Public Health Commons^™

Increasing Knowledge About Alpha-1 Antitrypsin Deficiency In The Chronic Obstructive Pulmonary Disease Population, Maureen Ann Wentink Barta

Walden Dissertations and Doctoral Studies

The purpose of the project was to increase awareness about alpha-1 antitrypsin deficiency (AATD) in chronic obstructive pulmonary disease (COPD), particularly among those with a familial history of genetic factor AATD; an additional goal was to understand its relationship to COPD. COPD is the third leading cause of death in the United States, with more than half of COPD patients experiencing significant disabilities. Major causes for COPD include smoking, air pollution, secondary smoke, upper respiratory infections, hereditary factors, occupational factors, environmental factors, and socioeconomic factors. Genetic factors, however, also play a significant role in early onset COPD and in those …

Concordance Of Genotyping And Phenotyping In The Classification Of Methicillin-Resistant Staphylococcus Aureus, Ali M. Bazzi

Walden Dissertations and Doctoral Studies

Methicillin-resistant Staphylococcus aureus (MRSA) strains have spread in Saudi Arabia, increasing morbidity, mortality, and financial burdens. Recent studies have suggested the phenotyping methods typically used to classify MRSA as either health care MRSA (HA-MRSA) or community-associated MRSA (CA-MRSA) cases are unreliable, because they lack concordance with the results of genotyping. Yet the expense associated with genotyping precludes its use in the Saudi Aramco population in Saudi Arabia. The absence of a standardized and affordable method to classify MRSA into CA-MRSA and HA-MRSA has been a challenge for infection control programs in Saudi Arabia. The objective of this quantitative, secondary data …

Uterine Fibroid Symptom Severity And Impact On Health-Related Quality Of Life Among African American Women, Ilisher Ford

Walden Dissertations and Doctoral Studies

A disproportionate number of African American women are at increased risk for uterine fibroid tumors (UF) compared to their Caucasian, Asian, and Hispanic counterparts. Researchers have indicated that women diagnosed with UF can have a poorer health-related quality of life (HRQOL) when compared to women who do not have a diagnosis of UF. The overall aim of this study was to explore the impact of UF symptoms on the HRQOL of African American women. A quantitative, cross-sectional design was employed utilizing the revised version of Wilson and Cleary's model of HRQOL. A sample was gathered of 80 participants who were …

Female Genital Mutilation/Circumcision: Culture And Sexual Health In Igbo Women In Dallas-Fort Worth, Texas, Dorothy Ebere Ukoha

Walden Dissertations and Doctoral Studies

Female genital mutilation (FGM) is practiced primarily in many African countries as well as some in Asia and the Arab Peninsula; however, it also takes place elsewhere around the globe among those who migrate from countries to which it is indigenous. This study was designed (a) to investigate the prevalence of FGM among the Igbo women in the Dallas-Fort Worth (DFW) area in Texas and (b) to understand the factors that support the continuation of the practice and the effects on women's sexual health. Using a quantitative approach to examine a variety of social variables aligning with the ecological framework, …

Underserved Patients' Perspectives On How The Ehr Impacts Their Health, Marie Mirna Lexima

Walden Dissertations and Doctoral Studies

Our modern health care system requires technology that can deal with multidisciplinary and complex processes, operations, and situations. The EHR, by far, is one of the greatest health information technology innovations that satisfy these requirements because of its efficiency and the effectiveness of its features. This study sought to develop an in-depth understanding of how underserved patients' perspectives about their health and illness, can contribute to greater use of the EHR. It also sought to improve their health outcomes and maintain sustainable change in the lives of the underserved. A quantitative non-experimental design study was conducted over a 6-week period …

Predictors Of Condom Use Among Middle-Income, African American Women, Yvonne Maire Reed

Walden Dissertations and Doctoral Studies

Abstract

The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome

(AIDS) continue to be a major public health threat, not only within the United States but

also on a global scale. Within the U.S. heterosexual population, African Americans

(AAs) continue to bear the greatest burden of new HIV infections. Additionally,

HIV/AIDS interventions have focused on low-income AA women, virtually ignoring

their middle-class counterparts who may be subject to the same sexual risks. The purpose of this quantitative, cross-sectional study was to determine whether if there was an association between the 5 constructs of the Health Belief Model (HBM) and …

