Medicine and Health Commons^™

Towards A New Health Politics In Kenya: Labor Organizing And Strikes By Health Workers In The Public Health Sector, Michael Scanlon

Graduate Doctoral Dissertations

There has been insufficient attention by global health scholars to labor organizing by health workers, including when and why organizing occurs, what forms and strategies it takes and its implications for governance and policy. These questions are critical but largely absent in research on what has been called the “global health workforce crisis.” Kenya represents an important case study. A new constitution in 2010 expanded institutional spaces for labor organizing and decentralized governance of the health system. Both reforms had significant implications for the health workforce and strikes by health workers have been pervasive. In 2017, nationwide strikes by public …

Differential Mirna Expressions Linking Environmental Risk Factors To Triple-Negative Breast Cancer Stages At Diagnosis, Amjila Bam, Yawen Hu, Xiaocheng Wu, Meng Luo, Nubaira Rizvi, Luis Del Valle, Arnold H. Zea, Fokhrul Hossain, Denise Moore Danos, Jovanny Zabaleta, Augusto Ochoa, Lucio Miele, Edward Trapido, Qingzhao Yu

School of Public Health Faculty Publications

Background/Objectives: Triple negative breast cancer (TNBC) is an aggressive, molecularly heterogeneous subtype of breast cancer, accounting for approximately 10–15% of all cases. While reproductive and metabolic factors contribute to breast cancer development, growing concerns about environmental exposures, alongside biological and socio-cultural influences, underscore the need for targeted prevention strategies across diverse populations. Despite increasing evidence linking biological, socioeconomic, and environmental factors to TNBC outcomes, the molecular mechanisms underlying these relationships remain poorly understood. Micro-RNAs (miRNAs), which regulate gene expression and play critical roles in cancer development, have emerged as potential mediators between environmental exposures and TNBC progression. The goal of …

Chronic Pain After Traumatic Brain Injury: Treatment Experiences And Effects On Cognition And Functioning, Rachael L. Snyder

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

Traumatic brain injury (TBI) can contribute to changes in cognitive and emotional functioning, quality of life, and psychosocial reintegration. Chronic pain is a common consequence of TBI which can uniquely impact such outcomes. Still, the exact nature of the contribution of pain on post-TBI outcomes remains unclear, and there are few existing studies exploring the treatment journey for chronic pain and injury rehabilitation through qualitative methods, specifically individual interviews with TBI survivors. This study aimed to document these narratives and to identify precisely how the experiences of TBI survivors seeking treatments, rather than the treatments themselves, impact outcomes. It also …

Resilience Of Interdependent Transportation And Healthcare Systems: A Simulation-Driven Framework Incorporating Social Equity And Facility Optimization, S. Yasaman Ahmadi

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

The overarching goal of this dissertation is to develop an integrated, simulation-driven framework to assess and enhance the resilience of interdependent transportation and healthcare systems before, during, and after natural hazards. By examining how spatial disruptions, social vulnerability, operational constraints, and infrastructure interdependencies affect access to and functionality of hospitals, this research offers a multifaceted evaluation of system performance under stress. This dissertation examines the impact of natural hazards, particularly floods, on the interdependent transportation and healthcare systems. The proposed approach combines and advances GIS-based network analysis, graph-theoretical modeling, and discrete-event simulation to evaluate system performance under different scenarios. The …

Temporal And Generational Changes In Depression Among Young American Adults, Ashley W. Kranjac, Dinko Kranjac, Valentine Chung

Sociology Faculty Articles and Research

The prevalence of depression among young American adults has risen significantly over the past two decades, but the mechanisms that underlie the population-level changes in depressive symptoms severity remain unclear. We used data from the 2005–2023 National Health and Nutrition Examination Survey (NHANES) and hierarchical age–period–cohort (HAPC) analysis to examine developmental (i.e., age), life stage (i.e., period), and generational (i.e., cohort) distribution of depressive symptoms among American adults aged 20–30 years old over an 18-year period. Our model results indicate that the probability of either mild, moderate, or severe depression increased among young adult females and males between 2005 and …

