Medicine and Health Sciences Commons^™

Risk Stratification For Treatment Decisions In People At Ultra-High Risk For Psychosis: A Cost-Effectiveness Analysis, Olajumoke Marissa Ologundudu

Electronic Thesis and Dissertation Repository

People with psychotic disorders have long-term negative health outcomes and contribute large health system costs. Intervening among those at ultra-high risk (UHR) for psychosis may prevent or mitigate risk for psychotic disorder; however, it is unclear if we should treat all UHR individuals or only those above a certain risk threshold. The objectives were to systematically review the literature on the cost-effectiveness of UHR programs, and to conduct an economic evaluation of a risk stratification strategy, where treatment decisions are based on the probability of transitioning to psychotic disorder. Our systematic review found that UHR programs are potentially cost-effective. The …

Intersectional Social Inequalities And Cognitive Functioning Among Community-Dwelling Older Adults In England: A Decomposition Analysis Of The Mediating Role Of Loneliness, Chantel Walwyn

Electronic Thesis and Dissertation Repository

Normative cognitive decline is an emerging public health issue for older adult populations. It is necessary that we take an intersectional approach to examining heterogeneity in cognitive health outcomes. Using complex longitudinal survey data from the English Longitudinal Study of Ageing (ELSA), multiple linear regression models were used to examine the relationship between intersectional group membership based on age, education, and sex, and change in cognitive functioning domains (memory function, and executive function) over an 8-year period. Three-way decomposition analysis was also used to examine the mediating effect of loneliness on the association between intersectional group membership and the change …

Creation Of A Covid-19 Community Testing Team For Home Health And Hospice, Lilah Raja

Master's Projects and Capstones

The novel SARS-CoV-2 strain (COVID-19) was identified in Wuhan, China in December 2019 (Eddy et. al, 2020). The resulting US outbreak has affected the Kaiser Permanente (KP) Oakland health care system. With the threat of COVID-19 highest among immunosuppressed and elderly clients, KP Oakland home health and hospice (HH/HO) department is rapidly mobilizing to provide community and in-home testing for eligible clients. A project was created to build a COVID-19 testing team workflow to provide diagnostic and preventative testing. This project focuses on team-based interventions that will change the pre-existing practice of requiring HH/HO clients to travel to remote testing …

Population-Based Studies On Medications And Fall-Related Injury In Older Adults, Yu Ming

Electronic Thesis and Dissertation Repository

Background: Fall-related injuries in older adults result in serious consequences to individuals and health care system, especially with the increasing aging population. The purpose of this study was to (1) describe medication prescription patterns within one year prior to fall-related injuries; (2) identify medication classes prescribed within 30 days prior to the injury that were associated to fall-related injury; and (3) examine the association between fall-related injuries and continuous use or new initiation of most commonly prescribed medications.

Methods: Studies used administrative health care data in Ontario. Study 1 described the frequency of medications prescribed to older adults within one …

Correlates Of Preventable Emergency Department Visits In Canada: Evidence From The Literature And The Canadian Community Health Survey, Tammy Lau

Electronic Thesis and Dissertation Repository

Emergency department (ED) visits for primary healthcare-treatable conditions are preventable and indicate barriers to primary healthcare. The goal of this thesis was to explore the prevalence and key correlates of preventable ED visits among adults in Canada. Our systematic review found that the prevalence of these visits ranged from 4.3% to 59.1% and were associated with younger age, low education, low income, rural residence, and worse self-rated health. Our analysis of data from the 2015-2016 Canadian Community Health Survey found that 39.9% of adults with a regular healthcare provider considered their last ED visit to be preventable. In addition to …

Trends And Factors Associated With Suicide Deaths In Older Adults, Eada Novilla-Surette

Electronic Thesis and Dissertation Repository

Suicide in older adults is a significant overlooked problem worldwide; particularly in Canada where a national suicide prevention strategy has not yet been established. This population-level study utilized and analyzed linked administrative health care databases (from 2011-2015) that were available at ICES (provincial health care administrative data steward), to build a better understanding of suicide (rate; trends; risks/preventive factors) in older adults living in Ontario, Canada. The findings suggest that suicide remains a persistent cause of death in older adults (with an average annual suicide rate of 0.1 per 1000 people over 5 years; the risks include being male, living …

Prevalence Of Rats And Rodent Borne Pathogens Across Post-Katrina New Orleans, Bruno Marco Ghersi

