Medicine and Health Sciences Commons^™

An Educational Intervention To Improve Neonatal Icu Nurses’ Breastfeeding Support Knowledge, Self-Efficacy, And Breastfeeding Rates At Discharge, Sarah Money

DNP Projects

Background: The benefits of breastfeeding for both mother and baby are known. It is recommended that all infants be exclusively breastfed until six months (Meek & Noble, 2022; North et al., 2021). Despite this, breastfeeding rates remain low, especially in medically fragile infants requiring care in the neonatal intensive care unit (NICU) (Rollins et al., 2016). Receipt of evidence-based breastfeeding support by healthcare providers has been shown to improve breastfeeding success; however, many healthcare providers report not being comfortable or knowledgeable enough to offer support consistently (Mulcahy et al., 2022; Rollins et al., 2016).

Purpose: This study aims …

ปัจจัยที่สัมพันธ์กับการเกิดค่าไอเอ็นอาร์ที่สูงเกินเป้าหมายในผู้ป่วยที่ได้ยาวาร์ฟารินที่มีภาวะหัวใจล้มเหลวเฉียบพลัน, รติยา รุ่งเรือง

Chulalongkorn University Theses and Dissertations (Chula ETD)

การศึกษานี้มีวัตถุประสงค์เพื่อ (1) ศึกษาปัจจัยที่สัมพันธ์กับการเกิดค่าไอเอ็นอาร์ที่สูงเกินเป้าหมายในผู้ป่วยที่รักษาด้วยวาร์ฟารินและเกิดภาวะหัวใจล้มเหลวเฉียบพลัน และ (2) เปรียบเทียบการเปลี่ยนแปลงของค่าไอเอ็นอาร์ขณะเกิดภาวะหัวใจล้มเหลวเฉียบพลัน เมื่อแบ่งกลุ่มตามค่าการบีบตัวของหัวใจห้องล่างซ้าย วิธีการวิจัยเชิงวิเคราะห์แบบย้อนหลังจากเหตุไปหาผลในผู้ป่วยที่ได้รับยาวาร์ฟารินที่แผนกผู้ป่วยใน เข้ารับรักษาด้วยภาวะหัวใจล้มเหลวเฉียบพลัน ระหว่าง 1 มกราคม พ.ศ. 2558 ถึง 30 กันยายน พ.ศ. 2566 วิเคราะห์ปัจจัยที่มีความสัมพันธ์กับการเกิดค่าไอเอ็นอาร์มากกว่า 4 ด้วยสถิติการถดถอยโลจิสติคพหุคูณ ที่ระดับนัยสำคัญทางสถิติที่ p

ผลของโปรแกรมการใช้น้ำมันหอมระเหย ต่อภาวะซึมเศร้าในผู้ป่วยภายหลังการเกิดภาวะกล้ามเนื้อหัวใจตายเฉียบพลัน, รดา วงษ์ศรี

Chulalongkorn University Theses and Dissertations (Chula ETD)