A Cancer Education Needs Assessment: Informing Middle-Aged Female Patients About The Relationships Between Obesity And Women’S Health Concerns In The Reproductive System, Breast, And Endometrial Health, Batul Mirza

MUSC Theses and Dissertations

Obesity significantly impacts women’s health, particularly among middle-aged women, by increasing the risk of hormone-sensitive cancers such as breast, endometrial, and reproductive system cancers. This study examines the educational needs of this demographic group regarding obesity-related cancer risks and explores effective intervention strategies. Obesity-induced mechanisms – hormonal imbalances, chronic inflammation, and insulin resistance – drive cancer susceptibility, emphasizing the need for targeted health education. The study employs a qualitative design, which includes interviews with subject matter experts (SMEs) and surveys of middle-aged women. The goal is to assess awareness, perceived barriers, and preferred learning methods. Findings suggest that with many …

A Call For Change: Supporting Children With Tourette Syndrome, Matt Reall

Journal of Nonprofit Innovation

Tourette Syndrome affects 1 in 100 U.S. children but remains widely misunderstood due to stigma, delayed diagnosis, and media misrepresentation. This neurological disorder is characterized by involuntary tics and often co-occurs with ADHD, anxiety, and sleep disorders. Children with Tourette Syndrome face disproportionate challenges in social, academic, and emotional settings—despite having average or above-average intelligence. One-third engage in self-harm, and suicide rates are four times the national average. Peer-education programs like the Tourette Association of America’s Youth Ambassador initiative have shown promise in reducing stigma, but unequal access and weak institutional support limit their impact. This paper calls for early …

U.S. Young Adults’ Family-Building Intentions In The Event Of Infertility And Knowledge Of Associated Costs, Jean Marie Place, John Horowitz, Minh Nguyen, Maya Guinn, Brennan Peterson

Marriage and Family Therapy Faculty Articles and Research

Introduction: Infertility affects approximately 8.5% of married women in the United States, yet there is limited understanding of how young adults anticipate and prepare for potential barriers to biological parenthood. As reproductive planning increasingly intersects with social, medical, and financial considerations, it is important to examine how emerging adults perceive and approach family-building options. This study aims to explore college students' intentions regarding childbearing, their openness to non-traditional family-building methods, and their awareness of the associated financial costs.

Methods: A cross-sectional survey was administered to undergraduate students (mean age = 20) at a Midwestern public university. Most participants had not …

Gender Differences In Regretted Consensual Sexual Experiences And Problematic Alcohol Use Among First-Year College Students, Shannon Shen, Soyoung Kwon, Sukho Lee

Journal of Social, Behavioral, and Health Sciences

Regretted sexual behaviors and alcohol use often occur in tandem for college students; however, few studies have examined their interrelationships or the variance across gender. This study tested gender differences in how regretting a consensual sexual experience is related to college students’ alcohol use. One hundred and forty first-year students (63% women, 69% Hispanic) surveyed in 2018 and 2019 reported their sexual behavior and alcohol use (following the Rutgers Alcohol Problem Index [RAPI]). Twenty-one percent of men and 16% of women reported a regretted sexual encounter. Interaction effects from regression models revealed that men with sexual regret had a significantly …

The Effect Of Birthweight And Gestational Age On Cognitive Function In Midlife: The Bogalusa Heart Study, Eunsun Gill, David J Libon, Soo Jung Kang, Ileana De Anda-Duran, Lydia A Bazzano, Wei Chen, Camilo Fernandez-Alonso, Emily W Harville

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Although the relationships between birthweight, gestational age (GA), and cognitive function (CF) before midlife have been demonstrated, the relationships after midlife and potential racial disparities remain inconclusive. This study examined the association between birthweight, GA, and midlife CF stratified by race.

