Public Health Commons^™

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

Dissertations and Theses (Open Access)

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

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

Dissertations and Theses (Open Access)

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

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

Dissertations and Theses (Open Access)

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

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

Dissertations and Theses (Open Access)

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

Evaluating Religiosity Across The Lifespan And Fatalistic Beliefs Among Patients Of A Chronic Care Management Intervention Program With Type 2 Diabetes, Cindy Lynn Salazar

Dissertations and Theses (Open Access)

The overall goal of the present study was to assess the effect of fatalistic beliefs and lifetime religiosity on glycemic control and blood sugar monitoring behavior among Mexican-American participants of a chronic care management intervention program of the Rio Grande Valley. In order to achieve these aims, a mixed methods prospective longitudinal study design was utilized among approximately 500 participants of the Salud y Vida program. Qualitatively, a phenomenological approach was used to analyze semi-structured interview data assessing fatalism and religiosity and type 2 diabetes management among 15 participants stratified by engagement in the Salud y Vida program. Fatalistic beliefs …

Primary Care Shortage And Physician Migration In Texas: Analysis And Policy Implications, Adele Semaan

Dissertations and Theses (Open Access)

This study aims to gain a better understanding of primary care (PC) physician movements in Texas between 2010 and 2014. The first and second objectives were to identify the person- and place-specific factors associated with those physicians moving to PC shortage counties. The third objective was to clarify the policy landscape related to PC shortage and identify any associations these policies had with changes to PC physicians’ movements. The methods combined quantitative and qualitative approaches. The study used data on licensed physicians from the Texas Medical Board, and data on Health Professionals Shortage Areas from the Texas Health Professions Resource …

Big Tobacco. Big Marijuana? Longitudinal Trends And Multi-Directional Tobacco And Marijuana Use Among Youth And Young Adults In Texas, Shannon Rogers

Dissertations and Theses (Open Access)

Due to the pace of legal changes in marijuana policy, shifting trends in marijuana use, and emerging products in the tobacco product marketplace (e.g., ecigarettes), the cycle of risk between marijuana and tobacco use is not currently wellunderstood. I used longitudinal data from two parallel rapid response surveillance studies of youth (aged 12-19 years) and young adults (aged 18-25 years) living in the five counties (Bexar, Dallas, Harris, Tarrant, and Travis) that surround the four largest cities in Texas (Austin, Houston, San Antonio, and Dallas/Fort Worth). I used Generalized Linear Mixed Models (GLMMs) and six-panel cross-lagged regression models to analyze …

Evaluating The Impact Of Heal Pregnancy Intervention On Breastfeeding Initiation And Duration, Dolly Noel Rinehart

Dissertations and Theses (Open Access)

Despite nationwide improvements in breastfeeding behaviors, many minority, low-socioeconomic status women in the United States fail to follow breastfeeding recommendations. Healthy Eating Active Living (HEAL), a free antenatal program in Houston, Texas, teaches pregnant women healthy lifestyle behaviors and promotes breastfeeding. The objective of this paper was to determine the impact of HEAL on breastfeeding initiation and length of breastfeeding duration among predominantly low income, minority, underserved women in Houston, TX. Methods: HEAL is a natural experiment rooted in Social Cognitive Theory and Theory of Planned Behavior. Data was collected from two sources, the HEAL pregnancy post-delivery survey and the …

Assessing The Relationship Between University Environmental Health And Safety Program Resourcing And Ultimate Outcomes, Jason R. Shyu

Dissertations and Theses (Open Access)

College and university campuses contain a diverse set of potential health and safety risks mixed with a population that is equally varied. Such a combination requires effective risk management programs adapted to address these challenges. Methods currently exist to predict risk financing premiums and institutional risk control resources (inputs), but there are no models addressing relationships to final Environment Health & Safety (EHS) program outcomes (outcomes such as injuries or illnesses). Publicly available data obtained from the University of Texas System Office of Risk Management describing their 14 campuses was combined with publicly available data from the National Science Foundation …