Doctoral Dissertations

Disasters are happening at an increasingly higher rate and intensity a trend that is expected to continue as more humans migrate to coastal urban areas. Disasters, and as importantly, disaster recovery can affect how native and pest populations will recover. My aim was to improve understanding of disease risk by evaluating the socioecological conditions that have shaped commensal rat recovery and distribution, as well as the pathogens they carry, across New Orleans after Hurricane Katrina. I first estimated relative abundance and distribution of commensal rats from rodent trapping conducted between mid-2014 and early-2017 across 96 sites in 10 areas of …

Emerging Zoonotic Pathogens At The Human-Wildlife Interface In Protected Areas: Game In The Southeastern United States And Bushmeat In Northern Uganda, Breeanna M. Dell

Doctoral Dissertations

The emergence of zoonotic pathogens through contact with animal reservoirs is a well-documented phenomenon and growing concern for public health. Particularly in light of the ongoing Ebola epidemic in the Democratic Republic of the Congo and the coronavirus pandemic, the need to understand mechanisms of contact and disease transmission at the human-wildlife interface and to understand which infectious agents may reside within wildlife reservoirs crucial. In this project, we investigated the potential introduction of zoonotic cestode Echinococcus canadensis to public lands in Tennessee subsequent to elk translocation effort and aimed to identify whether a transmission cycle was established in this …

Genetic And Clinical Determinants Of Racial/Ethnic Differences In Multiple Myeloma Susceptibility And Outcomes Focusing On Hispanics, Alem Belachew

Dissertations & Theses (Open Access)

Multiple Myeloma (MM) constitutes 10% of diagnosed hematologic malignancies in the US, with over 12,000 deaths recorded each year. Race/ethnicity is a well-known MM risk factor, where individuals of African descent have over 2- to 3-fold increased risk of incidence compared to those of European descent. Additionally, Hispanics are diagnosed approximately three years younger than white American counterparts, for unknown reasons. Differences in clinical phenotype are also present for MM patients by ancestry, including varying rates of common initiation mutations such as IgH translocations and TP53 mutation between patients of European and African descent. Studies have begun to interrogate the …

Estimating Covid-19 Survival Rate And Inferring Case Severity With Respect To Milwaukee County Policy Change Using Logistic Regression, Geoff M. Chappelle

Theses and Dissertations

Coronavirus disease 2019 (COVID-19) is a global issue, and it is affecting 170 countries in very different ways. In the United States, a lot of efforts have been made nationally and by individual states to curb the spread and severity of COVID-19. Policy changes and recommendations have been met with variable success across the country. There is a wealth of information on where COVID-19 infection and death are prevalent, and there are several articles discussing disparities in those outcomes among different populations. However, those findings are not necessarily tied to a policy change or, in the weeks that follow a …

Parent-Child Sexual Communication And Sexual Risk: A Meta-Analytic Review, Brittnie Star Peck

Theses and Dissertations

This meta-analysis examines the effect of parent-child sexual communication (PCSC) on sexual risk behaviors and outcomes during adolescence. Results confirm that PCSC increases risk prevention strategies and reduces sexually risky behaviors with corresponding reductions in unplanned pregnancy and sexually transmitted infections (STI). Moderating variables include extent of communication, the content of PCSC interactions, operationalization of risk, timing of the interaction, biological sex of the adolescent, the dyadic composition of the parent-child interaction (e.g., mother-daughter, father-son), and the racial or ethnic makeup of the sample. The frequency, depth, and breadth of PCSC interactions, and inclusion of descriptive/instructional and contraception/risk information are …

Gardasil Vaccine Trends Within Nevada, California, And The U.S.: A Comparative Study, Karen S. Gutierrez

UNLV Theses, Dissertations, Professional Papers, and Capstones

Despite decreasing incidence in cervical cancer in the U.S., there continues to be an increase in public health concern for cervical cancer worldwide. Recent studies report that individuals are disproportionately affected based on region, sex, and race. Additionally, the human papillomavirus (HPV) attributable cancers may be reduced between 70% and 90% through the universal use of HPV-vaccines. In order to expand current knowledge and implement intervention programs in Nevada, it is critical to examine the associations among the Gardasil vaccine, cervical cancer screening, and adverse events following immunization as well as to understand the different socio-demographic subgroups affected. To our …

Effects Of Climate Change On The Epidemiology Of Flood-Related Waterborne Disease: A Systematic Literature Review, Sarah M. Cadarette

