Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2022, Nursing

Nursing education transformation is necessary to change population health outcomes. A needs assessment is essential to learn practice expectations for population health competency before designing an education program. The purpose of the project was to develop a population health certificate program for post-bachelor nursing workforce. The project aims were 1) to identify population health competency needs, 2) to prioritize population health competency needs, 3) to assess the feasibility of a post-bachelor population health certificate program, and 4) to make recommendations for a certificate program. A hybrid framework of Witkin and Altschuld's three-phase needs assessment model and the PARIHS Framework Guide successfully organized project implementation and evaluation to make recommendations for the population health certificate. Purposive sampling selected six knowledgeable strategic stakeholders from academia and practice to participate in 30-to-40-minute recorded Zoom interviews. Reiterative thematic analysis of the transcripts identified and prioritized population health competencies. The triangulation comparison of the results with AACN Nursing Professional Education Essentials tested the validity of the convergence of themes. The overarching theme discovered is that the nursing workforce needs to move understanding beyond point of care encounters to population-focused needs. The needs assessment discovered compelling evidence that post-bachelor nursing workforce needs advanced development in population-focused care to improve actionable responses to change population health outcomes. The feasibility assessment determined a need for additional assessment of resources to build capability for the population certificate program.

Committee: Betsy List Ph.D. RN (Advisor); Victor Ronis-Tobin Ph.D. (Other); Elizabeth Bragg Ph.D. RN (Other) Subjects: Education; Health Care; Health Care Management; Health Education; Higher Education; Nursing

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2024, Nursing

Burn injuries are considered a global cause of morbidity and mortality (Fuzaylov et al., 2021). Increased incidences of burn-related injury have been found to coincide with the lack of community burn prevention programs (Fuzaylov et al., 2021). In this DNP scholarly project, findings are presented specific to the implementation of a pop-up community burn prevention event in the city of Norwood, Ohio. The following PICO(T) question was asked, are community members in Norwood, Ohio more likely to improve and implement individual fire safety and burn prevention interventions after participation in a community burn prevention program? The scholarly project assessed validity, reliability, and self-efficacy specific to the introduction of fire safety and burn prevention education via teach back and a self-assessment survey following the implementation of burn prevention education specific to fire extinguisher use, smoke detector operation, and mapping out a home fire escape plan. A total of 43 individuals participated in the burn prevention pop-up event. Of the 43 community members, 37 individuals completed and returned the questionnaire. Six community members opted not to participate in the post education assessment. Of the study participants measured, 38 individuals were able to correctly perform the PASS method of fire extinguisher operation, 41 individuals were able to demonstrate competence of smoke detector operation, and 35 individuals were able to correctly map out the correct exit sequence on a home escape map. Of the study participants measured, 31 individuals correctly identified that smoke detectors should be tested once monthly, 30 study participants were able to correctly identify the Pull, Aim, Squeeze, and Sweep process of fire extinguisher operation, and 30 study participants noted improved self-efficacy of fire safety/burn prevention knowledge. Study findings noted improvement in individual implementation specific to fire safety/burn prevention i (open full item for complete abstract)

Committee: Miranda Knapp PhD, DNP, APRN, AGNS-BC, CNE, EBP-C (Committee Chair); Angela Liggett DHA, MSN, RN, APFN (Advisor) Subjects: Health Care; Nursing

Doctor of Philosophy, Case Western Reserve University, 2023, Epidemiology and Biostatistics

Broad-scale interventions to improve food security and healthy food access for populations with a high chronic disease burden have largely not resulted in improved dietary patterns or reduced diet-related disease risk. These findings indicate current interventions may not be effective in modifying food system elements that drive health outcomes, illuminating a disconnect between a collective scientific understanding of food insecurity and creating successful interventions to improve population health. Food insecurity is currently operationalized and measured as a lack of financial resources to purchase food; however, this framework does not account for the multidimensional factors that compromise nutrition quality among low-income households. Nutrition security, a recently proposed term that expands on food security, has been defined as “consistent access, availability, and affordability of foods and beverages that promote well-being and prevent (and if needed, treat) disease.” Emphasizing nutrition in this context provides an opportunity to capture the complex and interrelated life experiences that structure diet quality outcomes in the development of a new nutrition security metric. This transitional phase poses an opportunity to conceptualize nutrition security with a system thinking lens to capture and unpack the interacting, multidimensional, and complex food system components that drive diet-related inequities among low-income populations. The goal of this dissertation is to gain system insights related to the complex food system that perpetuates nutritional and health disparities as well as examine proposed solutions (Chapter 2) and explore the relationship between diet quality, food security, and healthy food access factors to identify unique nutrition security typologies for low-income residents living in an urban area with low access to healthy food retail (Chapter 3). Chapter 2 investigates the system architecture and mechanisms related to nutrition secu (open full item for complete abstract)