Role Of Disinfectants In The Eradication And Propagation Of Clostridiodes Difficile Infection, Tasnuva Rashid

Dissertations and Theses (Open Access)

Introduction:

Clostridioides difficile is a motile, gram-negative, toxin-producing bacteria responsible for the majority of the nosocomial as well as community-acquired infection in the US and worldwide. A high rate of morbidity, mortality, recurrences, healthcare cost coupled with frequent epidemic outbreaks with drug-resistant strains has classified C. difficile as a pathogen with an urgent threat to human health. Current guidelines regarding disinfectant use are either limited or absent or are not effective in reducing the environmental burden of C. difficile. The aims for this study was first to determine the in vitro efficacy of select hospital disinfectants in eradicating the spores …

Machine-Learning And Statistical Subgroup Analyses Of Vasopressor Choice For The Treatment Of Non-Traumatic Subarachnoid Hemorrhage Using Electronic Health Records, Emy Anu Thomas

Dissertations and Theses (Open Access)

Abstract: Subarachnoid hemorrhage (SAH) is a life-threatening stroke caused by bleeding in the subarachnoid space. Delayed cerebral ischemia, a risk factor for death during non-traumatic SAH treatment, is often prevented by inducing hemodynamic augmentation through the administration of vasopressors. The three common vasopressors administrated to SAH patients are dopamine, phenylephrine, and norepinephrine. A recent study using Electronic Health Records (EHR) of nontraumatic SAH patients identified that the administration of phenylephrine is associated with lower hospital mortality; however, this study did not consider heterogeneity in treatment effects. Therefore, the goal of this paper is to study the heterogeneity in vasopressor treatment …

The Use Of Neoadjuvant Brachytherapy In Endometrial Cancer, Alison Yoder

Dissertations and Theses (Open Access)

Uterine cancer is the most common gynecologic malignancy in the United States with almost 62,000 cases expected in 2019. In general, treatment consists of primary surgery possibly followed by adjuvant radiation and/or chemotherapy. However, in cases with cervical involvement or when the patient is a non-surgical candidate, neoadjuvant treatment can be employed; specifically, neoadjuvant radiation with or without brachytherapy and/or chemotherapy. There have not been any large-scale studies looking at the addition of brachytherapy to external beam radiation in the neoadjuvant setting and whether or not its addition improves outcomes. In order to analyze this, the National Cancer Database was …

The Relationship Between Social Media Use And Depression In College Students: A Scoping Review, Susan Wu

Dissertations and Theses (Open Access)

Background: In 2017, 17.3 million adults in the U.S. (7.1% of all U.S. adults) have had at least one major depressive episode, with individuals ages 18-25 having the highest prevalence of major depression at 13.1%. Studies have looked at the association between social media (SM) use and depression with mixed findings. The goal of this research is to conduct a scoping review of existing evidence for the relationship between SM use and depression among college students.

Methods: Searches for articles published in the scientific literature were performed on PubMed, Embase and Scopus. Articles selected followed an inclusion criteria: studied SM …

Evaluating The Multivariate Relationship Between Breastfeeding, Early Childhood Obesity, Asthma, And Mental Illness In Dallas, Tx, Sitara Weerakoon

Dissertations and Theses (Open Access)

The aim of this study was to examine the associations between breastfeeding, asthma and mental illness in North Texas children aged two to five years, and to explore whether these associations are explained by the presence of obesity. The study population comprised of 1,174 children whose caregivers responded to a 2015 survey administered by Children’s Health and the Health & Wellness Alliance for Children. Information on breastfeeding, BMI, asthma, and mental illness were self-reported by primary caregivers. Of the 1,174 children, 61% were breastfed, 13% had asthma, and 17% had a mental illness. The odds of having asthma were 2.28 …

