<p> INTRODUCTION: Although recent studies have found that the lower respiratory tract microbiome was different in asthmatics compared to non-asthmatics in adults, the microbiome of asthmatic people with and without asthma exacerbation has not been well investigated. </p><p> OBJECTIVES: The primary objective of the study was to compare the abundance and diversity of the respiratory tract microbiome in children with and without asthma exacerbation. </p><p> METHODS: This was a cross sectional study where asthmatic children from 5-18 years old were recruited at the emergency department at LeBonheur Children&rsquo;s Hospital, Memphis, TN. Recruited children were further grouped by asthma exacerbation level and asthma severity level. Induced sputum samples and nasopharyngeal swabs were collected to analyze the microbiome in the two sources with Illumina based sequencing. The primary outcome to measure was the microbiome abundance and diversity of specific taxa in the two sites with or without current asthma exacerbation. The secondary outcome to measure was the microbiome abundance and diversity of specific taxa in the two sites with various levels of asthma severity. The additional outcome to measure was the specific microbial taxa in the two sites associated with an increased or decreased risk of asthma exacerbation or severity. </p><p> RESULTS: 51 children from 5-10 years old were recruited. The relative abundance of 9 taxa (e.g. Moraxella) were significantly higher in nasopharyngeal samples, and the relative abundance of 26 taxa (e.g. Streptococcus) were significantly higher in induced sputum samples. No significant difference in abundance and diversity was found with various asthma exacerbation and severity levels in either of the two sites. No specific taxon was significantly associated with an increased or a decreased risk of asthma exacerbation or severity. </p><p> CONCLUSION: Microbiome composition differed significantly in induced sputum samples compared to nasopharyngeal samples. No significant change of microbial abundance and diversity in the two sites was associated with asthma exacerbation or severity. No specific taxon in the two sites was associated with an increased or a decreased risk of asthma exacerbation or severity. Larger, comparative studies need to be performed to discover subtle difference in future.</p><p>

<p> Access to primary care is limited in rural communities across the United States. Evidence supports primary care as the cornerstone of healthcare. The purpose of this project was to explore community perceptions of barriers to primary care access with the aim of learning about ideas for possible interventions that could improve primary care access for Mifflin County residents. Penchansky and Thomas&rsquo;s model of healthcare access provided the theoretical framework for this qualitative phenomenological study. Using a community-based research approach, semistructured, open-ended telephone interviews and qualitative surveys were conducted with 26 participants, including physicians, nurses, and residents. Data were analyzed using Edward and Welch&rsquo;s extension of Colaizzi&rsquo;s 7-step method for qualitative data analysis. Key findings included perceptions that (a) primary care access is limited in Mifflin County due to inadequate health services emanating from insufficient community health centers, provider shortages, health insurance issues; (b) high cost and poor choice of services discourage residents from seeking preventative care; (c) distance from services reduce residents&rsquo; ability to access primary care; (d) service problems impact the quality of care received, such as a lack of provider training in opiate addiction; and (e) providers and residents should be involved in primary care service planning since they can provide valuable information to help improve access to services. Positive social change could occur through improvement in access to primary care using a collaborative approach and community involvement, in policy formation and service planning. </p><p>

<p> Postpartum depression (PPD) is internationally recognized as one of the most prevalent and severe but neglected maternal mental health complications of childbirth. Previous studies have indicated that there is a high burden of disease associated with PPD in both developed and developing countries. However, there remain gaps in the current literature regarding the recognition and management of PPD in remote parts of the developing world. Therefore, the purpose of this study was to understand the perceptions, attitudes, and beliefs of health professionals towards PPD and examine the factors that either facilitated or hindered its recognition and management in a remote setting in Nigeria. The pen-3 cultural model was the conceptual framework used in this study. The study focused specifically on professionals with regard to the recognition and management of PPD in a rural hospital in Nigeria. Ten semi structured qualitative interviews were conducted with doctors and nurses from a rural hospital in Nigeria. Data were analyzed via phenomenological interpretative analysis. Results from the study revealed that health professionals in a remote setting in Nigeria have a working knowledge of PPD and perceived the condition as a serious public health concern, but were faced with numerous barriers from the institutional, organizational, and community level that hindered their ability to recognize and manage PPD in a timely manner. These results make an important contribution to the existing literature and can enhance social change initiatives through the enhancement of awareness of PPD, and the need for improvement of policies on comprehensive maternal mental health in remote parts of Nigeria.</p><p>

