Other Public Health Commons^™

Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef

Theses and Dissertations

Corporal punishment (CP) and severe physical punishment (SPP) remain a major public health, child rights, and child protection policy concern. In Egypt, despite legislative reforms, survey-weighted analysis of the 2021 Egypt Family Health Survey (EFHS) 2021 (CAPMAS, 2022) reveals prevalence rates of 60.5% for CP and 27.4% for SPP among children aged 1–14 (author’s calculations using EFHS-2021, n=7623), yet evidence distinguishing the determinants of routine corporal punishment from escalation to severe physical punishment remains limited in low- and middle-income contexts. Guided by Bronfenbrenner’s ecological framework, this mixed-methods study identifies key drivers of CP and its escalation to SPP among Egyptian …

Prephiral Bacterial Infectious Agent Triggers Neuroinflammatory Responses And Neurobehavioral Impairment In Wild-Type Mice, Hadeer Atalah

Theses and Dissertations

Neurodegenerative diseases, including Alzheimer's and Parkinson's, present an increasing global challenge, with chronic neuroinflammation identified as a principal factor alongside genetic, environmental, and infectious influences (Boyd et al., 2022).  Epidemiological data associate bacterial infections with a 40% heightened risk of Parkinson's disease; however, the mechanisms—especially the direct connection between peripheral sepsis and the silent onset of central nervous system pathology absent acute meningitis—are inadequately investigated (Smeyne et al., 2021), particularly concerning common pathogens like Klebsiella pneumoniae in high-burden areas such as Egyptian ICUs, where it constitutes 30% of cases (Alkompoz et al., 2023). This study filled the gap by creating …

Investigating Tau Pathology In The Retina And Anterior Segment Structures Of The Eye In A 3-Nitropropionic Acid–Induced Tauopathy Mouse Model, Mohamed Sayed Ahmed Abdel-Kader Qasem

Theses and Dissertations

Background and Objectives: Alzheimer's disease, the most prevalent neurodegenerative disorder in older adults, is characterized by accumulation of hyperphosphorylated tau and amyloid-beta (Aβ) plaques in the central nervous system. Given the retina's shared embryological origin with the brain, its direct neural connectivity via the optic nerve, and similarities in vasculature and age-related degeneration patterns, retinal pathology may serve as an early, non-invasive biomarker for Alzheimer's disease. This study employed 3-nitropropionic acid (3NP) as a pathway-specific tauopathy model driven by mitochondrial dysfunction. The study particularly aimed to investigate whether retinal and corneal tau pathology reflects underlying tau-related neurodegeneration triggered by …

Investigating The Risk Factors Affecting The Control Of Diabetes And Hypertension In The Refugees Living In Egypt, Noura Seada

Theses and Dissertations

Introduction: Non-Communicable Diseases (NCDs) account for 74% of global deaths, with high prevalence of Diabetes and Hypertension worldwide. Egypt hosts over 1 million registered refugees and asylum seekers, often lacking inclusion in social protection or insurance schemes. This study aimed to assess the factors affecting the control of Type 2 Diabetes (T2D) and Hypertension (HTN) among Syrian and Sudanese refugees in Egypt, focusing on healthcare access, sociodemographic characteristics, lifestyle, and health behaviours.

Methods: This study employed a cross-sectional design using a self-administered questionnaire and BMI measurement. Data were collected from 246 refugees diagnosed with type T2D and/or HTN in the …

Child Maltreatment Risk Identification In Complex Caregiving Environments: A Public Health Review Of Split-Custody And Multi-Household Family Contexts, Makenzie Lee

Theses and Dissertations

Child maltreatment remains a significant public health concern with lifelong consequences for children's health, development, and well-being. As children's caregiving environments become increasingly diverse through split-custody arrangements, blended families, kinship care, and other multi-household contexts, recognizing and assessing child safety concerns may become more complex. Although these family structures are not inherently associated with maltreatment, the distribution of caregiving responsibilities and information across multiple households may complicate child maltreatment risk identification.

This capstone presents a scoping review of peer-reviewed literature examining child maltreatment risk identification within complex caregiving environments. The review synthesized evidence related to caregiving environments, caregiver relationships, child …

The Social Standing Versus The Mind Standing Of Older Adults In Egypt: Cross-Sectional Analysis Of The Relationship Between Social Capital And Cognitive Functions, Shaza H. Shinaishen Dr

Theses and Dissertations

Introduction: Egypt's population, much like that of other countries, is expected to age considerably over the course of the coming decades. Although biological and socioeconomic predictors of cognitive function have been studied widely, personal level social capital remains unexplored, especially in LMICs.