Numerical Study For Seamless Clinical Trials With Covariate Adaptive Randomization, Mengxi Wang

Dissertations and Theses (Open Access)

One important goal of the pharmaceutical industry is to evaluate new therapies in a time-sensitive and cost-effective manner without undermining the integrity and validity of clinical trials. Adaptive seamless phase II/III designs (ASD) have gained popularity for accelerating the drug development process and reducing cost. Covariate adaptive randomization (CAR) is the most popular design in randomized controlled trials to ensure valid treatment comparisons by balancing the prognostic characteristics of patients among treatment groups. Although adaptive seamless clinical trials with CAR have been implemented in practice1, the theoretical understanding of such designs is limited. In addition, current approaches to control the …

Long-Term Outcomes After Endovascular Stent Placement For Long-Segment Superficial Femoral Artery Lesions, Nader Zamani

Dissertations and Theses (Open Access)

Objective: Endovascular intervention is commonly pursued as first-line management of symptomatic, long-segment superficial femoral artery (SFA) disease. The relative effectiveness and comparative long-term outcomes among bare metal stents (BMSs), covered stents (CSs), and drug-eluting stents (DESs) for long-segment SFA lesions remain uncertain.

Methods: A retrospective cohort study identified patients with symptomatic SFA lesions measuring at least 15cm who successfully received an endovascular stent (BMS, CS, or DES). The outcomes were patency, patient presentation upon stent occlusion, amputation free survival (AFS), and all-cause mortality. Proportional hazards regressions and a multinomial logistic regression model were used to control for significant confounders.

Results: …

Lymphocyte-Specific Tyrosine Kinase Expression In Ovarian Cancer: A Valuable Prognostic Indicator, Emily Moss Hinchcliff

Dissertations and Theses (Open Access)

Cellular immune response, specifically tumor infiltrating lymphocytes (TILs), has been correlated to survival in epithelial ovarian cancer; however, specific gene expression patterns for this response remain poorly understood. The objective of this research was to investigate the prognostic and biologic significance of immune-related gene expression in high grade serous ovarian cancer (HGSOC). To do so, a panel of immune related gene expression was evaluated in HGSOC utilizing The Cancer Genome Atlas (TCGA) and validated in an independent cohort of ovarian tumors. Based on the strong association with survival, the cohort was grouped into LCK (lymphocyte specific tyrosine kinase) high and …

Clinical Diagnostic Whole Exome Sequencing For Infants In Intensive Care Settings: Outcomes Analysis And Economic Evaluation, Hadley Stevens Smith

Dissertations and Theses (Open Access)

Whole exome sequencing (ES) is an extensive form of genetic testing and increasingly used as a diagnostic tool. Clinical uptake of genome-scale sequencing occurred without clear guidelines for application or robust information regarding potential impact on patient health outcomes or cost of care. For infants in intensive care with suspected genetic conditions, ES can be especially powerful to identify a specific diagnosis and inform crucial decisions about medical care. However, little is known about the cost-effectiveness of ES compared to other diagnostic strategies. This project first assessed the literature on pediatric clinical ES. Then, using electronic medical record, diagnostic laboratory, …

Fire Department Support And Physical Activity Of Volunteer Firefighters: A Cross-Sectional Examination, Sarah Wagner

Dissertations and Theses (Open Access)

Greater health and fitness of volunteer firefighters protects them from cardiovascular disease-related deaths, reduces risk of injury, and improves job performance, which subsequently provides better protection for the majority of the U.S. population who is served by volunteers. Given the strong social support system characteristic of the U.S. fire service, there seems to be potential opportunity to influence the behaviors of firefighters by creating a culture that promotes healthy habits rather than unhealthy. Objective: Determine the association between fire department culture’s encouragement of physical activity and volunteer firefighters’ moderate- to vigorous-intensity aerobic activity. Methods: A cross sectional analysis was performed …

Evaluating The Impact Of Early Initiation Of Antiretroviral Therapy (Art) On Patient Outcomes Among Hiv-Infected Adolescents And Young Adults In Uganda, Hilda Sekabira Nakalema

Dissertations and Theses (Open Access)

Introduction: Since the introduction of anti-retroviral therapy (ART), treatment initiation criteria have continually been revised to start these lifesaving drugs before onset of advanced disease and optimize ART benefits for people living with HIV. However, little is known about the effect of these changes on treatment outcomes among young people. We evaluated the effect of such a policy change on long term adherence and treatment outcomes among young people, aged 15-24 years.