การศึกษาในครั้งนี้เป็นการวิจัยแบบกึ่งทดลอง มีวัตถุประสงค์เพื่อศึกษาผลของโปรแกรมการใช้น้ำมันหอมระเหย ต่อภาวะซึมเศร้าในผู้ป่วยภายหลังการเกิดภาวะกล้ามเนื้อหัวใจตายเฉียบพลัน กลุ่มตัวอย่าง คือ ผู้ป่วยที่มีภาวะกล้ามเนื้อหัวใจตายเฉียบพลัน อายุตั้งแต่ 20 ปีขึ้นไป ขณะเข้ารับการรักษาในหอผู้ป่วยวิกฤตโรคหัวใจและหลอดเลือด โรงพยาบาลพระมงกุฎเกล้า คัดเลือกกลุ่มตัวอย่างตามเกณฑ์คุณสมบัติ แบ่งเป็นกลุ่มควบคุมและกลุ่มทดลองกลุ่มละ 22 คน จับคู่ให้มีความใกล้เคียงกันในเรื่องเพศและอายุ กลุ่มควบคุมได้รับการพยาบาลปกติ ในขณะที่กลุ่มทดลองได้รับ โปรแกรมการใช้น้ำมันหอมระเหยต่อภาวะซึมเศร้าในผู้ป่วยภายหลังการเกิดภาวะกล้ามเนื้อหัวใจตายเฉียบพลัน ระยะเวลา 4 สัปดาห์ เครื่องมือที่ใช้เก็บรวบรวมข้อมูล คือ แบบสอบถามข้อมูลส่วนบุคคล แบบประเมินแบบสอบถามภาวะซึมเศร้า และ เครื่องมือกำกับการทดลอง คือ แบบบันทึกการใช้น้ำมันหอมระเหย มีค่าสัมประสิทธิ์ของครอนบาค 0.82 วิเคราะห์ข้อมูลโดยใช้สถิติบรรยายและสถิติt – test โดยกำหนดนัยสำคัญทางสถิติที่ระดับ .05 ผลการวิจัยพบว่า 1. ค่าเฉลี่ยคะแนนภาวะซึมเศร้าในผู้ป่วยภายหลังการเกิดภาวะกล้ามเนื้อหัวใจตายเฉียบพลันกลุ่มทดลองหลังได้รับโปรแกรมการใช้น้ำมันหอมระเหยต่ำกว่าก่อนได้รับโปรแกรมการใช้น้ำมันหอมระเหยอย่างมีนัยสำคัญทางสถิติที่ระดับ .05 (t = 7.35 ,df = 21 ,p = .000 ) 2. ค่าเฉลี่ยคะแนนภาวะซึมเศร้าในผู้ป่วยภายหลังการเกิดภาวะกล้ามเนื้อหัวใจตายเฉียบพลันกลุ่มทดลองต่ำกว่ากลุ่มควบคุมอย่างมีนัยสำคัญที่ระดับ .05 (t = 1.75 ,df = 42 ,p = .04 )

Identification Of A New Human Disease Gene For Dilated Cardiomyopathy (Dcm), Rutairat Wongong

Chulalongkorn University Theses and Dissertations (Chula ETD)

Pathogenic BAG5 variants recently linked to dilated cardiomyopathy (DCM) prompt further investigation into phenotypic, mutational, and pathomechanistic aspects. We explored the clinical and molecular characteristics of DCM associated with BAG5 variants, uncovering the consistently severe manifestation of the disease and its impact on the endoplasmic reticulum (ER) stress response. Analysis involved three siblings affected by DCM, along with their four unaffected siblings and consanguineous parents. Exome and Sanger sequencing identified a novel BAG5 variant, c.444_445delGA (p.Lys149AsnfsTer6), homozygous in affected siblings and heterozygous in parents and unaffected siblings. We generated heterozygous and homozygous Bag5 point mutant knock-in (KI) mice and evaluated …

The Unconscious Mind: Psychoanalysis And Art, Carlie Hoffer

MA Theses

The insights brought to society about the unconscious mind can be solely credited to Sigmund Freud’s groundbreaking works that were published in the early 1900’s. Specifically, the concept of the unconscious mind being a driver for human behavior was a unique theory that Freud introduced to a society that had never considered this possibility before this. The realization and acknowledgement of the unconscious mind as relevant to analyzing human behavior including art inspired other scholars and individuals in the field of psychology to explore a more nuanced understanding of human motivations. His novel ideas about human behavior emerged at a …

A History Of Cioms (Council For International Organizations Of Medical Sciences) And The Creation Of Multinational Consensus For Human Subjects Research Ethics, Abigail Belle Cheung

Public Health Theses

N/A

“How Long On Top Of The Hill?”: The Legacy Of Community Mental Health Programs, Institutionalized Relationships, And The Stifling Of Black Power (New Haven, 1963-1971), Sophie Elizabeth Edelstein

Public Health Theses

In the early 1960s, the Community Mental Health Centers Act aimed to overhaul the infrastructure of the mental health care system, transitioning patient care from dilapidated state psychiatric institutions to self-sufficient, comprehensive mental health centers within communities. Many academic medical centers viewed this federal legislation as an opportunity to gain access to an additional patient population for training and economic purposes. From New York City to Boston to New Haven, institutional aspirations for community control were burgeoning, and community psychiatry became a conduit for institutions to extend their reach into local communities under the guise of progressive mental health reform. …

Examining Factors Associated With Covid-19 Disruptions To Tuberculosis Services, Tejaswini Dharmapuri Vachaspathi

Public Health Theses

Background: The COVID-19 pandemic posed unprecedented challenges to global health systems, significantly impacting the delivery of essential health services, including tuberculosis (TB) care. It is important to analyze the factors associated with the reductions in TB notifications during the pandemic, with a focus on high TB burden countries, to inform strategies for making TB programs more resilient to health system shocks.