METHOD: 1,032 subjects from the Bogalusa Heart Study (67% Whites, 33% Blacks, mean age 48.1 ± 5.3 years) were studied. Cognition was assessed with tests measuring verbal episodic memory, working memory, attention, graphomotor information processing speed, and global CF. Each test was standardized by sex and age, then averaged. The global CF was computed by averaging all cognitive …

Tobacco, Alcohol, And Poverty In Lao Pdr Based On National Survey Analysis, Robert M. Semakula

Loma Linda University Electronic Theses, Dissertations & Projects

Tobacco and alcohol use are among the most prevalent and harmful addictive behaviors globally, including in the Lao People’s Democratic Republic (Lao PDR). In Southeast Asia and the Western Pacific, substance use patterns are shaped by cultural, social, economic, policyrelated, and environmental factors. This study aimed to: (1) explore associations between different patterns of alcohol and tobacco use among men and women in Lao PDR, and (2) investigate the effect of poverty on the relationship between alcohol and tobacco use. We conducted a secondary analysis of the 2013 Lao National Adult Tobacco Survey (N = 9,706), a nationally representative sample …

Navigating Crisis: A Qualitative Exploration Of Parents' Journeys With Suicidal Adolescents In Australian Emergency Departments, Demee Rheinberger, Lauren Mcgillivray, Fiona Shand, Sally Ann Pollard, Susanne Oliver Armstrong, Julia Lessing, Katherine Boydell

The Qualitative Report

Rates of emergency department (ED) presentations for suicide crisis (thoughts, feelings, plans and behaviours) in adolescents are increasing. Parents play a key role in supporting adolescents during and after the ED presentation, however little is known about parental experiences in the ED. Interviews with 20 parents from across Australia were undertaken to help understand this experience. A reflexive thematic analysis was conducted, resulting in three themes which explore the impact of the suicide crisis and ED presentation on the parents’ sense of identity. First, parents’ identity was threatened as they were faced with the juxtaposition between the role of protector …

Influences And Implications Of Medical Mistrust On Healthcare Behaviors In A Low Health Outcomes County In The State Of New Jersey, Dale Johnson, Adeena Javed, Nathaniel J Byrnes, Anne C Jones, Kristin N Bertsch

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Medical mistrust is an ongoing concern in the United States, with patient confidence in both individual practitioners and institutions decreasing sharply in recent years. Atlantic County, New Jersey has some of the worst health outcomes in the state and is below the national average. This study sought to investigate medical mistrust by recruiting participants to complete a survey and/or health screening at 12 food pantry distribution events throughout Atlantic County (N = 124). The mean score for the Medical Mistrust Index was 19.06 (SD = 5.6) for participants who reported receiving the annual influenza vaccine and 16.05 (SD = 4.7) …

From Oversight To Insight: Enhancing Vte Prophylaxis Through System-Level Improvements, Nehar Damle, Jessica Cobb, Jordan Feingold, Yunisse Gonzalez, Lamya Jaigirdar, Sheraz Qamar, Claire Ketchem

Health Equity and Quality Improvement (HEQI) Summit

Background

- Hospitalized patients – particularly those with prior venous thromboembolism (VTE), reduced mobility, severe sepsis, and operative procedures - are at significantly elevated risk for recurrent VTE events^1-4

- Although clinical evidence supports use of pharmacologic VTE prophylaxis in highrisk patients, gaps in delivery remain common (highlighted below):

• Miscommunication between managing teams
• Unclear documentation
• Lack of standardized peri-procedural protocols
• Challenges in care coordination

- Missed or delayed VTE prophylaxis represents a frequent and preventable threat to inpatient safety

- We present a near miss event involving a hospitalized patient with severe sepsis and history of pulmonary embolism within …

Utility Of Community Partnership And Sustainable Street Outreach, Daniel Lee, Hannah Klinghoffer, Mallika Kodavatiganti, Luke Benedict, Kelsey Van Housen, Ashley Wetzel, Lele Yang, Alisha Agarwal, Shane Nieves, Charlotte Harris, Jessica Lely, Vinh Dang, Ivel Morales, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• 14,088 individuals experience homelessness (IEH) across the state of Pennsylvania, with over 50% concentrated in Pittsburgh and Philadelphia¹
• In late 2021, only 4 medical school programs existed that conducted street outreach to support individuals experiencing homelessness in Pennsylvania before the pandemic.² None existed at the undergraduate level.
• Street outreach has been linked to increased motivation of IEH to seek services by removing stigma via positive, nonjudgmental relationships.^3,4