<p> <b>Background.</b> Previous research finds that (1) lesbian and bisexual (LB) women as well as gay and bisexual (GB) men have higher rates of rape victimization compared to their heterosexual (H) peers and (2) perceived familial support reduces the impact of some of rape&rsquo;s negative health outcomes in heterosexual victims. However, specific contextual factors regarding rape and assessment of familial support for LGB victims are severely lacking. Also, measurements of sexual assault victimization have yet to be validated in this population.</p><p> <b>Methodology.</b> The current study used a mixed-methods design that included two phases of data collection. Phase 1 was a national sample online survey of LBH women (<i>n</i> = 1,295). Phase 2 was a convenience sample online survey of LBH women and GBH men; data collection for Phase 2 is ongoing. Prevalence rates were calculated using a modified form of the Sexual Experience Survey &ndash; Short Form Revised (SES-SFV). </p><p> <b>Results.</b> In Manuscript 1, 63% of B women, 49% of L women, and 35% of H women reported experiencing rape in their lifetime. LB women had increased odds of victimization (B only) and re-victimization (L and B) compared to H women. H women reported more family support than LB women, but when victimization status was controlled for, all women reported equal levels of family support. In Manuscript 2, all nonconsensual behaviors and nearly all perpetration tactics in the original SES-SFV emerged inductively in our qualitative data. Using quantitative data, LB victims endorsed each perpetration tactic in the SES-SFV at comparable rates to H victims. However, the original SES-SFV did not capture some common experiences that participants described in their open-ended narratives.</p><p> <b>Conclusion.</b> In Manuscript 1, some contextual factors of sexual violence differed between LBH women while others were the same across sexual orientation. Yet, sexual orientation clearly played a role in sexual violence risk given it had the strongest relationship with victimization status compared to all other demographic characteristics. In Manuscript 2, the SES-SFV satisfactorily assessed sexual assault and rape experiences in LBH women. Possible additions and deletions to the SES-SFV are presented alongside discussion of managing comprehensiveness and participant fatigue.</p><p>

<p> Obesity in the United States is the highest among children in families with an income-to-poverty ratio of 100% or less. Exploration of whether parents&rsquo; employment status contributes to children&rsquo;s diets may clarify pathways through which socioeconomic status may impact childhood obesity. The present study is a cross-sectional secondary analysis utilizing the baseline data from the Transitions study; a longitudinal, biobehavioral study assessing changes in physical activity among Latina and African American girls. The secondary analysis assessed the relationship between parental employment status and child feeding practices, dietary behavior, and adiposity. One-way independent ANOVAs were conducted to compare child feeding practices, dietary intake, and adiposity by employment status. No significant findings were found; however, there was an indication that employment status likely influences children&rsquo;s eating patterns and weight status. The association between parental employment status and childhood obesity is understudied, and the available results do not present a consistent relationship.</p><p>

