Medical Specialties Commons^™

Us Hospices’ Approach To Racial/ Ethnic Minority Inclusion: A Qualitative Study, M. Courtney Hughes, Erin Vernon, Monica Kowalczyk, Marlon Basco-Rodillas

Faculty Articles, Papers, and Other Scholarship

Objective: To examine hospices’ approaches to improving the current racial/ethnic hospice utilisation disparity.

Methods: During June and July 2020, we conducted in-depth, semistructured interviews with 22 hospice leaders from across the USA. The interviews focused on inclusive strategy approaches. We analysed the data using qualitative methods.

Results: Multiple themes emerged about racial/ ethnic minority inclusion strategies: (1) hospices tailor strategies to the local communities they serve; (2) improvement involves addressing social determinants of health that extend beyond end-of-life care; (3) costs of strategies are not a primary concern and the benefits are worth the costs; and (4) hospices want to …

Addressing Healthcare Disparities Faced By Aging Down Syndrome Populations, Rhea Mistry

Pitzer Senior Theses

Down syndrome (DS) is a chromosomal genetic condition that impacts the development of the body and brain. The life expectancy of individuals with DS has drastically improved over the decades, increasing from 9 years in 1929 to 25 years in 1983 and further reaching 60 years by 2002. Individuals with DS face a variety of prominent co-occurring health conditions that are subject to change over time, including cognitive, visual, and hearing impairments, sleep apnea, cardiovascular defects, Down syndrome regression disorder, and dementia. Despite this increase in life span, DS is still most familiar to pediatric care providers, resulting in healthcare …

Models Of Video Feedback For Youth Athletes Performing An American Football Tackle, Eric Schussler, Richard J. Jagacinski, Ajit Chaudhari, John A. Buford, James A. Onate

Rehabilitation Sciences Faculty Publications

Context: Video feedback is an expeditious method for improving athlete safety when performing activities with an inherent risk of injury. Providing appropriate and validated feedback during tackling training in American football may be a mechanism for athletes to learn safe tackling performance.

Objective: To determine the effect of video feedback in the instruction of tackling form.

Design: Controlled laboratory study.

Setting: Laboratory.

Patients or Other Participants: A total of 32 youth football athletes (28 boys, 4 girls; age ¼ 11.8 6 0.8 years) participated in 1 day of training. Of those, 14 participants completed 2 additional days of training and …

The Unequal Distribution Of Social Risk For Black Men Across The Life-Span. A Novel Framework., Waleed Y. Sami

Adultspan Journal

This conceptual overview offers a comprehensive overview of systemic pathways that negatively impact the mental health of Black Men throughout their lives. Our argument highlights the importance for counselors and mental health professionals to utilize a thorough social risk assessment that considers these pathways in order to effectively address the mental health needs of Black Men while fostering positive working relationships. This overview strongly advocates for the use of context and structural determinants when evaluating mental health symptoms. Without an appropriate understanding of social risk and determinants, counselors may inadvertently perpetuate disparities by decontextualizing symptomology, and reproducing racist discourse.

Survivor Guilt And Posttraumatic Stress Among Young Adult Survivors Of Childhood Cancer, Alexandra Neenan

Master's Theses and Doctoral Dissertations

Childhood cancer survivors are at risk for a variety of adverse physical and mental health outcomes. Posttraumatic stress disorder (PTSD) occurs in a small, but notable, minority of childhood cancer survivors. Little is known about modifiable factors that may increase the risk of developing PTSD as a young adult survivor. One of the difficulties that has been minimally explored in this group is exposure to the deaths of other children with cancer, despite a 25% 15- year mortality rate among children who are diagnosed with cancer. The current study was among the first to explore potential impacts of this high …

Disentangling Accelerated Cognitive Decline From The Normal Aging Process And Unraveling Its Genetic Components: A Neuroimaging-Based Deep Learning Approach, Yulin Dai, Yu-Chun Hsu, Brisa S Fernandes, Kai Zhang, Xiaoyang Li, Nitesh Enduru, Andi Liu, Astrid M Manuel, Xiaoqian Jiang, Zhongming Zhao, Alzheimer’S Disease Neuroimaging Initiative

Faculty, Staff and Student Publications

BACKGROUND: The progressive cognitive decline, an integral component of Alzheimer's disease (AD), unfolds in tandem with the natural aging process. Neuroimaging features have demonstrated the capacity to distinguish cognitive decline changes stemming from typical brain aging and AD between different chronological points.

