Public Health Commons^™

Stress Management For Cancer Survivors Using A Technologically Adapted Psychosocial Intervention: A Randomized Trial Determining The Effect Of Expressive Writing On Psychoneuroimmunology Based Outcomes, Utkarsh B. Subnis

Theses and Dissertations

Patients with cancer transitioning from completing their final cancer treatments to survivorship are particularly at risk for experiencing psychosocial stress, and the Institute of Medicine (IOM) has referred to these cancer patients as “lost in transition.” In this study, patients with cancer in their transition phase after completing their final radiation treatment were defined as cancer survivors (CS). CS must deal with chronic stressors such as the fear of cancer recurrence as well as the resumption of their roles in their family and work lives. Chronic stress impacts the nervous system and increases secretion of stress hormones (e.g. cortisol) from …

Barriers And Facilitators To Infant Feeding Among Low-Income African American Women, Cecilia E. Barbosa

Theses and Dissertations

Objective The purpose of the mixed methods study was to compare barriers and facilitators encountered by low-income African American women who engaged in different infant feeding practices. Methods Using the positive deviance approach and modified Integrated Model as theoretical frameworks, the research began with a qualitative study that informed a survey examining intention, skills, and environmental factors differentiating women’s infant feeding practices. Results Twenty-eight and 190 low-income African American adult women participated in focus groups or interviews and a survey, respectively. In the qualitative study, positive deviants, who breastfed for at least four months, seemed to have stronger breastfeeding intentions, …

Elucidating Perceived And Actual Cancer Risk In Disadvantaged Neighborhoods Differentially Impacted By Environmental Hazards To Inform Future Public Health Interventions, Lashanta J. Rice

Theses and Dissertations

In the United States, racial and ethnic minorities, economically disadvantaged and medically underserved groups bear a disproportionate amount of the cancer burden. Myriad social and environmental factors attribute to these disparities including disparate exposures to environmental pollutants, which account for two percent of all cancer deaths nationally. There is empirical evidence demonstrating risk perceptions and cancer worry are shaped by race/ethnicity and social and environmental experiences. Cancer risk perceptions among Non-Whites, especially Blacks compared to Whites is lower for various reasons. Low perceived cancer risk may explain persistent cancer disparities, since protective health behaviors are higher among persons who perceive …

Food Insecurity And Physical Activity Among U.S. Populations, Quyen G. To

Theses and Dissertations

Objectives: Examine the association between food insecurity (FI) and physical activity (PA) in the U.S. population.

Methods: Accelerometry (PAM) and self-report PA (PAQ) data from NHANES 2003-2006 were used. Those aged less than six years or were older than 65 years, pregnant, with physical limitations, or with family income above 350% of the poverty line were excluded. FI was measured by the USDA Household Food Security Survey Module. Crude and adjusted odd ratios were calculated from logistic regression to identify the association between FI and adherence to the PA recommendation. Crude and adjusted coefficients were calculated from linear regression to …

Microbes As Proton Exchange Membranes In Microbial Fuel Cells, Andrew Timothy Stroud

Theses and Dissertations

Microbial fuel cells (MFCs) use proton exchange membranes (PEMs) to deliver protons to the cathode for electricity production. MFCs have been limited to low power generation because of complex ionic media characteristic of MFCs using the conventional Nafion-based PEM with high attraction for the competing ions. Benthic microbial fuel cells (BMFCs) use the marine sediment between the anode, embedded in marine sediment, and cathode, overlying in water, as a PEM. BMFCs have been shown to generate high power densities representing high proton permeability by the marine sediment layer between the anode and cathode. However, there is limited knowledge about this …

Comparison Of Confidence Intervals Of Intracluster Correlation Coefficient Estimates For Binary Variables, Ashok Varma Samantapudi

Theses and Dissertations

The present study evaluates the length of the confidence interval and the percentage of time the true parameter is captured by the confidence interval for four intracluster correlation estimators. These are the ANOVA estimator, the Pearson pairwise estimator with constant weights (PEQ), the kappa type estimator called FC, and an estimator using a Resampling method (RM) for binary data. We compared these different estimates by using a large simulation study. The data we simulated is correlated binary data, which assumes an exchangeable correlation structure. We also included different variations of the number of clusters, cluster size, cluster size variation, event …

