Medicine and Health Sciences Commons^™

Economic Analysis Of Population-Based Next Generation Sequencing For Breast Cancer, Sapphire Curelaru

University Honors Theses

Breast cancer develops due to accumulated DNA replication insults which causes cancer to uncontrollably proliferate. An individual's predisposition to developing cancer, as well as the composition of a tumor, can be sequenced using genetic tests. Myriad's BRACAnalysis CDx^® seems to be the most utilized genetic test. However, Next Generation Sequencing (NGS) seems to be a better genetic test for breast cancer when compared to Myriad's BRACAnalysisCDx^® in terms of return-time, accuracy, efficiency, and healthcare cost. By using Next Generation Sequencing tests, stakeholders can save money on genetic testing which can be invested in more genetic tests. Payers can …

Treatment Disparities In Emergency Medical Services: The Influence Of Race/Ethnicity, Obesity, And English Proficiency, Jamie Kennel

Dissertations and Theses

Different treatment in healthcare settings provided to different social groups of people may lead to disparities in health, quality of life, and life span. Despite the critical role among healthcare services that Emergency Medical Services (EMS) provides disproportionately for marginalized communities, it remains unclear if and to what extent treatment disparities take place in the pre-hospital setting. Guided by the theoretical frameworks of social worth, aversive racism, and stigma, this study utilizes medical chart data from three different public and private datasets to investigate treatment disparities by Emergency Medical Service providers for racial minority, obese, and limited English proficiency patients. …

Reflecting On Resilience: Insight Into Resiliency Development And Utilization In Oregon's Older Adults From 2020 To 2022, Riley A. Wilton

University Honors Theses

The events of the last 2 years have complicated the lives of older adults throughout the world. For many, their survival can be traced back to one key trait: resilience. In the state of Oregon, the years 2020-2022 came with a host of issues that expanded past the COVID-19 pandemic. These events provide context for the world our storytellers discuss.

Using a snowball recruitment strategy through the efforts of community organizations and senior centers, 4 storytellers sat down to describe their resilience in different ways. They were asked to reflect on their own life experiences, how it influenced their resilience, …

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 …

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 …

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 …

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. …

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 …

Dual Panics: A Media Analysis Of Narratives On The Role Of Unauthorized Migration In America's Overdose Crisis, Morgan Godvin

University Honors Theses

Background: The realms of drug policy and immigration policy have long been fueled by misinformation, where sensationalism and panics help shore up political support. Most recently, the "border crisis" has been invoked to explain the "overdose crisis" in mass media narratives. Although the increase in migration is being blamed for illicit drug flows, drug importation occurs primarily through legal points-of-entry. The extent and excess visibility of false narratives linking overdose to migration in mainstream media is unknown.

Methods: We used the Media Cloud ecosystem to compile and characterize mainstream media content published between June 2021 and July 2021 regarding the …

Racial Disparities In A State Based Workers' Compensation System, Caroline Kristine Smith

Dissertations and Theses

Racial, ethnic, and linguistic minority workers suffer higher rates of work-related injuries and illnesses in the United States compared to their White counterparts. Explanations for these higher rates include potential socioeconomic causes (education, income, and wealth) and occupational segregation into more dangerous occupations. What is less studied are the post-injury sequelae for minority workers, which is their experiences in the workers' compensation system, as well as their health and return to paid employment. What is known comes primarily from qualitative literature, which includes themes of racial discrimination (from employers, health care providers, and workers' compensation employees), a lack of information …

Socioeconomic Determinants Of Health Disparities By Race And Ethnicity: The Mediating Role Of Social, Psychological And Behavioral Factors, Amanuel Zimam Melekin

Dissertations and Theses

Socioeconomic status (SES) is inversely related to health status. Disparities in health status among races and ethnic groups are partly attributable to differences in SES, but the indirect pathways by which SES may influence health status are not widely studied.

