Public Health Commons^™

Hospital Charge And Ricing Transparency, Kunal N. Patel

All ETDs from UAB

Hospital pricing is not uniformly disclosed to patients up-front before the delivery of healthcare. Moreover, pricing is not commonly understood by consumers and researchers, because the information was largely unavailable due to the lack of a federal policy mandate to make the information publicly available up until recently. The federal government instituted a series of regulations that initially began to take effect in 2019 in order to increase hospital pricing transparency with the aim of bending the healthcare cost curve. In this dissertation, hospital response, hospital standard charge variation, and healthcare management and policy expert opinion surrounding the implementation of …

Challenges And Promising Strategies For Maximizing Pregnant Women's Adherence And Retention In Niv Care In The Context Of Option B+ In Kenya, Anna Helova

All ETDs from UAB

Under the current Kenyan guidelines, pregnant/postpartum women who test HIV-positive are immediately put on the lifelong antiretroviral (ART) therapy (Option B+) and are initiated into the prevention of mother-to-child (PMTCT) protocol. Gaps at each step of the PMTCT continuum undermine the positive impact of lifelong ART. Challenges at the individual, interpersonal, community, and health facility-levels contribute to these gaps. A community-based mentor mother (cMM) program tested under the Mother-Infant Visit Adherence and Treatment Engagement(MOTIVATE!) Trial (NICHD R01 R01HD080477; ClinicalTrials.gov#14-0331) is a potential approach to address these challenges. The three manuscripts comprising this dissertation used qualitative and quantitative methods with the …

Effect Of Patient-Level Characteristics On Fluoroquinolone Susceptibility, Jeffrey Alan Franks

All ETDs from UAB

Antimicrobial stewardship programs are becoming more widespread to combat antibiotic resistance. This study aimed to evaluate the influence of patient-level characteristics on fluoroquinolone susceptibly among five gram-negative isolates to help better their implementation. We performed a retrospective analysis of patients over the age of 18 for five gram-negative isolates (Acinetobacter species, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa). We utilized Cox proportional hazards to determine the risk of patient-level characteristics, for both hospital and community-acquired infections, on fluoroquinolone resistance between 2016 and 2019. The population sample consisted of 8,285 patients receiving fluoroquinolones for at least one of the …

Impact Of Different Human Coronaviruses (Hcovs) On Pediatric Patients At A Tertiary Pediatric Hospital – Retrospective Study, Abdulsalam Alsulami

All ETDs from UAB

Background: Human Coronaviruses (HCoV) are important pathogens associated with respiratory disease in humans and animals. The majority of HCoVs are emerging human pathogens with 7 known types causing human disease and 5 being identified in the last 2 decades. Methods: We performed a retrospective review of all encounters with known HCoV at a tertiary pediatric hospital from January 2015 until January 2018. Electronic medical records (EMRs) were reviewed for demographic data, HCoV type, viral copathogens, time to testing, admission, need for increased intensity of care (HLC), requirement for supplemental oxygen, radiographic findings suggestive lower respiratory tract disease (LRT) when available …

Marginalized Models With Heterogeneous Random Effects For Zero-Inflated Longitudinal Count Data, Steve Boateng Ampah

All ETDs from UAB

Longitudinal count data sometimes called panel data come up most often in publichealth and biomedical research, where investigators are interested in assessing the association between an identified exposure and the correlated count outcomes. It is worth mentioning most of these correlated count data exhibit over-dispersion, excess zeros and heterogeneous properties which when ignored during analysis can lead to biased estimates of covariate effects. The traditional zero-inflated count models with random effects have been developed to analyze such correlated count data, however the two sets of regression coefficients from this model, directly allow subgroup interpretations with the first set of coefficients …

Race, Type Ii Diabetes Mellitus And Vertebral Fragility Fractures: A Cross-Sectional Analysis From Nhanes, Yuchen At Xiao