Gestational Weight Gain And The Risk Of Obesity Among Preschool Children: Is This Mediated Through Birth Weight?, Nomathamsanqa Louise Mgutshini

Theses and Dissertations

Data from the 2001 Early Childhood Longitudinal Study Birth- Cohort were used to examine the association between maternal gestational weight gain (GWG) and the risk of obesity in the offspring, and the possible mediating role of birth weight. The Centers for Disease Control growth 2000 reference charts and child's height and weight measured at age 4 or 5 years old were used to determine child body mass index (BMI) Z-scores or obesity status (greater than or equal to the 95th percentile). Multiple linear or logistic regression models were used to adjust for maternal age, race, education, smoking status and prepregnancy …

Hepatitis B, C Virus And Hiv Co-Infection Among Reported Female Cases In South Carolina, 2004 - 2011: An Epidemiological Analysis Of Pregnancy Outcomes, Afiba Manza-Azele Agovi

Theses and Dissertations

HIV, hepatitis B and C virus (HBV, HCV) are three of the most common blood-borne infections and they continue to be a major public health problem in the United States (US) and globally. It is not well understood if maternal infection with either HBV or HCV has an adverse impact on pregnancy outcomes as findings from previous studies have provided some mixed results. The overall goal of this study was to assess the risk of preterm birth, low birth weight (LBW), small for gestational age (SGA) and admission into neonatal intensive care unit (NICU) for babies born to HBV- and …

A Community-Driven Approach To The Development Of A Digital Decision Aid To Facilitate Informed Decision Making For Prostate Cancer Screening Among African-American Men In Communities Of Faith, Otis Lashaun Owens

Theses and Dissertations

Background: African American (AA) men are significantly more likely to die of prostate cancer (PrCA) than other racial groups. Therefore, it is critical to identify effective strategies for providing information about the risks, benefits, and uncertainties of PrCA screening and the importance of informed decision making (IDM). To assess whether a computer-based IDM decision aid (DA) for PrCA screening would be appropriate for middle-age and older AA men, this formative evaluation study examined participants (1) PrCA risk and screening knowledge, 2) decision-making processes for PrCA screening, and 3) usage of, attitudes toward, and access to interactive communication technologies (ICTs). The …

Dr. Who?: The Science And Culture Of Medical Wear Design, Patricia Duignan

Theses and Dissertations

The multi-million-dollar medical uniform industry has not utilized advancements in garment and textile technology that could positively impact the protection of healthcare professionals and patients. In most cases the uniforms meet basic requirements – they clothe the professional in a recognizable way. Little innovation in design, function and performance, has been applied to these garments. This is particularly evident in the case of the stereotypical white lab coat worn by many physicians, despite evidence indicating that these lab coats may carry contamination and play a role in the spread of deadly bacteria. Healthcare Associated Infections (HAIs) are among the most …

Examining The Effect Of Race On The Relationship Between Posttraumatic Stress Disorder And Metabolic Syndrome In Women, Leia Harper

Theses and Dissertations

Posttraumatic stress disorder (PTSD) is a psychiatric condition affecting approximately 8% of the adult U.S. population with rates twice as high in women than men. Increasingly, evidence has suggested a close relationship between PTSD and increased risk of metabolic diseases. However, the literature on PTSD and metabolic disease risk factors has been limited by the lack of investigation of the potential influence of race on this relation. The current study examined the possible effect of race on the relation between PTSD and metabolic risk. Data for this study were provided from sample of that included 50 African American women and …

Relationship Between The Experience Of Perceived And Physician Diagnosed Arthritis And The Presence Of Dsm-Iv Criteria-Based Major Depression (Mdd) Among Older, Ryan Neil Schmidt

Theses and Dissertations

BACKGROUND: The purpose of this study was to explore both positive screened MDD and the perception of being depressed (P) and the likelihood of either increasing if the patient suffered from arthritis (P/E), either perceived or evaluated by a physician. The study explored the univariate, bivariate, and multivariate relationships between MDD and depression (P) to better describe influencing characteristics and their prevalence, as related to MDD and depression (P).

METHODS: The study examined a cross section of patients 65 years and older (n=8,205) within the National Epidemiologic Survey on Alcohol Abuse and Alcoholism (NESARC) [2001-02] sponsored by the National Institute …

Hybrid Pet/Mri Nanoparticle Development And Multi-Modal Imaging, David Hoffman

Theses and Dissertations

The development of hybrid PET/MRI imaging systems needs to be paralleled with the development of a hybrid intrinsic PET/MRI probes. The aim of this work was to develop and validate a novel radio-superparamagnetic nanoparticle (r-SPNP) for hybrid PET/MRI imaging. This was achieved with the synthesis of superparamagnetic iron oxide nanoparticles (SPIONs) that intrinsically incorporated 59Fe and manganese iron oxide nanoparticles (MIONs) that intrinsically incorporated 52Mn. Both [59Fe]-SPIONs and [52Mn]-MIONs were produced through thermal decomposition synthesis. The physiochemical characteristics of the r-SPNPs were assessed with TEM, DLS, and zeta-potential measurements, as well as in imaging phantom studies. The [59Fe]-SPIONs were evaluated …

Personal Characteristics And Learning Preference In End-Of-Life Decision Making Of Chronically Ill Community Dwelling Elders, Leigh Ann Bonney

Theses and Dissertations

Leigh Ann Bonney, RN, MSN; Susan Kossman, RN, PhD; MyoungJin Kim, PhD; Wendy Woith, PhD, Caroline Mallory, PhD

Illinois State University, Mennonite College of Nursing

Personal Characteristics and Learning Preference in End-of-Life Decision Making of

Chronically Ill Community Dwelling Elders

Purpose and Background: Clear decision-making (DM) about end-of-life [EOL] contributes to a good death This requires knowledge of life-sustaining treatment with lack of knowledge contributing to feelings of decisional conflict Decision aids can increase knowledge, but elders' preferred learning methods are unknown. Identifying characteristics associated with preferred learning method and decisional conflict can help nurses tailor information to assist in …

Positron Emission Tomography For Pre-Clinical Sub-Volume Dose Escalation, Christopher Bass

Theses and Dissertations

Purpose: This dissertation focuses on establishment of pre-clinical methods facilitating the use of PET imaging for selective sub-volume dose escalation. Specifically the problems addressed are 1.) The difficulties associated with comparing multiple PET images, 2.) The need for further validation of novel PET tracers before their implementation in dose escalation schema and 3.) The lack of concrete pre-clinical data supporting the use of PET images for guidance of selective sub-volume dose escalations. Methods and materials: In order to compare multiple PET images the confounding effects of mispositioning and anatomical change between imaging sessions needed to be alleviated. To mitigate the …

Principled Variance Reduction Techniques For Real Time Patient-Specific Monte Carlo Applications Within Brachytherapy And Cone-Beam Computed Tomography, Andrew Sampson

Theses and Dissertations

This dissertation describes the application of two principled variance reduction strategies to increase the efficiency for two applications within medical physics. The first, called correlated Monte Carlo (CMC) applies to patient-specific, permanent-seed brachytherapy (PSB) dose calculations. The second, called adjoint-biased forward Monte Carlo (ABFMC), is used to compute cone-beam computed tomography (CBCT) scatter projections. CMC was applied for two PSB cases: a clinical post-implant prostate, and a breast with a simulated lumpectomy cavity. CMC computes the dose difference between the highly correlated dose computing homogeneous and heterogeneous geometries. The particle transport in the heterogeneous geometry assumed a purely homogeneous environment, …

Pain Management And Menopausal Health Outcomes In Multiple Sclerosis, Rachel Jawahar

Theses and Dissertations

Background: Previous studies have addressed multiple sclerosis (MS) symptom management and improved health-related quality of life (HrQOL). Yet lowered estrogen levels in post-menopasual women with MS may further worsen physical function and symptomology and not all types of pain management have been examined. Objectives: For post-menopausal women with MS, we evaluated the extent to which smoking is associated with worsened health outcomes and HrQOL, and the extent to which menopausal hormone treatment (MHT) improves health outcomes and HrQOL. For all adult men and women with clinically diagnosed MS, we systematically reviewed pharmacological and non-pharmacological strategies for the reduction of pain. …

Time Dependent Cone-Beam Ct Reconstruction Via A Motion Model Optimized With Forward Iterative Projection Matching, David Staub