Methods: Amongst 98 selected high-burden countries, a GLM analysis was employed to examine the association between ‘missed’ TB case notifications from 2020 to 2021, and various country-level factors including: COVID-19 mortality estimates, lockdown stringency index, GDP per capita, health …

Bmi's Early Echo: Deciphering Adolescent Body Mass Indicator On Adulthood Breast Cancer, Tianyu Feng

Public Health Theses

This study aimed to explore the association between body mass index (BMI) during adolescence and the risk of breast cancer in adulthood among a Chinese female population. We conducted a nested case-control study within a prospective cohort comprising 62,487 Chinese women aged 25-55 years. Adolescent BMI was retrospectively collected via interviewer-administered questionnaires and analyzed as the primary exposure variable. Breast cancer incidence served as the primary outcome. Propensity Score Matching (PSM) was employed to adjust for confounding variables, such as socioeconomic status, lifestyle factors, and adult BMI.Of the 9,163 participants eligible for analysis, 57 breast cancer cases were identified during …

Exploring The Associations Between Stereotypes Of Aging And Dementia And Self-Reported Health In Parent-Adult Child Dyads, Yunke Gu

Public Health Theses

Stereotypes and stigma about Alzheimer’s Disease continue to emerge, as the number of populations affected by the disease in society is escalating. The sociocultural context sets the stage for the significant impact that Alzheimer’s has on family dynamics, especially for the adult children who provide over half of informal caregiving. Our study aims to adopt a dyadic approach, examining the interrelated experiences of adult child caregivers and their parents with ADRD. 126 dyads were included in this secondary data analysis. Measures included depressive symptoms and self-reported physical and mental health, stereotypes of aging and of person with memory loss. Results …

A Geospatial Review Of Covid-19 Testing Sites In Kentucky, Jose Marco Hernandez

Public Health Theses

The COVID-19 pandemic has accentuated healthcare access disparities, especially impacting underserved rural and urban areas. This paper investigates the accessibility of COVID-19 testing centers across Kentucky, focusing on spatial and demographic disparities. Using geospatial techniques, the study comprehensively examines testing site distribution and accessibility challenges to inform strategies addressing healthcare disparities. Adopting an observational cross-sectional design, the study utilizes 2020 US Census tract data to assess testing center accessibility in Kentucky's 120 counties. Geospatial analysis, including GIS techniques, maps testing center distribution, evaluates travel time, and examines demographic influences. Statistical tests explore associations between socio-economic factors and testing accessibility. Findings …

Comparing Hpv Vaccination Uptake In Democrat And Republican Us States Using Presidential Elections Voting Patterns In 2016 And 2020, Omar Guerrero

Public Health Theses

Abstract Objective: To investigate the association between state-level voting patterns and Human Papillomavirus (HPV) vaccination coverage in teenagers in the US. Methods: States were categorized as either Democratic or Republican based on the 2016 and 2020 Presidential election results. A paired t-test was conducted to examine the difference between vaccination coverage between the two groups. A multivariable linear regression model was conducted to examine how state-voting patterns are associated with HPV vaccination coverage after adjusting for confounding (percentage of people living in poverty, percentage of uninsured people, percentage of non-white population, and the percentage of people living in rural areas …

Evaluation Of One Health Education Materials: A Scoping Review And Quality Assessment, Sydney Jones

Public Health Theses

The increasing risk of zoonotic spillover, driven by climate change and evolving human behaviors, requires a systematic shift in pandemic prevention strategies towards a One Health approach. Central to this approach is effective health communication intended to translate knowledge into actionable recommendations for the most vulnerable populations. This thesis aims to systematically evaluate the quantity and quality of existing One Health communication materials through a scoping review and two distinct methods of quality evaluation: the CDC Clear Communication Index and content analysis. Among 82 communication materials identified in the scoping review, the median overall CDC Clear Communication Index score was …

Diagnostic Evaluation For Abnormal Uterine Bleeding At Emergence Departments In The United States, Wanyi Huang

Public Health Theses

Objectives: To examine the pattern of diagnostic evaluation for abnormal uterine bleeding (AUB) in a national sample of women seeking care at emergency departments (ED) and to identify potential influencing factors with a focus on race and ethnicity.

Methods: We identified 1,049 (unweighted, or 7,900,653 weighted) women without previous cancer diagnosis who visited ED for non-pregnancy related AUB from the National Hospital Ambulatory Medical Care Survey during 2014-2021. The primary outcomes were whether an ultrasound was provided/ordered and whether a referral/return for follow-up consultation was recommended. Multivariable logistic regressions were conducted to assess the association of race and ethnicity with …

Effect Of A Weight-Loss Intervention On Oxidative Stress Biomarkers Among Breast Cancer Survivors In The Lifestyle, Exercise, And Nutrition (Lean) Study, Yiyi Li

Public Health Theses

Introduction: As the number of breast cancer survivors increases, ensuring quality of life during the survivorship period is important. Obesity may induce oxidative stress, which may be relevant mechanistically for adverse health outcomes among breast cancer survivors. Diet, exercise, and weight loss may mitigate oxidative stress, yet few lifestyle trials have investigated if these interventions have impacted oxidative stress. Therefore, we conducted a secondary analysis in a 6-month weight loss randomized controlled trial, the Lifestyle, Exercise, and Nutrition (LEAN) study, among breast cancer survivors with a body mass index (BMI) ≥ 25 kg/m2 to evaluate the effect of the intervention …

Exploring The Use Of Mobile Health Application To Promote Self-Managment Of Cardiovascular Disease: A Study Of Age-Related Differences And Technology Adoption Among Chinese Patients, Yunan Mei

Public Health Theses

Background: Cardiovascular diseases (CVD) are the leading cause of mortality globally, particularly in China's aging population. Mobile health (mHealth) technologies offer a promising avenue to address healthcare disparities and enhance CVD management among the elderly. This study aims to explore the acceptance of mHealth in improving self-management of CVD among older adults in China, focusing on its potential to mitigate accessibility and treatment challenges.

Methods: This cross-sectional study was conducted at the Xinhua Hospital of Shanghai Jiao Tong University. Data were collected using an online Qualtrics questionnaire from 225 participants who met inclusion criteria including being Chinese speakers, diagnosed with …

U.S. Hospital Readmissions Following Discharge For A Non-Fatal Overdose Among Adolescents, 2016-2020, Gabriela Mendoza Cueva

Public Health Theses

Importance: It is not yet known how many adolescents are readmitted within six months in the U.S. following a non-fatal overdose and the risk factors associated with all-cause readmission. Objective: To examine the risk of 6-month readmission following hospitalization for a non-fatal drug overdose among adolescents and the risk factors for readmission. Design, Setting, and Participants: This retrospective chart analysis utilized the Nationwide Readmission Database (NRD) from 2016 to 2020 to identify nonfatal overdose readmissions among adolescents aged 11 to 19. Exposures: Non-fatal prescription and illicit drug overdose. Main Outcome Measures: The study used weighted state-level discharge data to derive …

Indoor Air Pollution In Nomadic Himalayan Highlander Communities, Charles Minicucci

Public Health Theses

Indoor air pollution (IAP) from burning solid biomass fuel is a major global health challenge, especially in resource-limited settings without access to electricity or reliable fuel sources. In the Kingdom of Bhutan, where, despite a reported 99% of households having access to electricity, the vast majority of rural households still use biomass fuels for cooking and indoor heating. Given the resource limitations and access challenges associated with Bhutan’s remote highlander and herding communities, few solutions for or details about their exposure to IAP are available – especially during nomadic periods where families may spend months beyond the reach of infrastructure …

Exploring The Association Between The Supplemental Nutrition Program For Woman, Infants And Children (Wic) And Gestational Weight Gain, Oyinlola Obatolu

Public Health Theses

Background: The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has been an impactful federal public assistance program that has provided nutrition education and support to millions of low income women and children around the country. Despite its positive impact on perinatal and birth outcomes, the precise mechanisms between WIC and these outcomes remain unclear. Past studies have looked at the relationship between WIC and gestational weight gain (GWG), a potential mediator of the effect of WIC on birth outcomes, but they have mainly focused on city or state level data or Medicaid enrollees. This study aims to …