OBJECTIVE: To disentangle the normal aging effect from the AD-related accelerated cognitive decline and unravel its genetic components using a neuroimaging-based deep learning approach.

METHODS: We developed a deep-learning framework based on a dual-loss Siamese ResNet network to extract fine-grained information from the longitudinal structural magnetic resonance imaging (MRI) data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. …

Secondhand Tobacco Smoke Exposure In Homes And Vehicles In Youth: Disparities Among Racial, And Sexual And Gender Minorities, Rajesh Talluri, Sahil S Shete, Surendra S Shastri, Sanjay Shete

Faculty, Staff and Student Publications

BACKGROUND: Secondhand smoke exposure (SHSe) among youth is a serious public health concern, leading to an increased risk of conditions such as asthma and respiratory infections. However, there is little research on SHSe among vulnerable populations, such as racial and sexual minorities. Understanding the factors associated with youth SHSe in homes and vehicles is crucial to developing better protective policies.

METHODS: This study utilized 2020 data from the National Youth Tobacco Survey, a representative sample of middle- and high-school students in the US. The primary outcomes were youth SHSe at home and while riding in a vehicle. Multinomial regression models …

Different Cohort, Disparate Results: Selection Bias Is A Key Factor In Autopsy Cohorts, Kathryn Gauthreaux, Walter A. Kukull, Karin B. Nelson, Charles Mock, Yen-Chi Chen, Kwun C. G. Chan, David W. Fardo, Yuriko Katsumata, Erin L. Abner, Peter T. Nelson

Neurology Faculty Publications

INTRODUCTION: Research-oriented autopsy cohorts provide critical insights into dementia pathobiology. However, different studies sometimes report disparate findings, partially because each study has its own recruitment biases. We hypothesized that a straightforward metric, related to the percentage of research volunteers cognitively normal at recruitment, would predict other inter-cohort differences.

METHODS: The National Alzheimer’s Coordinating Center (NACC) provided data on N = 7178 autopsied participants from 28 individual research centers. Research cohorts were grouped based on the proportion of participants with normal cognition at initial clinical visit.

RESULTS: Cohorts with more participants who were cognitively normal at recruitment contained more individuals who …

Social Determinants Of Health: Evaluation Using Rates Of Vision Screening And Follow-Up Examinations, Madeline Dyer

Williams Honors College, Honors Research Projects

Vision care is essential to the quality of life of young children, impacting them over the course of their lives. Social Determinants of Health (SDOH) affect the likelihood of a child having access to appropriate care specified by the Bright Futures. The aim of this study was to assess the impact of SDOH on the completion of vision screening and the rate of follow-up with an eye care provider when applicable. In addition, rates of instrument-based vision screening and recommended ophthalmology follow-up were compared with COI, a metric assessing the quality of resources available and the conditions that matter for …

Public Perceptions Of Peripheral Nerve Surgery On Social Media: A Narrative Review, Nicholas Obias, James Hughes

School of Podiatric Medicine - Student Research

Objective: The intent of this study is to conduct a Narrative review of the Public Perceptions of Peripheral Nerve Surgery on Social Media.

Introduction: Peripheral nerve surgery is an effective therapeutic modality for difficult diagnoses such as peripheral neuropathy, neuromas, and complex regional pain syndrome. This study aims to explore public perceptions of peripheral nerve surgery on Instagram, a popular social media site. Information on posts such as authorship, relevance, accuracy, and purpose were collected. Conclusions from this study may direct efforts to enhance medical advice and improve patient education for extremity nerve surgeons.