<p> In Nigeria, childhood tuberculosis (TB), a debilitating and deadly disease, is highly prevalent and case reporting is poor due to weak health systems. Globally, children account for at least 10 percent of the TB burden, yet they remain neglected in TB prevention and control efforts. Research studies integrating family and community-centered strategies have been recommended by stakeholders to address the paucity of current local prevention and management strategies for childhood TB. This observational cross-sectional study explored the relationship between caregivers&rsquo; quality of life (QOL), gender, and socioeconomic status (SES) and the incidence of TB in children aged 0&ndash;14 years. Using the abbreviated version of World Health Organization&rsquo;s (WHO) QOL tool, the WHOQOL-BREF, data were collected individually in a face-to-face setting from caregivers (<i>n</i> = 47) whose children had been diagnosed with TB in Bauchi State, Northeastern Nigeria, over a 5-year period. Data were collected in the same manner from another set of caregivers of children without TB (<i>n</i> = 47) within the same period and setting. Results from logistic regression indicated a statistically significant relationship (<i>p</i> &lt; .001) between the caregivers&rsquo; QOL and the occurrence childhood TB. However, the caregivers&rsquo; gender and SES were not significantly related to the incidence of childhood TB. This finding underscores the need to identify the factors that positively impact the QOL of caregivers of childhood TB cases. It also reflects the importance of integrating QOL interventions as part of TB control programs seeking to improve childhood TB reporting. This can mitigate the disease burden in vulnerable age-groups living in resource limited settings, thereby contributing to positive social change in the society.</p><p>

The study examined the applicability of the Theory of Planned Behavior (TPB), the Theory of Reasoned Action (TRA) and the Health Belief Model (HBM) to the study of condom use intentions of university students in Ghana. The data provided full support for the TPB when the constructs of the model were explicated with their direct measures. However, when the belief-based (indirect) measures of the constructs were used, the perceived behavioral control construct ceased to be a significant predictor of intention and the data provided only partial support for the TPB. The TPB explained up to 47.2%, the TRA, 45.9% and the HBM, 20% of the variance in students' condom use intentions. A composite model comprising significant constructs of the TPB and the HBM successfully predicted 55.7% and 74.4% of male and female students' intentions respectively. Subjective norm played a key role in the condom use intentions of the university students. Both "intenders" (those students who intended to use condoms consistently) and "non-intenders" (those who did not intend to use condoms) were equally motivated (or unmotivated) to comply with the wishes of their significant referents, in this case, sexual partners, close friends, parents and doctors. Thus, the critical difference between the "intenders" and the "non-intenders" was the belief that significant referents approved of condom use. There was also an important gender difference in the condom use intentions of the university students. Among the female students, in addition to the belief that significant referents approved of condom use, perceived severity of HIV/AIDS also significantly differentiated between intenders and non-intenders. The importance of subjective norm highlights the critical role that respondents' social networks played in formulating the intention to use or not to use condoms. It is therefore recommended that AIDS education interventions targeting university students like those in this study should shift their foci away from individuals alone and instead, focus simultaneously on individuals and their social networks as one way of enhancing perceptions of significant referents' acceptance of condom use.

Objectives. The major objectives of this dissertation were to: (1) identify predictors of occupational musculoskeletal disability, with a focus on knee-related outcomes; (2) demonstrate that a series of related case-control comparisons can be used to identify differences in the determinants of causally related outcomes (knee injury and knee-related disability); and (3) demonstrate that data collected for administrative purposes represent a cost-effective resource for analytical epidemiological studies. Methods. Using data from the U.S. Army, we adapted Haddon's Matrix to the study of occupational disability by conducting separate case-control comparisons of occupational knee injury and knee-related disability discharge from active duty service. Each case-control comparison was nested within the population of Army personnel on active duty between 1980 and 1997. We developed multiple logistic regression models to analyze the independent contributions of sociodemographic and occupational characteristics to the risk of knee-related injury and disability. All models were stratified by gender. Results. Among men and women, non-whites were at about 30% lower risk than whites for both knee injury and disability. There was increasing risk of both injury and disability with increasing age for women, and for disability among men. Duration of service (positive) and pay grade (negative) were also associated with both outcomes for men and women. Other risk factors differed for men and women by outcome, and the final models predicting injury and disability included different parameters for each gender. Exploratory analyses of possible effect modification suggested interactions between demographic and occupational factors. Conclusions. These analyses were possible because of the availability of a large database containing occupational, demographic and health information for a cohort of Army personnel. The wide range of data elements and the large, relatively diverse population enabled the evaluation of the separate and combined influence of sociodemographic and occupational characteristics on the risk of occupational injury and disability. This is among the first analytical epidemiological studies of its kind. The differences between the final injury and disability models suggests that the use of separate case-control comparisons to identify risk factors for related outcomes is a viable research method.