Purpose: This study primarily investigates the relationship between individual social capital and cognitive functioning among older adults aged 65 years and older in Egypt using the structural and cognitive components of social capital, including group membership, civic engagements, and caregiving roles.

Methods: A cross-sectional survey on 363 older individuals in different geographical and demographic segments of Egypt using …

1 Studying The Determinants Of Successful Aging: Diet, Lifestyle, And Social Relations In Egypt, Fayrouz Shaltout

Theses and Dissertations

Abstract

Background

The global population is aging rapidly, with projections indicating that by 2050, one in six people will be over the age of 65. In Egypt, the aging population, particularly those aged 60 and above, is expected to grow significantly, posing a growing public health concern. Unhealthful diets (that are associated with overweight and obesity), are one of the main reasons associated with non-communicable diseases (e.g., diabetes and cardiovascular diseases) are major risk factors for poor aging outcomes. Despite this, there is limited research on the specific determinants of successful aging (SA) in Egypt, especially among individuals aged 50 …

Modeling Vaccination Strategies And Intervention Impacts On Infectious Disease Dynamics, Elizabeth B. Amona

Theses and Dissertations

This dissertation explores how mathematical and statistical modeling can inform vaccination strategies and evaluate the impact of interventions during infectious disease outbreaks. Motivated by the challenges observed during the COVID-19 pandemic, the research integrates compartmental modeling, Bayesian inference, and agent-based simulation to assess policy effectiveness and disease control across varying contexts. The first study develops a SEIRDV model that incorporates government interventions and vaccination rollout to examine COVID-19 dynamics in Qatar. A Bayesian approach is used to estimate parameters and compute time-varying transmission rates. The model captures shifts in transmission following policy changes and quantifies the reduction in deaths attributable …

Place, Culture, And Care: A Socioecological Examination Of Type 2 Diabetes Among Hispanics In The U.S., Danielle Montoya

Theses and Dissertations

Introduction: Type 2 diabetes (T2D) disproportionately affects U.S. Hispanic populations. This dissertation examined whether structural determinants fundamentally drive T2D disparities among Hispanics, with attention to within-group racial heterogeneity.

Methods: Three studies utilized nationally representative data. Study 1 examined neighborhood segregation and ethnic enclave residence associations with T2D using restricted NHANES data (2011-2018, n=5,056). Study 2 investigated acculturation and T2D associations using restricted NHANES data (2011-2018, n=4,540). Study 3 analyzed patient-provider racial/ethnic concordance and adequate diabetes care using MEPS data (2008-2021, n=17,138).

Results: Structural factors demonstrated primacy across all studies. Neighborhood segregation (aOR=1.17, p>0.05) and ethnic enclave residence showed no …

The Inflammatory Exposome Of Major Depressive Disorder In An Egyptian Sample, Reem Deif

Theses and Dissertations

Major depressive disorder (MDD) has been recognized as a global public health concern affect-ing the lives of 264 million people with increasing prevalence worldwide. Inspired by the expo-somic research, this study aims to investigate the dynamic and complex interplay between dif-ferent demographic, lifestyle, environmental factors and bimolecular factors that are potentially involved in the pathology of MDD in a sample of Egyptian adults living in Cairo. This is in an attempt to acknowledge the biological underpinnings of MDD without underestimating the role of environmental influences. The context of Egypt provides richness to the current study given the national transition from …

The Brain Drain Of The Egyptian Physicians: A Look From Both Sides, Hebatalla Ahmed Mohamed Ismail

Theses and Dissertations

The brain drain of well-educated and trained workers is a problem that faces many nations. The pandemic revealed the importance of being ready with all resources, especially the healthcare workers. In Egypt, according to records of the Egyptian medical syndicate, half of the registered physicians in the syndicate are working abroad. In this study, we aimed to understand the relationship between individual satisfaction regarding work or family, his capability factors, and his intention to leave the country to work in another one. A quantitative approach was used by a self-administered online questionnaire. The results showed that 66.4% of physicians who …

New York City’S Health Governance And Activism From The 1950s To The 1970s, Andres Valcarcel