Committee: Darcy Freedman (Advisor); Jin Kim-Mozeleski (Committee Chair); Peter Hovmand (Committee Member); William Bush (Committee Member); Jill Clark (Committee Member) Subjects: Nutrition; Public Health; Public Policy

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2021, Nursing

Population health encompasses direct measures to address health equity and health disparities. Health outcomes of a population are directly influenced by social determinants of health (SDoH) such as neighborhoods where patients live, ability to have sufficient income, access to transportation and availability of nutritional foods. Healthcare professionals such as nurses are in a pivotal position to impact health outcomes by addressing the SDoH with the patient population. For the nurse to be equipped to address these SDoH, nursing programs need to include educational experiences related to the SDoH for the nursing students. The purpose of the scholarly project is to further integrate SDoH into a hospital-based pre-licensure Associate of Applied Science in Nursing (AASN) curriculum. Developed student learning outcomes (SLO) specific to the health determinants were written addressing access to healthy foods and transportation, assessment of neighborhoods and home environments and resources for skills development to impact patient income. The SLOs were mapped to the curriculum matrix of the AASN nursing program. Collaboration with nursing faculty on the significance of the SDoH on health outcomes and the nurse's role facilitated dialogue on the incorporation of SDoH SLOs into the curriculum matrix and exploration of teaching strategies with the AASN students. Recommendations were provided to the nursing educators and leadership team to address SDoH within the AASN nursing curriculum. These recommendations will strengthen the practicing nurse's skills related to addressing SDoH, to have greater gains in impacting health outcomes of a population.

Committee: Betsy List Ph.D. (Committee Chair); Susan Allen Ph.D. (Committee Member) Subjects: Health Care; Nursing

Master of Science in Biology, Cleveland State University, 2020, College of Sciences and Health Professions

Inspiration for the Clean Water Act (1972), the Cuyahoga River has been one of the most protected rivers in the country since the 1970s. Water quality is now within acceptable limits outlined by the Ohio Environmental Protection Agency, shoreline integrity has improved, and sediments mostly test free from toxins and heavy metals. With recovery, various faunal communities, such as freshwater mussels (family Unionidae), are expected to re-establish; no previous surveys of the Cuyahoga focus on this issue. To better understand whether mussel populations recovered as water quality improved within the Cuyahoga Watershed, surveys were completed by two-person teams for one hour each. Sites were selected to compare either with earlier surveys in the 1990s within the Upper Cuyahoga or with possible dam removal sites within the Middle and Lower regions of the River. Site choice depended upon access. Surveys in 2012 were consistent with trends observed in the 1990s in species richness and population size within the upper portions of the Cuyahoga. However, when resurveyed in 2016 at the same sites, both abundance and species richness declined even in generalist species, as live individuals counted declined from 389 to 111. Species richness declined from the original eight species to four found in the 2012 survey. No previous work existed to provide comparison to our 2015 survey of 20 sites. In all, only 37 live individuals, representing three species, were located. One live individual was located within the Lower Cuyahoga in 2016, after teams surveyed 15 sites, representing a significant decline in abundance and diversity as the Cuyahoga flows from Geauga County, Ohio to the Cuyahoga Valley National Park and into Lake Erie. The loss of freshwater mussels is a complex problem resulting from the building and release of impoundments, pollution, and flow dynamics, challenging the ability to isolate a single cause. Removal of dams has increased complexity of this problem (open full item for complete abstract)

Committee: Robert Krebs (Advisor); Bernard Walton (Committee Member); Emily Rauschert (Committee Member) Subjects: Biology; Environmental Health; Environmental Studies

