Public Health Commons^™

Managing Burnout And Secondary Traumatic Stress In Human Service Organizations, Naomi Ingram

School of Professional Studies

This Case Study explores how burnout and secondary traumatic stress impact staffing, service delivery, and organizational effectiveness in a human service agency. The Case Study is focused around Ascentria Care Alliance’s Children & Family Services in Massachusetts, which encompasses three foster care programs: the Unaccompanied Refugee Minor (URM), Division of Children’s Services (DCS), and Intensive Foster Care (IFC) programs. Both individual and organizational approaches are needed to most effectively address burnout and secondary traumatic stress. Individual workers need to build resilience factors such as self-compassion and mindfulness, set appropriate boundaries with clients, engage in ongoing training, support, consultation, and supervision, …

Rest Homes: Their Value On Massachusetts Healthcare Continuum, Ronald Pawelski

School of Professional Studies

In Massachusetts, rest homes provide cost effective care for elderly residents in a community setting. Rest homes, however, are not well-understood and the rest home industry itself suffers greatly, not only from a lack of understanding of the services they provide, but also from the strain on their financial resources due to both competition from other healthcare options and insufficient reimbursement rates for residents’ care.

The paper explores the financial challenges facing the industry and outlines the data that speaks to the value of the rest home care option for both the residents themselves and Massachusetts state healthcare budget. It …

A Case Study On The Best Practices Of The Facilitating Organization For Peer Recovery Support Services In The State Of New Hampshire, Maggie Ringey

School of Professional Studies

In working with the Facilitating Organization for Peer Recovery Support Services through Harbor Homes, I have found that the Recovery Community Organizations that receive support through the FO provide valuable services that help individuals that struggle with substance use disorder achieve and maintain long term sobriety and recovery. The RCOs throughout New Hampshire bridge gaps in services and treatments that are left untouched by traditional clinical methods and through regular check ins, participants at the RCOs have reported that the services provided resulted in positive outcomes in their lives. Throughout the course of this research, I found that the RCOs …

Elder Isolation In Immigrant Communities, Jessica Da Silva

School of Professional Studies

This paper examined loneliness, as a measurement of perceived social isolation, in older immigrant adults. Previous research shows that older adults are more likely to experience social isolation and loneliness. Both of which have a direct correlation with their overall health (Wilson & Molton, 2010, Cacioppo et al., 2002) and mortality rates (Holt-Lunstad et al, 2015). Another international study found that immigrants in particular are at a higher risk for experiencing loneliness (Government of Canada, 2018). In this study, 35 immigrants and non-immigrants participants answered a survey which included 20 questions from the UCLA Loneliness Scale Version 3 (Russel, 1996). …

Dallas, Tx: The Staggering Wealth Gap, Macy Golman

School of Professional Studies

In the summer of 2019, I had the privilege of serving as an AmeriCorps member with an organization called Equal Heart. One of Equal Heart’s main initiatives was to provide meals to children in underserved populations, to make sure that without school in session, these children would still be receiving food. Unfortunately, in many instances, without these meals, many of the children we served would likely not know when they would be eating their next fulfilling meal. There were certain pockets of Dallas that we would travel to everyday, places that were fifteen minutes maximum from my house, but places …

Polysubstance Exposure And Its Relationship To Pharmacological Treatment Characteristics, Parker Miller

Undergraduate Honors Theses

Neonatal Abstinence Syndrome (NAS) remains an ever-growing public health issue and a continued avenue for future research. The research question for this retrospective study was whether polysubstance exposure is related to the dose of medication the infant received or to the number of opioid-medications required to treat the infants’ withdrawal symptoms? The hypothesis for the retrospective study was there will be a significant relationship between polysubstance exposure and the dose of medication the infant received as well as the number of opioid-medications required to treat the infants’ withdrawal symptoms. A bivariate correlational indicated that there was not a significant association …

The Effectiveness Of Implementing A Collaborative Mental Health Approach On Quality Of Life For Individuals Of Low Socioeconomic Status, Tyler Z. Tooley

