Health Services Research Commons^™

Comparative Analysis Of Health Outcomes In Gastric Cancer: Robotic Vs. Laparoscopic Gastrectomy, Maftuna Kurbonnazarova

Rowan-Virtua Research Day

Exploring the most effective surgical approach for gastrectomy is crucial for determining superior health outcomes in patients. This research compares robotic and laparoscopic techniques with the aim of pinpointing the optimal method, offering valuable insights for improved postoperative well-being.

A Problem-Based Approach To Racial And Ethnic Inequities In The German Health System, Thomas C. Lane

German Studies Undergraduate Senior Theses

This work is the first comprehensive book-length survey of racial and ethnic inequities in Germany’s health system. It takes a novel approach to understanding health inequities by focusing on the overarching structures which shape them in the German context, using examples from various areas of the health system to clarify their nuances. The Introduction grounds the need for understanding and combating health inequities in Germany’s unique postwar constitutional commitment to human dignity. Next, Chapter 1 outlines the current methods by which inequities are measured in Germany and why they are problematic. Chapter 2 covers current inequities in the provision of …

Socioecological Factors Associated With The Timing Of Prenatal Care Initiation In Kentucky And Beyond: An Exploratory Study., Melissa B. Eggen

Electronic Theses and Dissertations

Objectives: Early prenatal care is initiated in the first twelve weeks of pregnancy and is a known contributor to improved short- and long-term outcomes for women and infants. Despite its known benefits, many women do not initiate early prenatal care. The purpose of this dissertation was to explore the socioecological factors associated with the timing of prenatal care initiation in the United States and in Kentucky. Methods: Chapter Two of this dissertation used a scoping review methodology to identify barriers and facilitators related to first-trimester prenatal care initiation among women in the United States. Chapter Three of this dissertation used …

Reimaging Safety After Sexual Violence: A Qualitative Exploration Of Survivors' Experiences With Formal And Informal Crisis Response Networks., Hallie Ruth Decker

Electronic Theses and Dissertations

Sexual violence (SV) is a highly prevalent public health and human rights concern impacting communities across the United States. SV is associated with a myriad of adverse physical, reproductive, sexual, mental, behavioral, financial, and social health outcomes which may be acute or chronic. Health challenges associated with post-traumatic stress and post-traumatic stress disorder are particularly common among victims and survivors of SV. Engagement in early psychological/psychosocial intervention strategies may prevent or reduce PTSD-related symptomatology after experiencing an SV encounter. Despite the availability of crisis response and support options to support individuals who have experienced SV, significant barriers exist across social …

Fatty Acid Concentrations In Preterm Infants Fed The Exclusive Human Milk Diet: A Prospective Cohort Study, Lindsay F Holzapfel, Jana P Unger, Pam Gordon, Heeju Yang, Joanne E Cluette-Brown, Laura A Gollins, Amy B Hair, Camilia R Martin

Faculty, Staff and Student Publications

OBJECTIVE: Quantify blood fatty acids and growth outcomes in preterm infants fed the exclusive human milk diet.

METHODS: A prospective cohort study of 30 infants 24-34 weeks gestation and ≤1250 g fed the exclusive human milk diet. Blood fatty acids were quantified at two time points. Comparisons were made using two-sample t-tests and Wilcoxon rank sum.

RESULTS: Donor human milk-fed (n = 12) compared to mother's own milk-fed infants (n = 18) from birth to after 28 days of life, had an increased interval change of linoleic to docosahexaenoic acid ratio (5.5 vs. -1.1 mole percent ratio, p = 0.034). …

Perceptions Of Metabolic Syndrome Management Utilization In Relation With Patient Characteristics And Health-Related Quality Of Life, Olajide Adekunle

Pharmaceutical Sciences (PhD) Dissertations

Challenges in managing MetS include untreated risk factors and ineffective management, resulting in poor health-related quality of life (HRQoL). A significant factor contributing to these challenges is the underutilization of management services, possibly due to patients' perceptions of disease management resource utilization (PMU). Therefore, understanding patients' PMU is crucial for improving health outcomes. The study investigated PMU, explored PMU predictors, and investigated the impact of PMU and patients’ demographics on HRQoL. Using a cross-sectional design, data on perceptions of healthcare, medication, and pharmacy service utilization, prior experience with pharmacy services, demographics, and HRQoL were collected from adult individuals with obesity …