Master of Arts, Miami University, 2019, Economics

Medicare and Medicaid are U.S. Federal health insurance programs established in 1965 as an amendment to the Social Security Act of 1935. They provide coverage to the aged population (65+), low-income individuals, and to other subsets of the U.S. population. After reviewing the foundations of Medicare/Medicaid, I analyze the political economy of Members of Congress vote choices on the original 1965 Medicare/Medicaid law. I find evidence that the number of doctors per 100,000 individuals in a state is a strong predictor of vote choice and there is statistically significant interaction between percentage of Black Americans and the South. Moreover, there is evidence to suggest that party alignment of constituencies and geographic region played roles in persuading Republicans in party-contested states to defect. The behavior of these defectors is dependent on their party alignment and the party alignment of the majority in Congress. To assess the strength of the model across time and legislation, I run a fully interacted, pooled OLS regression on both the 1965 legislation, and the Medicare Modernization Act of 2003. I find the effects of hospitals do not hold across time. However, I find evidence target populations remain insignificant in both datasets, suggesting they are not strong influencers of vote choice.

Committee: Melissa Thomasson (Advisor); Gregory Niemesh (Committee Member); Deborah Fletcher (Committee Member) Subjects: Economic History; Economics; Health Care; Political Science; Public Policy

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2018, Nursing

Background: National healthcare has focused on diagnosis and treatment; while current evidence attributes population health and individual well-being largely to social determinants of health (SDH). Social determinants of health factors such as food insecurity, insufficient housing conditions, inadequate education services, safety, and limited access to medical care are associated with poor pediatric health outcomes. Problem: Nurses are uniquely positioned to address SDH in healthcare and have a professional obligation to screen for SDH when providing healthcare. However, nursing education has traditionally focused on acute care with minimal population health relevancy. The lack of association between nursing assessment of SDH and health outcomes impedes the advancement of population health and prevention. Global Aim: Promote population health and health equity by identifying and addressing SDH to improve the health and well-being. Objective aims include: (1) increase nurses' knowledge of SDH; (2) screen at least 50% of all admissions for core social determinants of health; and (3) appropriately refer 80% of patients who screened positive for SDH factors. Methods: Create an evidence based SDH education module and screening tool based on core SDH recommended by the Center for Medicare & Medicaid Services (CMS). After completing education, nurses will utilize the screening tool to efficiently identify unmet core SDH needs and make appropriate referrals. Results: Implementation of module significantly increased nursing knowledge and SDH screenings were completed on 47% of all admitted patients and families to the pilot unit. Additionally, nurses gave appropriate referrals to 85% of patients who screened positive for one or more unmet core SDH factor.

Committee: Debbie Van Kuiken PhD, RN, AHN-BC (Committee Chair); Susan Allen PhD, RN (Committee Member) Subjects: Nursing; Public Health

PHD, Kent State University, 2017, College of Public Health

Introduction: Up to 29.5% of U.S. adults are physically inactive. Physical inactivity is associated with excess mortality and morbidity and may contribute an estimated $131 billion in health care expenditures annually. Exercise prescriptions and referrals are an economical solution to physical inactivity, and several health care provider associations and proposed government policy initiatives support adoption of exercise prescriptions. Yet as few as 14% of primary care providers prescribe exercise or make exercise referrals. The purpose of this pilot study is to identify provider characteristics, knowledge, perceived barriers, practices, and needs related to place-based exercise prescription and referral to exercise either at a specific location, or to an exercise professional. Methods: An 88-item questionnaire was developed and administered electronically and in paper format to alumni of a university's nurse practitioner program and two hospital systems' networks of primary care physicians and nurse practitioners. Descriptive statistics were generated regarding clinical practices related to patient exercise and providers' perceived needs related to exercise prescription and referral. Factor analysis was conducted to identify underlying constructs. Bivariate analyses were utilized to identify variables significantly related to exercise prescription and referral. A binomial logistic regression was performed to determine factors related to whether or not providers refer patients to place-based exercise. Results: Responses were received from 166 providers; 61.5% were female, 86.9% were white. Respondents' specialties were: family medicine (20.6%), internal medicine (27.8%), nurse practitioner (29.4%), and other (22.2%). Overall, 14.8% of providers prescribe exercise to at least some of their patients and 54.3% refer patients to specific exercise locations or professionals. Almost 90% ask about patient exercise, 64.3% document patient exercise, and 20.8% assess (open full item for complete abstract)