Methods: Searches were conducted in September …

Assessing Preventive Care Utilization For Cardiovascular Disease Among U.S. Latinos, Melanie Helena Paredes

Honors Undergraduate Theses

Accounting for nearly 19% of the United States population in 2020, Latinos and Hispanics represent the second largest racial/ethnic group in the United States, totaling roughly 62.1 million people. Given the growing population size and longer life expectancy estimates amongst the U.S. Latino/Hispanic community, healthcare practitioners and public health officials are increasingly emphasizing the healthcare needs and outcomes of this population. Alarmingly, current literature has highlighted significant disparities in cardiovascular disease (CVD) incidence and risk factors among U.S. Latinos/Hispanics. As CVD continues to be one of the leading causes of death amongst all racial/ethnic groups across the United States, risk …

Understanding Guardian Perceptions Of Whole-Foods Plant-Based Diets As Interventions In Pediatric Medicine, Vijay R. Luthra

Honors Undergraduate Theses

The obesity epidemic is widespread in American society, often affecting children who bear its consequences innocently. Due to a lack of nutrition knowledge, children rely on caregivers to meet their nutritional needs and instill healthy habits. This study examines parents' attitudes, knowledge, and behaviors, as well as perceived barriers to adopting a whole-foods plant-based diet (WFPD) for their children. Using a modified survey instrument by Morton et al., this study focused on parents and children regarding dietary choices. Participants were recruited from the waiting area of a pediatric clinic at the Medical College of Georgia between April and May 2023. …

Co-Occurrence Of Autism Spectrum Disorder And Attention-Deficit/Hyperactivity Disorder With Idiopathic Hypersomnia: Data From The Hypersomnia Foundation Registry, Sophie Sevan Mikkelsen

Honors Undergraduate Theses

In recent years, hypersomnia patients and researchers alike have increasingly discussed the possibility of heightened comorbidities, or co-occurrences, of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) with the central disorders of hypersomnolence: idiopathic hypersomnia (IH) and narcolepsy (N). While a few scarce studies have investigated a link between ADHD and N, there has been no research on the co-occurrence of these conditions with IH. This study, using data from the Hypersomnia Foundation’s CoRDS Patient Registry, is the first to identify self-reported rates of ASD and ADHD diagnoses by people with idiopathic hypersomnia. Four chi-square tests were conducted to determine …

Assessment Of Forensic And Clinical Criteria Of Orbital Blowout Fractures For Use In Bioarchaeological Analysis, Dylan E. Ornot

Honors Undergraduate Theses

Orbital blowout fractures are a particular facial fracture occurring within the inner eye orbits of the face caused by blunt force trauma to the eyeball or the lower orbital rim. This fracture is common in modern clinical contexts due to physical assaults, but examining this fracture in skeletal material can also provide insights into the patterns of interpersonal violence within the fields of bioarchaeology and forensic anthropology. Issues with analyzing this fracture in skeletal material arise due to the clinical assessment practices of blowout fractures, where medical practitioners are highly focused on the soft tissue presentations of the fracture in …

Grading Of Malnutrition Among Under 5 Children Residing In Urban Slum In Mysuru Using Who Classification And Indian Academy Of Pediatrics (Iap) Classification: A Comparative Study, Ravali Annaram Dr, Amogha Shree Dr, Saurish Hegde Dr, Krishnaveni Y S Dr

Digital Journal of Clinical Medicine

Background

Malnutrition in Indian children under five is widespread, driven by insufficient food intake and diseases like diarrhoea and respiratory infections. Factors such as food security, maternal literacy, and healthcare access influence malnutrition rates. Growth monitoring utilizes WHO standards globally and IAP guidelines in India. Implementing these charts improves early identification and management of malnutrition, crucial for addressing childhood health challenges in India. This study compare the prevalence of malnutrition in WHO classification with Indian Academy of Paediatrics (IAP) classification among under 5 children residing in urban slum.