Theses and Dissertations

The purpose of this work is to present the development and validation of a novel method for reconstructing time-dependent, or 4D, cone-beam CT (4DCBCT) images. 4DCBCT can have a variety of applications in the radiotherapy of moving targets, such as lung tumors, including treatment planning, dose verification, and real time treatment adaptation. However, in its current incarnation it suffers from poor reconstruction quality and limited temporal resolution that may restrict its efficacy. Our algorithm remedies these issues by deforming a previously acquired high quality reference fan-beam CT (FBCT) to match the projection data in the 4DCBCT data-set, essentially creating a …

Automatic Block-Matching Registration To Improve Lung Tumor Localization During Image-Guided Radiotherapy, Scott Robertson

Theses and Dissertations

To improve relatively poor outcomes for locally-advanced lung cancer patients, many current efforts are dedicated to minimizing uncertainties in radiotherapy. This enables the isotoxic delivery of escalated tumor doses, leading to better local tumor control. The current dissertation specifically addresses inter-fractional uncertainties resulting from patient setup variability. An automatic block-matching registration (BMR) algorithm is implemented and evaluated for the purpose of directly localizing advanced-stage lung tumors during image-guided radiation therapy. In this algorithm, small image sub-volumes, termed “blocks”, are automatically identified on the tumor surface in an initial planning computed tomography (CT) image. Each block is independently and automatically registered …

A Study Of Coverage Optimized Planning Incorporating Models Of Geometric Uncertainties For Prostate Cancer, Huijun Xu

Theses and Dissertations

A fundamental challenge in the treatment planning process of multi-fractional external-beam radiation therapy (EBRT) is the tradeoff between tumor control and normal tissue sparing in the presence of geometric uncertainties (GUs). To accommodate GUs, the conventional way is to use an empirical planning treatment volume (PTV) margin on the treatment target. However, it is difficult to determine a near-optimal PTV margin to ensure specified target coverage with as much normal tissue protection as achievable. Coverage optimized planning (COP) avoids this problem by optimizing dose in possible virtual treatment courses with GU models directly incorporated. A near-optimal dosimetric margin generated by …

Optimization Of Radiation Therapy In Time-Dependent Anatomy, W. Tyler Watkins

Theses and Dissertations

The objective of this dissertation is to develop treatment planning techniques that have the potential to improve radiation therapy of time-dependent (4D) anatomy. Specifically, this study examines dose estimation, dose evaluation, and decision making in the context of optimizing lung cancer radiation therapy. Two methods of dose estimation are compared in patients with locally advanced and early stage lung cancer: dose computed on a single image (3D-dose) and deformably registered, accumulated dose (or 4D-dose). The results indicate that differences between 3D- and 4D- dose are not significant in organs at risk (OARs), however, 4D-dose to a moving lung cancer target …

Correlates And Predictors Of Risky Sexual Partnering, Jennifer Nield

Theses and Dissertations

Introduction: Sexually Transmitted Diseases, including HIV/AIDS, continue to be a major burden in the United States. Sexual partnering behaviors contribute to the spread of STDs. Sexual concurrency has been shown to exponentially increase STD prevalence in populations. Serial monogamy with short periods between sexual partners also introduces risk. Methods: We identified sexually active men and women from the 2006-2010 National Survey of Family Growth (NSFG) and used sub sets for each particular study. Sexual partnering was defined as being concurrent, serially monogamous or monogamous in the previous year. Polytomous logistic regression models were developed to evaluate the associations between age …

Health Risk Assessments Of Waste Combustion Emissions Using Surrogate Analyte Models, Michael A . Schmidt

Theses and Dissertations

Exposure assessments of open burn pits are often complicated by a lack of sampling equipment and resources. This research investigated the hypothesis of carbon dioxide (CO₂) as a viable surrogate for particulate matter with diameter ≤ 2.5 μm (PM2.5). Large-scale solid waste combustion tests resulted in linear trends between mean PM2.5 and CO₂ (R2 = 0.964 - 0.989). This pilot study demonstrates the feasibility of using CO₂ as a surrogate of PM2.5 concentration as CO₂ sensors potentially provide a cost-effective solution for monitoring in lieu of expensive PM instruments. It also indicates the potential reduction …

Patient Understanding Of Coordinated Medical Treatment Success Within The Minnesota Medical Home Model: An Exploratory Qualitative Inquiry, Jeremy F. Stockinger

Theses and Dissertations

The US health care system is often described as a complex, fragmented system where patients experience less access, coordinated, and comprehensive care that is ultimately more costly (Rosenberg, 2009). The problem addressed in this study was to understand coordinated medical treatment in the medical home model from the patient perspective. This study provides the opportunity to increase the understanding of the factors affecting coordinated medical treatment success.