Committee: Sonia Alemagno (Committee Chair); Jeffrey Hallam (Committee Member); Jonathan VanGeest (Committee Member) Subjects: Health; Health Care; Health Sciences; Public Health; Public Policy

Master of Science (MS), Ohio University, 2016, Industrial and Systems Engineering (Engineering and Technology)

The healthcare sector possesses big issues needing to be addressed in a number of nations including the United States. Problems within and effecting healthcare arena are complex as they are interdependent on several factors. It. To cope this situation and find solutions, best of predictions backed by data for effective decision making are required. Even though predictions are made, it takes extreme cautiousness to make claims for policy inaction. The EuroQol five Dimension (EQ-5D) questionnaire developed by the Euro-Qol group is one of the most widespread used tools assessing the generic health status of a population using 5 dimensions namely mobility, self-care, usual activities, pain/discomfort and anxiety/depression. This thesis develops a methodology to create forecasting models to predict these EQ-5D model indicators using chosen 65 indicators, capable of defining population health, from the World Bank, World Health Organization and the United Nations Development Programme databases. The thesis provides the capability to gauge an insight into the well-being at individual levels of population by maneuvering the macroscopic factors. The analysis involves data from 12 countries namely Argentina, Belgium, Denmark, Finland, France, Germany, Italy, Netherlands, Slovenia, Spain and United States, for both sexes with ages ranging from 18 to 75+. The models are created using Artificial Neural Networks (ANN) and are contrasted with statistical models. It is observed that the ANN model with all 65 indicators performed the best and the age group of 75+ was found to be the most correlated with EQ-5D dimensions. Conclusively the research also provides with the countries and indicators that need the most attention to improve the corresponding EQ-5D parameter. This thesis aims at fostering better policy making for increasing well-being of populations by understanding the impact of predominating factors affecting population health.

Committee: Gary Weckman (Advisor); Diana Schwerha (Committee Member); Tao Yuan (Committee Member); Andy Snow (Committee Member) Subjects: Aging; Artificial Intelligence; Behavioral Psychology; Behavioral Sciences; Behaviorial Sciences; Cognitive Psychology; Demographics; Demography; Developmental Psychology; Economics; Educational Tests and Measurements; Evolution and Development; Finance; Gender Studies; Health; Health Care; Health Care Management; Health Sciences; Higher Education; Industrial Engineering; Information Science; Information Systems; Information Technology; Literacy; Mental Health; Public Health; Public Policy; Sanitation; Social Psychology; Social Research; Statistics; Sustainability

Psy. D., Antioch University, 2022, Antioch New England: Clinical Psychology

The COVID-19 pandemic exacerbated the prevalence of anxiety disorders, making it a population health concern in the United States and worldwide. The growing need for effective prevention and treatment of anxiety coincides with a deficit of mental health providers and physicians. With the healthcare system currently overwhelmed and the slow training pipeline of new providers, the gap between patient demand and treatment providers will not be closed in the next decade. There is a growing need for evidence-based treatments for anxiety disorders that can increase access to care while addressing the underlying mechanisms of anxiety. Digital therapeutics is a fast-developing field that can be one such solutions provided in “one-to-many” format. It can be used in conjunction with individual therapy, as well as independently, depending on the severity of patients' symptoms. This quantitative dissertation study aimed to investigate the mechanism of reducing anxiety in the digital application (app) Unwinding Anxiety Program and its impact on emotion regulation, self-representation (self-esteem), and the degree of attachment security in adults. The study used a single-case experimental design to assess the effect size of the intervention in these domains. Five study participants completed the program. The results of the study demonstrated the efficacy of the intervention for reducing anxiety among participants with medium to large effect size and decrease of attachment-related anxiety for all participants with small effect size. All study participants demonstrated improved emotion regulation with moderate effect size for the sample. Self-esteem scores improved for some participants, while decreased for others. These findings support the existing evidence for the efficacy of mindfulness-based interventions for anxiety demonstrating the key role of emotion regulation in the mechanism of change. This study brings the novelty of examining the impact of digital therapeutic interven (open full item for complete abstract)

Committee: Theodore Ellenhorn PhD, ABPP (Committee Chair); Jennifer McLean PsyD (Committee Member); Barbara Belcher-Timme PsyD (Committee Member) Subjects: Clinical Psychology

