Chronic pain is an ever-present issue and some estimate its cost to society at $635 billion per year. Not only does chronic pain cause increased visits to medical personnel, it also complicates other medical conditions and lowers productivity in the workplace. One area of study includes Chronic Post Surgical Pain (CPSP) in children that have undergone spinal fusion surgery for Adolescent Idiopathic Scoliosis (AIS). Some of the major factors that may lead to CPSP include preoperative pain, psychosocial factors, age, intraoperative nerve injury, acute postoperative pain, and genetics. In order to explore the psychological factors, our lab has employed an Unpredictable Chronic Mild Stress (UCMS) paradigm, which models unforeseen life stressors and depression. Some sensory testing was conducted included Hot Plate and von Frey fiber testing. Previous studies from this lab have shown that adult male mice have hyperalgesia to thermal stimuli following a UCMS paradigm. To further explore this finding, a younger mice cohort of both sexes and a cohort that underwent Maternal Deprivation (MD) were added. Maternal Deprivation is a model of early-childhood stress and older female mice have been shown to have changes in thermal sensitivities as a result of early childhood stressors. Our lab found that stressed young females also exhibit a heightened sensitivity to thermal stimuli at 49°C compared to their male and control counter parts. These results indicate that the thermal sensitivity of young females can be affected by early childhood stress and depression.

Early deficits in childhood growth and development contribute to long-term problems that can persist into adulthood, including poor psychosocial wellbeing and reduced adult income. According to recent estimates, more than 200 million children worldwide fail to reach their full developmental potential. Underdevelopment is particularly widespread among children in Zambia; approximately 40% of Zambian children under five years of age are stunted due, in large part, to widespread malnutrition. It is a tremendous challenge for the public health care system in the country to address this burden. In this thesis, I investigate the capacity of rural health workers in Southern Province, Zambia to treat acute malnutrition among children under 5 years of age. Data presented in this thesis were collected from several sources. Information regarding current guidelines, trainings for treatment of acute malnutrition and supply chain for supplemental nutritious and ready-to-use therapeutic foods were collected during key informant interviews performed with nutritionists (n=4) and rural health workers (n=5) in Lusaka and Southern Province, Zambia. Nutritionists working within the health care system at the national, provincial and district levels were interviewed, as were rural health workers selected from a sample of health centers. Information on child nutrition was collected using 24-hour food recall questionnaires that were administered to mothers from a sample of households (n=215) in Southern Province. Data were analyzed with qualitative and quantitative methods. Outcomes of interest included the following: capability of rural health workers to address and treat acutely malnourished children; average daily consumption of carbohydrate, protein and fruit containing meals and snacks among infants; maternal perception of child growth and development as compared to other children of the same age; and mothers’ satisfaction with nutrition information and services provided by their local health centers. The first key finding of this study was that only 40% of rural health workers had been trained in the treatment of acute malnutrition within the last five years, while 100% of nutritionists had received training within the last two years. The second key finding was that infants six to 12 month old in the study sample were reported to have low protein and high carbohydrate consumption. On average, children consumed protein 0.75 times per day and carbohydrates 3.24 times per day. The third key finding was that mothers appeared to overestimate the development of their children. Despite the high rate of childhood stunting in the study sample (38%), 76% of mothers felt their child was the same height or taller than other children of the same age and sex, and close to 75% of mothers felt their child learned at the same speed as or quicker than other children of the same age and sex. These findings suggest that there are currently inadequate resources and capabilities within the Zambian health care system to properly manage the high rate of child malnutrition and stunting in the country. In order to have a greater effect on the reduction of stunting in children, efforts to better disseminate resources from the national level to the rural health centers for the treatment of chronic and acute malnutrition should be considered. Necessary resources include better access to trainings for rural health workers, anthropometric tools to measure levels of malnutrition and supplemental nutritious foods or ready-to-use therapeutic foods to treat children who are moderately or severely malnourished should be increased.

In the study of diseases such as chronic traumatic encephalopathy (CTE), the ability to gather retrospective estimates of an individual’s total repetitive head impacts (RHI) is paramount. Although the exact mechanism responsible for the development of CTE is still unknown, it is well accepted that RHI play a critical role. Until recently, however, the methodology used to collect retrospective estimates of RHI have been very limited. In the beginning of 2016, Montenigro et al. from the Boston University’s Alzheimer’s Disease and CTE Center published a new method of RHI estimation called the Cumulative Head Impact Index (CHII). The CHII was developed by collecting self-reported football histories (years of play, positions of play and levels of play), and using that data to extrapolate the findings of short-term helmet-accelerometer studies into career-long estimates of cumulative head impacts. In addition to publishing this new method, Montenigro et al. (2016) also determined that the CHII was very successful at predicting later-life neurobehavioral and cognitive impairment, an essential ability of any RHI estimate intended to be used in CTE research. Participants in the Montenigro et al. (2016) analysis were part of an ongoing longitudinal study where individuals take yearly surveys of their neurobehavioral and cognitive well-being in addition to answering surveys about sports participation, head injuries and overall wellbeing. Participants had played football at the high school or college level, but had not played any other contact sports. This thesis serves as an initial validation of that publication, and also tests the ability of the CHII to predict later-life impairment in a more diverse population of athletes. Participants in this thesis were selected from the same ongoing longitudinal study according to two distinct sets of inclusion and exclusion criteria. For the purposes of conducting a validation study, the first set of criteria were identical to those used by Montenigro et al. (2016). The second experimental set allowed for participants who had participated in a secondary contact sport if it was at the high school level or below. These two sets of criteria resulted in 70 “validation” participants, and 82 “experimental” participants. Using the same methods as Montenigro et al. 2016, we calculated the CHII for all participants, and examined the ability of the CHII to predict later-life impairment. Our findings validated that the CHII was indeed successful at predicting later-life impairment from cumulative head impacts among the validation group of 70 participants. In particular, the CHII successfully predicted a threshold dose-response relationship between CHI and apathy (p >0.001), depression (p >0.001), executive function dysregulation (p >0.001), and self-reported cognitive impairment (p >0.001). We then found that the CHII was much less successful at predicting impairment in the experimental group of 82, only finding significance in measures of apathy (p=0.0502) and executive function dysregulation (p=0.0277). Overall, our findings indicate that the CHII is an excellent improvement in methods of estimating RHI in people whose only contact sport is football.