Graduate Theses/Dissertations

The ultimate purpose of this study is to provide insight and education to mental health clinicians, politicians and the general public of the numerous effects poverty has on mental health, in addition to the most beneficial ways to combat those insidious effects. The specific barriers met by individuals of low socioeconomic status severely affect psychological and physical health, as well as social and environmental relationships, which therefore diminish overall quality of life. The aim of this study is to examine the effectiveness of implementing a collaborative mental health approach for low income individuals on length of engagement in services and …

Safe Patient Handling – A Case For National Legislation, David O. Oba

Dissertations and Theses (Open Access)

Introduction: This study examined the effectiveness of Safe Patient Handling (SPH) legislations in difference states across the country. In January 2006, the state of Texas legislated the Safe Patient Handling and Movement Practices Act which required all hospitals and nursing homes to implement safe patient handling and movement program. To date, 10 other states have enacted law or regulations to control work-related musculoskeletal disorders (MSDs) among healthcare workers (HW). Despite the effectiveness of these policies in the individual states, MSDs remain prevalent among HW nationwide. Hence, the call for national legislation. Methods: Using the state-level incidence rate data from the …

Physician Hospital Arrangement Influence On Nonprofit Hospital Quality,Financial Performance And Community Benefit Expenditures, Andrea Cervin

Dissertations and Theses (Open Access)

Federal policy has encouraged hospitals to provide certain quality outcomes and cost containment. Hospitals have responded by forming physician hospital organizations in attempts to achieve quality outcomes and capture reimbursements. At the same time, federal policy has awarded hospitals with nonprofit status with the requirement to provide community benefits in exchange for the tax exemption they receive. With the formation of physician hospital organizations, there remains the question of whether hospitals are achieving desired quality metrics and whether hospitals are financially viable. There is also public and media interest recently regarding whether nonprofit hospitals fulfill their obligations for community benefit …

T​He​ E​Ffect​ ​Of​ U​Nconventional​ G​As​ ​And​ O​Il​ D​Rilling​ E​Missions​ ​On​ A​Sthma​ ​And​ R​Espiratory D​Iseases​ ​In​ ​The​ B​Arnett​ S​Hale​ ​Of​ T​Exas, Stella A. Okoroafor

Dissertations and Theses (Open Access)

Unconventional gas and oil drilling (UGOD) has increased substantially in the United States for more than a decade. The resultant environmental unsafe air pollution effects of UGOD both locally and regionally have been well documented in the literature. Despite the dramatic increase in unconventional well drilling and the toxicant exposure, the health consequences of UGOD remain largely uncertain. This study assesses the relationship between active wells and healthcare use for respiratory diseases by zip code from 2004 to 2008 in the Barnett shale area of Texas. The first modern shale gas well was drilled in the Barnett shale area of …

A Geospatial Examination Of The Association Between Geographic Food Access And Food Insecurity In Central Texas: The Role Of Race/Ethnicity And Urbanicity, Kathryn Janda

Dissertations and Theses (Open Access)

Food insecurity is a public health issue that affects one in ten Americans, one in seven Central Texans, and is associated with malnutrition, chronic disease, and obesity. Geographic food access is the most intervened upon aspect of food insecurity and is often measured objectively through mapping software, such as ArcGIS. Yet when geographic food access is only measured in terms of distance to food retail, analyses do not full capture the nuances of community context. Thus, other sources of data, like survey data, and demographic indicators, such as race/ethnicity and urbanicity, should be incorporated into the research exploring the association …

Determining The Drivers Of Quality Of Life In Hiv Patints Treated With Antiretroviral Therapy In Subsaharan Africa, Oubote Sangbana

Dissertations and Theses (Open Access)

During the last decade, HIV in sub-Saharan Africa has shifted from a fatal disease to a chronic condition thanks to the expansion of antiretroviral therapy (ART). As a result, the focus of care has transitioned from survival to quality of life (QoL), and the latter has become a significant outcome measure during patient follow up. Yet, the determinants of QoL among HIV patients in western and central Africa are not well known. The objective of this dissertation was to determine the main factors associated with QoL among ART-treated HIV adult patients in western and central Africa to ensure healthcare providers …

Utility Of Plasma Biomarkers In The Validation Of Reported Loc & Pta For Gcs 13-15 Patients: A Track-Tbi Pilot Study, Jeffrey Brennan