Master of Public Health, The Ohio State University, 2022, Public Health

Having risen as a global concern, characterization of antimicrobial resistant (AMR) bacteria within different agricultural landscapes is essential to recognize and mitigate AMR-associated global health risks. Individual animal factors such as lactation stage, parity, and previous antimicrobial use and herd-level factors like size and production type may need to be supplemented with community-level factors such as landscape diversity, density of agricultural animals, soil composition, landscape fragmentation, and connectivity to describe AMR in across agricultural landscapes. Because cephalosporins are used extensively and commensal organisms often harbor resistance in cattle, we investigated herd and community level risk factors of broad-spectrum cephalosporin resistance (BSCR) in cattle across 54 cattle farms in two Ohio counties to explore the role of community-level factors in AMR. From the summer of 2019 through the summer of 2021, interview data, pooled manure samples from cattle, and deer manure samples were collected from farms (n=54) across two counties with different landscape types in Ohio. Proportions of BSCR Enterobacteriaceae were calculated using counts of bacterial colonies grown on non-selective and selective MacConkey agar plates. Herd level predictors included in analysis were outdoor access, other livestock species' presence on the farm, cattle imports to the farm, and herd size. Community level predictors were calculated using a centroid buffer with a 3-kilometer radius around each farm and included cropland diversity, mean dairy kernel density, mean beef kernel density, distance to nearest hospital, distance to nearest wastewater treatment plant, and proportion of broad spectrum cephalosporin resistance in deer manure collected on the property. Beta regression was used to identify significant predictors across both counties combined and stratified by county. Of all models, those including only herd size outcompeted the others in the combined ana (open full item for complete abstract)

Committee: Rebecca Garabed (Advisor); Jiyoung Lee (Committee Member); Stephen Matthews (Committee Member) Subjects: Public Health; Veterinary Services

Doctor of Philosophy, The Ohio State University, 2021, Consumer Sciences

This dissertation consists of three essays on the impact of publicly funded programs and how they can affect the well-being of the low-income population. The first essay focuses on Broad-based Categorical Eligibility (BBCE) expansion in Supplemental Nutrition Assistance Program (SNAP) eligibility in the United States. Applying the difference-in-difference model, I find that BBCE expansion in SNAP eligibility increases SNAP participation and weekly food expenditure and decreases food insecurity. The event-study model suggests that there is a lag between the effect of BBCE expansion on SNAP participation and food insecurity and the expansion and the effects are long-lasting. Using BBCE expansion as an instrumental variable for SNAP participation, I show that the effect of BBCE expansion on weekly food expenditure is through increased SNAP participation; however, the reduction in food insecurity cannot be explained by increased SNAP participation. The second essay focuses on maternity leave policies in the United States. Using the propensity score matching method, I find that a mother's maternity leave-taking is positively associated with the probability of children graduating from high school and the probability of children ever attending college. Subsample analyses also show that the effect is slightly larger for low-income mothers. The third essay examines the effect of New Rural Pension Schemes (NRPS) on the health conditions of older adults in rural China. Both regression discontinuity and triple-difference methods show that NRPS significantly improves self-reported health for the elderly in rural China and reduces reported symptoms of headaches, stomachaches, and asthma. In all, public transfer programs targeting the low-income population not only serve as a safety net to low-income individuals but also benefit the low-income population by improving their diet, health, and their children's outcomes.

Committee: Drew Hanks (Advisor); Caezilia Loibl (Committee Member); Robert Scharff (Committee Member) Subjects: Economics

Master of Arts, The Ohio State University, 2020, Sociology

Summary birth history (SBH) is a low-cost instrument widely used in developing countries lacking complete vital registration system for estimating demographic statistics. Indirect methods are utilized to estimate mortaliy rates the total number of children born and total number of children surviving data from SBH. However existing methods don't allow estimation for full detailed mortality age schedule with uncertainty. This paper introduces an innovative Singular Value Decomposition(SVD)-based method within the Bayesian framework, the SVD-Bayes model, to jointly estimate full age schedules of mortality for children and fertility for women from SBH data by single-month intervals along with uncertainty estimates. SVD model enables construction of full mortality and fertility age schedules with a few SVD-weight components. Posterior distributions for SVD-weight components are obtained using modified Approximate Bayesian Computation (ABC). Based on the results from simulation study, the SVD-Bayes model estimates full mortality age schedules by single-month age group from summary birth history data for children aged 0-20 years. The model also produces probability of giving birth by single-month age group for women of reproductive age. With SVD-Bayes model, SBH data from censuses and surveys could be used to produce mortality and fertility estimates for evidence-based policy-making and program monitoring and evaluation. The attempt of using ABC algorithm with SVD-Bayes model also shows the promising future of applying this advanced statistical technique in demographic research.