Illness-Related Diabetes Social Support And Glycemic Control Among Middle Aged And Older Adults, Favel Leah Mondesir

Theses and Dissertations

Objective

The objective of this study is to investigate the association between illness-related diabetes social support (IRDSS) and glycemic control (GC) among a racially diverse sample of middle aged and older adults. In gender-stratified models we examine whether the relationship between IRDSS and GC is modified by race/ethnicity. Additionally, we explore the association between eight individual types of IRDSS and GC.

Methods

We used the Health and Retirement Study (HRS) 2002 and the 2003 Diabetes Survey. The final analytic sample consisted of 914 study respondents. Gender-stratified multivariable logistic regression models were used to calculate odd ratios (ORs) and 95% confidence …

Fishing And Fish Consumption Patterns In The Gullah/Geechee Sea Island Population, Jamelle Heyward Ellis

Theses and Dissertations

The Gullah/Geechee (G/G) people are descendants of West African slaves who remained in seclusion on the Sea Islands of South Carolina, North Carolina, Georgia, and Florida until the end of the Civil War in 1865. In addition to retaining their unique cultural language, they also remain largely a fishing subsistence population. Decades of urban development have reduced the G/G population's access to traditional fishing locations and have increased exposures to environmental contaminants in some bodies of water that are frequently fished by the G/G. Approximately 98.4% of SC rivers and streams and 77.6% of lakes have been assessed for aquatic …

Assessment Of The Effectiveness Of An Innovative Screening Colonoscopy Protocol In Producing High Quality Performance And Outcomes By Trained Primary Care Physicians, Yi Jhen Li

Theses and Dissertations

Colorectal cancer (CRC) is the 3rd most prevalent cancer and 2nd leading cause of cancer death in the U.S. Colonoscopies have been recommended as the preferred screening method to prevent cancer by removing polyps before they transform into cancer. Although colonoscopy every 10 years is considered to be the preferred screening method, it is not perfect mainly owing to the variable quality of screening colonoscopy under community-based practice conditions. Although the effectiveness of colonoscopy in preventing CRC is documented, screening colonoscopy coverage in the US population remains low. This is partly due to low colonoscopy capacity due to a shortage …

Associations Between The Perceived And Built Food Environment, Timothy L. Barnes

Theses and Dissertations

Neighborhood food environments have been associated with dietary intake and obesity. Measures of the food environment have typically been characterized with geographic information systems (GIS)-based measures, however, the use of perception-based measures of the food environment have increased in frequency. Few studies have fully examined the relationship between perceptions and GIS-based measures of the food environment, especially considering the congruency between perceived and GIS-based presence of specific retail food outlets, nor the relationship between food outlets and perceived availability of healthy foods or fast food opportunities.

Telephone survey data from 705 residents in an eight-county region of South Carolina were …

Evaluation Of Mass Media Campaigns To Change Smokers' Knowledge, Attitudes, And Behaviors In China And Taiwan, Li-Ling Huang

Theses and Dissertations

Research in high income countries (HICs) suggest that anti-smoking television advertisements are most effective if they contain emotionally evocative graphic messages or personal testimonials that depict serious consequences from smoking. The ability to effectively translate these messaging strategies to low- and middle-income (LMICs) countries outside of Western cultures remains understudied. It is critical to determine which smoking cessation messages work best in LMICs because they increasingly bear the global burden of tobacco-related disease. To date there is limited evidence on the efficacy of tobacco control mass media campaigns and the relative effectiveness of different tobacco control messaging strategies in China …

Examining The Role Of Electronic Medical Record Generated Provider Reminders On Provider Offering Of Breast Cancer Screening Services, Charles Beverley, Jr.

Theses and Dissertations

Introduction:Breast cancer affects the lives of millions of women each year in the United States. Early detection by mammography screening can reduce the risk for advanced stages of breast cancer and improve the probability of long-term survival in women. Electronic medical records (EMRs) have been identified as a successful approach for increasing the offering of preventive care in breast cancer. This study examines the impact of EMR usage, and EMR generated provider reminders on physician ordering or providing of mammography screenings.

Methods:This study used survey data from the 2008-2010 National Ambulatory Medical Care Survey (NAMCS). Our sample included non-federal office-based …