Spheres Of Influence: Understanding African American Males' Perceptions And Attitudes Toward Infant Feeding Practices, Makeva M. Rhoden

Walden Dissertations and Doctoral Studies

Although U.S. breastfeeding rates have steadily increased since 2000, there continues to be a disparity in breastfeeding rates for African American (AA) women compared to their non-Hispanic White counterparts. A male partner's perception, specifically his positive attitude toward breastfeeding, may influence breastfeeding initiation and duration rates. This study was an exploration of AA male perceptions and attitudes toward breastfeeding and what effect masculinity ideology (gender norms) has on such attitudes. The socio-ecological model (SEM) was used as the theoretical framework to examine the various environmental levels that intersect with one another to influence these attitudes. A mixed methods study design, …

Barriers To The Influenza Vaccination In Veterans, Zina Floyd

Walden Dissertations and Doctoral Studies

Influenza is the eighth leading cause of death in the United States, accounting for 56,000 deaths annually and leading to an average of more than 200,000 hospitalizations every year. Adults 65 years of age and older account for 50% to 60% of influenza-related hospital admissions and an estimated 90% of influenza-associated deaths occur in people age 65 and older. During the 2011 to 2012 influenza season, approximately 50 % of veterans between 45 and 70 years of age refused the influenza vaccine within the metro-area outpatient Veteran Administration (VA) facility in Atlanta, Georgia. The aim of this project was to …

Determinants Of Hiv Stigma Among Healthcare Workers In Ghana, Catherine Gyamfua Dawson-Amoah

Walden Dissertations and Doctoral Studies

HIV-related stigma and discrimination is a complex concept that affects HIV reduction interventions. HIV-related stigma occurs among healthcare providers resulting in reduction of quality of care of people living with HIV. Social psychological research into stigma reduction has led to the development of many stigma reduction interventions, but has not resolved the underlying problem. This study was designed to identify predictors of stigmatizing behavior among healthcare workers in Ghana using the social cognitive theory (SCT) for use in developing an evidence-based intervention. The study used a cross-sectional research design incorporating a preexisting survey, Measuring HIV Stigma and Discrimination Among Health …

Differentiating Demographic Factors In Latino Patients With Type 2 Diabetes, Carol Lynne Manning

Walden Dissertations and Doctoral Studies

The American Diabetes Association (ADA) data suggest that Latinos share a greater burden of disease than do non-Latino Whites with type 2 diabetes. As a result of poor glycemic control, Latinos also suffer consequences such as blindness, kidney disease, and limb amputation more often than do other ethnic groups. The purpose of this study was to compare demographic factors of Latinos with well-controlled type 2 diabetes, as measured by a HgbA1c of 7 or less (n = 118) to Latinos not well controlled (n = 105). This cross sectional study used a secondary data set with a sample selected from …

Albumin Levels In Hispanic Dialysis Patients With And Without Type Ii Diabetes, Hector Hernandez

Walden Dissertations and Doctoral Studies

Albumin provides the vital scaffolding for growth and tissue repair and supports oncotic blood pressure and hemodynamics. In hemodialysis patients, albumin aids with fluid removal by drawing excess fluid from edematous tissues back into the blood where it can then be removed by a dialyzer. The hyperglycemia seen in dialysis patients with Type II diabetes progressively damages kidney glomeruli, which permits albumin seepage into the urine, thus lowering serum albumin. The conceptual framework underpinning this research is the van't Hoff theory of osmotic pressure. Under this framework, the solute-solvent relationship largely contributes to the osmotic movement of fluid. The purpose …

Diabetes Among Hispanic Immigrants: The Impact Of Age At Migration, Nancy Hahn

Walden Dissertations and Doctoral Studies

Diabetes is a disease that affects the Hispanic population in disproportionate numbers. With larger numbers of immigrants coming to the United States who are of Hispanic origin, the individual risk and health burden of this disease will have a major impact on the quality of life and the health care system. Research into the influence of the timing of changes in lifestyle suggested an association between specific levels of socioecological exposures and certain health conditions. This study examined that possibility. The use of the National Health Interview Survey, 2005-2011, provided adequate data for examining whether age at migration was associated …

Sociodemographic Predictors Of Medication Nonadherence Among Latinos Diagnosed With Diabetes Type Ii, Bianca L. Tristan

Walden Dissertations and Doctoral Studies

Latinos of low socioeconomic status are disproportionately affected by diabetes Type II complicated by poor adherence to diabetes Type II medications and management programs. Self-management of diabetes Type II is a tool used to teach health education to patients with diabetes. The objective of this retrospective quantitative study was to explore if there are predictors of nonadherence to diabetes Type II medications and programs among Latinos with diabetes Type II. Data from 200 patient records from a community clinic in Fresno County California were analyzed using both bivariate and multivariate analysis. Selected sociodemographic independent variables were age, gender, income, migrant …

Women's Experiences With The Follow-Up System For Cervical Cancer In A Developing Country, Christine Carol Richards

Walden Dissertations and Doctoral Studies

Although Grenada has an extensive health care infrastructure and cervical cancer screening rates are relatively high, Grenada also has a disproportionate rate of morbidity and mortality from cervical cancer. The aim of this study was to explore factors that contribute to these disproportionate rates in Grenada. Using a phenomenological qualitative approach, Andersen's behavioral model of health care utilization and a systems based model for assessing care were used as a guide to explore Grenadian women's follow-up experiences with Pap test and cervical cancer screening. Purposive sampling was used to recruit 8 women for semi-structured in-depth interviews. Data were collected on …

Predictors Of Full Childhood Immunization Status In Owerri, Nigeria, Osuala Uzor Kelvin

Walden Dissertations and Doctoral Studies

Full (complete) childhood immunization against tuberculosis, poliomyelitis, diphtheria, tetanus, hepatitis B, yellow fever, measles, and the maternal retention of immunization documentation are the most cost-effective interventions against vaccine-preventable childhood diseases. The full childhood immunization rate in Nigeria has not reached the expected target level of compliance at 90%. Using the social ecological model, this study investigated the influence of maternal satisfaction with postnatal services and paternal support on full childhood immunization status; it also examined the association between maternal factors and the maternal retention of immunization documentation in Owerri, Nigeria. The hypotheses were that maternal satisfaction with postnatal services and …

The Role Of Sociodemographic Characteristics And Antiretroviral Prophylaxis On Risky Sexual Behavior Among Men Who Have Sex With Men, Leonard Obodo

Walden Dissertations and Doctoral Studies

Recent multicenter, randomized, double blind clinical trials have shown no association between HIV preexposure prophylaxis (PrEP) and increased sexual risk behavior among high-risk men who have sex with men (MSM). However, little research has been conducted under natural conditions devoid of clinical trial controlled environment to confirm the lack of association between PrEP and increased sexual risk behavior. Also, research has shown conflicting associations between sociodemographic characteristics and sexual risk behavior among MSM. In this cross-sectional, web-based, primary data analysis, MSM who reside in United States of America (USA) and who make use of PrEP for HIV prevention were examined …

Statistical And Methodological Challenges In Cochrane Public Health Systematic Reviews: An Overview, Melissa Glenda Lewis Ms, Ravishankar N Mr, Anusha Mujja Ms, Sreekumaran Nair N Dr

Manipal Journal of Nursing and Health Sciences

Background: The article aims to investigate the suitability of Cochrane handbook for the preparation of systematic reviews of public health importance. Methods: The information about various aspects of a systematic review was extracted from all 39 Cochrane public health systematic reviews, independently by three reviewers. This was carried out by means of a data extraction form and was examined if the methodological constructs used by the reviews have been furnished in the Cochrane handbook. Results and Discussion: It was observed that17 (44%) of the 39 reviews adopted meta-analysis and 20(52%) of the systematic reviews used the risk of bias assessment …

Significance Of Herb-Drug Interactions In Clinical Practice: A Narrative Review, K J. Malagi Dr, Kamath Madhusudhana Dr

Manipal Journal of Nursing and Health Sciences

Background: There has been a drastic increase in herb-drug interactions day-by-day as a result of an increase in the population using herb and its supplements along with the contemporary medicines. Objectives: To discuss the safety of usage of herbal medicines along with contemporary medicines in the management of lifestyle disorders. Method: This is a systemic review with narrative analysis. A study was carried out to understand the mode of herb-drug interaction in lifestyle disorders. Literature search was conducted with various titles and reports on medical indexed journals, focusing on herb-drug interaction on selected lifestyle disorders. Conclusion: The issue like herb-drug …

Multiple Fungal Brain Abscesses In A Neonate: Successful Treatment With Liposomal Amphotericin B, Leslie Lewis Dr, Jayashree P Dr, Y Ramesh Bhat Dr

Manipal Journal of Nursing and Health Sciences

Invasive fungal infections are common among infants hospitalized in the Neonatal Intensive Care Unit (NICU). Central Nervous System (CNS) involvement occurs in two third of the disseminated fungal sepsis. Fungal cerebral abscess is one of the severe complications of disseminated fungal sepsis. We report a case of multiple fungal brain abscesses in a term neonate, which was successfully treated with Liposomal Amphotericin B.

Crash Risk Associated With Cellular Phone Use While Driving, Tiffani Ann Fordyce

Walden Dissertations and Doctoral Studies

There are inconsistencies in the published literature on the effect of cellular phone use while driving. The objective of this study was to estimate an adjusted nationwide crash rate associated with cell phone use while driving and to compare statewide crash rates prior to and following the implementation of legislation banning cell phone use while driving. Crash rates in nationally representative databases were calculated based on imputed values for cell phone use using the propensity score method. The imputed nationwide crash rate for fatal crashes (1.61 per 100 fatal crashes) and all crashes (1.409 per 100 crashes) represented a 2 …

Three Studies On Cardiovascular Health: Modifiable Risk Factors And Health Expenditures In Medicare, Kristal Jo Aaron

All ETDs from UAB

This dissertation comprises a series of studies conducted on modifiable risk factors as they contribute to cardiovascular health and disease and their associated health service expenditures and utilization. Specific topics in this compilation include (1) exploring the role of dietary sodium and potassium intake in cardiovascular health and disease; (2) examination of direct health expenditures in the Medicare-linked REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort as associated with Life’s Simple 7 (LS7), a composite measure of cardiovascular health defined by the American Heart Association (AHA) that is based on seven modifiable risk factors (blood pressure, blood cholesterol, …

Association Between Physical Activity And Learning, Pain Coping Strategies, Perceived Stress, And Depression Among Adults With Diabetes And Chronic Pain, Susan J. Andreae

All ETDs from UAB

In addition to the role of physical activity (PA) in the prevention of chronic disease and premature death, PA may have psychosocial benefits. We examined the association between four different domains of PA and three outcomes that may contribute to the emotional and mental well being of individuals. This is a secondary analysis of community dwelling adults with diabetes and chronic pain in which we examined the association between four domains of PA and learning (measured using diabetes knowledge, self efficacy in diabetes and pain management), pain coping strategies, perceived stress, and depression. Regression models were used to model changes …

Examination Of Racial/Ethnic Disparities In Ovarian Cancer Stage Of Diagnosis, Surgery Treatment And Survival: Multilevel Analysis Of 2001-2012 Seer Data, Chen Chen

College of Graduate Studies: Theses & Dissertations

Context. Racial/ethnic disparities in cancer outcomes are major public health concerns. Ovarian cancer is the tenth most common cancer and the fifth leading cause of cancer-related deaths among women. Identifying individual- and contextual-level factors contributing to racial/ethnic disparities in ovarian cancer stage of diagnosis, surgery treatment and survival is necessary for reducing and eliminating these disparities.

Objective. The study aims to examine racial/ethnic disparities in ovarian cancer diagnosis, surgery treatment and survival outcomes; to explore individual- and contextual-level factors contributing to these disparities, and to examine the trend of ovarian cancer racial/ethnic disparities from 2001 to 2012.

Methods. The …

Characteristics And Behaviors Based On Introduction To Opioids Among Adults In Buprenorphine/Naloxone Treatment, Angela R. Gallien

All ETDs from UAB

Buprenorphine/naloxone (BNT) is a pharmacological treatment for opioid use disorders and is available by prescription in an office-based setting from physicians with specialized training. The purpose of this study was to identify the characteristics and behaviors among adults on BNT with the intent to identify the linear combination of variables that account for the differences based on the origins of opioid use. Four opioid user groups were identified a priori: recreational users (RU); self-treaters (ST); medical users misusing (MUM); and medical users not misusing (MU). The dependent variables were mental health and mood, pain and medical problems, internal or external …

The Influence Of Personal, Interpersonal, And Community Factors On The Parenting Self-Efficacy Of First-Time Mothers, Tamika L. Smith

All ETDs from UAB

The Social Ecological Model (SEM) allows for examining human behavior and the factors that influence behavior change in totality. In addition, the model offers guidance in identifying the factors that may lead to a change in or explanation of behavior. This study utilizes SEM to identify factors at the personal, interpersonal, and community level in order to determine the relationship between specific ecological factors and parenting self-efficacy. Furthermore, the study examines the predictive quality of the ecological factors on parenting self-efficacy. Data collected from the Parenting for the First-time Project (PFT) was used. PFT is a multi-site longitudinal study of …

Exploring Body Image And The Association Between Body Image Dissatisfaction And Waist Circumference Among Overweight And Obese Rural African American Women Participating In A Weight Loss Program, Erica Rayshelle Johnson

All ETDs from UAB

African American (AA) women are disproportionately burdened by obesity, an epidemic with implications that reach beyond physiological consequences. Given that perceptions of body image may impact health-promoting behaviors and weight management efforts, we sought to evaluate the presence and magnitude of body image dissatisfaction (BID) and explore its relationship with waist circumference (WC), independent of weight among overweight and obese treatment-seeking rural AA women. Participants referred to images from the Pulvers Figure Rating Scale that included nine body silhouettes to answer: “How I think I look now” (i.e., current body image) and “How I would like to look” (i.e., desired …

Prevalence And Determinants Of High Risk Human Papillomavirus (Hpv) Among Wives Of Migrant Workers - A Study In Far - West Nepal, Derek Johnson

All ETDs from UAB

This dissertation research focuses on the risk factors associated with high-risk HPV infection (HR-HPV) and abnormal cervical cytology in Nepali women residing in Nepal’s Far-West district of Achham. The first part of this dissertation assesses the HR-HPV test concordance of self-collected vs. clinician-collected cervico-vaginal specimens. Of 261 women with both clinician- and self-collected cervical samples, 25 tested positive for HR-HPV, resulting in an overall HR-HPV prevalence of 9.6% (95% Confidence Interval [CI]: 6.3 – 13.8). The overall Kappa value for clinician- and self-collected tests was 0.64 (95% CI: 0.48 – 0.84), indicating a “good” level of agreement. The second part …

Evaluation Of Sample Size Re-Estimation Procedures For Non-Inferiority Designs With Time-To-Event Outcomes, Hwasoon Kim

All ETDs from UAB

Study designs that allow sample size review may potentially save a study by identifying misspecified assumptions, modifying the planned sample size, and reinforcing the study’s power. Most sample size re-estimation (SSR) methods in non-inferiority trials have been developed for continuous or binary outcomes. In many medical domains studying cancer, heart failure, and other chronic diseases, most phase III trials use censored endpoints (e.g. survival or event-free survival). Non-inferiority designs have inherent complexity by the introduction of the non-inferiority margin and therefore understanding of strategies in these methods is essential. In our first paper, we detail the issues related to misspecification …

Spatial Analysis Of Hypertension Prevalence Using A Large Us Cohort, Matthew Loop

All ETDs from UAB

Stroke mortality rates are highest in the Southeast US, and the cause for this "Stroke Belt" is not well understood. We investigate the spatial distribution of hypertension, an important risk factor for stroke. This investigation explores statistical issues in performing spatial analysis in a large cohort (over 30,000 participants), relating to type 1 error rate control and geocoding error. Recommendations for handling these statistical issues are made. In an applied analysis, we find that hypertension prevalence varies across the continental US, and is highest in northeast Louisiana, southeast Arkansas, west Mississippi, and east Michigan. These areas are not concordant with …

Assessing Potential Diesel Exhaust Exposure In Truckers Resting At Truck Stops, Gumindenga Farayi Mabvuta

All ETDs from UAB

The nature of long haul truck driving places workers in this occupation in a peculiar setting for chronic exposure to diesel exhaust which is a known carcinogenic. These drivers endure exposure to diesel exhaust in traffic and potentially greater exposure at truck stops where they park for rest breaks as mandated by DOT regulations. This study looked at the potential exposure to diesel exhaust in long haul truck drivers resting at truck stops where up to two hundred trucks are left idling for air conditioning and other reasons. Two different trucks were used consecutively over the 21 days of sampling. …