All ETDs from UAB

IntroductionThis study examined the association between race and bone health, and if T2DM modifies this association in a diverse sample of adults. Methods We conducted a cross-sectional study using the 2013-2014 National Health and Nutrition Examine Survey (NHANES) data. Bone health outcomes included lumbar spine BMD (lowered BMD based on T-scores <-1), and vertebral deformities, assessed via vertebral fracture assessment (VFA), including presence, number of deformities, and severity ratio of deformities. T2DM status and other demographic, lifestyle, and health characteristics were self-reported via questionnaire data. To assess if T2DM modifies the association between race and bone health outcomes, we conducted stratified analyses using logistic regression for dichotomous outcomes, Poison regression for count outcomes, and linear regression for continuous outcomes. Results Non-Hispanic (NH) Blacks have significantly less odds of being lowered BMD and osteoporosis comparing to NH-Whites in the crude model and significantly less odds of having vertebral deformities comparing to NH-White in both crude and adjusted model for non-diabetic participants. Such differences are not observed in diabetic groups. Participants in Other race group have significantly more odds of being lowered BMD comparing to NH-Whites in the adjusted model for both diabetic and non-diabetic groups. And have significantly more odds of having vertebral deformities in the diabetic group, crude and adjusted, yet the differences are not significant in non-diabetic groups. Similar results were seen in the number of deformities and total bone loss ratio. The potential modification effect of T2DM was not significant in these models. Conclusions In our national evaluation, bone health differs not only by race and ethnic group but also by T2DM status. The protective vertebral fragility effects observed among NH-Blacks was no longer present among those with diabetes. Likewise, among participants in other racial and ethnic groups, T2DM seemed to magnify the association of worse vertebral fragility. Such trends indicate a potential modifying effect of participants’ T2DM status and should be noted clinically, yet more studies are required for more precise results.

Disparities In End-Of-Life Care In Children Dying Of Cancer In Alabama: A Cross Sectional Study, Elizabeth Statham Davis

All ETDs from UAB

Regional studies show that children dying of cancer receive medically intense end-of-life care but there is limited information about end-of-life care in the Deep South and limited information about hospice and palliative care involvement at EOL. We conducted a retrospective electronic medical record review of children (0-x years) that died of cancer between 2010-20199 who received cancer directed therapy at Children’s of Alabama. We collected patient clinical and sociodemographics factors, including sex, race, and area deprivation index, cancer diagnosis and treatment, palliative care and hospice involvement, location of death, and medical care in the last 30d of life, including chemotherapy …

Incorporating Spatial Structure Into Bayesian Variable Selection Using Spike-And-Slab Priors With Application To Imaging Data, Justin Leach

All ETDs from UAB

Many applications in neuroscience, psychology, medicine, and public health require collecting and analyzing imaging data. While fine resolution images may appear continuous to the naked eye, they are in fact made up of measurements at discrete locations, either pixels in 2D or voxels in 3D. These data may be treated as the scientific outcomes of interest, or as predictors of outcomes of interest. Here, the concern is with the latter situation, which involves converting images into formats amenable to a linear modeling framework; i.e., each subject’s image is converted into a vector, and used to model the subject’s (scalar) outcome …

Life-Space And Cognitive Function By Cardiovascular Disease Risk: A Cross-Sectional Analysis From The Regards Study, Emiri Matsuda

All ETDs from UAB

Performance on mobility assessments has been extensively linked to processing speed and executive function among older adults. However, less is known about the relationship between cognitive function and functional mobility as part of day to day life. African American individuals are at higher risk of cardiovascular complications, functional mobility, and cognitive decline compared to Whites. In addition, cardiovas-cular disease risk factors and neuropathology have been linked to impairment in several domains of cognitive function, including processing speed. The current study examined the cross-sectional association between life-space and cognitive function, specifically performance on the Digit Symbol Substitution Test (DSST), a measure …

Peace. Love. Youth. (In) Yoga: Development Of A Mental Health Program Among Adolescents Living In The Inner City, Sherilyn Jonnell Garner

