Medicine and Health Sciences Commons^™

Relationships Among Optimism, Inflammation, And Stroke Recovery, Yun-Ju Lai

Dissertations and Theses (Open Access)

Objective: Post-stroke inflammation is detrimental to the brain and results in an unfavorable recovery. Optimism has been associated with lower inflammation and better health outcomes among people with medical conditions, but no studies have assessed this association in the stroke population. The overall goals were to examine the relationships among optimism, stroke severity, physical disability, and inflammation during hospitalization and evaluate the relationships among optimism, inflammation, and stroke recovery over the three-month post-stroke period.

Methods: This study was a secondary analysis of data collected from the BioRepository of Neurological Diseases biobank. Outcomes included optimism, stroke severity, physical recovery, and inflammatory …

Exploring Occupational Stress Among Nurse Leaders: Factors Influencing Nurse Leader Retention And Organizational Commitment, Nnenna Emelogu

Dissertations and Theses (Open Access)

Background: Nurse leader sustainability is essential to organizational climate and patient care outcomes. The state of science of nurse leader sustainability is fragmented and warrants critical examination. Current research exists examining the impact of occupational stress among frontline nurses. However, research is scarce exploring occupational stress among nurse leaders.

Purpose: To narrow knowledge gaps by exploring perceptions of occupational stress among nurse leaders and their responses to stress.

Methods: A generic qualitative descriptive approach was used to explore perceptions of occupational stress among nurse leaders. The final sample consisted of 17 participants via purposive sampling. Thematic content analysis was used …

Waiting For A Liver Transplant: A Qualitative Study, Ayoka Badmus

Dissertations and Theses (Open Access)

Background: Advances in liver transplantation have significantly improved survival rates, making liver transplant a viable option for those with End Stage Liver Failure (ESLF). However, patients diagnosed with ESLF may experience a significant period of waiting before a liver transplant surgery, due to a limited supply of donor livers. Empirical evidence is scarce on the experience of patients waiting for a liver transplantation.

Objective: The objective of this study was to explore the waiting experience of patients diagnosed with ESLF and to identify their perceived challenges and needs while waiting for a liver transplant.

Methods: Using a generic qualitative …

Comparative Analysis Of Early And Late Tracheostomy Among Patients With Acute Heart Failure Exacerbation, Trends, Clinical And Economic Outcome Assessment, From 2005 To 2014 Nationwide, Min Ji Kwak

Dissertations and Theses (Open Access)

Heart failure is one of the leading causes of high morbidity and mortality. Acute exacerbation of heart failure may result in acute respiratory failure, which requires mechanical ventilator support. Despite supportive management, patients can fail extubation of the endotracheal tube and need a tracheostomy to continue mechanical ventilator support. However, optimal timing of tracheostomy has been controversial. Systemic study to assess the clinical and economic outcome of early tracheostomy among patients with acute heart failure exacerbation is lacking. The purpose of the study was to assess the national trend of tracheostomy among those who are admitted for acute respiratory failure …

Concurrent And Concordant Oral And Genital High Risk Human Papillomavirus Infections In The United States Population; Results From National Health And Nutrition Examination Survey (Nhanes), James M. Custer

Dissertations and Theses (Open Access)

Human papillomavirus (HPV) is a common sexually transmitted disease which infects various sites in the body including the genitals, oral cavity, and anal regions. Very little research has assessed the prevalence of concurrent and concordant high risk (HR) HPV oral and genital infections in the general United States population despite the fact that HR HPV oral pharyngeal cancers are on the rise in the US, particularly in men. To further our understanding of HR HPV concurrent and concordant infections we aim to estimate the prevalence of HR HPV concurrent and concordant infections in the U.S. population, and for men and …

Assessing The Impact Of Environmental Factors On Sedentary Behavior, Brandy Baker

Dissertations and Theses (Open Access)

Objectives Mexican Americans are burdened with many of the same noncommunicable diseases present in sedentary populations. Those living on the Texas/Mexico border have higher rates of obesity and diabetes than others in the nation. Sedentary behavior and perceptions of the environment have not been well studied among Mexican Americans, especially when examining education, gender and age. Study Design Sample was drawn from the Cameron County Hispanic Cohort (CCHC) where participants were randomly selected and completed a survey to report sedentary behavior and perceptions of the environment among other examinations. The participants’ initial visit with the CCHC was included in the …

Predictors Of Non-Adherence To Primary Care Follow-Up After Diagnosis Of Asymptomatic Hypertension In The Emergency Department, Stephanie Cornell