Approximately 30% of U.S. women 65 years of age and older suffer from osteoporosis. The 300,000 hip fractures that occur annually in the U.S. may account for about 31,000 excess deaths within six months of the fracture. Several medications have been approved for the treatment of osteoporosis in post-menopausal women with low bone density that have been shown to maintain or increase bone density, and/or to reduce the risk of hip and wrist fractures. The evidence to date suggests many women who could benefit from treatment are not receiving it. The first study in this dissertation assessed the patterns of screening, diagnosis and treatment for osteoporosis in a Northeast U.S metropolitan area among women age 50 to 84 that had a history of wrist/forearm or hip fractures. We evaluated the full range of prescription and non-prescription treatments available, as well as change in treatment after the fracture, through a patient survey. Only 42% of our survey respondents were prescribed medication to treat osteoporosis after a hip or wrist fracture. We also found little difference in treatment prevalence based on risk factors for osteoporotic fractures. In our second study, we investigated treatment among older women after bone mineral density exams, and the degree to which bone mineral density and other risk factors cited in treatment guidelines were independently associated with treatment. We found that 69% of subjects with osteoporosis and 45% of those with osteopenia received prescription treatment other than hormone replacement therapy. The presence of at least one additional risk factor also significantly increased the likelihood of receiving osteoporosis treatment among women with osteopenia. In Chapter 4 of this dissertation we systematically reviewed a growing literature examining whether women receive appropriate treatment for osteoporosis. Studies of osteoporosic fracture patients consistently found a wide gap in treatment, though treatment frequency was higher for spinal fractures than for other fractures, and treatment rates appeared to have increased over time.

More than two million youth who identify as lesbian, gay, bisexual, or transgender are at high risk for victimization based on increasing visibility and a subsequent decreasing societal tolerance for their existence (D'Augelli, 1996; Hershberger & D'Augelli, 1995; Human Rights Watch, 2001 a). This victimization is associated with negative health outcomes including anxiety, depression, substance abuse, and suicide (D'Augelli, 1998; Herek, Cogan, & Gillis, 1999; Meyer 1995; Paul et al., 2002; Savin-Williams & Cohen, 1996). The public health community is in a unique position to create necessary changes at the larger community and societal levels to address anti-gay violence. Understanding the risks associated with identifying as lesbian, gay, bisexual, or transgender in a heterosexually dominated society is essential to an effective public health response. Equally important is an understanding of how these youth demonstrate resilience, succeeding despite adverse conditions. Current models of resilience, however, have not considered the social worlds of lesbian, gay, bisexual, and transgender youth. Situated within a critical research paradigm, the study employs a grounded theory methodology guided by theories of oppression, feminism, and relational-cultural to explore with the participants the larger socio-political system within which victimization is fostered and maintained. The purposes of this study include: (1) Explore the perceptions and experiences of anti-gay violence among lesbian, gay bisexual, and transgender youth. (2) Identify the consequences of these experiences. (3) Develop a conceptual model of resilience from the narratives of the participants. Two focus groups with 12 youth and 22 in-depth individual interviews with 15 youth were conducted. The participants describe a culture of homophobia that makes acts of violence against them acceptable, creating a sense of disconnection and alienation for the participants, an experience named, Becoming the Other. The conceptual model developed represents resilience as a dynamic process. The core category, Reclaiming the Self, is the process by which the participants resist against their otherness by reclaiming their true selves and gaining a sense of pride in their lives. The model asserts that Reclaiming the Self is developed through two channels: connection and resistance. Using a social-ecological framework, implications for prevention programming and policy are discussed.