Committee: Samuel Clark (Advisor); Jon Wakefield (Committee Member); David Melamed (Committee Member) Subjects: Demography; Public Health; Sociology

PHD, Kent State University, 2020, College of Nursing

Between 18.5% and 21% of patients hospitalized for heart failure (HF) are readmitted within 30 days, representing a significant burden to the U.S. healthcare system. Readmission within 30-days has been considered an issue of poor quality of care by CMS, but for patients it may indicate the worsening of the disease process or difficulty managing their HF and other comorbidities. Further, disparities are known to exist for HF and HF hospital readmission for patients living in highly disadvantaged neighborhoods. Multidisciplinary interventions that account for care across health care settings, as well as the upstream factors that impact health overall, are needed to improve outcomes. The purpose of this study was to examine the relationship between early provider follow-up, nursing care coordination/transition management (CCTM) intensity, and 30-day hospital readmission in a population of older adults with HF, and to determine if an interaction exists with neighborhood disadvantage. The study was a retrospective, correlational design utilizing existing data. Inclusion criteria were age ≥ 65 years, hospitalization for heart failure, and discharge to the home setting. In the primary study, population-level data were obtained based on the geocoded addresses of record from the index admissions. All other data were obtained from medical records and billing databases. Logistic regression and moderated mediation analysis were used to describe the relationships between the study variables. A direct relationship between early provider follow-up within 14 days and decreased 30-day readmission was identified, but no indirect relationship through CCTM intensity. Further, neighborhood disadvantage did not moderate the direct effect of early provider follow-up on 30-day readmission. The relationship between early provider follow-up and CCTM intensity was significant and moderated by neighborhood disadvantage. Patients who had an early provider follow-up and lived in areas (open full item for complete abstract)

Committee: Dana Hansen PhD (Committee Chair); Lisa Onesko DNP (Committee Member); Amy Petrinec PhD (Committee Member); Lynette Phillips PhD (Committee Member); Hallam Jeffrey PhD (Other) Subjects: Health Care; Health Sciences; Nursing

Master of Public Health, The Ohio State University, 2018, Public Health

Influenza A virus is a zoonotic pathogen whose introduction to humans from animals could potentially cause a pandemic. Animal-linage influenza A viruses (IAVs) that infect humans are referred to as variant IAVs, which are designated with a `v' after the subtype. To better understand the epidemiology of IAV in exhibition swine and resulting H3N2v in humans, we performed a phylogenetic analysis using full genome sequences from 279 IAV isolates collected from exhibition swine in 5 states from 2013-2015 and 23 of the 25 H3N2v cases reported during those same years. Sixty-six fairs (23.7%) had at least one sample that was positive for IAV and 20 of those fairs (30.3%) had more than one IAV genotype circulating in the pigs. An overall 3-year prevalence of 9.7% (95% CI: 9.1-10.3) was observed. However, the prevalence of IAV in swine significantly decreased from 2014 to 2015 when the proportion of fairs with IAV infected pigs decreased from 30.14% (95% CI: 19.6-40.1) in 2014 to 13.5% (95% CI: 6.9-20.1) in 2015. We found 19 IAV genotypes infecting swine and 6 IAV genotypes in humans, with 5 genotypes in both host species. There was a positive correlation between the number of fairs at which a genotype was present among the pigs and the number of human cases of that same genotype. Additionally, we showed that H3N2v isolates clustered tightly with exhibition swine isolates that were prevalent in the same year. Our data indicate that there are multiple genotypes of swine-lineage IAV that can infect humans, and highly prevalent IAV genotypes during a given year are the strains most likely to infect humans.