Exploring The Lived Experience Of Self-Care In Young Adults With Type 2 Diabetes, Holly Berry-Price

Electronic Theses and Dissertations

Introduction

The prevalence of prediabetes in adults aged 18 or older was as high as 38% between 2017-2020. Youth-onset T2DM is a more aggressive phenotype than T2DM that occurs later in life. Young adults with T2DM have poorer health outcomes, lose an average of 15 years of life, all resulting in significant economic burden impacting the person. Current self-management interventions do not improve health outcomes in young adults with T2DM.

Purpose

The purpose of this research was to explore the self-care experiences of young adults living with T2DM.

Methods

Existential hermeneutic phenomenology informed the research. Inclusion criteria as follows: adults …

An Assessment Of The Current State Of Nursing Homes In The United States, Southern Region, And Tennessee, Nicole Galler

Electronic Theses and Dissertations

Introduction: Nursing homes throughout the U.S. have faced unprecedented challenges in recent years because of staffing shortages, and under-investment, especially since the COVID-19 pandemic. To gain insight into the current state of nursing homes, this study examined nursing home characteristics, quality, and accessibility from a national, regional and state perspective.

Methods: This cross-sectional study used secondary data from the Centers for Medicare and Medicaid Services, American Community Survey, Medicare Beneficiary, and the Tennessee Department of Health. Nursing home characteristics and quality were assessed through bivariate and multivariate regression in the U.S. Assessment of HHS Region 4 nursing home characteristics and …

Healthcare Providers’ Screening And Counseling For Tobacco Use Among Youth In The United States: Prevalence, Practices, And Providers’ Perspectives, Adeola Omolade Ayo

Electronic Theses and Dissertations

Youth tobacco use is a public health concern in the United States (U.S.) with about 2.8 million middle and high school youth reporting current tobacco use in 2023. Healthcare providers (HCPs) can play a crucial role in addressing youth tobacco use through screening and counseling, yet rates of these interventions are suboptimal. Tennessee has a high prevalence of youth tobacco use and not much is known about these interventions in Northeast Tennessee. This study has several objectives: 1) conduct a scoping review of available evidence on screening and counseling for youth tobacco use and identify related gaps; 2) assess youth …

The Association Between Prenatal Care And Postpartum Depression: Current State And Future Directions, Esther Adebayo-Abikoye

Electronic Theses and Dissertations

Background

Postpartum depression (PPD) is a major public health challenge and associated with poor maternal and infant health outcomes. Quality prenatal care decreases adverse outcomes in pregnancy and may reduce PPD risk factors. This study critically reviews the evidence about the role of prenatal care practices in reducing PPD prevalence across population groups and examines the association between prenatal care timing and counseling content with PPD prevalence.

Methods

A scoping review was completed across eight databases to synthesize evidence about prenatal care and PPD across different contextual settings. National data from the Pregnancy Risk Assessment Monitoring System (PRAMS) was used …

Trends And Updates On The Epidemiology Of Cancer Associated Thrombosis: A Systematic Review, Ang Li, Emily Zhou

Faculty, Staff and Students Publications

Introduction: Cancer associated thrombosis (CAT) is a significant complication for patients with cancer. This review summarizes an updated epidemiology of CAT in the past decade.

Methods: A systematic review was conducted on relevant population cohort studies published 2011-2024.

