors with FSH levels among 588 postmenopausal women in the Kuopio Ischemic Heart Disease Risk Factor Study. Participants were aged 53 to 73 years and not using hormone therapy at baseline (1998-2001). Reproductive factors were assessed at baseline, along with FSH levels. After adjustment for sex steroids, adiposity measures, plasma lipids, blood pressure, …

Impact Of Parity On Gait Biomechanics, Bekah P. Stein

Masters Theses

Background: Symptomatic knee osteoarthritis (OA) is an incurable condition that affects nearly 50% of adults, and women are twice as likely as men to develop OA. Throughout pregnancy, women experience large changes in morphology and gait mechanics, as well as changes in joint loading. It is possible these adaptations could cause lasting changes postpartum, which may potentially contribute to initiation of OA, thereby increasing the overall risk of OA for women.

Purpose: This exploratory study looked to identify differences between lower limb gait mechanics of healthy nulliparous women and healthy parous women.

Methods: 28 healthy female participants (14 parous, 14 …