Committee: Andrew Bowman DVM, MS, PhD (Advisor); Armando Hoet DVM, PhD (Committee Member); Gregory Habing DVM, PhD (Committee Member); Kurt Stevenson MD, MPH (Committee Member) Subjects: Animal Diseases; Animals; Public Health

Master of Science, Miami University, 2014, Exercise and Health Studies

This paper reports on an examination of first year students across their first semester with regards to changes in and associations among exercise stage of change, body weight, body dissatisfaction, and low self-esteem. The study was a secondary data analysis with three main objectives: to examine associations among variables at each time point, to examine changes in each variable across time, and to explore how change in exercise stage of change may explain changes in the other variables. Results were analyzed via a chi-square test of independence, correlations, several dependent t-tests, and a multinomial logistic regression. Across time, observed exercise stage of change was more stable than expected, and significant changes occurred in body weight and body dissatisfaction. However, exercise stage alone did not predict changes in other variables. This paper also presents limitations and strengths of the study, as well as directions for future research.

Committee: Rose Marie Ward PhD. (Advisor); Karly Geller PhD. (Committee Member); Jay Kimiecik PhD. (Committee Member) Subjects: Behaviorial Sciences; Health; Health Sciences; Social Psychology

Master of Science, University of Toledo, 2010, Pharmaceutical Science

Diabetes is a leading cause of morbidity and mortality in the United States. The American Diabetes Association has put forth guidelines to screen and prevent the progression of diabetes. However, lack of access to adequate health care can hinder treatment options for individuals diagnosed with diabetes. A number of organizations help uninsured individuals by providing access to health care. Toledo Lucas County CareNet has provided healthcare access to uninsured residents since 2003. The presented study focused on evaluating outcomes related specifically to CareNet members diagnosed with diabetes. The objectives of this study were to determine the percentage of patients with Type 2 diabetes that reached ADA recommended guidelines in A1c, blood pressure (Systolic and Diastolic) values, and lipid levels (HDL and LDL), and to determine the factors related to goal attainment. The factors studied were age, gender, race/ethnicity, height, weight, tobacco use, and pharmacotherapy. The study design was a retrospective chart review. Patient charts of Toledo Lucas County CareNet clients were reviewed. Data were collected from three major health systems in Toledo, Ohio, where CareNet members receive medical services. The results showed 179 patients met the inclusion criteria out of 712 charts reviewed from the three respective health centers. Goal attainment was observed in all clinical markers. About 62% of CareNet members in the study met goal in A1c, 60% of members met goal in systolic blood pressure, and 75% met goal in diastolic blood pressure. In regard to HDL, 40% of men met goal compared to 77% of women. Over 51% of members met goal in LDL value. T-test results for changes in A1c were significant for participants greater than 40 years of age compared to those less than 40 years of age. Similarly, ANOVA results showed significant results for changes in A1c in African Americans compared to other races. The regression analysis model explained about 21% of variance, and age (open full item for complete abstract)

Committee: Monica Holiday-Goodman PhD (Committee Chair); Varun Vaidya PhD (Committee Member); Gregory Stone PhD (Committee Member) Subjects: Health Care

Doctor of Philosophy, The Ohio State University, 2008, Anthropology

The last 10,000 years have witnessed a handful of major adaptive transitions experienced by the human species, the most recent, rapid, and violent of which was contact between Native Americans and Europeans beginning in the fifteenth century A.D. Humanity was irrevocably altered on a global scale as part of a "total biocultural phenomenon." This dissertation presents the first study of the human skeletal remains from a Central Andean historic population in the Lambayeque Valley Complex, north coast of Peru. Synthesizing archaeological, ethnohistoric, and bioarchaeological data, this work tests six linked hypotheses that the indigenous Mochica ethnic group experienced negative social and biological stress but dynamically adapted to the strains of Spanish colonialism through a culturally adaptive response. These hypotheses are tested using multiple lines of archaeological and skeletal biological datasets including 1,041 skeletons from the late pre-Hispanic period and the Colonial-era Chapel of San Pedro de Morrope.Examination of postcontact mortuary behaviors at Morrope reveal their burials reflect ritual patterns that encoded syncretic interplays between the colonial order, Mochica agency and identity, cosmological roles of the dead, and resistance. Skeletal biological evidence at Morrope illustrates an unprecedented increase in systemic biological stress, a shift to a more strenuous lifestyle, and a decline in oral health. Paleodemographic analyses suggest postcontact biological stress led to lowered female fertility. Elevated rates of periosteal infection, porotic hyperostosis, and decreased oral health correlate to increased population density and a shift to a greater consumption of dietary carbohydrates. Elevated prevalence of degenerative joint disease likely stems from Spanish labor extraction. Lowered prevalence of enamel hypoplasias and unchanged terminal adult stature point to surprising nutritional consequences that are only beginning to be understood but m (open full item for complete abstract)

