School of Public Health
Permanent URI for this communityhttp://hdl.handle.net/1903/1633
The collections in this community comprise faculty research works, as well as graduate theses and dissertations.
Note: Prior to July 1, 2007, the School of Public Health was named the College of Health & Human Performance.
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Item Couples Coping with Li-Fraumeni Syndrome: A Mixed-Methods Study of Family Strengths(2018) Young, Jennnifer Louise; Epstein, Norman B; Family Studies; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Using mixed methodology involving qualitative and quantitative data, this dissertation fills gaps in knowledge regarding psychosocial implications for families living with the genetically-transmitted Li-Fraumeni cancer susceptibility syndrome, specifically targeting couple dyads. An initial review of the existing literature on couples coping with heritable cancer syndromes identified gaps in knowledge, and pointed to future directions for research in this area. The three papers that comprise this dissertation provide multiple perspectives on the levels of distress, coping styles, and social support patterns of couples in which one partner is at high risk of cancer. The first paper investigates spousal distress and coping styles in relation to cancer worry for individuals with Li-Fraumeni Syndrome, using quantitative data from one of the largest existing collections of Li-Fraumeni Syndrome cases. The second paper identifies couples’ coping and communication processes regarding cancer stressors, using semi-structured qualitative interviews of individuals with Li-Fraumeni Syndrome and their partners. The third paper utilizes a social network approach to illustrate shared patterns of emotional, tangible, and informational support that couples report accessing. The integrated findings from these three studies indicate that these subjects are low in general distress but high in cancer-specific worry. Couples cope with this worry by balancing multiple roles, exercising flexibility in family dynamics, and utilizing extensive social support networks. This research provides significant information that can aid in development of effective interventions for couples as they face their ongoing threat of cancer. Recommendations for clinical work with this population include an integrated blend of couple therapy, genetic counseling, and oncology practice that is sensitive to the unique needs of individuals with heritable cancer syndromes and their partners.Item BIOLOGICAL AND FUNCTIONAL CHANGES IN SUPRASPINATUS MUSCLE AFTER ROTATOR CUFF TEAR(2017) Valencia, Ana Patricia; Spangenburg, Espen E; Hagberg, James M; Kinesiology; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Rotator cuff (RTC) tears impair upper limb mobility and affect 20% of the adult population. Unfortunately, surgical repair of major RTC tears often fails to restore shoulder function and has a high risk of re-tear. RTC tears induce irreversible, degenerative changes to the muscle that may hinder the recovery of shoulder function. Currently, very few studies have comprehensively assessed RTC muscle function, thus, little is known about which markers may be able predict changes in function after RTC tear. In this dissertation, I present three studies designed to systemically determine the impact of a RTC tear on contractile function of the supraspinatus (SS), the muscle most commonly affected in the RTC. In study #1 I developed a novel method to test in vivo SS contractile function using animal species common to RTC research. In study #2, I found that the SS exhibited a 30% loss in force prior to onset of muscle atrophy after acute RTC tear using the rat model. The initial loss of force was associated with a decrease in the size and continuity of the neuromuscular junction (NMJ). The SS muscle was also more susceptible to injury, which was associated with a reduction in collagen packing density. Therefore, SS size is not the strongest predictor of force output with acute RTC tears. In addition, the increased susceptibility to injury could compound the dysfunction already apparent in the SS muscle after RTC tear. In study #3, I found that the rabbit model experienced a 40% loss of force after 6 weeks of RTC tear that persisted at 12 weeks. Using a number of different in vivo and ex vivo imaging approaches I found the degree of fatty infiltration (FI) to be the strongest predictor of muscle force production after RTC tear. Surprisingly, the data suggested that muscle atrophy only explained the loss in force in torn muscles when little to no FI was present. Therefore, FI is a prognostic marker for muscle weakness after RTC tear, and can help clinicians predict the force generating capacity of the SS for surgery and rehabilitation decision-making. Results from both studies found that SS contractile function was significantly impaired after RTC tear, and identified measureable markers beyond muscle atrophy that were associated with the loss in muscle force that may act as potential therapeutic targets to improve functional outcomes after RTC tear.Item Analysis of Factors Associated With Tuberculosis Outcomes in District Kullu, India(2012) Stone, Heather; Lee, Sunmin; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)India is the country with the largest number of tuberculosis (TB) cases, contributing 20% of the global burden of infection (1) and 2 million cases annually (2). However, few if any studies have examined the epidemiology of TB in the Northern state of Himachal Pradesh. This study is a retrospective review of medical records of all tuberculosis patients (N=1086) seen at the two hospitals in Manali, District Kullu, Himachal Pradesh, India between 2008-2011. The analysis determined that being younger, female, living in a town, and/or a patient at Mission Hospital, were factors significantly associated with having extrapulmonary versus pulmonary tuberculosis (EPTB). Being older was associated with an increased likelihood of previous/complex treatment compared to new patients. Being female, from a town, and/or older were associated with receiving a non-standard regimen. Finally, patients who were previously treated/complex were significantly more likely to receive a non-standard regimen than new patients.Item MEDICAL STUDENTS' BELIEFS TOWARDS SCREENING FOR INTIMATE PARTNER VIOLENCE: A QUALITATIVE STUDY(2012) Aluko, Oluwatoni Eniola Moronke; Beck, Dr. Kenneth H.; Public and Community Health; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Researchers have found that medical students receiving training on intimate partner violence (IPV) report greater comfort with screening for IPV, and improved IPV interviewing skills than their counterparts. However, more information is needed about medical students' intention to screen, and beliefs towards screening for IPV. Therefore, the purpose of this study was to qualitatively assess these beliefs by conducting semi-structured interviews with medical students (N=15) using the Theory of Planned Behavior (TPB) and Social Cognitive Theory (SCT) as theoretical frameworks for the interview instrument. Most students felt that screening for IPV could help to identify victims, but also offend patients. Reported barriers included time, while reported facilitators included receiving IPV training. Interviewees identified physicians as both supporters and non-supporters of IPV screening. Behavioral intention scores ranged from 17 to 50. Findings from the study can help inform the IPV training needs of medical students.Item Independent and joint effects of parental attitudes and special health care needs on physical activity and screen time among chlldren and adolescents in the United States(2012) Gingold, Janet Ann; Carter-Pokras, Olivia; Epidemiology and Biostatistics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Sedentary lifestyles pose a threat to the health of children, especially those with special health care needs (SHCN). Using data from the 2007 National Survey of Children's Health, this study examined relationships between parental attitudes and low physical activity and high screen time among 6- to 17-year-olds with and without SHCN. Perceived limitation was associated with increased likelihood of low physical activity (AOR, 1.339; 95%CI, 1.079-1.662). Parenting stress (AOR, 1.189; 95%CI, 1.052-1.344) and lack of trust (AOR, 1.243; 95%CI, 1.104-1.399) were associated with increased likelihood of high screen time. Perceived limitation modified the effect of special health care needs status on high screen time. The likelihood of combined low physical activity and high screen time was greatest among children with SHCN whose parents reported both functional limitations in the child and parenting stress (AOR, 2.659; 95%CI, 1.741-4.060). Parental attitudes and SHCN should be addressed in interventions to promote active lifestyles.