All ETDs from UAB

Adolescence is a unique developmental stage during which physical, cognitive, social, and emotional changes occur simultaneously and the traumatic effects of adverse childhood experiences (ACEs) can be particularly salient for the emotional and cognitive development of adolescents as they navigate and adjust to the social environment (Blakemore & Mills, 2014). Seventy-seven percent of Black adolescents have unmet mental health needs, and only 13% of those adolescents receive services compared to 31% of White adolescents. Meeting mental health needs of Black adolescents is imperative as their mental health needs continue to grow and resources become increasingly scarce. Innovative, culturally acceptable, accessible …

Employer Sponsored Health Insurance And Children With Special Health Care Needs, Kathryn Corvey

All ETDs from UAB

This dissertation is composed of three papers related to children with special health care needs (CSHCN) who are covered by private health insurance, including employer sponsored health insurance. Over the past couple of decades, researchers and advocates have expressed concern about the impact that widespread changes in private insurance coverage may have on families of CSHCN. These researchers point to the rise in high deductible plans and declining generosity in the form of higher premiums and copayments in more traditional plans offered by employers. Despite this expressed concern, little research has been conducted examining how these changes in employer sponsored …

Translating Public Health Strategies To Examine Hypertensive Disorders Of Pregnancy In Alabama, Matthew Dean Moore

All ETDs from UAB

Hypertensive disorders of pregnancy (HDP) are on the rise in the United States and contribute significantly to maternal and infant morbidity and mortality. The impact of such disorders is especially burdensome for women insured by Medicaid, for those who live in the South, and for those representing racial and ethnic minorities. It is evident across the aims of this dissertation that HDP remains an important public health concern to stakeholders in Alabama, its diagnosis is influenced by various maternal characteristics, and it can result in disparate severe outcomes for some populations. The first aim examines systems level decision-making in the …

Understanding Financial Hardship In Women With Breast Cancer, Courtney Williams

All ETDs from UAB

Individuals with cancer are at risk of material, psychological, and behavioral financial hardship due to costly new treatments, increasing time on treatment, and longer survival. Breast cancer is an ideal environment to study financial hardship. Treatment options for metastatic breast cancer are heterogeneous due to differences in patient characteristics, disease biology, and because it has the largest number of treatment options of any metastatic cancer. In early stage breast cancer, treatment options include multimodality treatments, including surgery, radiation, and medical therapy (chemotherapy, hormone therapy, targeted therapy), with the choice for each modality being dependent on the other modality decisions. Despite …

Smoke Inhalation, Lung Function, And Heart Rate In Wildland Firefighters, Jordan E. Nelson

All ETDs from UAB

Given the close proximity to the fire front and limited use of respiratory protection, wildland firefighters are exposed to elevated levels of biomass smoke during regular occupational shifts. Due to the complex composition of biomass smoke, the relationships relating biomass smoke exposure to health outcomes has yet to be elucidated. In addition to occupational exposures, increasing intensity of wildfire events may place communities within close proximity to wildfires at risk of biomass smoke exposure. This study aimed to assess exposures to biomass smoke particles and quantify respiratory and cardiovascular health responses during active fire events using novel monitoring techniques. Personal …

Emotional Response To Climate Change Learning: An Existential Inquiry, Jennifer Hutchinson

Antioch University Dissertations & Theses

This qualitative study aims to explore and explain the existential underpinnings of learning about climate change and potential emotional responses to climate change learning. Undergraduate students in environmental sciences and studies classes at the University of Washingrounded theory on in Seattle, WA participated in semi-structured interviews. Participants were asked about their experiences learning about climate change and how they responded emotionally to the learning. This dissertation examines the responses from those interviews and builds a theory out of the data analyzed. Constructivist Grounded theory as outlined by Kathy Charmaz (2014) was used to analyze the interviews. Codes were created and …