Results: The 12-month incidence of CAT among patients with unselected cancers is approximately 3-5% (9-fold increase vs. matched non-cancer population); although the risk increases to 6-8% in patients with advanced cancers requiring systemic therapy (20-fold increase vs. matched non-cancer population). Despite improvement in anticoagulation usage and adherence, recurrence risk remains high at 5-8% at 6 months and 7-15% at 12 months. Important …

Travel-Time Disparities In Access To Proton Beam Therapy For Cancer Treatment, Todd Burus, Alexander Vanhelene, Michael Rooney, Krystle Lang Kuhs, W. Jay Christian, Christopher Mcnair, Sanjay Mishra, Arnold Paulino, Grace Smith, Steven Frank, Jeremy Warner

Department of Pharmacology, Physiology, and Cancer Biology Faculty Papers

IMPORTANCE: Proton beam therapy is an emerging radiotherapy treatment for patients with cancer that may produce similar outcomes as traditional photon-based therapy for many cancers while delivering lower amounts of toxic radiation to surrounding tissue. Geographic proximity to a proton facility is a critical component of ensuring equitable access both for indicated diagnoses and ongoing clinical trials.

OBJECTIVE: To characterize the distribution of proton facilities in the US, quantify drive-time access for the population, and investigate the likelihood of long commutes for certain population subgroups.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study analyzed travel times to proton facilities in …

Risk Evaluation In Occupational Safety And Health Research: Results From A Benchmarking Exercise Of Federal And Academic Irbs, Sarah A Felknor, Jessica M K Streit, Angela M Morley, John D Piacentino

Faculty, Staff and Student Publications

OBJECTIVE: Research involving working populations can pose unique ethical and risk evaluation challenges. The purpose of this benchmarking project was to assess how federal agencies and academic institutions approach the interpretation and application of key risk evaluation concepts in research involving workers in their places of employment.

METHODS: Key informant interviews were conducted to ascertain current practices related to assessing soundness of research design, determining risk reasonableness and research relatedness of risks, and evaluating the risk of noninvasive clinical tests in occupational settings.

RESULTS: There were noteworthy commonalities among the approaches described to review and address critical aspects of risk …

Examining Current Capacity Of Healthcare Systems: Identifying Potential Adaptations For Children And Youth With Special Healthcare Needs, Caitlin Koob

All Dissertations

Children and youth with special healthcare needs (CYSHCN) are a growing proportion of the pediatric population, accounting for 23% of children in South Carolina (SC). Children with medical complexity (CMC) are a subgroup of CYSHCN who experience the most complex conditions and comprise

This dissertation investigates equitable healthcare access, service quality, and health and well-being among CYSHCN and their families, within the context of SC’s healthcare system. Three studies make up this dissertation, focusing on various aspects of healthcare access and experiences of CYSHCN and their families.

Impact Of Medicaid Redetermination On Underserved Populations In Region 7 States: A Review, Brianna Parr

Capstone Experience: Master of Public Health

When the COVID-19 Public Health Emergency ended in May of 2023, Medicaid began the process of redetermination across the states and returned to its original eligibility rules. Because of this, the healthcare status of many Americans was affected, resulting in the loss of healthcare coverage for millions of people. Of those who have lost coverage, children make up almost half of the total. This paper assesses the negative effects of Medicaid redetermination on children and other underserved populations in communities across the four states in Region 7 (Nebraska, Iowa, Missouri, and Kansas) and identifies programs that these states can implement …

Emerging Evidence For Glucagon-Like Peptide-1 Agonists In Slowing Chronic Kidney Disease Progression, Michael W Holliday, Livia Frost, Sankar D Navaneethan

Faculty, Staff and Students Publications

PURPOSE OF REVIEW: Diabetic kidney disease continues to increase, and several novel therapeutic agents have been shown to slow the progression of chronic kidney disease in those with diabetes. This review summarizes more recent data on the role of glucagon-like peptide-1 (GLP-1) receptor agonists and kidney outcomes.