“Their Body, Their Choice. Your Body, Your Choice. Your Baby, Your Choice.”: A Reflexive Thematic Analysis Of Vaccine Access And Acceptance Among U.S. Pregnant People On Reddit, Sydney Marie Perlotto

Public Health Theses

Compared to the general population, pregnant people and newborns are at a higher risk of contracting infectious diseases and experiencing worse adverse outcomes. Vaccines delivered during pregnancy, known as prenatal vaccines, represent a critical yet underused form of preventive care for these populations in the United States. Increasing successful prenatal vaccination uptake requires a focus on both access and acceptance, which pregnant people may experience differently than non-pregnant people due to their unique physiological and social state. Given the evolution of vaccine hesitancy following the COVID-19 pandemic, coupled with the recent expansion of the U.S. prenatal immunization schedule, this study …

Greening And Mental Distress: Effect Modification By Housing Tenure, Saira Prasanth

Public Health Theses

Access to high-quality residential greenspace is associated with improved long-term health, particularly mental health. However, many interventions to promote “greening” or increased greenspace in urban areas have been shown through numerous qualitative studies to exacerbate environmental and health inequities, primarily through green gentrification. Our objective was to quantify the association between greenspace and mental distress in the U.S. as well as evaluate whether the association between greenspace and mental distress is modified by housing tenure. We hypothesized that increased greenspace was associated with reduced mental distress, and that this effect was more protective among homeowners than non-homeowners. Mental distress and …

Macronutrient Intake In Us Adults: Race, Gender, Age, Education, Ana Karina Raygoza Cortez

Public Health Theses

Background: The US has seen a consistent increase in obesity rates over the last sixty years across all racial and ethnic groups, with similar trends even among privileged groups. This study examines Macronutrient intake trends in US adults from 1999-2018 and their association with demographic factors: race ethnicity, age, gender, and education.

Methods: We conducted a serial cross-sectional analysis of US adults using 24-hour dietary recall data from 10 NHANES survey cycles (1999-2018). Piecewise regression models identified significant dietary pattern changes over time, by demographic groups. Statistical analysis was done in R and SAS utilizing NHANES sampling weights.

Results: Study …

Hybrid Medical Practices In Malaria Management Among Sao Tome And Principe’S Elderly, Yihan Shi

Public Health Theses

Africa has the global heaviest burden of malaria. Sao Tome and Principe, a low-transmission island nation in the Gulf of Guinea with a population of about 200,000, has entered the malaria elimination phase. Despite this, the prevalence and mortality rates of malaria among the elderly in Sao Tome and Principe remain high compared to high transmission areas. This study employed a mixed-methods approach to explore the association between age and recommended malaria management strategies for adults in Sao Tome and Principe, with a focus on examining samples older than 50 years. All participants (N = 274) completed surveys, with in-depth …

Child And Adolescent Exposure To Environmental Chemicals And Mental Health Outcomes: A New Haven Study, Yunyue Shi

Public Health Theses

Child and adolescent mental health disorders, including anxiety, depression, and behavioral problems, contribute significantly to the global health burden. Exposure to toxic air contaminants such as semi-volatile organic compounds (SVOCs)—especially polycyclic aromatic hydrocarbons (PAHs) and phthalates—during critical developmental periods can have detrimental impacts on children’s brain development and function. This study aimed to identify potential associations between children and adolescents’ chemical exposure and mental health outcomes. The objectives were: 1) to characterize the distribution of individual environmental chemical exposures among children and adolescents using Fresh Air samplers and 2) to determine the association between chemical exposures, particularly PAHs and phthalates, …

Long-Term Exposure To Ambient Pm2.5 & Intentional Self-Harm, Caroline Elise Sutton

Public Health Theses

A growing body of literature is finding that air pollution exposure may contribute to disease onset of certainbrain disorders, including mental disorders such as depression, through mechanisms of neuroinflammation and oxidative stress1. However, even as there is increasing attention on the impacts of air pollution and mental illnesses, most studies focus on mental illness outcomes that might not represent severe or life-threatening symptoms (such as self-harm)2–7 , while a majority of studies focused on intentional self-harm assess the relationship between short-term air pollution exposure (as opposed to chronic and cumulative exposure) and self-harm outcomes8–13 . Given the barriers to treatment …