Methodology

A community based cross-sectional study was conducted among children aged 6 …

Perspectives From Cystinosis: Access To Healthcare May Be A Confounding Factor For Variant Classification, Chen-Han Wilfred Wu, Alicja Tomaszewski, Louisa Stark, Fernando Scaglia, Ewa Elenberg, Fredrick R Schumaker

Faculty, Staff and Students Publications

Genetic variability persists across diverse populations, and it may impact the characterization of heritable diseases in different ancestral groups. Cystinosis is a metabolic disease caused by pathogenic variants in the CTNS gene causing the cellular accumulation of cystine. We attempted to assess the currently poorly characterized prevalence of cystinosis by employing a population genetics methodology. However, we encountered a significant challenge due to genetic variations across different populations, and the consideration of potential disparities in access to healthcare made our results inconclusive. Pathogenic CTNS variants were identified in a representative global population cohort using The Human Gene Mutation Database (HGMD) …

Pediatric Dentists’ Considerations Concerning Obesity-Related Education For Parents Of Young Children: Who Should Educate About What, How And When?, Arianne Swanson Dds, Ms, James R. Boynton Dds, Ms, Larry B. Salzmann Dds, Yu-Ju Yang Dds, Marita R. Inglehart Dipl. Psych., Dr. Phil., Dr. Phil. Habil

The Journal of the Michigan Dental Association

This study aimed to explore pediatric dentists' perspectives on obesity-related interventions for parents of young children. A web-based survey was administered to 210 American Academy of Pediatric Dentistry members. Findings revealed that respondents considered it important for various healthcare professionals, especially pediatricians and nurse practitioners, to engage in obesity-related parent education. Strong consensus existed on educating parents about the link between early childhood caries and diet, soft drink and fruit juice consumption, and healthy snacking. The study also found positive attitudes correlated with increased engagement in objective weight determination, data collection, and diet/nutrition counseling.

Always Politically Correct: Supporting Seriously Ill Older Populations And Their Families, M. Courtney Hughes, Erin Vernon

Faculty Articles, Papers, and Other Scholarship

We have been researching outcomes related to seriously ill individuals for over a decade, critically examining countless research articles from around the world, and extensively interviewing various stakeholders in this space, including hospital leaders, hospice leaders, lobbyists, nurses, social workers, and informal caregivers. We have also experienced firsthand the heartwrenching difficulty of caring for seriously ill loved ones. While we have learned a tremendous amount along the way, two specific observations consistently stand out. First, regardless of culture, income level, or politics, most people can personally identify with caring for seriously ill individuals. Second, the research evidence indicates that not …

Racial And Ethnic Disparities In Acuity Of Presentation Among Children With Newly Diagnosed Acute Leukemia, Lena E Winestone, Kelly D Getz, Yimei Li, Evanette Burrows, Michael E Scheurer, Vicky Tam, M Monica Gramatges, Jennifer J Wilkes, Tamara P Miller, Alix E Seif, Karen R Rabin, Brian T Fisher, Richard Aplenc

Center for Medical Ethics and Health Policy Staff Publications

We evaluated disparities in disease burden, organ dysfunction, vital signs, and timing of therapy in children newly presenting with acute leukemia. Among 899 patients with acute leukemia diagnosed at two large children's hospitals, a priori lab-based definitions of high disease burden, infection risk, renal dysfunction, and coagulopathy were applied to electronic health record data. Black patients with acute myeloid leukemia had increased prevalence of elevated white blood cell count and uric acid; Black patients with acute lymphoblastic leukemia demonstrated increased prevalence of coagulopathy. Black patients' presentation more frequently included multiple lab abnormalities consistent with advanced physiologic dysfunction. No differences were …

Perceptions Of Acute Care Telemedicine Among Caregivers For Persons Living With Dementia: A Qualitative Study, Anita Chary, Norvin Hernandez, Ana Paulina Rivera, Vivian Ramont, Tracey Obi, Ilianna Santangelo, Christine Ritchie, Hardeep Singh, Emily Hayden, Aanand D Naik, Shan Liu, Maura Kennedy

Faculty, Staff and Student Publications

Persons living with dementia (PLWD) have high emergency department (ED) utilization. Little is known about using telemedicine with PLWD and caregivers as an alternative to ED visits for minor acute health problems. This qualitative interview-based study elicited caregivers' perspectives about the acceptability of telemedicine for acute complaints. We performed telephone interviews with 28 caregivers of PLWD from two academic EDs, one in the Northeast and another in the South. Using a combined deductive-inductive approach, we coded interview transcripts and elucidated common themes by consensus. All caregivers reported they would need to participate in the telemedicine visit to help overcome communication …

Circulating Sphingolipids In Relation To Cognitive Decline And Incident Dementia: The Cardiovascular Health Study, Kristine F Moseholm, Héléne T Cronjé, Manja Koch, Annette L Fitzpatrick, Oscar L Lopez, Marcia C De Oliveira Otto, W T Longstreth, Andrew N Hoofnagle, Kenneth J Mukamal, Rozenn N Lemaitre, Majken K Jensen

Faculty, Staff and Student Publications

INTRODUCTION: Whether circulating levels of sphingolipids are prospectively associated with cognitive decline and dementia risk is uncertain.