Dissertations and Theses (Open Access)

Background: One strategy to decrease uncontrolled hypertension is to increase follow-up with primary care after diagnosis of asymptomatic hypertension in the Emergency Department (ED). To improve such interventions, this study identified risk factors of nonadherence among individuals 18-60 years old with a diagnosis of asymptomatic hypertension in the ED and access to care. Methods: Data was obtained from the IBM® MarketScan® Commercial Database between January 2012 and September 2015. Rates of non-adherence to follow-up was determined for individuals discharged from the ED with a primary diagnosis of essential hypertension. Multivariate logistic regression was used to calculate adjusted odds ratios. Demographic …

Understanding The Similarity And Diveristy Of The Accessory Gene Regulator Quorum Sensing Systems In The Genus Clostridium, Rotem Magal

Dissertations and Theses (Open Access)

The Accessory Gene Regulator (Agr) quorum sensing system is a cell-cell communication system that is involved in regulating various bacterial processes such as toxin production, antibiotic production, biofilm formation, and other biomolecules. Despite the importance of the Agr system to Clostridia, the similarity and diversity of the system have been overshadowed by phylum-wide investigations of individual Agr components. To determine the variability of the Agr system within and between Clostridium species, we compared the sequences of its components within and between species using bioinformatics and phylogenetic tools. Putative Agr operons were found in over 50 Clostridia species, including undescribed components …

Estimating The Usual Intake From Fruits And Vegetables Consumed By Children At Baseline In Tx Sprouts, Taryn Alkis

Dissertations and Theses (Open Access)

Background: Past studies developed two- and three-part models to estimate the usual intake of episodically consumed foods in adults but not in children. The goal of this study is to evaluate if the three-part method is successful, by incorporating the dietary screener and two 24-hour recalls, in estimating the usual intake of fruits and vegetables consumed by boys and girls at baseline in TX Sprouts. Methods: Secondary data analysis of two 24-hour recalls and a dietary screener from TX Sprouts. Two approaches were used. First, the three-part model estimated the distribution of the usual intake of fruits and vegetables in …

Assessment Of The Common Dental Needs And Evaluation Of Rate Of Attendance Post Emergency Dental Management Among The Homeless Population In Houston, Texas, Heera Govindarajan Venguidesvarane

Dissertations and Theses (Open Access)

Background: Dental care resources for the homeless population are scarce, underfunded and generally inadequate to meet their oral health needs. While poor oral health is clearly an added burden for people who struggle daily to survive under miserable living conditions, little is known about their views on dental health, their perceived needs and their attitudes towards dental care. The purpose of this study was to determine the most common oral health needs of homeless patients and to identify their participation in receiving comprehensive care. Methods: The study was a cross sectional analysis where data were collected retrospectively using the records …

Predictors Of On-Treatment Mortality Of Patients Undergoing Palliative Radiation Therapy: Improving The Quality Of End-Of-Life Cancer Care, Matthew Stephen Ning

Dissertations and Theses (Open Access)

PURPOSE: Excessive medical treatment at end-of-life is an indicator of poor quality care. While radiation therapy (RT) is effective for palliation, some patients die shortly after or even during treatment. Any treatment that requires terminal patients to spend significant time in the hospital setting contradicts palliative goals. This study investigates patterns of end-of-life RT to inform quality improvement initiatives. METHODS: All patients who died within 6 months of starting RT at a single large academic cancer center between 2015 through 2018 were identified through our institutional databases on an Institutional Review Board-approved protocol. Clinical factors including age, treatment service, number …

Validation Of The Conflict In Adolescent Dating Relationships Inventory (Cadri) In Young Adolescents: An Analysis Of Construct Validity And Measurement Invariance, Stephanie J. Stroever

Dissertations and Theses (Open Access)

Adolescent dating violence, defined by the Centers for Disease Control and Prevention as “physical, sexual, psychological, or emotional aggression within a dating relationship, including stalking,” among adolescents in intimate relationships is a serious public health concern (Centers for Disease Control and Prevention, 2018). Per the 2017 national Youth Risk Behavior Surveillance (YRBS) survey of high school students in the United States, 10.7 percent of females and 2.8 percent of males that reported a romantic relationship in the prior 12 months experienced sexual dating violence (Kann et al., 2018). Additionally, 9.1 percent of females and 6.5 percent of males reported physical …

The Prevalence Of Birth Defects Among Non-Hispanic Asians And American Indians/Alaska Natives In Texas, 1999-2015, Van Le

Dissertations and Theses (Open Access)

Background: Birth defects are disproportionately higher among certain race/ethnic groups. We examined how birth defects prevalence differs among the less studied non-Hispanic (NH) Asian and any American Indian/Alaska Native (AI/AN) populations, relative to NH Whites. Methods: Data were obtained from the Texas Birth Defect Registry from 1999 to 2015 for infants born to Texas-resident mothers who were NH White, NH Asian, or AI/AN. This covers a livebirth population of 2.6 million. Prevalence ratios were calculated for NH Asians and AI/ANs (relative to NH Whites) for 44 birth defects using Poisson regression and were adjusted for maternal age. Results: After adjustment, …

Protective Or Destructive? Investigating The Relationship Between Gentrification And Childhood Health Outcomes, Mike Henson Garcia

Dissertations and Theses (Open Access)

Gentrification is a wildly contentious, highly politicalized issue that some scholars view as beneficial and others view as harmful. Historically, public health researchers have studied several neighborhood effects on health but only recently has this research field evolved to include studies specifically looking at the health ramifications associated with this neighborhood-change process. This secondary analysis is one of the first studies to examine the effect neighborhood-level gentrification has on mental health status in a childhood and adolescent sample. Results find that no main effect exists between gentrification and mental health problems directly. However, a statistically significant interaction-- between gentrification and …

Failed Initial Tumor Necrosis Inhibitor (Tnfi) Therapy – What Next For Rheumatoid Arthritis Patients?, Aliza Matusevich

Dissertations and Theses (Open Access)

Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints affecting over 1.3 million Americans with annual societal costs estimated at $39.2 billion, rising faster than medical inflation. Therapy with tumor necrosis factor inhibitors (TNFi) has greatly improved the management of patients with rheumatoid RA; however, substantial numbers of patients do not experience an adequate response to these drugs, necessitating a change in treatment regimen. There are two basic approaches for TNFi failure: cycling (switching to a second TNFi) or swapping (to a drug with another mechanism of action) but the choice is controversial due to questions of comparative …

Women In Leadership: A Qualitative Review Of Challenges, Experiences, And Strategies In Addressing Gender Bias, Brynn Harris

Dissertations and Theses (Open Access)

Women are entering the workforce at an increasing rate, yet they are still drastically underrepresented in leadership positions. The primary research question addressed in this study was two-fold: what challenges have women faced in pursuit of leadership positions, and how have these women overcome these challenges to achieve success? While quantitative research has ventured into determining why there is still such a large gender gap in leadership positions, this study aimed to better understand the actual life experiences of successful female leaders. In this study, twenty-six women who hold – or recently held – significant leadership positions participated in qualitative …

Redesigning Care: Evaluation Of A Postpartum Depression Screening And Treatment Program In Obstetric Clinics In Houston, Texas, Haley D. Jackson

Dissertations and Theses (Open Access)

Postpartum depression is a common complication of childbirth and is often underdiagnosed although it affects about 13-15% of new mothers (O’Hara and Swain, 1996; Munk-Olsen et al., 2006). To improve detection and treatment for postpartum depression, four obstetric clinics in Houston, Texas were trained to use the Edinburgh Postnatal Depression Scale (EPDS) to screen women for postpartum depression at the 6 week postpartum visit. The purpose of this study was to evaluate compliance with screening women for postpartum depression at the 6 week postpartum visit, with referring women that score at-risk to the women’s reproductive mental health clinic, and with …

Additional Healthcare Expenditures Of Depression For Elderly Cancer Patients With Depression, Dian Gu

Dissertations and Theses (Open Access)

The risk of depression is high for cancer patients and a large portion of cancer patients are age 65 and over. Both depression and cancer are economically burdensome and depression is associated with healthcare expenditure increase for elderly patients. However, whether comorbid depression affects healthcare expenditures in elderly cancer patients from payers’ and patients’ perspectives is largely unknown. Objective: To investigate whether depression is associated with higher healthcare expenditure among elderly cancer patients from both payers’ and patients’ perspectives and, and determine whether depression is associated with higher probability of having high out-of-cost burden. Methods: From the Medicare Current Beneficiary …

Understanding Local Produce Sourcing By Restaurateurs In Houston, Texas, Robin Jump

Dissertations and Theses (Open Access)

As of 2017, Americans are spending more per year on eating out at restaurants and bars than on grocery shopping (Baer, 2016). While restaurateurs have a substantial amount of influence over what foods are served and ultimately consumed by their patrons, they have received little attention as target populations for understanding or changing behavior. Health interventions taking place in restaurants have focused on changing restaurant patron behavior rather than changing the behavior of the restaurateur, the individual who owns and or operates the restaurant. Industrialization of food has been associated with a loss of biodiversity, environmental pollution, erosion, and over-use …