Feasibility Of Quantifying The Physical Exposure Of Materials Handlers In The Workplace With Magnetic And Inertial Measurement Units, Xavier Robert-Lachaine, Christian Larue, Denys Denis, Alain Delisle, Hakim Mecheri, Philippe Corbeil, André Plamondon

Études primaires

Handling tasks can expose workers to risk factors. The objective was to describe the feasibility of using magnetic and inertial measurement units (MIMUs) to quantify the physical exposure of materials handlers in the workplace. Full-body kinematics were obtained with MIMUs on 10 handlers gathering products ordered by retailers with a pallet truck. An observer classified the visual difference (VD) of segment orientation between a MIMUs avatar and video recordings in three categories (none, minor and major) for each product transfer. The feet, arms, shoulders and head were considered similar for ≥97% of observations. The trunk segment obtained the most differences …

Factors Associated With Hiv Testing In Liberia: Findings From The 2013 Demographic Health Survey, Miatta M.E. Dennis

College of Graduate Studies: Theses & Dissertations

Human immunodeficiency virus (HIV) is among the world’s most serious challenges. The African region is severely affected with nearly one in 25 adults being HIV infected –accounting for over two-thirds of HIV infected people worldwide. In 2013, approximately three in four men and half of women aged 15-49 had never been HIV tested. In 2018, over 7,000 Liberians were HIV positive. Increasing HIV testing rates is the primary step to reducing HIV infection rates. This study examines factors associated with HIV testing behavior among Liberians using the Knowledge Attitude Behavior (KAB) model as a conceptual framework. The 2013 Liberia Demographic …

Visual Estimates Of Blood Loss By Medical Laypeople: Effects Of Blood Loss Volume, Victim Gender, And Perspective, Rachel Phillips, Marc Friberg, Mattias Lantz Cronqvist, Carl-Oscar Jonson, Erik Prytz

Psychology Faculty Publications

A severe hemorrhage can result in death within minutes, before professional first responders have time to arrive. Thus, intervention by bystanders, who may lack medical training, may be necessary to save a victim's life in situations with bleeding injuries. Proper intervention requires that bystanders accurately assess the severity of the injury and respond appropriately. As many bystanders lack tools and training, they are limited in terms of the information they can use in their evaluative process. In hemorrhage situations, visible blood loss may serve as a dominant cue to action. Therefore, understanding how medically untrained bystanders (i.e., laypeople) perceive hemorrhage …

Contemporary Epidemiology Of Rising Atrial Septal Defect Trends Across Usa 1991–2016: A Combined Ecological Geospatiotemporal And Causal Inferential Study, Albert Stuart Reece, Gary Kenneth Hulse

Research outputs 2014 to 2021

© 2020, The Author(s). Background: Cardiovascular anomalies are the largest group of congenital anomalies and the major cause of death in young children, with various data linking rising atrial septal defect incidence (ASDI) with prenatal cannabis exposure. Objectives / Hypotheses. Is cannabis associated with ASDI in USA? Is this relationship causal? Methods: Geospatiotemporal cohort study, 1991–2016. Census populations of adults, babies, congenital anomalies, income and ethnicity. Drug exposure data on cigarettes, alcohol abuse, past month cannabis use, analgesia abuse and cocaine taken from National Survey of Drug Use and Health (78.9% response rate). Cannabinoid concentrations from Drug Enforcement Agency. Inverse …

Evaluation Of A Remote Symptom Assessment And Management (Sam) System For People Receiving Adjuvant Chemotherapy For Breast Or Colorectal Cancer: Mixed Methods Study, Lisa Whitehead, Laura Emery, Deborah Kirk, Diane Twigg, Deborah Brown, Joanna Dewar

Research outputs 2014 to 2021

©Lisa Whitehead, Laura Emery, Deborah Kirk, Diane Twigg, Deborah Brown, Joanna Dewar. Background: The Symptom Assessment and Management (SAM) program is a structured, online, nurse-supported intervention to support symptom self-management in people receiving adjuvant chemotherapy post surgery for breast or colorectal cancer. Objective: The objective of this study was to describe the development, implementation strategy, and evaluation of the SAM system. Methods: The development of the SAM program involved 3 phases. In phase 1, the web app was developed through consultation with consumers and clinicians and of the literature to ensure that the system was evidence-based and reflected the realities …