Capstone Experience

Natural disasters, such as flooding related to extreme precipitation, can lead to many adverse health effects (i.e. waterborne disease). Several outbreaks of waterborne disease have been linked to extreme precipitation, and gastrointestinal infection has been shown to increase after floods. Climate change is likely to lead to a higher frequency of waterborne disease through increases in extreme precipitation and associated flooding affecting water and sanitation infrastructure. This review sought to answer 2 research questions: 1. Has the epidemiology of waterborne disease related to floods changed over time? 2. Can this difference be related to climate change? A literature search was …

Characterization Of Adiposity And Inflammation Genetic Pleiotropy Underlying Cardiovascular Risk Factors In Hispanics., Mohammad Yaser (Anwar)

Electronic Theses and Dissertations

The observed overlap between genetic variants associated with both adiposity and inflammatory markers suggests that changes in both adiposity and inflammation could be partially mediated by common pathways. The pervasive but sparsely characterized “pleiotropic” genetic variants associated with both adiposity and inflammation have been hypothesized to provide insight into the shared biology. This study explored and characterized the genetic pleiotropy underpinning adiposity and inflammation using genetic and phenotypic observations from the Cameron County Hispanic Cohort (CCHC). A total of 3,313 samples and >9 million single nucleotide polymorphisms (SNPs) were examined in this study. Mixed model genome-wide association studies (GWAS) were …

Epidemiology And Pathophysiology Of Common Skin Diseases In West Africa: An Immunodermatological Framework, Osazomon Imarenezor

All HCAS Student Capstones, Theses, and Dissertations

This capstone reviews the common skin diseases on a global scale. With these dermatoses being further funneled into Africa and then magnified into common West African dermatoses, the meta-analyses of literature available paints a clear picture of the epidemiological & pathological factors and their contribution to the skin disease. Each article analysed in this analysis was taken from a 20-year span of January 2000 to December 2019. The selection of articles was fine-tuned by identifying the distribution of skin disease, revealing the populations affected (age, gender, ethnicity, etc), the main causes, country of origin, the prognosis of disease, and the …

Quantifying The Impact Of Chronic Stress On Racial Disparities In Cardiovascular Disease, Nnadozie Emechebe

USF Tampa Graduate Theses and Dissertations

Background: Despite declining mortality in cardiovascular diseases (CVD), racial disparities between non-Hispanic Blacks (NHB) and to non-Hispanic Whites (NHW) persist. Although the prevalence of traditional risk factors of CVD such as hypertension, is higher in NHB compared to NHW, adjusting for this difference does not eliminate the disparity completely. This suggests other factors might explain the persisting disparities. Thus, the purpose of this dissertation is to quantify the impact of chronic stress in explaining the racial disparities in cardiovascular diseases (CVD). This dissertation contains three studies that addressed the following Specific Aims: Specific aims: 1) To create and assess the …

Understanding Physical Activity Behaviour In Ontario, Canada: A Cross-Sectional Cohort Analysis Of Carrot Rewards App Users, David D. Mchugh

Electronic Thesis and Dissertation Repository

Little device-measured data are available to describe the physical activity (PA) of rural-dwelling individuals living with chronic disease. PURPOSE: From accelerometer data collected using a smartphone app (‘Carrot Rewards’), we sought to provide mean daily step counts for app users in general and by age and gender for those living in rural/urban areas and those self-reporting a chronic disease or not. METHODS: This cross-sectional cohort study used device-assessed data from Ontario app users (i.e., PA data collected over a 7-day period for each user) who completed an in-app chronic disease survey from December 2018 to April 2019. A …

A Review Of American College Campus Tobacco Or Smoke Free Policies: A Case Study Of A Large Urban University, Sarah E. Powell

USF Tampa Graduate Theses and Dissertations

Objective: A year after a tobacco free policy was passed, the University of South Florida (USF) was interested in the overall policy opinions and efficacy. To assess this a project was completed that included a survey and geospatial data. The survey measured tobacco policy enforcement behavior and a geographic information system (GIS) mapped tobacco policy violation. This project introduces an evaluation process that can efficiently assess an institutions tobacco-free policy. Methods: Using a cross-sectional survey sent to students, faculty, and staff, understanding of policy and resources, tobacco use observations, stage of change regarding policy enforcement, self-efficacy to enforce, and perceived …

Mood And Anxiety Disorders, Measurement, And Migrant Groups In Ontario, Jordan Edwards

Electronic Thesis and Dissertation Repository

Our objectives were to: (1) evaluate the current literature on the epidemiology of mood or anxiety disorders among migrant groups; (2) assess how current tools for measuring mood or anxiety disorders at the population level influence our understanding of the epidemiology by a) analyzing the concordance between two commonly used population measures, and b) using a Bayesian analysis to create a combined estimate using both measures; (3) estimate the prevalence and effects of potential risk factors on the prevalence of mood or anxiety disorders among first-generation migrant groups compared to the general population in Ontario. We conducted a systematic review …

Understanding The Determinants Of The Cost Of Coronary Artery Bypass Graft Surgery, Hun Lee

Electronic Thesis and Dissertation Repository

Introduction: The relationship between patient demographics, clinical factors, and cost of coronary artery bypass graft (CABG) is complex. Investigation of these relationships is important to aid clinical practice and inform reimbursement models. This thesis analyzes multiple different domains in order to understand the significant factors that impact the cost of CABG at the London Health Sciences Centre (LHSC).

Methods: Model selection, construction of nested descriptive models, exploration of mediation analysis of the impact of peri-operative factors and cost through length of stay, and construction of estimative models were performed.

Results: Several baseline characteristics, socio-demographics, peri-operative variables, and post-operative variables were …

Plasma Proteins That May Cause Parkinson’S Disease And Multiple Sclerosis: A Mendelian Randomization Study, Brigid A. Staley

Dissertations and Theses

Multiple sclerosis (MS) and Parkinson’s disease (PD) are progressively disabling neurologic disorders that profoundly affect quality of life and shorten life expectancy. There is no cure for either disease, and current treatments only alleviate symptoms and may cause serious side effects. The causes of MS and PD are not well understood. Previous epidemiologic studies have documented numerous environmental risk factors for both diseases. However, these studies are inherently prone to bias from confounding which may generate spurious results. The lack of unbiased evidence on environmental causes of MS and PD has been a critical barrier to fully understanding their pathophysiology. …

Perinatal Anxiety And Depression During The Covid 19 Pandemic, Helen Xumin Chen, Nancy Selix, Marcianna Nosek

DNP Qualifying Manuscripts

Abstract

The novel coronavirus disease 2019 (COVID-19) outbreak places perinatal women at higher risk of developing anxiety and depression. Uncertainty, fear, and confusion in medical, social, economic, occupational and political aspects of life in the US add to existing stressors that perinatal women experience. To optimize the quality of perinatal care during the pandemic, appropriate mental health interventions must be implemented to prevent and alleviate perinatal anxiety and depression and improve maternal and infant outcomes. Measures include increased screening, non-pharmacologic and/or pharmacologic interventions and the use of telehealth for care delivery.

Keywords: perinatal anxiety, perinatal depression, COVID-19, SARS CoV-2, maternal …

An 8-Year Longitudinal Assessment Of Health-Related Quality Of Life In Children With Epilepsy, Emily Chemnitz

Electronic Thesis and Dissertation Repository

This study estimated the course of health-related quality of life (HRQL) over 8 years among children newly diagnosed with epilepsy. Levels of HRQL in children newly diagnosed with epilepsy were assessed over 8 years and compared to levels reported for peers in the general population. Data came from the Health-Related Quality of Life in Children with Epilepsy Study, a multi-center prospective study of children in Canada with epilepsy. Parents of children with epilepsy reported their children were comparable to (or better than) their counterparts in the general population on the majority of individual health concepts 8 years post diagnosis. On …

Impact Of 2012 Spanish Health Care Reform On Hiv-Positive Immigrants: A Mixed Methods Approach, Megi Gogishvili

Dissertations and Theses

Background: The financial crisis of 2008 hit Spain hard. As a consequence, the government took multiple austerity measures, including reforms in the healthcare system in 2012. Specifically, the government reduced the budget for health and social services by 13.7% in 2012.The reduction was further followed with structural changes via the 2012 Royal Decree Law (RDL) and Royal Decree (RD).The 2012 RDL and RD entailed broad areas of action,but most importantly the Spanish National Health System (SNS) no longer covered undocumented immigrants. The 2012 RDL and RD excluded approximately 500,000 undocumented immigrants from SNS.

The number of immigrants in Spain has …

The Impact Of Cooking Knowledge, Attitude, Behavior, And Food Security Status On Diet Quality Of College Students At The University Of Maine, Angela I. Czup

Electronic Theses and Dissertations

Food insecurity in the United States is a complex issue. Nutrition interventions and studies are often designed for high-risk populations with others being overlooked. Until recently, few studies and interventions have focused on college-aged students. In order to understand the nutrition-related needs of students at the University of Maine, it is necessary to determine their cooking knowledge, attitudes, behaviors, and food security status. Study participants included college sophomores, juniors, and seniors [n=16 sophomores, (38.1%), n=15 juniors, (35.7%), n=11 seniors, (26.2%)]. The study design was cross-sectional where participants completed a combined Qualtrics online survey and the Automated Self-Administered 24-Hour Dietary Assessment …

Reducing Adverse Outcomes In Hepatocellular Carcinoma Patients Undergoing Hepatectomies, Yongyue Qi

Theses & Dissertations

The incidence and mortality of liver cancers are increasing in the United States. In addition to the classic risk factors of hepatic viral infection and high alcohol consumption, non-alcoholic Fatty Liver Disease (NAFLD), has emerged as a risk factor for hepatocellular carcinoma (HCC). The most effective curative treatment for HCC is liver resection (hepatectomy), however, hepatectomy is a major operation with potential risks of mortality, hospital readmission and other adverse outcomes such as postoperative complications and longer hospital stay. The reported 90-day mortality and 30-day readmission rates following a hepatectomy vary widely across studies, most of which have limitations due …

The Prevalence Of Multimorbidity Among People With Non-Affective Psychotic Disorders 10-Years After First Diagnosis, Myanca D. Rodrigues

Electronic Thesis and Dissertation Repository

Prior research suggests that people with psychotic disorders have an excess risk of individual chronic conditions, however less is known about their risk of co-occurring multiple chronic health conditions; that is, multimorbidity. The overall objective of this thesis was to examine the association between psychotic disorders and multimorbidity using two complementary studies. First, our systematic review and meta-analysis of fourteen studies found that people with psychotic disorders had an increased risk of 2+ chronic conditions relative to those without psychosis (RR=1.69, 95%CI=1.37,2.08). Second, our retrospective matched cohort study found that people with psychotic disorders treated by an early psychosis intervention …

Examining The Simultaneous Influence Of Individual And Neighborhood Determinants On Cardiovascular Health: A Multilevel Study In Canadian Adults, Sarah Singh

Electronic Thesis and Dissertation Repository

Introduction: Previous studies have found that the cardiovascular health of individuals may be influenced not only by their personal characteristics, but also independently by their social relationships and the neighborhoods in which they reside. Still, it is unclear how these determinants act together to influence cardiovascular health and whether these determinants account for differences in cardiovascular health among Canadian adults.

Objective: The main objectives were: 1) to examine the status of cardiovascular health in Canadian adults and, 2) to describe how individual and neighborhood determinants can: a) act together to influence cardiovascular health and, b) account for differences …

Investigation Of Factors Affecting The Hiv Continuum Of Care In Tennessee, Elaine Loudermilk

Electronic Theses and Dissertations

Introduction: Factors contributing to the HIV continuum of care (HCC) for adults in Tennessee (TN) have not been studied in depth with known predictors for HIV risk, specifically adverse childhood experiences (ACEs), among low annual income or sexual minority groups [lesbian, gay, bisexual, or transgender (LGBT)].

Methods: A mixed methods study design was used to assess factors related to the HCC. Quantitative analysis used the TN Behavioral Risk Factor Surveillance System data to examine at risk and ever tested for HIV, to (1) investigate ACEs among adults with low-income (<$25,000 annually) in 2016-2017 and (2) among LGBT in 2018. Descriptive statistics and multiple logistic regression (MLR) analysis stratified by TN grand division were performed. Qualitative analysis included 11 interviews with persons living with HIV (PLWH) receiving care at a local clinic to evaluate surveillance questions related to ACEs and the HCC to develop a culturally appropriate survey.

Results: Quantitative results found that among LGBT (N=262) and low-income …

Structural Magnetic Resonance Imaging As A Diagnostic Biomarker Of Hiv-Associated Neurocognitive Disorders (Hand), Mikki Schantell

Capstone Experience

Objective: The goal of this study was to do an exploratory analysis to determine if gray matter brain volumes and cortical thickness measures obtained from structural magnetic resonance imaging (sMRI) can discriminate people with HIV-associated neurocognitive disorders (HAND), neurocognitively unimpaired people with HIV (NU PWH), and HIV-negative controls (HIV- controls) using linear discriminant analyses.

Methods: A total of 231 participants, including 110 PWH and 121 HIV- controls, completed a neuropsychological (NP) battery and an sMRI protocol. The bilateral gray matter volumes and cortical thickness brain regions were analyzed using 18 linear discriminant models to assess the discriminability of gray matter …