The Association Between Sleep Duration And Dementia: A Meta-Analysis, Sherri Hong

Dissertations and Theses (Open Access)

In the United States, the current cases of Alzheimer’s disease will double by 2050. Therefore, it is important to study risk factors associated with dementia such as sleep duration. This meta-analysis was conducted to understand the discrepancy in study results since some demonstrated a V shaped association between duration of sleep and dementia while others found no association. If there truly is an association then sleep duration could be targeted to decrease the burdens caused by dementia. A meta-analysis of published studies was conducted to assess the association between sleep duration and the different forms of dementia. The articles were …

A Bundled Payment Profile For Head & Neck Cancer: Descriptive Statistics, Risk Assessment, And Pricing Recommendations For 1 Year Treatment Bundles Using A Large National Claims Database, Alexis Barboza Guzman

Dissertations and Theses (Open Access)

Bundled payments have the opportunity to promote care standardization and coordination while incentivizing efficiency and value-based healthcare delivery. However, bundled payments have been scrutinized due to challenges with defining the bundled lengths (also known as the episode of care period), limited inclusion/exclusion criteria, the absence of IT systems to support new payment models, and the lack of federal support. The objective of this study was to develop a profile for head and neck cancer, including descriptive statistics, risk assessment and bundled payment pricing recommendations using a large national claims database. The ability to assess pricing risks associated with head and …

The Mental Health Of Sexual And Gender Minority Adolescents Living In Texas, Sylvia Marie Lawler

Dissertations and Theses (Open Access)

Sexual and gender (SGM) adolescents face a higher burden of mental health disorders than their heterosexual and cisgender peers. SGM adolescents living in Texas are vastly understudied. Using three papers, this dissertation aimed to address this gap in knowledge concerning SGM adolescents in Texas. The aim of paper 1 was to analyze data from an online state-wide survey of SGM adolescents and adults in Texas to: 1) estimate the prevalence of anxiety, depression, and suicidal ideation; and 2) to determine which demographic, social support, and discrimination variables are associated with self-reported measures of depression, anxiety, and suicidal ideation. The aim …

A Narrative Review Of Factors That Contribute To Sustainability Of Community-Based Fall Prevention Programs, Stephanie Koweek

Dissertations and Theses (Open Access)

Falls are a significant problem for the geriatric population globally. As the population ages and elderly people continue to live longer with co-morbidites, they will continue to be at risk for falls. While several community-based fall prevention programs exist, they face chal lenges with sustainability. This paper is a narrative review of factors that contribute to the sustainability of community-based fall prevention programs as well as barriers to sustainabil ity. In total eight papers were included in this review. Findings from this review indicated that the following factors were keys to sustainability of community-based fall prevention pro grams: funding, external …

Geospatial Analysis Of Pediatric Tuberculosis In Bohol, Philippines: Disease Clusters And Access To Care, Lauren M. Leining

Dissertations and Theses (Open Access)

Worldwide, children represent approximately 10% of global tuberculosis (TB) cases. We recently reported a high tuberculin skin test (TST)-positive prevalence (355/5,476; weighted prevalence=6.4%) among children (<15 years) throughout the island of Bohol, Philippines, with some geographically isolated communities having prevalence as high as 29%. In this study, we conducted a secondary geospatial and hot-spot analysis of this household-based cluster survey to assess the association between access to care (distance to a health care facility) and TST-positive prevalence. Our analysis indicated that villages with high TST-positive prevalence (≥10%) were significantly further from Provincial Health Office based in the capital city of Tagbilaran in time-distance (p=0.0001, r=0.2387) and kilometers (p=0.0011, r=0.3170). Similarly, prevalence was positively correlated with distance to the municipal Rural Health Unit (RHU), where most receive their medical care, in time-distance (p=0.0055; r=0.0415); however, the association was not significant in kilometers (p=0.3315; r=0.0715). Distance to health care facilities could represent an obstacle to access to care, thereby limiting diagnosis and treatment and resulting in increased risk of transmission to others in the community. Health care outreach in geographically isolated areas is critical to treatment and control of efforts for pediatric TB.