Dissertations and Theses (Open Access)

Depending on a brain injury patient to accurately report their duration of unconsciousness and amnesia is clearly flawed. We constructed biomarker-based models to validate these self-reported measurements using a GCS 13-15 subset of participants from TRACK-TBI, a multi-institutional study on traumatic brain injury. Potential covariates were assessed for significant interactions with biomarker level. We report that the predictions of LOC and PTA failed. GFAP exhibited the most consistent serum level increase between categories of both LOC and PTA. Given a number of issues with the study sample, we recommend continued investigation on the prediction of LOC and PTA using a …

Something To Celebrate?: Demoting Dairy In Canada's National Food Guide, Maneesha Deckha

Journal of Food Law & Policy

In early 2019, the Canadian Government released the much-anticipated new Canada Food Guide. It is a food guide that de-emphasizes dairy products and promotes plant-based eating. Notably, in the new version, milk and milk products are de-listed as one of the previously four essential food groups. On the surface, it seems that the federal government is promoting veganism and helping to bring about a friendlier future for animals and humans harmed by being producers and consumers of dairy, as the new Guide may seriously contract the currently robust Canadian dairy industry and its powerful lobby. On closer inspection, the messaging …

Intimate Partner Violence Against Women In Pakistan: A Review Of Qualitative Research, Tazeen S. Ali, Rida Farhan, Michelle Ayub

Community Health Sciences

Objective: To consolidate research data and provide an insight into areas that need further research regarding intimate partner violence.
Methods: The review targeted qualitative research-based studies done in the English language and conducted in Pakistan from 2008 to 2018 regarding intimate partner violence against women. A thorough search of Google Scholar and PubMed databases was done. Data from each selected article was extracted using a data-extraction template.
Results: Of the 2,479 results, 21(0.8%) articles were selected along with 4(0.16%) texts from grey literature. An in-depth analysis led to six broad categories: experiences/perspectives of married women facing intimate partner violence; perspectives …

Self Perception Of Dental Esthetics And Its Impact Among Adults Self Esteem In Sonoma And Marin County, Carolina Camacho

Global Public Health | Senior Theses

Background

One out of four American adults refrain from smiling attributable to the condition of their dentofacial area. The aim of this study was to analyze the relationship between self-perception of dental esthetics and individual self-esteem among Sonoma and Marin County adults. Analytical concepts and processes were utilized to determine and describe the statistical significance of this plausible association.

Methods

In order to assess the interconnection of this relationship from an analytical approach, an observational study design method was utilized consisting of both a quantitative and qualitative analysis. A total of 163 participants consensually responded to an online questionnaire containing …

Fatal & Non-Fatal Opioid Overdoses In Marin County: Using Ems And County Data To Locate The Presence Of Fentanyl, Naloxone Distribution, Repeated Overdoses, And Demographics, Josette Rojo

Global Public Health | Senior Theses

Background. In recent years, the United States has been greatly affected by prescription drug overdose deaths, 68% of which are caused by opioids. Like many communities nationwide, Marin County in California is deeply affected by the opioid epidemic with accidental overdose being one of the leading causes of injury-related death. This study examines how fatal and non-fatal opioid overdoses in Marin County are associated with factors such as suspected fentanyl involvement, naloxone administration (EMS), and repeat overdose events.

Methods. A cross-sectional study was conducted by Marin County’s Health and Human Services using data collected from EMS dispatch calls and vital …

Covid-19 And Studying Disasters In Singapore, Wee-Kiat Lim

CCX Research

Dealing practically with the web of complexities that constitutes the COVID-19 pandemic requires going beyond public health and economic repercussions. Social science research on disasters can contribute to this. In this article, I will sketch three approaches drawn from sociology, psychology, geography, and political science.