To investigate the possibility that chronic diabetes mellitus was related to specific neuropsychological deficits, cognitive functioning was measured in subjects with diabetic retinopathy (without secondary disabilities), and in subjects classified as normal blind adults (also without secondary disabilities). The scores for the two groups were then compared.

OBJECTIVE: To examine associations and trends between chronic diseases and tooth loss using BRFSS 2012-2018. METHODS: Self-reported permanent tooth loss from tooth decay/gum disease and several self-reported chronic disease diagnoses were analyzed by cycle (2012, 2014, 2016, 2018) to explore associations and trends. Chi-square analyses were performed for the primary outcome of one or more teeth lost with the following ailments: physical health, mental health, weight, diabetes, myocardial infarction, coronary heart disease, stroke, asthma, cancer, respiratory diseases, arthritis, and kidney disease. Multivariate logistic regressions were performed to estimate the odds for tooth-loss for each disease using gender, age, race, insurance, income, education and smoking as covariates. Effects of one or more concurrent chronic disease diagnoses on tooth loss were calculated and 2012-2018 results compared. Interaction between disease and year were used in the multivariate regression aanalyses to find differences in tooth loss from 2012- 2018. All calculations were performed using SAS 9.4. RESULTS: Tooth loss has declined from 45% - in 2012 to 39% - in 2018 in individuals with one chronic disease. A similar decline in tooth loss is seen in those with two, three, four or more chronic diseases. Increased tooth-loss was significantly associated with each chronic disease, with adjusted odds of tooth-loss ranging from 1.08-1.72. Diabetics, had an increased and significant odds of tooth loss with time: 1.36 (2012)-1.54 (2018). The odds of tooth-loss increased as number of concurrent chronic diseases increased -1.2 (one chronic disease)-2.4 (four or more chronic diseases). CONCLUSION: Fewer people are losing teeth, but those with chronic disease experience higher odds of tooth-loss. Having more concurrent diseases is associated with increased tooth-loss. Oral health is essential for overall health, therefore access to oral health care and educating the public and health professionals about these associations is vital. / 2021-07-29T00:00:00Z

As a result of alcohol consumption being highly prevalent in today’s society, research has been done to investigate the effects of alcohol on the body’s physiological systems. Research has indicated that heavy alcohol consumption is detrimental to the normal structure and function of some organs, especially the liver. However, little research has focused on the effects of chronic alcohol consumption on the female reproductive system. To investigate these effects, the uterine tissues of mice fed an ethanol diet (the NIAAA model also known as the Lieber-DeCarli diet) and mice fed a control diet were compared. The NIAAA model was chosen for this research because it simulates the drinking pattern that is known to cause liver disease in alcoholic hepatitis patients. This is achieved by incorporating both chronic and binge drinking patterns of alcohol consumption. In this study, the mucin layer that lines the endometrial surface of the uterus was analyzed in mice separated into ethanol and control fed groups. The ethanol fed mice were put on the Lieber-DeCarli 5% (v/v) ethanol diet ad libitum for 10-days followed by a single high dose of ethanol (5g/kg) on the 11th day. The control fed mice were placed on an ethanol free isocaloric diet (supplemented with maltose dextrin to match the calories of ethanol). After the 11th day, the mice were sacrificed, and uterine tissues were harvested. The tissues were then embedded in paraffin, sectioned, stained via the Hematoxylin and Eosin (H&E) technique, and examined under a microscope. The thickness of the uterine mucin layer was then measured for each animal and the average thicknesses were calculated. A one-way ANOVA test was employed to compare the mucin thickness between the two groups of animals. The test revealed no statistically significant difference between the thicknesses of the uterine mucin layer in the control and ethanol fed animals (P-value: 0.774).

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Thesis (D.Sc.N.S.)--Boston University, Henry M. Goldman School of Graduate Dentistry, 1993 (Nutritional Sciences). / Includes bibliography (leaves 176-187) / This dissertation has been presented in two related studies: A. Fish Oil Reduces Proteinuria and Interstitial Injury but not GIomerulosclerosis in the Milan Nomotensive Rat Rats of the Milan Normotensive strain (MNS) spontaneously develop severe Proteinuria and excessive glomemlar thromboxane (Tx)A2 PrOduction at a young age. These are accompanied by podocyte alterations and progressive focal glomerulosclerosis (FGS) and interstitial fibrosis. Since previous studies showed that pharmacologic... [TRUNCATED]

Exercise tolerance, measured as peak oxygen consumption (VO₂ peak), is very low in patients with end-stage renal failure undergoing maintenance haemodialysis. Due to their associated anaemia and low peak heart rates during maximal exercise it has been argued that the reduced blood oxygen carrying capacity and central cardiovascular limitations are primarily responsible for the poor exercise tolerance of these patients. However, others suggest that peripheral (skeletal muscle) limitations including impaired substrate utilization, muscle weakness caused by peripheral neuropathy and myopathy, malnutrition and general physical deconditioning are responsible for the poor exercise tolerance. The present thesis was therefore designed to study whether central cardiovascular function or anaemia or muscle weakness causes patients with end-stage renal failure to terminate exercise at workrates well below those achieved by healthy controls.

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