Medicine and Health Sciences Commons^™

Evaluating The Impacts Of Antidepressant Use On The Risk Of Dementia, Ran Duan

Theses and Dissertations--Epidemiology and Biostatistics

Dementia is a clinical syndrome caused by neurodegeneration or cerebrovascular injury. Patients with dementia suffer from deterioration in memory, thinking, behavior and the ability to perform everyday activities. Since there are no cures or disease-modifying therapies for dementia, there is much interest in identifying modifiable risk factors that may help prevent or slow the progression of cognitive decline. Medications are a common focus of this type of research.

Importantly, according to a report from the Centers for Disease Control and Prevention (CDC), 19.1% of the population aged 60 and over report taking antidepressants during 2011-2014, and this number tends to …

Everybody’S Working (But The Weakened): An Assessment Of Medicaid Work Requirements And Their Administrative Burdens, Samuel Misleh

MPA/MPP/MPFM Capstone Projects

Although Medicaid work requirements are currently halted in both Arkansas and Kentucky, this analysis utilizes the data available to make an assessment and estimate of what Kentucky’s Medicaid enrollment will look like if work requirements similar to those Arkansas had are ever implemented. The relative severity of the administrative burden of such requirements provide a tool for comparison, and a difference-in-differences analysis of the change in Medicaid enrollment between Arkansas and West Virginia, a state that has not implemented and currently has no plans to implement Medicaid work requirements, provide the bases for this estimate. After coding the work requirements …

Metabolism Reprogramming In Hexavalent Chromium-Induced Human Lung Carcinogenesis, James Tate Fortin Wise

Theses and Dissertations--Pharmacology and Nutritional Sciences

Hexavalent chromium, Cr(VI), is an established human carcinogen that is a worldwide environmental health concern. It is well understood that reactive oxygen species, genomic instability, and DNA damage repair deficiency are important contributors to Cr(VI)-induced carcinogenesis. After decades of research some cancer hallmarks remain understudied for the mechanism of Cr(VI) carcinogenesis. Dysregulated cellular energetics have been established as a hallmark of cancer. Energy pathways that become dysregulated in cancer include mitochondrial respiration, lipogenesis, pentose phosphate pathway, one carbon metabolism, and increased anaerobic glycolysis in the presence of oxygen or ‘Warburg effect’.

To investigate metabolism changes in Cr(VI) carcinogenesis, we exposed …

The Stimulation Of Dendritic Cells By Cationic Lipids, John Peyton Bush

Theses and Dissertations--Medical Sciences

The discovery that cationic lipids can independently stimulate the immune system has generated interest in their potential as vaccine adjuvants. Here, we show that the cationic lipid R-DOTAP can independently stimulate type 1 interferon production in dendritic cells in both primary culture and immortalized cell culture. Levels of type 1 interferon production are cell line-dependent and limited in vitro by lipid-induced cell death. We show that cationic lipids can independently activate TLR-7 and TLR-9, suggesting a mechanism for type 1 interferon induction. This TLR-stimulatory activity is not restricted to R-DOTAP and can be extended to other similar cationic lipids in …

Evaluating Ways To Reduce Errors In Medication Reconciliations Performed By Nurses In A Rural Hospital Setting, Kalen T. Freeman

MPA/MPP/MPFM Capstone Projects

Medication reconciliation, also known as “med recs”, are an important part of a patient’s care during their hospitalization. A med rec is when hospital personnel generate a list of the medications the patient takes at home. Med recs are vital in the hospital admission process because home medications need to be restarted at appropriate times to fully care for the patient. Also, mistakes in a home medication list can lead to serious consequences in the patient’s health. This study focuses on med recs being performed at Marcum and Wallace Hospital in Irvine, Kentucky. More specifically, the study explores the different …

Impact Of Area-Under-The-Curve Monitoring For Vancomycin On Incidence Of Acute Kidney Injury In Orthopedic Patients, Kelli R. Keats

MPA/MPP/MPFM Capstone Projects

Vancomycin is an antibiotic used regularly in hospitals across the world. The most concerning adverse effect of vancomycin is its documented effect on kidney function. This study examines the impact of two dosing strategies of vancomycin on patients’ kidney function at the University of Kentucky Albert B. Chandler Medical Center. It specifically focuses on patients on the orthopedic service because these patients traditionally receive higher doses of vancomycin for longer periods of time due to the severity of their infections, which puts them at an increased risk of vancomycin-induced nephrotoxicity compared to other patients.