Australian Consumers Are Willing To Pay For The Health Star Rating Front-Of-Pack Nutrition Label, Sheri L. Cooper, Lucy M. Butcher, Simone D. Scagnelli, Johnny Lo, Maria M. Ryan, Amanda Devine, Therese A. O’Sullivan

Research outputs 2014 to 2021

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. The Australia and New Zealand Ministerial Forum on Food Regulation has supported the recommendations set out in the 2019 Health Star Rating System Five Year Review Report. Specifically, the forum supported, in principle, Recommendation 9, to mandate the Health Star Rating if clear uptake targets were not achieved while the system is voluntary. Given that mandatory labelling is being considered, it is important to investigate how much consumers value the Health Star Rating in order to understand potential consumer uptake and inform industry. The aim of this study was to assess …

Fruit And Vegetable Knowledge And Intake Within An Australian Population: The Ausdiab Study, Caroline R. Hill, Lauren C. Blekkenhorst, Simone Radavelli-Bagatini, Marc Sim, Richard J. Woodman, Amanda Devine, Jonathan E. Shaw, Jonathan M. Hodgson, Robin M. Daly, Joshua R. Lewis

Research outputs 2014 to 2021

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Understanding the relationship between fruit and vegetable knowledge (FVK) and fruit and vegetable intake (FVI) is an important consideration for improved public health and successful targeting of health promotion messaging. The aim of this study was to investigate the association between FVK and FVI in Australian adults and to identify subgroups most at risk of poor knowledge. Using data from the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab), we investigated associations between FVK and FVI, as well as demographic and lifestyle factors. Baseline FVK was measured using two self-reported questions. FVI …

Medical Injection And Access To Sterile Injection Equipment In Low- And Middle-Income Countries: A Meta-Analysis Of Demographic And Health Surveys (2010–2017), Emmanuel O. Adewuyi, Asa Auta

Research outputs 2014 to 2021

Background Unsafe injection practices contribute to increased risks of blood-borne infections, including human immunodeficiency virus, hepatitis B and hepatitis C viruses. The aim of this study was to estimate the prevalence of medical injections as well as assess the level of access to sterile injection equipment by demographic factors in low- and middle-income countries (LMICs). Methods We carried out a meta-analysis of nationally representative Demographic and Health Surveys (DHSs) conducted between 2010 and 2017 in 39 LMICs. Random effects meta-analysis was used in estimating pooled and disaggregated prevalence. All analyses were conducted using Stata version 14 and Microsoft Excel 2016. …

Can Instagram Be Used To Deliver An Evidence-Based Exercise Program For Young Women A Process Evaluation, Rachel G. Curtis, Jillian C. Ryan, Sarah M. Edney, Carol A. Maher

Research outputs 2014 to 2021

Background Instagram provides an opportunity to deliver low cost, accessible and appealing physical activity content. This study evaluated the feasibility of delivering an exercise program for young women using Instagram. Methods A single-group pre- and post-intervention trial examined the feasibility and preliminary efficacy of a 12-week Instagram-delivered program with young inactive women (n = 16; M = 23 years), which prescribed running and body weight exercises to complete three times per week. Daily Instagram posts delivered the exercises, video demonstrations and motivational content. Feasibility was evaluated by examining exposure (Instagram posts viewed per week), engagement (likes, comments and tags on …

Validity And Bias On The Online Active Australia Survey: Activity Level And Participant Factors Associated With Self-Report Bias, Rachel G. Curtis, Timothy Olds, Ronald Plotnikoff, Corneel Vandelanotte, Sarah Edney, Jillian Ryan, Carol Maher