Using the Health and Retirement Study (HRS) data, this dissertation examined the pathways by which SES, via social, psychological, and behavioral factors predicted physical impairment and overnight hospitalization, and asked whether these indirect relationships differed by race/ethnicity. The HRS is a nationally representative multistage area probability sample administered biennially to respondents over the age of 51 and their spouses. Data …

Rural Interprofessional Health Care Education: A Study Of Student Perspectives, Curt Carlton Stilp

Dissertations and Theses

As the cost for health care delivery increases, so does the demand for access to care. However, individuals in a rural community often do not have access to the care they need. Shortages of rural health care professionals are an ever-increasing problem. The Affordable Care Act of 2010 sought to increase health care access by focusing on team-based care delivery. Thus, the need to educate health care students in the fundamentals of team-based practice has led to an increased emphasis on Interprofessional Education (IPE). While past research focused on urban IPE, a literature gap exists for the effects of a …

Transgender Patients' Experiences Of Discrimination At Mental Health Clinics, Corrine Ann Stocking

Dissertations and Theses

The transgender population is makes up about 0.3% of the U.S. population (Gates 2011). The term transgender is both an identity and an umbrella term used to describe people who do not adhere to traditional gender norms (Institute of Medicine 2011). Transgender people experience many barriers to services, negative health outcomes, and discrimination (Fredrikson-Goldsen et al. 2013; Institute of Medicine 2011; Eliason et al. 2009; Hendricks & Testa 2012). Mental health clinics are an important site for understanding transgender peoples' experiences due to being a gatekeeper for other medical services and their role in helping transpeople with issues surrounding coming …

Gender And Prescription Painkiller Misuse: Findings From The 2011 National Survey On Drug Use And Health, Robin Jo Clough

Dissertations and Theses

This study examines the effects of gender and social bonds on the experience of prescription painkiller misuse for men and women. The theoretical framework for the project is Travis Hirschi's social control theory (1969), and the social bond elements of attachment, commitment, involvement, and belief, which emphasizes the importance of these bonds in creating a "stake in conformity" for the individual, leading to acceptance of social norms and desistence from deviance. This theory, however, is relatively silent with regard to gender differences and was developed to examine delinquency in an all male sample of adolescents. The elements of this theory …

Exploring The Effects Of Multi-Level Protective And Risk Factors On Child And Parenting Outcomes In Families Participating In Healthy Start/Healthy Families Oregon (Hs/Hfo), Peggy Nygren

Dissertations and Theses

While many studies focus on the links between multiple risk factors and negative outcomes such as child maltreatment, less is known about the influence of protective factors in the face of risks. The theoretical base of this study was a social ecological model of interactive influences including individual parent, family, and neighborhood level factors to predict outcomes. Protective Factor Index (PFI) and Risk Factor Index (RFI) predictors were developed to explore potential multi-level protective factor buffering effects on key child development and parenting outcomes. Participants were first time mothers enrolled in a randomized controlled study of the Healthy Start/ Healthy …

Batterer Intervention Programs' Response To State Standards, Ashley Lynn Boal

Dissertations and Theses

The study of policy implementation has recently garnered research and federal attention highlighting the importance of implementation in achieving desired policy and program outcomes (Durlak & DuPre, 2008; Meyers, Durlak & Wandersman, 2012; National Institutes of Health, 2013). Psychology is one discipline that is well poised to guide the study of policy implementation as it can inform the creation, development, and outcomes associated with the introduction of a policy (Esses & Dovidio, 2011; Fischhoff, 1990). Given that batterer intervention programs (BIPs) have been developed to prevent future intimate partner violence (IPV) and improve victim safety, ensuring these programs have successfully …

The Impacts Of Change In Governance On Faculty And Staff At Higher Education Institutions: A Case Study Of Ohsu, Dana L. Director

Dissertations and Theses

In the early 1990s, Oregon Health and Science University leadership examined the political and economic landscape and determined it needed a new operational model to survive and thrive. In 1995 OHSU separated from the state higher education system and became a public corporation, with goals of increased efficiency, customer-focus, ability to attract world-class researchers and physicians, and salaries commensurate with an urban academic health center.