Covid-19-Related Knowledge, Attitudes, And Practices Among Adolescent Girls In Bangladesh: Concept Note, Sajeda Amin

Poverty, Gender, and Youth

The Population Council COVID-19 study team is implementing rapid phone-based surveys of a representative sample of girls living in the catchment area of two skills-building programs. The two programs (one with UNFPA, the Ministry of Women and Children Affairs; and the second with UNICEF and the Ministry of Education/DSHE) are affiliated with the UNFPA-UNICEF Global Programme to Accelerate Action to End Child Marriage. The overall goal of the programs is to prevent child marriage. The rapid assessment will explore how the pandemic and associated lockdown is changing girls' experience of schooling, time use, care responsibilities and household scarcity as mediating …

The Impact Of Location On Healthcare Access For Individuals With Disabilities, Addison Kimber

Honors Scholar Theses

This paper analyzes healthcare access for individuals with disabilities living in rural areas. In current political discussion, we typically think of insurance coverage as the metric to analyze healthcare access. However, as demonstrated by studies of healthcare in the United Kingdom, people with disabilities continue to face barriers to health care even with universal healthcare systems. In particular, individuals in rural areas have less healthcare access than urban residents. This is due to factors including socioeconomic status, insurance coverage, access to competent care, and transportation. This study aims to understand if disability status exacerbates the issue of access in rural …

Landscapes Of Danger: A Geospatial Analysis Of Perceived And Realistic Risk In Bryce Canyon National Park, Tia Francis

Graduate Theses and Dissertations

The quantification of risk has inspired a wide breath of literature from the physical sciences, social sciences, and interdisciplinary disciplines like geography. Many attempts to estimate risk via natural hazards either focus on quantifying realistic risk or perceived risk of lay persons, with very little overlap between these paradigms. Due to this, a considerable knowledge gap exists within perceived risk and natural hazards research. This study aims to provide a comprehensive, risk estimation and assessment strategy through a multi-hazard risk assessment of Bryce Canyon National Park (BRCA). This case study analyzed knowledge of risk among visitors with perception surveys and …

Assessing Conduct Disturbance And Fly Ash Exposure In Children., Jillian G. Winn

College of Arts & Sciences Senior Theses

Minimal research has been conducted on fly ash (a byproduct of coal combustion) and health outcomes among exposed communities, and even less has looked at its effect on children’s behavior. This study specifically looks at fly ash exposure and conduct disturbance, using logistic regression to characterize their relationship. Conduct disturbance was gauged by t-scores of 55 or higher on the dimensions of aggression and delinquency of the Child Behavior Checklist. Fly ash exposure was determined by air and surface sampling of the children’s homes. While the odds ratios suggested fly ash exposure increases the likelihood of conduct disturbance, the results …

Sample Size Calculations For Longitudinal Mediation Analysis With Continuous-Time Markov Chain Variables, Abigail Christine Sedory

Dissertations and Theses (Open Access)

Mediation is a type of analysis used to determine the causal mechanism linking a predictor and an outcome through a mediator variable. Various research has examined the inclusion of different variable types for the predictor, mediator, and outcome. However, no studies include the presence of a continuous-time Markov chain (CTMC) as any of the components in a mediating model. If researchers wanted to design a study with a CTMC in the mediating process, one of the first steps would be to determine the minimum number of subjects or observations needed to detect a significant mediating effect. Therefore, in this study, …

Nudging Quality Improvement In Cancer Care: Influence Of A Clinical Decision Support System To Nudge Adherance To Evidence Based Guidelines In Adult Cancers, Debra Patt

Dissertations and Theses (Open Access)

Cancer care is changing rapidly. Understanding of the increasing subtypes of cancer and exponentially increasing therapeutic interventions are unprecedented due to the rapid pace of scientific discovery and clinical innovation. This immense change within the field, lends itself to quality control initiatives, especially among general oncology providers who see a wide array of cancer types as general oncologists will see many different tumor types, and most of which have several potential treatment choices that have grown over time. Evidence-based pathways are an effective way to nudge quality control by presenting choice architecture at the point of care to facilitate guideline …

Understanding Participation In A Workplace Physical Activity Intervention Using Self-Determination Theory: The Booster Break Study, Kathleen Ochipa

Dissertations and Theses (Open Access)