Research outputs 2014 to 2021

Background This study examined the criterion validity of the online Active Australia Survey, using accelerometry as the criterion, and whether self-report bias was related to level of activity, age, sex, education, body mass index and health-related quality of life. Methods The online Active Australia Survey was validated against the GENEActiv accelerometer as a direct measure of activity. Participants (n = 344) wore an accelerometer for 7 days, completed the Active Australia Survey, and reported their health and demographic characteristics. A Spearman’s rank coefficient examined the association between minutes of moderate-to-vigorous physical activity recorded on the Active Australia Survey and GENEActiv …

#Science: The Potential And The Challenges Of Utilizing Social Media And Other Electronic Communication Platforms In Health Care., Violette Gijsen, Michele H. Maddux, Adam Lavertu, Graciela Gonzalez-Hernandez, Nilam Ram, Byron Reeves, Thomas Robinson, Victoria Ziesenitz, Valentina Shakhnovich, Russ Altman

Manuscripts, Articles, Book Chapters and Other Papers

Electronic communication is becoming increasingly popular worldwide, as evidenced by its widespread and rapidly growing use. In medicine, however, it remains a novel approach to reach out to patients. Yet, they have the potential for further improving current health care. Electronic platforms could support therapy adherence and communication between physicians and patients. The power of social media as well as other electronic devices can improve adherence as evidenced by the development of the app bant. Additionally, systemic analysis of social media content by Screenome can identify health events not always captured by regular health care. By better identifying these healthcare …

Person-Centered Physical Training Programs For Individuals With Intellectual Disabilities: Stimulating Motivation And Participation As Essential Components Of Program Development, Monica Bolaños-Boudreau

UNF Graduate Theses and Dissertations

This qualitative case study explored the perceptions of two individuals with intellectual disabilities who participated in a person-centered physical training program that identified factors of motivation and influences on self-determined physical choices. The findings of this study revealed five factors that seemed to motivate participants to exercise; (a) enjoyable activities, (b) personalized program, (c) exercises that promoted health and positive self-images, (d) exercise routines that were familiar and safe, and (e) an exercise partnership with the trainer. Considering these factors of motivation, community leaders, administrators, and practitioners may promote self-determination and ultimately, impact participation by individuals with intellectual disabilities. Additionally, …

Colors Of Fruits And Vegetables And Diabetes Risk In The United States Latino Population, Raymond Anthony Colon

UNF Graduate Theses and Dissertations

Objectives: Fruits and vegetables (FV) play an important role in people’s health. The current study aimed analyzed if specific colors of FV are associated with type 2 diabetes mellitus (DM) risk in the United States (US) Hispanic/Latino population.

Methods: This study used participants from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). It is a multi-center, prospective cohort study with 5,740 self-identified Hispanic/Latino individuals from 2008-2011. Data collected include anthropometrics, oral glucose tolerance test (OGTT), dietary intake, medical history, physical activity, and sociodemographic information. FV are categorized into five color groups: green, white, yellow/orange, red/purple, and uncategorized.

Results: A total …

Do Paramedics Have A Professional Obligation To Work During A Pandemic? A Qualitative Exploration Of Community Member Expectations, Cameron Anderson, Julie Ann Pooley, Brennen Mills, Emma Anderson, Erin Smith

Research outputs 2014 to 2021

Objectives:

Previous research has identified a lack of clarification regarding paramedic professional obligation to work. Understanding community expectations of paramedics will provide some clarity around this issue. The objective of this research was to explore the expectations of a sample of Australian community members regarding the professional obligation of paramedics to respond during pandemics.

Methods:

The authors used qualitative methods to gather Australian community member perspectives immediately before the onset of the coronavirus disease 2019 (COVID-19) pandemic. Focus groups were used for data collection, and a thematic analysis was conducted.

Results:

The findings revealed 9 key themes: context of obligation …

Entrevista Ccs, Carlos Eduardo Siqueira, Leila B Göttems, Luciano De Paula Camilo

Gastón Institute Publications

No abstract provided.