METHODS: We measured 14 sphingolipid species in plasma samples from 4488 participants (mean age 76.2 years; 40% male; and 25% apolipoprotein E (

RESULTS: Higher plasma levels of sphingomyelin-d18:1/16:0 (SM-16) were associated with a faster cognitive decline measured with 3MSE, in contrast, higher levels of sphingomyelin-d18:1/22:0 (SM-22) were associated with slower decline in cognition measured with DSST. In Cox regression, higher levels of SM-16 (hazard ration [HR] = 1.24 [95% confidence interval [CI]: 1.08-1.44]) and ceramide-d18:1/16:0 (Cer-16) (HR = 1.26 [95% CI: 1.10-1.45]) …

The Perpetual Evidence-Practice Gap: Addressing Ongoing Barriers To Chronic Pain Management In Primary Care In Three Steps, Laura Ellen Ashcraft, Megan E Hamm, Serwaa S Omowale, Valerie Hruschak, Elizabeth Miller, Shaun M Eack, Jessica S Merlin

Faculty, Staff and Student Publications

Background: Most management of chronic pain, a serious illness affecting the physical and psychological wellbeing of millions, occurs in primary care settings. Primary care practitioners (PCPs) attempt to provide evidence-based practices to treat chronic pain. However, there continues to be a gap between the care people receive and the evidence. The objectives for this study were to (1) explore determinants of evidence-based chronic pain management and (2) develop a novel approach to using implementation science to address the evidence-practice gap.

Method: A convenience sample of twenty-one Pennsylvania PCPs participated in one-time semi-structured telephone interviews. Interviews were transcribed verbatim and both …

Colonial Drivers And Cultural Protectors Of Brain Health Among Indigenous Peoples Internationally, Rita Henderson, Joyla A Furlano, Shayla Scott Claringbold, Ashley Cornect-Benoit, Anh Ly, Jennifer Walker, Lisa Zaretsky, Pamela Roach

Faculty, Staff and Student Publications

Despite relatively higher rates of dementia among Indigenous populations internationally, research into drivers of disparities in brain health and cognitive function has tended to focus on modifiable risk factors over cultural understandings and contextual determinants. By seeking to characterize social and cultural factors that shape brain health and cognition in Indigenous populations, this mini scoping review expands prevailing schools of thought to include Indigenous knowledge systems. This reveals important gaps in culturally aligned care. It also reclaims horizons for research important to Indigenous Peoples that have garnered diminished attention in biomedical approaches. Twenty-three sources were included for data extraction. This …

Sociodemographic Correlates Of Low Health Literacy Skills Among Cancer Survivors: National Findings From Brfss 2016 And Implications For Precision Survivorship Care, Qi Chen, John Moore, Lailea Noel, Kirk Von Sternberg, Barbara Jones

Publications and Research

Purpose: This study aimed to explore associations of sociodemographic factors with difficulties in three health literacy (HL) skills and the severity of low HL skills.

Design: Cross-sectional secondary data analysis. Subjects: Data came from 17,834 adults who responded to the HL module with a response rate of 47% in the 2016 Behavioral Risk Factor Surveillance System.

Measures: Independent variables included sex, age, race/ethnicity, education, employment and income. Dependent variables are three HL skills: obtaining, understanding oral, and understanding written health information.

Analysis: We conducted weighted Chi-square tests and multinominal logistic regressions.

Results: Cancer survivors younger than 65 (aged 18-39: AOR=4.46, …

Gender Equality– A Sustainable Development Goal In Progress At A Medical College And Hospital In South India, Mr. Manoj S M, Kusuma Kasapura Shivashankar, Suma M. Natraj, Praveen Kulkarni

Digital Journal of Clinical Medicine

Background: Gender Equality is one of the most important SDG and attaining it will ensure a peaceful, prosperous and a balanced world with equal opportunities for both women and men. The Indian scenario in the field of women education has changed with mindset of most parents undergoing a paradigm shift and many girls are encouraged to attend schools, colleges and women are allowed to work. Considering the above shift, our study intended to find out if the same was true and SDG-5, Gender Equality was attained or in progress at our medical college and hospital and hence the study.

Methods: …

Frozen By Worry And Fatigue? A Mixed Methods Approach To Understanding The Lived Experiences Of Freezing Of Gait, Sarah M. Ghose

Theses and Dissertations

This study utilized a mixed methods emergent, phenomenological approach to (1) understanding the lived experience of freezing of gait for individuals diagnosed with Parkinson’s Disease and (2) determining the role of anxiety and sleep in freezing of gait outcomes. Participants included 13 adults diagnosed with Parkinson’s Disease (N=14 for qualitative data, N=13 for quantitative data; 23.1% female-identifying, 76.9% male-identifying) who were predominantly white (92.3%) with an average age of 69 years (SD = 6.73 years). Data collection consisted of semi-structured interviews, self-report measures, actigraphic sleep data, and salivary alpha amylase biomarker collection. Results are organized into …

Mild Traumatic Brain Injury In Yucatan Minipigs: Assessing Changes In Approachability And Mechanical Nociception Following Diffuse Central Fluid Percussion Injury, Mark D. Pavlichenko

Theses and Dissertations

Traumatic brain injury (TBI) is a major healthcare concern affecting millions. Symptoms of TBI include sensory sensitivity and social changes that may persist long-term. Due to similarities in cytoarchitecture, metabolism, and inflammation, higher order minipig models are advantageous for translational TBI research, however, there remains a shortage of information regarding their behavioral and sensory sequelae following injury. Therefore, in this study, we assessed changes in sociability and somatosensation in adult male and female Yucatan minipigs for up to one-week following a sham or central fluid percussion injury (cFPI). Specifically, the voluntary human approach task (VHAT) and the forced human approach …

The Patient Experience Of Language Discordance And Interpreter Services In The Emergency Department, Keri L. Baker

Theses and Dissertations

Background: Clear communication is critical to the interaction of a patient and medical provider. For non-English speaking patients, language discordance, described as the lack of proficiency in a shared language, with the medical team results in a poor patient experience and poor patient outcomes. The predominant solution to language discordance is the use of interpreter services, however these services are underused in the emergency department (ED). Studies examining underuse of interpreter services have primarily focused on the clinician and little is known about the patient’s influence on the use of interpreter services.

Methods: Semi-structured interviews were conducted with 12 Spanish-speaking …

An Ewas Of Dementia Biomarkers And Their Associations With Age, African Ancestry, And Ptsd, Mark W. Miller, Erika J. Wolf, Xiang Zhao, Mark W. Logue, Sage E. Hawn

Psychology Faculty Publications

Background

Large-scale cohort and epidemiological studies suggest that PTSD confers risk for dementia in later life but the biological mechanisms underlying this association remain unknown. This study examined this question by assessing the influences of PTSD, APOE ε4 genotypes, DNA methylation, and other variables on the age- and dementia-associated biomarkers Aβ40, Aβ42, GFAP, NfL, and pTau-181 measured in plasma. Our primary hypothesis was that PTSD would be associated with elevated levels of these markers.

Methods

Analyses were based on data from a PTSD-enriched cohort of 849 individuals. We began by performing factor analyses of the biomarkers, the results of which …

Expanding A Behavioral View On Digital Health Access: Drivers And Strategies To Promote Equity, Maura M. Kepper, Lauren A. Fowler, Isabelle S. Kusters, Jean W. Davis, Manal Baqer, Sarah Sagui-Henson, Yunyu Xiao, Adati Tarfa, Jean C. Yi, Bryan Gibson, Kristin E. Heron, Nicole M. Alberts, Marissa Burgermaster, Veronica Njie-Carr, Lisa M. Klesges

Psychology Faculty Publications

The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for …