Visiting Medical Student Stipends In The Us | An Analysis Of Equity Within Physiatry, Ashley Otto, Do, Mbs, Jeffrey Gray, Md, Summer Nestorowicz, Md, Adrian Oppong, Md, Ms, Oluseye Raymond, Md, Andrew Walrond, Md, Alexis Tingan, Md, Marisa Moreta, Do

Health Equity and Quality Improvement (HEQI) Summit

Introduction & Aims

Health inequities are ubiquitous throughout medicine especially pertaining to accessibility, affordability, and availability. These challenges disproportionately affect minorities- both patients and providers alike [3,4]. Patient outcomes have been shown to improve when treated by physicians of similar backgrounds [3,4,7]. The journey to improve outcomes begins with pre-residency rotations; medical students who can complete audition rotations have an increased opportunity to matriculate into said residency program. Physical Medicine & Rehabilitation (PM&R), like many specialties, is disproportionately represented by men and Caucasians [1,5, 8] with the greatest drop in URM representation occurring between applicants and residents [Escalon]. This project …

The Effect Of Targeted Outreach To Improve Cpap Adherence In Patients With Socioeconomic Disparities, Henry Ideker, Md, Ethan Zheng, Ba, Stephen White, Md, Ritu Grewal, Md

Health Equity and Quality Improvement (HEQI) Summit

Introduction

• Continuous positive airway pressure (CPAP) is first line treatment for obstructive sleep apnea (OSA) in adults given its high efficacy; however, it is limited by poor patient compliance
• Socioeconomic disparities are known to be associated with significantly worse health outcomes and adherence to therapy¹
• Area deprivation index (ADI) is a validated tool that highlights populations with high socioeconomic disparities on a neighborhood level.² Prior research in our department in 2022 demonstrated significantly worse CPAP adherence in OSA patients with higher ADI scores.³
• Initial CPAP use has been shown to predict long-term adherence, and strategies to maximize …

Framing The Future: A Community Health Analysis Of The Pee Dee Region, Stephen Borders, Jean Anton, Rian Fontaine, Donielle Phillips, Treyton Ringer, Jessica Robinson, Caitlin Thompkins

Public Health

This report presents a comprehensive, data-driven analysis of community health across South Carolina’s Pee Dee region, encompassing Florence, Darlington, Chesterfield, Marlboro, Marion, and Dillon Counties. Using tract-level data from CDC PLACES, the U.S. Census, and the National Provider Identifier registry, it assesses chronic health conditions, health behaviors, and social determinants of health. The analysis incorporates the South Carolina Healthy Communities Index (SCHCI) and a Suitability Analysis to identify the region’s most disadvantaged communities. The findings highlight persistent disparities, particularly in rural counties, where high rates of poverty, chronic disease, and unmet basic needs intersect with limited access to care. Despite …

Integrating Positive Psychology And Spirituality To Foster Meaning And Well-Being In Older Adults, Crystal Morris

Adultspan Journal

This perspective article explores the integration of positive psychology interventions (PPIs) and spirituality in therapy to foster meaning and well-being in older adults. It highlights exercises such as the positive introduction, positive legacy, character strengths, mindfulness, mindful-based yoga, and a manifestation prayer journaling. The interventions presented are tools to support older adults that may experience depression, difficult life transitions, and the search for renewed meaning. Therapists who integrate PPIs and spirituality into therapy can promote a holistic, non-pathological approach to treatment.

A Clinical Review Of Suicide Risks In Dermatology, Rahib K. Islam, Victoria T. Tong, Shari R. Lipner

School of Medicine Faculty Publications

Patients with visible skin diseases, including acne, psoriasis, and atopic dermatitis, face heightened risks of psychological distress, depression, and suicidal ideation, often exacerbated by social stigma and reduced quality of life. This review explores the intersection between dermatology and suicide, highlighting the psychosocial impact of visible skin conditions and the controversies surrounding treatment-related risks, including isotretinoin and biologic exposure. Current evidence suggests that while isotretinoin has been historically linked to mood changes, robust studies do not support a direct association with suicide. Incorporating mental health screenings into dermatological practice is essential for early identification and management of at-risk patients. By …

Frontier Healthscapes: Competing Narratives Of Disease, Environment, And Wellbeing In Early Minnesota, Aidan Reynolds

Geography Honors Projects

Across settler societies, health narratives were shaped by evolving tensions between lay and expert knowledge, frameworks of disease causation, and perceptions of the environment as both a source of health and a threat. In the decades following Euro-American settlement (1860-1900), Minnesota became a focal point for these debates, with its landscape fostering complex and competing narratives on health, wellbeing, and disease. This paper explores how public health discourse developed in Minnesota through the perspectives of institutions, the public, and economic interests. Combining environmental history with critical discourse analysis of archival materials, this study examines shifts within the Minnesota State Board …

The Fraught Path To Residency For International Medical Graduates, Fatima Mossolem, Nidhi Chaudhary, Kate Whelihan, Venkat Venkataraman

Rowan-Virtua Research Day

Background:

International medical school graduates (IMGs) are a vital part of the physician workforce in the United States helping to combat the ongoing physician shortage. The Association of American Medical Colleges reported that 42.3% of hospitalists were IMGs, physicians that also comprise a significant part of primary care physicians in rural underserved areas. Students in a gray area of immigration statuses such as those in DACA or those that have lived in the US for years waiting to attain citizenship are automatically considered “international students” and have typically received less residency interviews, and have had a harder time matching into …

Enhancing The Eden Alternative Model With Well Standards: A Case Study Analysis, Mariah Stoner

Architecture Masters of Science Program: Theses

This thesis investigates the potential for improving the Eden Alternative Model, a person-centered approach to elder care that emphasizes creating a homelike environment and meaningful relationships, using WELL Standards, a building certification system focused on enhancing human health and well-being through improvements in environmental quality. Through a mixed-methods approach involving quantitative data analysis and qualitative case studies, this research examines how WELL Standards, which cover aspects such as air quality, water quality, lighting, and thermal comfort, can improve environmental quality and resident satisfaction within the Eden Alternative Model. This research introduces a tailored approach to elder care by combining these …

Broadening And Broadcasting The Impact Of Cardiovascular Risk Factors Among Muslim Residents Of Southern New Jersey With Special Emphasis On Opportunities Of Future Interventions And Prevention Tactics, Maikel Mansour, Ocean Alam, Samiha Hossain, Kirsten M. Carlberg, Katarina Rusinak

Rowan-Virtua Research Day

According to AHA and NIH, CVD includes stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease. Between 2017 and 2020, 127.9 million US adults (48.6%) had some form of CVD.

Among the target population, it was found that observing Ramadan fasting leads to an increase in total cholesterol, low-density lipoprotein cholesterol, and triglycerides levels post-fasting. Yet, Islam emphasizes the importance of physical health as a privilege from God (Allah (swt)) and is seen as a religious duty.

The objective of the HCOP service project was to investigate the …

Men’S Fertility Beliefs, Intentions, And Contraceptive Use, Meagan Kunitzer

Dissertations and Doctoral Documents, University of Nebraska-Lincoln, 2023–

Despite advancements in reproductive technology, gender-inclusive approaches remain limited, and research on men’s reproductive health is scarce. Specifically, little is known about how men conceptualize reproductive health and how perspectives vary by race and social class. As such, the purpose of this study is to further the field’s understanding of men’s reproductive health, including fertility beliefs, intentions, and behaviors. Guided by the theory of conjunctural action, this study uses survey-driven narrative construction to explore how 35 men think about their reproductive health and how this varies by race and class. The main benefit of using this method is that it …

Assessing The Accessibility Of Wound Care Education For Unhoused Individuals Of South Jersey, Marilyn A. Chen, Selma S. Benkhoukha, Allysone Martinez

Rowan-Virtua Research Day

Unhoused individuals face disproportionately high rates of wound-related complications due to environmental exposure, limited access to hygiene facilities, and delayed care. This study assessed the accessibility of wound care for the unhoused population in South Jersey, where approximately 2,607 individuals experience homelessness on any given night. Our research identified significant barriers to wound care access, including transportation limitations, lack of identification documents, absence of a physical mailing address, and language barriers. Data analysis revealed concerning trends: a 24% increase in New Jersey's homeless population in 2024, with Black/African American individuals representing 49% of the homeless population despite comprising only 12% …

Patient Perspectives On The Role Of Healthcare Providers In Addressing Food Insecurity In A Nj Primary Care Setting, Anna Flts, Lisa Huang, Aarsa Moosavi, Jha Stuti, Philip B Collins

Rowan-Virtua Research Day

Background:

Food insecurity is a critical social determinant of health, yet is rarely discussed with patients in primary care settings. The objective of this project is to explore patient perspectives on the physician role in addressing food insecurity as well as to identify factors associated with food insecurity among patients in family medicine clinics.

Methods:

A cross-sectional survey was distributed to patients (n=250) across two academic family medicine clinics in South New Jersey between May 2023 and December 2024. Demographics, self-reported health status, and comfort with discussing food insecurity were collected. Additionally, food insecurity status was determined based on the …

Exploring Anticoagulant Prescription Disparities: A Focus On Hispanic Patient Care, Michael Acevedo, Vanessa Veltre

Rowan-Virtua Research Day

Anticoagulants play a critical role in preventing thromboembolic events, yet disparities persist in their prescription among minority populations. This presentation explores inequities in anticoagulant prescribing patterns, with a specific focus on Hispanic patient care. Using retrospective electronic health record data, we analyzed the prescription rates of warfarin versus direct oral anticoagulants (DOACs) among adults with clinical indications for anticoagulation. Our findings reveal that Hispanic patients are significantly less likely to receive DOACs compared to non-Hispanic White patients, even after adjusting for demographics, comorbidities, and insurance status. Contributing factors include language barriers, lack of insurance, and potential implicit bias in provider …

Indirect Cost Cap: Perspectives On Efficiency, Waste, And Equity, Neel B. Patel, Lakshman Segar

Rowan-Virtua Research Day

Background: On February 10, 2025, the NIH enacted a 15% cap on indirect costs, reallocating $4 billion from institutional overhead to direct research within a $35 billion funding framework. The policy follows longstanding concerns about unchecked growth and inefficiencies in indirect cost reimbursements, which rose from 15% in the 1950s to over 70% at some institutions by the 1990s. Notable examples include a $200 million overcharge at Stanford and millions in questionable expenditures identified in federal audits.

Objective: To evaluate the financial, operational, and equity-related impacts of the NIH’s indirect cost cap on U.S. research institutions.

Methods: …

Pre-Operative Clinical Characteristics Vary By Race In Patients With Obesity Undergoing Bariatric Surgery, Minjal Patel, Jasmine Park, Melissa Gott, David Kelter, Luke Perry, Ajay Menon, Paul Osterdahl, Casey Connors, Venkateswar Venkataraman, Nicole Stouffer, Gus J. Slotman

Rowan-Virtua Research Day

Background Data and Purpose: With the increasing prevalence of obesity, it impacts the practice of surgeons across various specialties. Non-bariatric surgeons are confronted with morbid obesity need clinical insight in managing medically fragile patients. The objective of this study is to identify pre-operative clinical variation by race among surgical patients with obesity.

Methods: Pre-operative data from 156,502 bariatric surgery patients were analyzed in four groups: Caucasian (C; n=125,492), African American (AA; n=18,226), Hispanic (H; n=12,405), and Asian (A; n=379). Data: Demographics, weight, BMI, and 33 obesity co-morbidities. Statistics: Chi-square and ANOVA.

Results: Pre-operative C/AA/H/A weight (KG) (130+-27/135+-28/127+-27/122+-26), BMI (46+-8/48+-9/47+-8/45+-7), % …