Theses and Dissertations

New York City's expansive network of hospitals and preventative health services has an intense history outside of the popular narratives of biomedical and technological advancement. This thesis will discuss the period between the 1950s and 1970s and the various movements and parties that shaped the city's health and hospital system. During this period, New York City's healthcare delivery system became increasingly privatized and commercialized; processes that improved the quality of healthcare yet simultaneously barred the poorest from accessing it. Communities, healthcare workers, and civil rights organizations worked to address perceived faults and extend their agency in health and hospital policy; …

Transforming Children's Oral Health: The Impact Of Oral Healthcare Policies On Virginia Medicaid Dental Health Outcomes., Anita M. Kumar

Theses and Dissertations

Abstract: Transforming Children's Oral Health: The Impact of Oral Healthcare Policies on Virginia Medicaid Dental Health Outcomes.

Objectives: This dissertation uses Department of Medical Assistance Services (DMAS) administrative files at the individual and provider level from fiscal years (FY) 2011 to 2021 to systematically study the effect of recently implemented oral health policies (EBD guidelines on sealants, CMS updated quality measures, expansion of Medicaid oral healthcare for qualifying pregnant women) on oral health outcomes of Virginia Medicaid-enrolled children.

Methods: The studies employ a difference in differences regression methods (negative binomial, Poisson, and logistic) to examine the effects of oral health …

Mathematical Models Of Infection Prevention Programs In Hospital Settings, Kelly A. Reagan

Theses and Dissertations

Hospitals play a vital role in providing for the healthcare needs of a community. Patients can develop hospital-acquired infections (HAIs) during their hospitalization due to exposure to foreign bacteria, viruses, and fungi. Infection prevention programs target and reduce HAIs, but implementing the infection prevention programs often comes with a cost. The goal of my research is to use mathematical models to quantify the impact of infection prevention programs on cases of HAIs and total healthcare costs. First, I use a Markov chain model to quantify how one infection prevention program reduces general HAIs in the hospital. Then, I calculate the …

Behavioral Screening And Chiral Bioanalysis Of Emerging Stimulant-Type Drugs In Rats, Tyson R. Baird

Theses and Dissertations

The epidemic of drug use in the United States and elsewhere in the world has resulted in tragic loss of life and substantial economic costs. Novel psychoactive substances (NPS) are one of the contributors to this problem, and the lack of information about many of these drugs compounds their risk. This dissertation proposes a strategy to use intracranial self-stimulation (ICSS) as a behavioral screening tool to assess emerging drugs of abuse for their abuse potential in order to generate a proactive threat assessment. A series of stimulant-type drugs including methcathinone, α-pyrrolidinohexanophenone (α-PHP), cocaine, and the phenyltropane analogs of cocaine WIN35428 …

The Role Of Insurance Coverage In Outpatient Substance Use Disorder Treatment Referral, Utilization, And Outcomes, Huyen Pham

Theses and Dissertations

Opioid-related overdoses increased dramatically in recent years. Medicaid plays a predominant role in paying for opioid use disorder (OUD) treatment. However, there is a critical gap in understanding the role of Medicaid coverage in referrals to treatment, treatment utilization, and treatment retention. The three studies used observational and quasi-experimental (i.e., natural experiment) designs leveraging state and year variation in Medicaid expansion to characterize the role of Medicaid coverage in OUD treatment. We found that individuals with OUD with Medicaid insurance were more likely to use outpatient treatment, whereas those who were uninsured were more likely to use self-help groups only. …

Policies Addressing Barriers To Low-Income Women And Children’S Health Care Utilization In The United States And Kenya: The Role Of Physician Payments And Cash Transfer Programs, Muloongo Simuzingili

Theses and Dissertations

This dissertation examined two policies to improve low-income women and children’s healthcare utilization: physician payments and cash transfer programs. Higher physician payments increase the supply of healthcare services while cash transfers increase individuals’ demand for healthcare services. Cash transfer programs can improve health outcomes, yet the extent to which they are a cost-effective strategy is largely understudied. Therefore, this dissertation examines three overarching research questions:

1. Are Medicaid physician fees associated with access to substance abuse disorder (SUD) treatment among low-income women of reproductive age?
2. Do economic preferences moderate cash transfer program effects on children’s health care utilization? Evidence from a …

The Impact Of The Fda Warning On Post-Tonsillectomy Opioid Prescribing In Publicly And Privately Insured Children, Dianna J. Soelberg