RECENT FINDINGS: Posthoc analysis of cardiovascular outcome trials, as well as several retrospective studies, demonstrate benefits of GLP-1 receptor agonist therapy for chronic kidney disease progression in diabetics. Although limited randomized clinical trials evidence assessing the effects of GLP-1 receptor agonists on kidney outcomes in diabetic chronic kidney disease patients have been published, …

Caenorhabditis Elegans Endorse Bacterial Nanocellulose Fibers As Functional Dietary Fiber Reducing Lipid Markers, Amanda Muñoz-Juan, Adrien Assié, Anna Esteve-Codina, Marta Gut, Núria Benseny-Cases, Buck S Samuel, Esther Dalfó, Anna Laromaine

Faculty, Staff and Students Publications

Bacterial nanocellulose (BNC) is a promising dietary fiber with potential as a functional food additive. We evaluated BNC fibers (BNCf) in the Caenorhabditis elegans model to obtain insight into the BNCf's biointeraction with its gastrointestinal tract while reducing the variables of higher complex animals. BNCf were uptaken and excreted by worms without crossing the intestinal barrier, confirming its biosafety regarding survival rate, reproduction, and aging for concentrations up to 34 μg/ml BNCf. However, a slight decrease in the worms' length was detected. A possible nutrient shortage or stress produced by BNCf was discarded by measuring stress and chemotactic response pathways. …

Engineering Small-Molecule And Protein Drugs For Targeting Bone Tumors, Yixian Wang, Chenhang Wang, Meng Xia, Zeru Tian, Joseph Zhou, Julian Meyer Berger, Xiang H-F Zhang, Han Xiao

Faculty, Staff and Students Publications

Bone cancer is common and severe. Both primary (e.g., osteosarcoma, Ewing sarcoma) and secondary (e.g., metastatic) bone cancers lead to significant health problems and death. Currently, treatments such as chemotherapy, hormone therapy, and radiation therapy are used to treat bone cancer, but they often only shrink or slow tumor growth and do not eliminate cancer completely. The bone microenvironment contributes unique signals that influence cancer growth, immunogenicity, and metastasis. Traditional cancer therapies have limited effectiveness due to off-target effects and poor distribution on bones. As a result, therapies with improved specificity and efficacy for treating bone tumors are highly needed. …

Angiogenic Gene Therapy For Refractory Angina: Results Of The Exact Phase 2 Trial, Kenta Nakamura, Timothy D Henry, Jay H Traverse, David A Latter, Nahush A Mokadam, Geoffrey A Answini, Adam R Williams, Benjamin C Sun, Christopher R Burke, Faisal G Bakaeen, Marcelo F Dicarli, Bernard R Chaitman, Mark W Peterson, Dawn G Byrnes, E Magnus Ohman, Carl J Pepine, Ronald G Crystal, Todd K Rosengart, Elaine Kowalewski, Gary G Koch, Howard C Dittrich, Thomas J Povsic, Exact Trial Investigators

Faculty, Staff and Students Publications

Background: XC001 is a novel adenoviral-5 vector designed to express multiple isoforms of VEGF (vascular endothelial growth factor) and more safely and potently induce angiogenesis. The EXACT trial (Epicardial Delivery of XC001 Gene Therapy for Refractory Angina Coronary Treatment) assessed the safety and preliminary efficacy of XC001 in patients with no option refractory angina.

Methods: In this single-arm, multicenter, open-label trial, 32 patients with no option refractory angina received a single treatment of XC001 (1×1011 viral particles) via transepicardial delivery.

Results: There were no severe adverse events attributed to the study drug. Twenty expected severe adverse events in 13 patients …

Mechanisms Driving Fasting-Induced Protection From Genotoxic Injury In The Small Intestine, Kali Deans-Fielder, Timothy Wu, Thanh Nguyen, Sarah To, Yang-Zhe Huang, Steven J Bark, Jason C Mills, Noah F Shroyer

Faculty, Staff and Students Publications

Genotoxic agents such as doxorubicin (DXR) can cause damage to the intestines that can be ameliorated by fasting. How fasting is protective and the optimal timing of fasting and refeeding remain unclear. Here, our analysis of fasting/refeeding-induced global intestinal transcriptional changes revealed metabolic shifts and implicated the cellular energetic hub mechanistic target of rapamycin complex 1 (mTORC1) in protecting from DXR-induced DNA damage. Our analysis of specific transcripts and proteins in intestinal tissue and tissue extracts showed that fasting followed by refeeding at the time of DXR administration reduced damage and caused a spike in mTORC1 activity. However, continued fasting …