Committee: Clark Larsen PhD (Committee Chair); Izumi Shimada PhD (Committee Member); Paul Sciulli PhD (Committee Member); Sam Stout PhD (Committee Member); Kenneth Andrien PhD (Committee Member) Subjects: Ancient Civilizations; Archaeology; Human Remains; Latin American History; Physical Anthropology

Doctor of Philosophy, Miami University, 2011, Gerontology

Palliative care has grown enormously across the world since the establishment of first modern hospice by Cecily Saunders in the United Kingdom in late 1960s. Two decades later, in 1986, the WHO developed the first definition of palliative care. Subsequent revisions were done in 1996 and 2002 to reflect the increasing need for comprehensive palliative care. In 1990, the WHO pioneered the Public Health Strategy, a model aimed at helping countries integrate palliative care into their healthcare systems. Partly as a result of the WHO leadership, palliative care has grown tremendously. Other factors have contributed to this growth as well. However, there has been little systematic documentation and analysis of this growth, or of the current status of palliative care worldwide. This project employed a mixed methods approach to explore the underlying frameworks and concepts for palliative care standards in different countries and to investigate the salient factors associated with growth of palliative care around the world. Findings from qualitative analysis suggested that the “primary domains” framework (comprising physical, psychological, social, and spiritual), and operationalized from the WHO's definition features prominently in standards addressing palliative care at the micro-level (i.e., patients/families) and meso-level (i.e., facilities/other care settings). The study also found that the importance of the domains enables delivery of comprehensive services by multidisciplinary staff. The quantitative study employed the Public Health Strategy to examine the salient factors associated with the growth of palliative care. Both population aging (as a risk factor for chronic illnesses) and adequate health care personnel have led to growth of palliative care services. HIV-mortality is another predictor of the existence of palliative care; this pattern was typical in sub-Saharan African countries. These two findings (the role of population aging and an adequate health care (open full item for complete abstract)

Committee: Suzanne R. Kunkel PhD (Committee Chair); Robert A. Applebaum PhD (Committee Member); J. Scott Brown PhD (Committee Member); Jennifer R. Bulanda PhD (Committee Member); Cameron Hay-Rollins PhD (Committee Member) Subjects: Gerontology; Public Health

Doctor of Philosophy, Case Western Reserve University, 1994, Social Welfare

Although there have been a number of studies linking both stressors and psychological distress to the demand for health services, few studies have examined this relationship among the aged. This issue is important, however, partly because it has been suggested that psychological distress resulting from stressors might cause some individuals to seek unneeded medical care. The financial impact of the aged seeking unneeded care on Medicare is thus a matter of public concern. This study explores the relationship between stressors, psychological distress and health services utilization among a random sample (N = 490) of Medicare enrollees aged 65 and over in Cuyahoga County. More specifically, this study examines four hypotheses: (1) Higher levels of stressors will be associated with higher levels of utilization of health services when controlling for demographics, self assessed health and perceived socsupport (2) Higher levels of stressors will be associated with higher levels of psychological distress when controlling for demographics, self assessed health and perceived social support, and (3) Higher levels of psychological distress will be associated with a higher levels of utilization of health services when controlling for demographics, self assessed health and perceived social support. The findings indi cate that there is not a direct relationship between stressors and utilization of health services when controlling for demographics, self assessed health and perceived social support. However there is support for a direct relationship between stressors and psychological distress when controlling for demographics self assessed health and perceived social support. There is also support for a direct relationship between psychological distress and utilization of health services when controlling for demographics, self assessed health and perceived social support. Thus, the elderly experiencing life situations or changes with which they have difficulty coping become emoti (open full item for complete abstract)

Committee: Sharon Milligan (Advisor) Subjects: