Health Psychology Commons^™

Diagnostic Coding Of Physical Abuse Among Patients Evaluated By A Multidisciplinary Child Protection Team In A Pediatric Level I Trauma Center, Holly Hughes Garza

Dissertations and Theses (Open Access)

Child abuse is a substantial public health problem. Numerous studies have used hospital discharge data coded using the International Classification of Diseases, 9th and 10th Editions, Clinical Modification (ICD-9 and ICD-10) to identify cases of physical abuse seen in hospitals. Published studies on the sensitivity and specificity of ICD coding for physical child abuse are limited using ICD-9, and non-existent with ICD-10. This study examined the accuracy of ICD coding for physical child abuse, among patients less than 18 years of age, who were evaluated due to concern for physical abuse by a Multidisciplinary Child Protection Team (MCPT) during 2012-2013 …

The Prevalence Of Practicing Safety Professionals’ Knowledge, Involvement, And Competency Associated With Workplace Wellness Programs: Gauging The Safety Profession’S Engagement With The Total Worker Health Initiative, Jennifer C. Laine

Dissertations and Theses (Open Access)

The morbidity and mortality burden of occupational injuries and illnesses in the United States became such a public health concern that in 1970 the Occupational Safety and Health Act was signed into law. This law requires employers to provide workplaces “free from recognized hazards” and spurred the development of specific regulations along with the creation of academic and professional training programs to educate individuals about the safety sciences and careers in safety fields. Today there are an estimated 26,000 professionally trained and board certified safety professionals supporting workplace programs across the country, alongside numerous non-certified, but degreed, practicing safety professionals. …

Predictors Of On-Treatment Mortality Of Patients Undergoing Palliative Radiation Therapy: Improving The Quality Of End-Oflife Cancer Care, Matthew Stephen Ning

Dissertations and Theses (Open Access)

PURPOSE: Excessive medical treatment at end-of-life is an indicator of poor quality care. While radiation therapy (RT) is effective for palliation, some patients die shortly after or even during treatment. Any treatment that requires terminal patients to spend significant time in the hospital setting contradicts palliative goals. This study investigates patterns of end-of-life RT to inform quality improvement initiatives.

METHODS: All patients who died within 6 months of starting RT at a single large academic cancer center between 2015 through 2018 were identified through our institutional databases on an Institutional Review Board-approved protocol. Clinical factors including age, treatment service, number …

Measuring Goal Attainment In Chronic Disease Self-Management Within Clinical And Research Contexts: Development And Initial Testing Of The Goal Attainment Outcome Measure For Stroke (Gam-S), Barbara Kimmel

Dissertations and Theses (Open Access)

Background and Aims: Self-management (SM) skills help stroke survivors achieve behavior risk factors control. Goal setting and attainment are fundamental for SM. The most salient elements of SM effectiveness and measurements are just beginning to be understood. Investigation of measurement of goal attainment of SM risk factors has been the major aim of the study. My dissertation explores research questions concerning the goal attainment measure using data collected at the Veterans hospital.

Methods and Results: Introductory Chapters 1 and 2, include the background on stroke prevention through self-management interventions and a preliminary literature review of goal attainment in the context …

Social Capital And Health Services Utilization In Msm, Edward Tsai

Dissertations and Theses (Open Access)

While incidence of HIV has decreased overall and in most population subgroups, men who have sex with men (MSM) continue to remain at disproportional risk for new infection. In particular, MSM of color experience HIV incidence rates that continue to rise and represent the overwhelming majority of new cases each year. Evidence suggests greater risk among MSM may not be attributable primarily to individual behavioral level factors, but instead to structural and social environmental level factors such as access to health services. Access to health services represents a critical link in HIV and STI prevention, as health services provide serological …

Comparative Analysis Of Early And Late Tracheostomy Among Patients With Acute Heart Failure Exacerbation, Trends, Clinical And Economic Outcome Assessment, From 2005 To 2014 Nationwide, Min Ji Kwak

Dissertations and Theses (Open Access)

Heart failure is one of the leading causes of high morbidity and mortality. Acute exacerbation of heart failure may result in acute respiratory failure, which requires mechanical ventilator support. Despite supportive management, patients can fail extubation of the endotracheal tube and need a tracheostomy to continue mechanical ventilator support. However, optimal timing of tracheostomy has been controversial. Systemic study to assess the clinical and economic outcome of early tracheostomy among patients with acute heart failure exacerbation is lacking. The purpose of the study was to assess the national trend of tracheostomy among those who are admitted for acute respiratory failure …

Concurrent And Concordant Oral And Genital High Risk Human Papillomavirus Infections In The United States Population; Results From National Health And Nutrition Examination Survey (Nhanes), James M. Custer

Dissertations and Theses (Open Access)

Human papillomavirus (HPV) is a common sexually transmitted disease which infects various sites in the body including the genitals, oral cavity, and anal regions. Very little research has assessed the prevalence of concurrent and concordant high risk (HR) HPV oral and genital infections in the general United States population despite the fact that HR HPV oral pharyngeal cancers are on the rise in the US, particularly in men. To further our understanding of HR HPV concurrent and concordant infections we aim to estimate the prevalence of HR HPV concurrent and concordant infections in the U.S. population, and for men and …

Assessing The Impact Of Environmental Factors On Sedentary Behavior, Brandy Baker

Dissertations and Theses (Open Access)

Objectives Mexican Americans are burdened with many of the same noncommunicable diseases present in sedentary populations. Those living on the Texas/Mexico border have higher rates of obesity and diabetes than others in the nation. Sedentary behavior and perceptions of the environment have not been well studied among Mexican Americans, especially when examining education, gender and age. Study Design Sample was drawn from the Cameron County Hispanic Cohort (CCHC) where participants were randomly selected and completed a survey to report sedentary behavior and perceptions of the environment among other examinations. The participants’ initial visit with the CCHC was included in the …

Predictors Of Non-Adherence To Primary Care Follow-Up After Diagnosis Of Asymptomatic Hypertension In The Emergency Department, Stephanie Cornell

Dissertations and Theses (Open Access)

Background: One strategy to decrease uncontrolled hypertension is to increase follow-up with primary care after diagnosis of asymptomatic hypertension in the Emergency Department (ED). To improve such interventions, this study identified risk factors of nonadherence among individuals 18-60 years old with a diagnosis of asymptomatic hypertension in the ED and access to care. Methods: Data was obtained from the IBM® MarketScan® Commercial Database between January 2012 and September 2015. Rates of non-adherence to follow-up was determined for individuals discharged from the ED with a primary diagnosis of essential hypertension. Multivariate logistic regression was used to calculate adjusted odds ratios. Demographic …

Understanding The Similarity And Diveristy Of The Accessory Gene Regulator Quorum Sensing Systems In The Genus Clostridium, Rotem Magal

Dissertations and Theses (Open Access)

The Accessory Gene Regulator (Agr) quorum sensing system is a cell-cell communication system that is involved in regulating various bacterial processes such as toxin production, antibiotic production, biofilm formation, and other biomolecules. Despite the importance of the Agr system to Clostridia, the similarity and diversity of the system have been overshadowed by phylum-wide investigations of individual Agr components. To determine the variability of the Agr system within and between Clostridium species, we compared the sequences of its components within and between species using bioinformatics and phylogenetic tools. Putative Agr operons were found in over 50 Clostridia species, including undescribed components …

Estimating The Usual Intake From Fruits And Vegetables Consumed By Children At Baseline In Tx Sprouts, Taryn Alkis

Dissertations and Theses (Open Access)

Background: Past studies developed two- and three-part models to estimate the usual intake of episodically consumed foods in adults but not in children. The goal of this study is to evaluate if the three-part method is successful, by incorporating the dietary screener and two 24-hour recalls, in estimating the usual intake of fruits and vegetables consumed by boys and girls at baseline in TX Sprouts. Methods: Secondary data analysis of two 24-hour recalls and a dietary screener from TX Sprouts. Two approaches were used. First, the three-part model estimated the distribution of the usual intake of fruits and vegetables in …

Assessment Of The Common Dental Needs And Evaluation Of Rate Of Attendance Post Emergency Dental Management Among The Homeless Population In Houston, Texas, Heera Govindarajan Venguidesvarane

Dissertations and Theses (Open Access)

Background: Dental care resources for the homeless population are scarce, underfunded and generally inadequate to meet their oral health needs. While poor oral health is clearly an added burden for people who struggle daily to survive under miserable living conditions, little is known about their views on dental health, their perceived needs and their attitudes towards dental care. The purpose of this study was to determine the most common oral health needs of homeless patients and to identify their participation in receiving comprehensive care. Methods: The study was a cross sectional analysis where data were collected retrospectively using the records …

Predictors Of On-Treatment Mortality Of Patients Undergoing Palliative Radiation Therapy: Improving The Quality Of End-Of-Life Cancer Care, Matthew Stephen Ning

Dissertations and Theses (Open Access)

PURPOSE: Excessive medical treatment at end-of-life is an indicator of poor quality care. While radiation therapy (RT) is effective for palliation, some patients die shortly after or even during treatment. Any treatment that requires terminal patients to spend significant time in the hospital setting contradicts palliative goals. This study investigates patterns of end-of-life RT to inform quality improvement initiatives. METHODS: All patients who died within 6 months of starting RT at a single large academic cancer center between 2015 through 2018 were identified through our institutional databases on an Institutional Review Board-approved protocol. Clinical factors including age, treatment service, number …

Validation Of The Conflict In Adolescent Dating Relationships Inventory (Cadri) In Young Adolescents: An Analysis Of Construct Validity And Measurement Invariance, Stephanie J. Stroever

Dissertations and Theses (Open Access)

Adolescent dating violence, defined by the Centers for Disease Control and Prevention as “physical, sexual, psychological, or emotional aggression within a dating relationship, including stalking,” among adolescents in intimate relationships is a serious public health concern (Centers for Disease Control and Prevention, 2018). Per the 2017 national Youth Risk Behavior Surveillance (YRBS) survey of high school students in the United States, 10.7 percent of females and 2.8 percent of males that reported a romantic relationship in the prior 12 months experienced sexual dating violence (Kann et al., 2018). Additionally, 9.1 percent of females and 6.5 percent of males reported physical …

The Prevalence Of Birth Defects Among Non-Hispanic Asians And American Indians/Alaska Natives In Texas, 1999-2015, Van Le

Dissertations and Theses (Open Access)

Background: Birth defects are disproportionately higher among certain race/ethnic groups. We examined how birth defects prevalence differs among the less studied non-Hispanic (NH) Asian and any American Indian/Alaska Native (AI/AN) populations, relative to NH Whites. Methods: Data were obtained from the Texas Birth Defect Registry from 1999 to 2015 for infants born to Texas-resident mothers who were NH White, NH Asian, or AI/AN. This covers a livebirth population of 2.6 million. Prevalence ratios were calculated for NH Asians and AI/ANs (relative to NH Whites) for 44 birth defects using Poisson regression and were adjusted for maternal age. Results: After adjustment, …

Protective Or Destructive? Investigating The Relationship Between Gentrification And Childhood Health Outcomes, Mike Henson Garcia

Dissertations and Theses (Open Access)

Gentrification is a wildly contentious, highly politicalized issue that some scholars view as beneficial and others view as harmful. Historically, public health researchers have studied several neighborhood effects on health but only recently has this research field evolved to include studies specifically looking at the health ramifications associated with this neighborhood-change process. This secondary analysis is one of the first studies to examine the effect neighborhood-level gentrification has on mental health status in a childhood and adolescent sample. Results find that no main effect exists between gentrification and mental health problems directly. However, a statistically significant interaction-- between gentrification and …

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

Dissertations and Theses (Open Access)

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

Women In Leadership: A Qualitative Review Of Challenges, Experiences, And Strategies In Addressing Gender Bias, Brynn Harris

Dissertations and Theses (Open Access)

Women are entering the workforce at an increasing rate, yet they are still drastically underrepresented in leadership positions. The primary research question addressed in this study was two-fold: what challenges have women faced in pursuit of leadership positions, and how have these women overcome these challenges to achieve success? While quantitative research has ventured into determining why there is still such a large gender gap in leadership positions, this study aimed to better understand the actual life experiences of successful female leaders. In this study, twenty-six women who hold – or recently held – significant leadership positions participated in qualitative …

Redesigning Care: Evaluation Of A Postpartum Depression Screening And Treatment Program In Obstetric Clinics In Houston, Texas, Haley D. Jackson

Dissertations and Theses (Open Access)

Postpartum depression is a common complication of childbirth and is often underdiagnosed although it affects about 13-15% of new mothers (O’Hara and Swain, 1996; Munk-Olsen et al., 2006). To improve detection and treatment for postpartum depression, four obstetric clinics in Houston, Texas were trained to use the Edinburgh Postnatal Depression Scale (EPDS) to screen women for postpartum depression at the 6 week postpartum visit. The purpose of this study was to evaluate compliance with screening women for postpartum depression at the 6 week postpartum visit, with referring women that score at-risk to the women’s reproductive mental health clinic, and with …

Additional Healthcare Expenditures Of Depression For Elderly Cancer Patients With Depression, Dian Gu

Dissertations and Theses (Open Access)

The risk of depression is high for cancer patients and a large portion of cancer patients are age 65 and over. Both depression and cancer are economically burdensome and depression is associated with healthcare expenditure increase for elderly patients. However, whether comorbid depression affects healthcare expenditures in elderly cancer patients from payers’ and patients’ perspectives is largely unknown. Objective: To investigate whether depression is associated with higher healthcare expenditure among elderly cancer patients from both payers’ and patients’ perspectives and, and determine whether depression is associated with higher probability of having high out-of-cost burden. Methods: From the Medicare Current Beneficiary …