Methods: We conducted a retrospective cohort analysis of young people, 15-24years old, who started ART from January 2012 – December 2016. We used administrative data from the District …

Ends Device Types And Subsequent Use Of Combustible Tobacco Products Among Texas Youth, Aslesha Sumbe

Dissertations and Theses (Open Access)

The aims of the study were to determine whether ENDS device types (i.e., disposable devices, replaceable cartridges, and refillables) at initial, or first ENDS use is longitudinally associated with subsequent initiation of combustible tobacco products (cigarettes, hookah, cigars) and continued, past 30-day use of combustible and ENDS products. This study is a secondary analysis of data from the Texas Adolescent Tobacco and Marketing Surveillance system (TATAMS) study, a longitudinal cohort study of students who were in the 6th, 8th, and 10th grades (n = 3907) during the 2014-2015 academic year. Data were collected every 6 months, from 2014-2018. Using data …

Dynamic Competing Risk Model For Multi-Type Recurrent Events With Dependent Termination, Alokananda Ghosh

Dissertations and Theses (Open Access)

Cardiovascular disease (CVD), defined by the World Health Organization (WHO) as diseases that involve the heart and/or blood vessels is the number one cause of morbidity and mortality worldwide. In the United States more health care dollars are spent managing and treating CVD and/or its complications than any other disease process. Coronary heart disease (CHD) is the leading cause of deaths (43.8%) attributable to CVD, followed by stroke (16.8%), hypertension (9.4%) and heart failure (HF) (9%). CVD-related deaths and attendant morbidities, which include lifelong disability are in many cases preventable. This research proposes a dynamic risk model that handles multi-type …

A Qualitative Analysis Of Men’S Intended Bystander Behaviors In Response To A Sexual Assault Vignette, Evelyn Day

Health, Human Performance and Recreation Undergraduate Honors Theses

Sexual assault is a pervasive problem; there are myriad negative consequences associated with sexual assault victimization. Given the commonality and consequences associated with victimization, preventing sexual assault is paramount. One mechanism thought to reduce rates of sexual assault is bystander intervention, in which third parties are encouraged to intervene when witnessing sexual assault risk factors and to challenge cultural norms regarding rape and assault. Despite the benefits of bystanding, not everyone intervenes. Previous research indicates that compared with women, men are less likely to intervene. Although some men intervene, researchers’ understanding of how men bystand is limited. The goal of …

The Impact Of Parenting Style On Emerging Adult Sexual Behavior, Xavier Smith

Health, Human Performance and Recreation Undergraduate Honors Theses

The objective of this study was to examine the impact of parenting style on emerging adult sexual behavior by surveying undergraduate students at the University of Arkansas. A total of 306 participants were evaluated for the study (101 men; 205 women). Methods: For the summer of 2018 through the fall of 2018, the survey was active. University of Arkansas students took the online survey via Qualtrics, and they reflected on topics including familial background, perception of parents, and sexual behavior to describe the relationship between parenting style and personal sexual behavior. Results: It was found that mother autonomy support …

Correlation Between Myostatin And Lean Muscle Mass In Older Adults, Mishann Luedders

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Correlation Between Myostatin and Lean Muscle Mass in Older Adults.

Luedders, M., Gray, M., Patton, S., Washington, T., Binns, A. Exercise Science Research Center, University of Arkansas, Fayetteville, AR.

Background: Our older adult population is growing exponentially and with it, the number of falls and debilitating injuries that afflict their population grows as well. A fall brings with it many possible injuries, healthcare costs, fear and increased mortality. There seems to be a lack of preventative measures in our healthcare system to help protect our elders. One possible measure is a simple blood test that looks at the level of …

The Association Between Advanced Maternal Age And Short Interpregnancy Intervals On Preterm Labor, Hannah N. Burns, Kristi L. Duchanois

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Abstract

Background: Preterm birth is the leading cause of neonatal and infant mortality and has become a major health concern due to the increasing rates of infant deaths in the United States (WHO, 2017). Studying maternal risk factors for preterm labor provides insight to this obscure condition and can assist in the identification of high risk women, as well as facilitate appropriate pregnancy planning. Purpose: Although research can be found on interpregnancy intervals and maternal age as independent risk factors for premature labor, gaps exist within the relation of these variables. This study was done to investigate whether there is …

Crumbling Foundations: The Case For Prioritizing Self-Care Among Educational Leaders, Joshua Brent Ray

Graduate Theses and Dissertations

There is a potentially dangerous disassociation between human behavior, decision-making, and ethics and the notion that these fundamental aspects of what it means to be human originate simply as the functions of an organ. A deeper knowledge of the operation and limitations of the brain suggests biological input could possess the ability to unknowingly alter human behavior and effectiveness. This study utilizes a research-based understanding of the implications of human health and self-care habits on neurological, psychological, and behavioral function to examine the current practices of educational administrators across Arkansas while exploring systemic and job-based factors within the profession that …

Socioeconomic Inequality In Life Expectancy In India, Miqdad Asaria, Sumit Mazumdar, Samik Chowdhury, Papiya Mazumdar, Abhiroop Mukhopadhyay, Indrani Gupta

Journal Articles

Introduction Concern for health inequalities is an important driver of health policy in India; however, much of the empirical evidence regarding health inequalities in the country is piecemeal focusing only on specific diseases or on access to particular treatments. This study estimates inequalities in health across the whole life course for the entire Indian population. These estimates are used to calculate the socioeconomic disparities in life expectancy at birth in the population. Methods Population mortality data from the Indian Sample Registration System were combined with data on mortality rates by wealth quintile from the National Family Health Survey to calculate …

When Saliva Is A Crime: Reforming Mississippi’S Hiv Criminalization Law Utilizing The Center For Disease Control And Prevention’S Policy Analytical Framework, Anastasia Walrod

Honors Theses

Mississippi is currently experiencing an HIV/AIDS crisis. The state is ranked in the top 10 for diagnoses of HIV infection, with Jackson, Mississippi ranked sixth in the nation for HIV diagnoses and fourth in the nation for AIDS diagnoses. Despite antiretroviral treatment allowing for persons with HIV to lead healthy lives, Mississippians continue to die from AIDS in large part because of stigma, misinformation, and lack of resources. This is furthered by Mississippi’s HIV criminalization law. HIV criminalization laws are used to penalize HIV exposure, but HIV-specific criminal laws are considered largely ineffective public health policies because these statutes further …

Pro-Anorexia Website Harm, Jane C. Silva Ramirez

Journal of Critical Issues in Educational Practice

This paper explores the nature of websites that glorify eating disorders, or EDs. These websites are often referred to as “pro-ED” (pro-eating disorder), “pro-ana” (pro-anorexia), or “pro-mia” (pro-bulimia). For the purpose of this paper, only pro-ED, pro-ana, and pro-recovery website research were the focus. Scholarly articles found in California State University San Bernardino’s database were used to distinguish the different ways that these websites help and cause harm to individuals. Articles about pro-ED and pro-ana websites helped prove harmful to individuals, claiming the disorder as a “lifestyle”. It also showed the support these communities feel when interacting through blogs, comments, …