Bayesian Estimation Under Informative Sampling: Investigating The Association Between Depression And Inflammation, Paula Lopez Gamundi

Dissertations and Theses (Open Access)

Survey data is often collected using complex sampling designs so that the probability of being included in the study is related to the outcome of interest (i.e. informative sample). Recently, a novel fully-Bayesian method has been developed for modeling data under informative sampling. Initial results indicate that this novel construction reduces bias in variance estimates compared to other pseudo-Bayesian techniques. The performance of this method has yet to be compared to traditional Frequentist approaches, which typically rely on Taylor series linearization (TSL) or resampling techniques for standard error (SE) estimation. Here, we modeled the relationship between depression and inflammation using …

A Mendelian Randomization Study Of Circulating Gamma Prime Fibrinogen And Total Fibrinogen Levels On Venous Thromboembolism And Ischemic Stroke Subtypes, Jillian Maners

Dissertations and Theses (Open Access)

Introduction: Fibrinogen is a key component of the coagulation cascade, and variation in its circulating levels may contribute to thrombotic diseases, such as venous thromboembolism (VTE) and ischemic stroke. Gamma prime (γ′) fibrinogen is an isoform of fibrinogen and has anticoagulant properties, including inhibiting thrombin and slowing platelet aggregation, that may affect clot formation.

Methods: Two-sample Mendelian randomization (MR) was applied to estimate the causal effect of total circulating fibrinogen and its isoform, γ′ fibrinogen, on risk of VTE and ischemic stroke subtypes using summary statistics from published genome-wide association studies of fibrinogen, VTE, and ischemic stroke, and an unpublished …

A Retrospective Analysis Of Claims Data To Determine Symptoms Associated With Ovarian Cancer, Denise Manon Langabeer

Dissertations and Theses (Open Access)

According to the American Cancer Society, approximately twenty percent (20% of women with ovarian cancer are diagnosed at an early stage (e.g. stage I or II), which subsequently means eighty percent (80%) of women diagnosed with this disease are at the late stage (e.g. stage III or IV) and are likely not to survive. No cure exists and, concurrently, studies show mixed results in utilizing blood tests and transvaginal ultrasounds to screen for ovarian cancer. While symptoms are not easily discernable, some oncologists have validated there are common symptoms women experience prior to diagnosis. As these symptoms are not routinely …

How Patient Cost Sharing Affects Tyrosine Kinase Inhibitors Adherence And Outcomes Among Commercially Insured Patients With Newly Diagnosed Chronic Myeloid Leukemia, Hsiao Ling Phuar

Dissertations and Theses (Open Access)

Untreated chronic phase chronic myeloid leukemia (CML) will eventually progress to advanced phase in 3 to 5 years. Treating CML with tyrosine kinase inhibitors (TKIs) has turned it into a chronic, manageable disease where most patients experience near normal life expectancy, particularly those diagnosed before age 65 years. Patients are required to continuously take their oral TKIs daily to produce the anticipated benefit of long-term survival. High out-of-pocket costs may lead to disparities in the initiation of and subsequent adherence to these expensive TKIs. Therefore, the goal of this dissertation is to assess the relationship between patient prescription cost sharing, …

Failed Initial Tumor Necrosis Inhibitor (Tnfi) Therapy – What Next For Rheumatoid Arthritis Patients?, Aliza Matusevich

Dissertations and Theses (Open Access)

Rheumatoid arthritis (RA) is a chronic inflammatory disease of the joints affecting over 1.3 million Americans with annual societal costs estimated at $39.2 billion, rising faster than medical inflation. Therapy with tumor necrosis factor inhibitors (TNFi) has greatly improved the management of patients with rheumatoid RA; however, substantial numbers of patients do not experience an adequate response to these drugs, necessitating a change in treatment regimen. There are two basic approaches for TNFi failure: cycling (switching to a second TNFi) or swapping (to a drug with another mechanism of action) but the choice is controversial due to questions of comparative …

Testing Patterns For Syphilis And Other Sexually Transmitted Infections In Pregnant Women Presenting To Emergency Departments, Ifeoluwa Shoyombo

Dissertations and Theses (Open Access)

Following an initial decrease in the incidence of congenital syphilis from 2008-2012, the rate of congenital syphilis rose by 38% across the United States between 2012-2014 (2). This trend followed a 22% rise in primary and secondary syphilis cases in women during the same period.(1) Vertical transmission of syphilis is a significant public health concern, contributing to stillbirth, infant mortality, and neurologic and skeletal morbidities in survivors. (2) The Centers for Disease Control and Prevention (CDC) recommends that all pregnant women be screened for sexually transmitted infections (STI) including HIV, syphilis, and hepatitis B at the first prenatal visit regardless …