Abstract: Sedentary behavior can lead to premature mortality, cardiovascular disease, Type 2 diabetes, and cancer incidence. Office workers are at risk for high amounts of sedentary behavior. Even brief bouts of physical activity that interrupt sedentary behavior can improve office workers’ physical and mental health. The workplace is an optimal setting for increasing physical activity and reducing sedentary behavior among office workers. However, limited literature exists related to the characteristics of participants that adhere to workplace physical activity interventions. This study aimed to identify characteristics of participants who enrolled in the Booster Break program, a 15 minute once-daily intervention during …

Economic Evaluation Of Implementing Hpv Vaccine Promotion Interventions For Cervical Cancer In The United States, Chi-Fang Wu

Dissertations and Theses (Open Access)

The HPV vaccine has been proven as a safe and effective method for preventing cervical cancer. However, the HPV vaccine coverage rate in the U.S. is suboptimal. Various interventions have been implemented to improve HPV vaccine coverage. However, evidence of the cost-effectiveness of HPV vaccine promotion interventions is lacking. We conducted an economic evaluation to assess HPV vaccine promotion interventions of cervical cancer in the U.S. Firstly, a systematic review was conducted to review evidence on interventions aimed at increasing HPV vaccine coverage and to summarize the cost and effectiveness of these interventions. We included 56 HPV vaccine promotion studies …

Comparison Of Interactive Electronic Versus Standard Document Method For Obtaining Patient Informed Consent, Jermaine Mcmillan

Dissertations and Theses (Open Access)

The primary objective of this study was to determine whether participants who received an interactive electronic consent (EC) had a better understanding of a medical procedure (apheresis) compared to those who received the standard document (SD) consent. The study was conducted with apheresis donors whose responses were used to determine if the EC facilitated better comprehension and retention of consent information by the study participants than by SD consenting methods. By comprehension, the goal was to have participants who can understand, summarize, or make judgments based on the content presented in the informed consent. By retention, the goal was to …

A Partial Likelihood Approach To Longitudinal Categorical Data Using A Continuous Time Semi-Markov Chain Model, Kusha A. Mohammadi

Dissertations and Theses (Open Access)

Longitudinal studies have been critical in understanding the characteristics of chronic diseases or interventions. Since many processes have natural multi-categorical responses over time, multi-state stochastic models have been used to estimate the transition rates between stages. Some multi-state models applied in practice assume the Markov property. The Markov property constrains the sojourn distribution to be exponentially distributed. While useful theoretical properties arise by the Markov assumption, we will consider a more flexible framework by allowing arbitrarily distributed waiting times. This describes a semi-Markov process which has already been applied to various fields in Public Health. Similar to Markov model developments, …

Pediatric Wound Care: What Can We Learn From A Systematic Review Of The Literature? Using A Systematic Review And A Clinical Consensus Group To Assess The Quality And Content Of Systematic Reviews Focusing On Pediatric Wound Care. Then Providing And Analytical Outline For Creation Of Pediatric Wound Care Guidelines For Evidence Based Clinical Practice, Ryan Krasnosky

Dissertations and Theses (Open Access)

Background: Wound care practices for neonatal and pediatric patients including the category of products, specific products within each category, and length of application of the products have created lack of standardized evidence-based guidelines for treatments in clinical practices. This dissertation addresses this concern by encompassing three crucial steps in developing evidence-based clinical guidelines for wound care specialists. Using a three-paper method, an expert consensus group was formed, a systematic review of reviews completed and a process for creating clinical decision trees created. Methods: Criteria for selection of the consensus group members included: 1) Research graduate active in Pediatric Wound Care …

Statistical Methods For Functional Annotation-Based Rare Variant Association Analysis, Yiding Ma

Dissertations and Theses (Open Access)

Despite ongoing large-scale population-based whole-genome sequencing (WGS) projects such as the TOPMed program, WGS-based association analysis of complex traits remains a tremendous challenge. External biological knowledge, such as functional annotations based on the ENCODE, Epigenomics Roadmap and GTEx projects, may be helpful in distinguishing causal rare variants from neutral ones; however, each functional annotation can only provide certain aspects of the biological functions. Our knowledge for selecting informative annotations a priori is limited and incorporating non-informative annotations will introduce noise and lose power. In the first part of this dissertation, we propose FunSPU, a versatile and adaptive test that incorporates …