This study will serve as a …

Depressive Symptoms Among Farm Women Aged 50 And Older, Cheryl Dean Witt

Theses and Dissertations--Nursing

Alarming rates of suicide among production farmers have prompted researchers to investigate factors associated with depressive symptoms among this population. Aspects of farm life and farming can contribute to higher levels of depressive symptoms. Higher levels of depression can also increase an individual’s risk of injury and development of chronic disease, impacting overall quality of life. Despite the approximate 3.5 million farm women in the U.S., current research has focused on the male farmer.

Men and women have different responses to stressors, and women in general have a higher prevalence of depressive symptoms. Farm women can be further subjected to …

A Lifestyle Intervention To Decrease Risk Of Developing Type 2 Diabetes Mellitus In A Rural Population, Amanda Culp-Roche

Theses and Dissertations--Nursing

Individuals with type 2 diabetes mellitus (T2DM) are at risk for developing life-threatening comorbidities such as cardiovascular disease (CVD). As a consequence, T2DM is associated with increased morbidity and mortality and decreased quality of life, thus highlighting the importance of prevention of T2DM. Further, the prevalence of T2DM is substantially greater in rural populations compared to urban populations, making rural individuals particularly appropriate targets for T2DM prevention.

T2DM is a largely preventable disease that is associated with modifiable risk factors such as poor diet, sedentary lifestyle, and obesity. Lifestyle interventions to improve these modifiable risk factors have been used to …

Polysubstance Opioid Use In A Justice-Involved Population: An Analysis Of Patterns And Reentry Outcomes, Amanda Marie Bunting

Theses and Dissertations--Sociology

The public health crisis surrounding opioid use is pronounced among justice-involved populations, who face high rates of overdose mortality as well as HIV, and hepatitis C due to injection drug use. The majority of opioid-related overdoses are due to polysubstance use (PSU), and a better understanding of the prevalence and patterns of PSU are necessary in order to inform interventions. This dissertation project has three aims: (1) understand the patterns of opioid PSU among a justice-involved population, (2) identify PSU patterns most at-risk for post-release relapse, and (3) examine engagement in post-release health service utilization. Post-release aims are guided by …

The Impact Of A Fruit And Vegetable Farmers' Market Voucher Prescription Program On A Low-Income Rural Population, Kevin Anthony Richie

Theses and Dissertations--Nutrition and Food Systems

Objective: Measures the impact of the Farmers’ Market Voucher program on weight, body mass index, waist circumference, during the 2016 summer on a rural, low-income population residing in Appalachian Kentucky.

Background: Rural communities often have limited access to fresh fruits and vegetables (FV) which contributes to low levels of consumption. FV are calorie poor, nutrient dense and are inversely associated with inflammation markers, obesity, hypertension, and high blood glucose levels. Appalachian rural communities have a higher prevalence of obesity, diabetes, strokes, and death by heart attack when compared to the U.S. Farmers’ markets

Methods: Pre-experimental intervention design examining FV consumption …

A Comparison Of Body Composition Estimates Between The Norland Dxa, The Idxa, And The Bodpod® In Overweight To Obese Adults, Jalyn Mason

Theses and Dissertations--Nutrition and Food Systems

Background: Body composition measures include fat mass (FM), fat free mass (FFM), and percent body fat (%BF), which are markers of health status and disease risk. Accurate body composition assessment is needed to evaluate an individual’s health and the efficacy of treatment strategies. Objective: Compare body composition estimates obtained from the Norland DXA, BodPod®, and iDXA before and after a 12-week exercise intervention. Subjects/setting: Overweight to obese (BMI 25–35 kg/m²) sedentary men and women (n=30) aged 18 to 40 years were recruited from central KY. Main outcome measure: Agreement in FM, FFM, and %BF between Norland DXA, iDXA, …

Promotion Of Fruit And Vegetable Intake Through Recipe Card Distribution And Sampling At Farmers’ Markets Throughout Kentucky, Umaima Sidra Afsheen Syeda

Theses and Dissertations--Nutrition and Food Systems

The Center for Disease Control and Prevention (CDC) reports indicate that 8% and 6.3% of Kentuckians consume enough fruits and vegetables, respectively. The Plate It Up! Kentucky Proud (PIUKP) project is a recipe-development project that aims to boost produce consumption by incorporating local fruits and vegetables. The purpose of this study was to implement promotional strategies using PIUKP recipes at farmers’ markets and determine their effects on consumers’ intent of purchasing and preparing the produce. The study was conducted at nine farmers’ markets across Kentucky (n=300) in collaboration with Cooperative Extension agents/assistants.

The consumers’ impression of the sample was positively …

Pilot Study Of Text Message Nudges As A Way To Improve Weight Loss Outcomes, Madison Copher

Theses and Dissertations--Nutrition and Food Systems

Weight loss programs for women are on the rise, including both face to face and online programs. However, current research is limited on the process measures and content which produce adherence and the largest outcomes. With obesity on the rise in the United States, it is important to understand out health coaches can strengthen their programs to better support the obese population in their weight loss journey. The purpose of this pilot study was to develop and test the acceptability of text message nudges among women participating in an online weight loss program; determine how dose may be associated with …

Beyond Telling: A Phenomenology Of Adoptive Parents' Adoption Communication Openness With Early Adolescents, Jane D. Samuel

Theses and Dissertations--Family Sciences

Despite calls for increased Adoption Communication Openness (ACO) within the adoptive family, research indicates that families still struggle to accomplish the recommended elements and levels of openness. What could be holding families back from this key process? Three focus groups comprised of 17 adoptive parents of early adolescents (aged 10-14) who were age 0-2 at the time of placement were thematically coded. This inductive analysis revealed the complexity rooted in being —sometimes successfully and sometimes not—communicatively open. Four key themes emerged painting a vivid and rich picture of: a) the breadth and depth of this experience; b) the work entailed; …

Neurochemical Factors Associated With The Initial Pathophysiological Reaction To Large Vessel Occlusion Stroke, Sarah R. Martha

Theses and Dissertations--Nursing

Ischemic stroke is the leading cause of disability world-wide and affects over 800,000 people per year in the United States. The majority of these strokes are ischemic due to a blockage of blood flow to the brain. Damage to the brain occurs at the onset of stroke, neuronal cell death is irreversible and therefore, quick treatment to remove blockage is critical factor in the recovery from stroke. Mechanical thrombectomy as a treatment for ischemic stroke provides an ideal opportunity to collect blood distal and proximal to the cerebral thrombus to examine neurochemical changes occurring during stroke.

The purpose of this …

Race-Based Discrimination, Occupational Stress, And Depression In Black Registered Nurses, Arica A. Brandford

Theses and Dissertations--Nursing

The purpose of this dissertation was to examine depression, experiences of work-related racism, and occupational stress among black nurses. Nursing is a highly stressful and demanding profession that can negatively affect health. Underscoring this is the high rate of depression experienced by nurses. In fact, nurses experience depression at a rate twice that of individuals in other occupations. Examining depression in nurses can provide insights that can inform measures addressing the psychological health of this group. This may be particularly important in black nurses who, in addition to the already high occupational stress associated with nursing, may experience additional stress …

Caregivers’ Influence On Patients’ Heart Failure Self-Care, Hospital Readmission And Mortality, Linda Clements

Theses and Dissertations--Nursing

Background: Heart failure (HF) is a leading cause of hospitalization, readmissions, and death in the United States. Patients hospitalized for HF are at risk for readmission, in- hospital mortality, and early post-discharge death. In the United States, inpatient care has been estimated to cost $83,980 over the lifetime of each patient with HF. The majority of patients with HF depend on caregiver support for successful HF self-care, which is essential for optimal patient outcomes. Support from caregivers is thought to be important for better self-care, and lower readmission and mortality rates. Yet, there are few studies considering the influence of …

Association Of Skeletal Muscle And Psychological Responses To Immobility After Major Injury, Jacob T. Higgins

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the physical and psychological responses to the combination of major trauma (Injury Severity Score [ISS] > 15) and variable periods of immobility. Specific aims were to: 1) develop a conceptual model that illustrates physiological and psychological alterations that occur after injury and subsequent immobility, and their association with skeletal muscle responses and recovery; 2) evaluate daily measures of skeletal muscle strength (bicep and quadricep) using dynamometry and skeletal muscle (rectus femoris and biceps brachii) muscle thickness measured with ultrasound in patients after major trauma; and 3) assess the predictive ability of anxiety and …

Gay Men And Satisfaction With Health Care Interactions, Michael Huggins

Theses and Dissertations--Nursing

The purpose of this research was to determine relationships among depression, anxiety, self-rated physical and mental health, self-advocacy, internalized homophobia, and quality of patient-provider communication to satisfaction with health care interactions. These were measured while controlling for select demographic variables: age; ethnicity; urban or rural domicile; relationship status; household income; highest educational attainment; health insurance; disclosure to health care provider as a gay man; reason for last healthcare visit; and, general health self-rating. The specific aims of this study were to: 1) identify general characteristics of gay men in this sample; 2) examine how levels of satisfaction with health care …

The Impact Of Maternal Nutrition During Pregnancy On Inflammation And Birth Outcomes, Lori Ogden

Theses and Dissertations--Nursing

More than 85% of American adults do not consume recommended amounts of fruits or vegetables. Preterm birth and hypertensive disorders of pregnancy are common adverse conditions affecting pregnancy and are leading causes of maternal and fetal morbidity and mortality. Preterm birth affects nearly 10% of all births in the United States and is on the rise, as are hypertensive disorders, which have increased by 25% over the last two decades. Pregnancy is a state of controlled inflammation, and dysregulation has been linked to preterm birth and other adverse gestational outcomes. A healthy diet is recommended in pregnancy, but little is …

Barriers And Facilitors Of Healthcare Use Among People Who Inject Drugs, C. Brooke Kuns-Adkins

Theses and Dissertations--Nursing

Hepatitis C Virus (HCV) is an infection that can have grave consequences when left untreated. Hepatitis C can be easily eradicated with direct acting antiviral therapy. People who inject drugs (PWID) and inmates are among those with the highest incidence of HCV. However, cure rates among this population remains low. This is, in part, related to an interruption in the HCV care cascade such that only 30% of PWID are linked to care and only 8% of those receive treatment. Inadequate screening and failure to be linked to HCV care remain the largest impediments to treatment success. There is limited …

Evaluating The Efficacy Of Systematic Patient Feedback In An Integrated Mental Health And Primary Care Setting, Alex Lengerich

Theses and Dissertations--Educational, School, and Counseling Psychology

The implementation of the Affordable Care Act (ACA, 2010) has resulted in efforts to make healthcare more affordable and effective. One strategy for making healthcare more affordable and effective is the integration of behavioral health and primary care. In today’s healthcare system, it is estimated that approximately one in three patients seen in a primary care setting meet the criteria for a mental health disorder and another third – while not meeting those criteria – are experiencing psychological symptoms that impair their functioning (Kessler, 2005). Despite the evidence supporting behavioral health services in a primary care setting, treatments tend to …

Leadership Development In Physical Therapy: Moving Toward A Community Of Transformative Practitioners, Kerry Cronin Mallini

Theses and Dissertations--Educational Leadership Studies

Physical therapy as an emerging profession is committed to establishing its identity and solidifying its role as a leader in health care. With expertise in human movement, wellness, and disease prevention, physical therapists possess invaluable knowledge and skill to influence public health and enhance patient recovery without increasing cost. Physical therapists have the opportunity to transform the delivery of public health services to meet current and future needs. A major challenge, however, is a dearth of leadership development in preparation programs. Because most physical therapists have not received formal education or explicit training in leadership, a problem of practice exists. …

Multigenerational Genomic And Epigenetic Effects Of Manufactured Silver Nanomaterials In Caenorhabditis Elegans, Anye Wamucho

Theses and Dissertations--Toxicology and Cancer Biology

There has been an increase in the incorporation of silver nanomaterials into consumer products due to their antimicrobial properties. Therefore there is potential for silver nanoparticles (Ag-NPs) to leach out into the environment during different life-cycle stages of these nanomaterial-containing products. Concern about the toxicity of Ag-NPs has led to investigations into their toxic effects on a variety of organisms mainly using acute and sub-chronic, single-generation exposures. The focus of this project was to understand the effects of long-term continuous multigenerational exposure to AgNO₃ and Ag-NPs in both pristine and environmentally transformed forms, on the model organism, Caenorhabditis elegans …

Mechanisms Of Trinucleotide Repeat Instability During Dna Synthesis, Kara Y. Chan