“I Don't Work For The Prison. I Don't Work For The Hospital Either. I’M Yours. Who Else Here Is Yours?” A Qualitative Analysis Of Facilitators And Barriers Of Launching Enhanced Perinatal Programs In Seven State Prisons, Karenna Thomas

Public Health Theses

The United States incarcerates women at the highest rate globally (Fair & Walmsley, 2022), while simultaneously failing to provide incarcerated individuals with adequate reproductive health care. Perinatal programs, including a combination of one-on-one and group prenatal and postpartum education, labor and birth support with a doula, separation support, and lactation care have been implemented as an alternative to standard care in around 21 states (Wilson et al., 2022). While the efficacy of these programs among incarcerated individuals has been established (Bard et al., 2016; Barkauskas et al., 2002; Schroeder & Bell, 2005; Shlafer et al., 2018; Shlafer, Saunders, Boraas, et …

Cost-Effectiveness Of Helicobacter Pylori Screenings In Asian Americans In The United States, Qin Wang

Public Health Theses

Background: Gastric cancer remains a significant public health concern, particularly for Asian Americans in the United States, who are at higher risk. Helicobacter pylori (H. pylori) infection is a known risk factor for gastric cancer (GC) and peptic ulcer disease (PUD), and its eradication has proven effective in preventing both conditions. Due to the lack of clinical standards in H. pylori screening for this high-risk group of Asian Americans, we explore whether population-based screening using carbon-13 urea breath test (C-UBT) and/or endoscopy is cost-effective in the United States for Asian Americans. Methods: We built a cohort state-transition Markov model to …

Birth Characteristics, Outdoor Artificial Light At Night, Ambient Air Pollution And The Risk Of Hepatoblastoma In Young Children, Peiyi Wang

Public Health Theses

Objective: The etiology of hepatoblastoma, the predominant malignant liver tumor in infancy and early childhood, is unclear. We assessed possible associations between birth characteristics, outdoor artificial light at night (ALAN), ambient air pollution (measured by particulate matter PM2.5), and the risk of hepatoblastoma.

Methods: Leveraging a population-based linkage of statewide birth records and cancer registry data in California, we conducted a case-control study that included 356 hepatoblastoma cases diagnosed at the age of 0-6 years during 1988-2015 and 17,800 controls frequency-matched by birth year. Restricted cubic spline transformation was employed to evaluate non-linear associations. Multivariable logistic regression models were used …

Assessment Of Suicide Risk In Emergency Department Settings For Adults In Nepal: Validation Of The Nepali Ask Suicide-Screening Questions, Pei Wang

Public Health Theses

Objectives: Suicide is a severe public health crisis around the globe. Low-middle-income countries (LMICs) bear 77% of the global suicide burden. Screening is a significant component of suicide prevention, but there is a dearth of suicide screening tools, especially in LMICs. This study focused on validating the Ask Suicide-Screening Questions (ASQ) within an adult Emergency Department (ED) population in Nepal. Although the validation occurred in an ED setting, the Nepali ASQ is designed with the flexibility to be useful in a variety of healthcare contexts, extending its applicability beyond just emergency care.Methods: We systematically translated and adapted the 4-item ASQ, …

Cost-Effectiveness Analysis Of Alternative Infant And Neonatal Rotavirus Vaccination Schedules In Malawi, Catherine Wenger

Public Health Theses

Rotavirus is the leading cause of cases and deaths related to diarrhea-related hospitalizations among children under five worldwide, especially in low- and middle- income countries. Although vaccination is proven to be the best strategy for preventing rotavirus, its impact has been suboptimal in LMICs.

The primary aim of this study was to evaluate the impact of and cost- effectiveness of the current Rotarix rotavirus vaccine, two alternative vaccine delivery schedules, and the next-generation vaccine (RV3-BB) in Malawi.

The cost-effectiveness of rotavirus vaccine strategies in Malawi was evaluated using moderate-to-severe and non-severe rotavirus cases derived from a mathematical model ofrotavirus transmission …