Theses and Dissertations

Due to reports of significant adverse events, the U.S. FDA placed a Boxed Warning on the opioid codeine in February 2013 – contraindicating its use in pediatric patients undergoing tonsillectomy and/or adenoidectomy. Studies conducted in privately insured children showed a reduction in codeine prescribing and a slight increase in alterative opioid prescribing following the FDA warning, yet the extent to which the FDA warning impacted prescribing in publicly insured children is unknown. Using a quasi-experimental interrupted time series design, this study evaluated codeine and alternative opioid prescribing before and after the FDA warning in both publicly and privately insured children …

Hiv Care Location: An Evaluation Of Single Versus Multi Facility Utilization Of Hiv/Aids Care Services And Patient Health Outcomes And Clinical Indicators In South Carolina, Melanie Gwynn

Theses and Dissertations

Background: On the HIV/AIDS care continuum, the “retention in care” metric does not distinguish between single-facility (SF) or multi-clinic utilization (MC), also described as HIV care location (or type). SF utilization is vital as it has been linked optimal clinical outcomes among People Living with HIV/AIDS (PLWH). Published research detailing the prevalence of HIV care type and its association with health outcomes/clinical indicators, has been studied only in limited urban settings. Additionally, coinfections such as sexually transmitted infections (STIs), have yet to be evaluated as potential predictive factors for HIV care type.

Methods: A cross-sectional design was used …

Did Medicaid Expansion Under The Affordable Care Act Reduce The Likelihood That People Report Employment Status Changes Due To Health, U.S., 2009-2017, Songyuan Deng

Theses and Dissertations

Medicaid expansion of Affordable Care Act (ACA) extended coverage to low-income working adults. While Medicaid expansion led to increased healthcare use and national healthcare expenditures, current studies do not examine the effects of Medicaid expansion on health status from the perspective of social roles, for example, changes in employment status. This study use data from the Current Population Survey to examine the association between Medicaid expansion and the probability to attribute part-time work or not-in-labor- force to health issues among people with family annual income no more than 138 of Federal Poverty Level, with a difference-in-differences study design. We found …

The Association Of Health Insurance And Prescription Drug Coverage On Cost-Related Non-Adherence And Hospitalization Across Age-Related Groups Of Individuals With Copd, Shamika Martin Walls

Theses and Dissertations

Background: COPD patients have poor adherence to prescribed treatment. Individuals with COPD have higher out-of-pocket treatment cost than individuals without COPD. The significant out of pocket COPD related treatment cost can lead to prescription drug non-adherence especially for individuals without health insurance or prescription drug coverage.

Significance: Since the implementation of Medicare Part D on January 1, 2006, there are no studies that have used national data to evaluate the association of health insurance and prescription drug coverage on cost related non-adherence and hospitalization among individuals 50-64 years old with COPD compared to individuals 65 years and older …

Clinically Integrated Networks: The ‘Magic Pill’ For Improving The Quality Of Health Care?, Kaitlyn Ann Crosby

Theses and Dissertations

The Patient Protection and Affordable Care Act (ACA) served as a paradigm shift to reimburse physicians based on health outcomes or quality of care patients receive in relation to and conscious of the cost to provide care, rather than the traditional fee-for- service (FFS) system. To implement value-based care under the ACA, value-based care models (VBCM), such as patient-centered medical homes (PCMH) and accountable care organizations (ACO), were formed with the ultimate goal to advance quality of care. Among commercially insured populations, clinically integrated networks (CIN) have emerged as another type of VBCM.

Since CINs are the newest type of …

The Relationship Between The Electronic Health Record Patient Portal And Shared Decision Making, Gloria Esoimeme

Theses and Dissertations

Shared decision making (SDM) is a collaborative decision-making style where the patient and the physician are involved in the clinical decision-making process. The goal of this dissertation project was to examine the relationship between the patient portal of an electronic health record (EHR) and SDM.

The SDM process has three main components: information sharing, deliberation and decision making. Patients participate in SDM at varying levels: some patients may prefer to share information and deliberate but leave the final decision making to the provider while others prefer to participate in all the three components of SDM. The patient portal of an …

Examining Women’S Perceptions Of Maternity Care In Public And Private Sectors Of National Guard Hospitals In Saudi Arabia: A Qualitative Study, Hanin M. Almahmoud

Theses and Dissertations

Every second, a baby is born. The process of birth is a complex one – biologically, medically, and emotionally. In particular, women in labor need both physical and emotional care. They need to be heard, to be comforted, and to be safe.

Women’s satisfaction can be used as a legitimate way to measure the quality of maternity care. Moreover, when health systems practice patient-centered care and listen to women’s concerns and what they want out of their care, it can lead to improvements in their satisfaction. Hospitals in Saudi Arabia are considered to be among the best and most technologically …

The Association Of Reimbursement Methods With The Tendency Of Primary Care Physicians To Apply The American Diabetic Association’S Recommendations And Make Referrals To Specialists Among Ambulatory Care Patients In Us Outpatient Settings., Abdullah Alharbi

Theses and Dissertations

We report on a study of the comparison of two reimbursement methods, capitation (CAP) and fee for service (FFS), as well as mixed payment, with respect to the implementation of the ADA recommendations for Diabetes Type 2 (DM2) management and referral rates for specialist health care in the outpatient setting of the United States.

Our purpose in examining these specific topics is to determine whether there is any difference in the implementation of the ADA recommendations or the frequency of referral between visits paid under CAP vs under FFS because both quality and cost of healthcare is affected by these …

Health Insurance Program For The Poor, Out-Of-Pocket Costs, And Catastrophic Health Expenditures In India, Shyamkumar Sriram

Theses and Dissertations

Background

India is currently taking steps to provide Universal Health Coverage (UHC) as envisaged in its National Health Policy 2017. Financial protection is considered the backbone of UHC. In India, OOP expenses accounts for about 62.6% of total health expenditure - one of the highest in the world. Out of 1.324 billion people in India, around 12.4% of the population is below the poverty line. Lack of health insurance coverage and inadequate coverage are important reasons for high OOP health expenditures. High OOP health expenditures push many households into poverty. The objective of this research is to examine the effect …

The Intergenerational Effects Of Adverse Childhood Experiences On Children’S Emergency Department Utilization And Depression And Anxiety In South Carolina, Eboni E. Haynes

Theses and Dissertations

Adult exposure to adverse childhood experiences (ACEs) is common in the U.S., with over half of adults reporting exposure to at least one ACE. Childhood trauma is associated with risk factors for premature death, disability, poor physical and mental health, and lower quality of life in adults. Traumatic experiences also influence parenting behaviors later in life, placing offspring at an increased risk of ACE exposure. Few studies have explored the intergenerational effects of ACEs on the health and well-being of offspring. This study sought to identify whether associations existed between caregiver ACE exposures and emergency department (ED) utilization for sick …

Behavioral And Neural Correlates Of Aging Effects On Temporal Predictive Mechanisms During Speech Production And Limb Movement, Karim Joharikhatoonabad

Theses and Dissertations

Existing evidence suggests that the brain facilitates motor responses to temporally predictable sensory inputs by generating more robust predictions about the timing of incoming stimuli to better estimate the next state of movement. In this context, previous studies have shown that motor responses are generated with faster reaction time in response to sensory stimuli with predictable compared to those with unpredictable temporal dynamics. However, our understanding of the underlying behavioral and neural mechanisms of temporal predictive mechanisms during movement production has remained limited by several factors. First, studies regarding temporal predictive mechanisms have mainly examined limb movement as a target …

The Association Of Rural Hospital Closures With In-Hospital And 30-Day Post Hospital Discharge Mortality From Emergency Care Sensitive Conditions, Melinda A. Merrell

Theses and Dissertations

Purpose

Over 100 rural hospitals have closed in the U.S. since 2010. Continuous pressures on the rural health care delivery system suggest that the trajectory of closures will continue in at least the short-term. While the causes of rural hospital closures have been described in the literature, the effects on the health outcomes of populations that experience these closures are still poorly understood. The purpose of this study was to determine associations between rural hospital closures and in-hospital and 30-day post hospital discharge mortality rates for affected residents experiencing time-sensitive emergencies in two U.S. states.

Methods

Rural hospital closures were …

An Evaluation Of The Impact Of Leading Pedestrian Interval Signals In Nyc, Jeremy J. Sze

Theses and Dissertations

I evaluated the impact of the phased introduction of Leading Pedestrian Interval Signals (LPIs) on collision and injury outcomes at 12,987 signalized traffic intersections in New York City over the course of 25 quarters from 2012 to 2018. An intersection is treated when a LPIs is installed to give pedestrians lead time to cross the street before vehicles are allowed to move. Outcomes from NYPD’s Motor Vehicle Collisions data were matched to signalized intersections. I hypothesize that LPIs would reduce collisions and reduce injuries for pedestrians at intersections. A difference in difference fixed effects panel regression was used to identify …