Theses and Dissertations--Toxicology and Cancer Biology

Genomic instability, in the form of gene mutations, insertions/deletions, and gene amplifications, is one of the hallmarks in many types of cancers and other inheritable genetic disorders. Trinucleotide repeat (TNR) disorders, such as Huntington’s disease (HD) and Myotonic dystrophy (DM) can be inherited and repeats may be extended through subsequent generations. However, it is not clear how the CAG repeats expand through generations in HD. Two possible repeat expansion mechanisms include: 1) polymerase mediated repeat extension; 2) persistent TNR hairpin structure formation persisting in the genome resulting in expansion after subsequent cell division. Recent in vitro studies suggested that a …

The Impact Of Dysphagia And Gastrostomy On Quality Of Life In Caregivers Of Patients With Amyotrophic Lateral Sclerosis, Emily Clare Sither Goggin

Theses and Dissertations--Communication Sciences and Disorders

There is little research studying the relationship between caregiver quality of life and gastrostomy, a palliative intervention recommended to manage dysphagia and malnutrition in patients diagnosed with Amyotrophic Lateral Sclerosis (ALS). To facilitate a more comprehensive assessment of treatment effectiveness and to better guide patients and their families, this study investigated the relationship between gastrostomy, caregiver strain, and patient disease-related factors. Patients with bulbar-onset ALS and their caregivers were recruited regardless of their decision to accept or decline future gastrostomy. Caregivers completed the Modified Caregiver Strain Index (MCSI) to assess levels of caregiver strain as an index of quality of …

Estimating Disease Severity, Symptom Burden And Health-Related Behaviors In Patients With Chronic Pulmonary Diseases, Radmila Choate

Theses and Dissertations--Epidemiology and Biostatistics

Chronic pulmonary diseases include a wide range of illnesses that differ in etiology, prevalence, symptomatology and available therapy. A common link among these illnesses is their impact on patients’ vital function of breathing, high symptom burden and significantly impaired quality of life.

This dissertation research evaluates disease severity, symptom burden and health behaviors of patients with three different chronic pulmonary conditions. First, alpha-1 antitrypsin deficiency (AATD) is an inherited condition that typically is associated with an increased risk of early onset pulmonary emphysema. This study examines differences in demographic, health, and behavioral characteristics and compares clinical outcomes and health related …

Longitudinal Descriptive Profile Of Collegiate Pitchers Participating In A Summer Baseball League, Isabelle Leslie Gillis

Theses and Dissertations--Kinesiology and Health Promotion

The purpose of this study was to provide a longitudinal profile of pitching performance in a cohort of pitchers over two collegiate seasons and a summer league. Thus, this study utilized a longitudinal design to evaluate the impact of summer league participation on subsequent collegiate regular season pitching performance. Specifically, the performance of a cohort of Division 1 collegiate baseball pitchers during the 2018 Spring collegiate season, 2018 Summer League season, and the 2019 Spring collegiate season was evaluated and stratified by pitcher designation, arm dominance, and academic status. Analyses of variance were used to identify main and interaction effects …

Tanglewood Trail Walking And Voucher Program, Kelci Marie Mchugh

Theses and Dissertations--Nutrition and Food Systems

Rural Appalachian populations have greater rates of obesity and chronic diseases attributed to lesser consumption of fruits and vegetables (F/V) and physical inactivity. Barriers to F/V consumption and physical activity include poor access and affordability. To help overcome these barriers, a community-initiated walking and farmers market F/V voucher program was implemented.

Participants were encouraged to walk (1.2 miles roundtrip) to the local farmers market to redeem a $10 voucher which could only be spent on F/V. The 16-week program (June – Sept) included 121 participants. Data was analyzed by creating two groups, low-engagers and high-engagers that differed significantly in the …

Comparison Of The Kentucky Nutrition Education Program Healthy Eating Index Pre- And Post- Test Data For 2012-2013, Corey Joe Shepherd

Theses and Dissertations--Nutrition and Food Systems

Nutrition education has become a topic of significant concern in today’s society. An area prominent in the interest of nutrition is the battle against food security. Programs like the Supplemental Nutrition Assistance Program – Education (SNAP-Ed) is helping to improve its participants’ food security by providing nutrition education. Kentucky SNAP-Ed participants were asked to complete a survey and a 24-hour food recall to evaluate their knowledge in the following areas: Healthy Eating Index (HEI) scores, food resource management and nutrition practices. Each participant completed an average of 7-12 nutrition education lessons throughout the year. To graduate from the program participants …