This research examines the internal impacts when universities undergo significant change, using OHSU's governance change as a case study. Central is the question: what effect(s) did OHSU's decision to become a unique public corporation have …

Humor-Related Social Exchanges And Mental Health In Assisted Living Residents, Ann Elizabeth Mcqueen

Dissertations and Theses

Social contact is known to be vital for older adults' mental and physical health, but few studies of social interactions have taken place in long-term care settings. The current study investigated whether the psychological well-being of assisted living residents was influenced by factors associated with residents' social interactions involving humor. Specific aims of the present study were to develop and test a measure related to humor-related social exchanges, to examine how humor-related social exchanges affect residents' mental health, and to explore whether humor-related social exchanges mediated the effects of resident and facility characteristics on indices of mental health. One hundred …

Coping With Interpersonal Conflicts At Work: An Examination Of The Goodness Of Fit Hypothesis Among Nurses, Robert Randon Wright

Dissertations and Theses

Increasingly, evidence indicates that workplace interpersonal conflicts (WIC) are the most upsetting/troublesome daily work stressors (Sulsky & Smith, 2007), and within the context of nursing, WIC is a problem of high prevalence and intensity (Baltimore, 2006; Farrell, 1999). In relation to coping with stressors such as WIC, Lazarus and Folkman (1984) established the transactional model of stress and coping, where cognitive appraisals of the stressor (e.g., perceived control) are central to coping and classified all coping behaviors as either problem-focused or emotion-focused. They also proposed the "goodness of fit hypothesis", which predicts that problem-focused coping efforts used to cope with …

Nine Months, Esther Lim

Dissertations and Theses

This is a collection of short stories that traces a chronological movement through one family's experience of the mother's illness. Each piece in the collection is meant to be an independent, free-standing short story. Each story is different, told from distinctive points-of-view, angles, and voices. However, every story covers a span of time within the nine months of the family's experience, in the presented order, as part of a collective movement toward the core. All together, the pieces hope to reflect a mosaic of sorts--one that tells a story that cannot otherwise be told.

Exploring Support Network Structure, Content, And Stability As Youth Transition From Foster Care, Jennifer E. Blakeslee

Dissertations and Theses

Many older youth in foster care lack adequate resources and ongoing support in their social networks as they transition into young adulthood, while other youth in these circumstances experience stable social networks providing comprehensive support. Systematically measuring the supportive personal and service-oriented relationships in youth networks expands the scope of inquiry in this area by identifying patterns of social network structure, member composition, and relational qualities that are associated with more or less support provision through formal and informal relationships. These can also be measured over time to observe changes in network form and content and assess network stability. This …

Physicians Providing Alternative Medicine: Boundary Crossing And The Emergence Of Integrative Medicine, Richard Scott Lockwood

Dissertations and Theses

Integrative medicine (IM) has organized as a new area of specialization in mainstream healthcare. The development of IM is widely attributed to popular demand for the range of therapies known collectively as Complementary and Alternative Medicine (CAM). During the 1990's the rate of acceptance of CAM accelerated among consumers, professions, financing and education. The Medical Expenditure Panel Survey (MEPS) measured CAM utilization and professional service provision during the years 1996 and 1998, but never since. These surveys were unique because they specifically inquired as to whether CAM was provided by a physician, among other types of professionals. This dissertation defines …

The Duration Of Tinnitus In An Aging Population, Mary Engel

Dissertations and Theses

The purpose of the present study was to determine whether the perceived severity of chronic tinnitus in a geriatric population increased, decreased, or remained constant with the passage of time. A questionnaire was designed to ascertain the subjects' perceived severity at time of onset and the perceived severity of their current tinnitus. The subjects were asked to rate their past and present tinnitus severity according to how much it bothered them. They were also asked questions pertaining to noise exposure history, hearing aid use, and tinnitus sound parameters for purposes of comparison with other groups previously studied.

Reading Comprehension In Dementia Of The Alzheimer's Type : Factual Versus Inferential, Donna Jensen Graville

Dissertations and Theses

The purpose of this study was to investigate the reading comprehension abilities of those with mild and moderate dementia of the Alzheimer's type (DAT) and compare their performance to that of a sample of non-demented elderly. Thirty-eight male subjects were used, 20 non-demented elderly, nine mild DAT and nine moderate DAT. All were administered level B of the NRST. This test contains questions requiring three levels of inference: literal, translational, and high-level inference.

Eating Disorders: The Correlation Of Family Relationships With An Eating Disorder Continuum, Jana Schweitzer

Dissertations and Theses

For the purposes of this study, eating disturbances were placed on a continuum ranging from disordered to normal, and family factors were examined via this framework. Research on anorectics and bulimics indicates that a variety of family variables contribute to the etiology of eating disorders. Research suggests the presence of a subgroup of persons who experience some disturbance in their relationships with food but not to the severity observed among eating disordered individuals. This study examined the relationship between family factors and eating disturbances.

The Descriptive Function Of Language: Changes With Age And Pressure To Inform, Eve Susan Liebman

Dissertations and Theses

Currently language is viewed as a multi-dimensional construct, consisting of three interrelated components; content, form and function (Bloom and Lahey, 1978). In recent publications, language function has been referred to as pragmatics (Prutting, 1979). The essence of pragmatic theory is that language is used functionally in social contexts, to accomplish specific types of communication (Wood, 1981). One such communicative function is referred to as the informative function, which occurs when a speaker provides ideas and information to others, as in describing, naming and giving examples {Wood, 1981). It is not clear, however, when children become competent in making specific, clear …

Verbal Fluency Performance Of Normal Elderly Subjects, Molly Secrest

Dissertations and Theses

The purpose of this study was to measure the verbal fluency of normal gerontologic subjects and to determine the extent of association between verbal fluency score and level of education. Specifically, this investigation sought to determine means, ranges and standard deviations for three groups of subjects: those 61 to 69 years of age, those 70 to 79 years of age, and those 80 years of age and above. In addition, correlations between verbal fluency score, and age, sex, years of education, and order of stimulus presentation were computed.

The Use Of Discrediting Labels In The Maintenance Of Socially Constructed Reality, Nathan Church

Dissertations and Theses

Over the past two decades an increasing number of theorists and practitioners have called for a thorough rethinking of the underlying assumptions of the concept of rrental illness and the traditional psychiatric nodes of responding to mental disorders. The work of this group of writers has come to be referred to as the "antipsychiatry" literature. The insights of this perspective center largely about a rejection of those theories and methods of treatment that are based upon the medical model. Many writers point to the use of traditional psychiatric practice as an oppressive instrument of social control. While much of this …

An Examination Of The Relationship Between Population Density, Density Related Social Factors, And Physical Morbidities, Douglas King Huebner

Dissertations and Theses

The relationship between the number of persons per room in the home and the relative occurrence of stress-related morbidities of hospitalized patients is investigated. The social factors of age, social class, and level of social support also are examined as they relate to both density and morbidity type occurrence. The population under study is composed of all Kaiser-Permanente Medical Care Program members twenty years of age and older, discharged from Bess Kaiser Hospital during 1974, and whose diagnosed morbidity was included in specific morbidity categories. All data were obtained through the facilities of the Health Services Research Center, Kaiser Foundation …

The Treatment-Moral Career Of Clients In A Community Based Treatment Program, Charles Edward Forster Jr.

Dissertations and Theses

The research reported here was intended to consider in an exploratory fashion the impact of a community based treatment program, Services for Problem Drinker Drivers, (SPDD), for persons convicted of driving while under the influence of liquor on: (1) the self-concept, (2) consequences for public identity, and (3) the careers or changes over time in both self-concept and public identity of clients in the program.