The objective of this study was to examine possible correlations between sleep duration and sleep quality on health outcomes in the Marshallese community members in Northwest Arkansas. Little research has been conducted on the association between sleep health and health outcomes in Native Hawaiian Pacific Islanders, and even less so in the Marshallese populations. Using cross sectional date from a cluster randomized controlled trial study (n=374), I will examine whether sleep duration and sleep quality are associated with hypertension, type 2 diabetes, body mass index, and overall self-reported health rating in the Marshallese. Systolic and diastolic blood pressure, HbA1c levels, and height and weight were all measured for hypertension, type II diabetes, and BMI, respectively. General health status was determined by self-reported measures from the National Health and Nutritional Examination survey-derived questions. Sleep duration was categorized as very short sleep (0-4 hours), short sleep (4-7 hours), normal sleep (7-9 hours), and long sleep (9 or more hours). Sleep quality was determined by answers to the question: “Over the last two weeks, how many days have you had trouble sleeping or staying asleep?” For the continuous dependent variables (BMI, blood pressure, and HbA1c), median and interquartile range values were examined. For non-continuous variable (general health outcomes), the Spearman Correlation Coefficient was examined to determine association. Statistically significant associations were found between sleep duration and diastolic blood pressure and HbA1c, and sleep quality and general health. These associations among the Marshallese provide foundation for further longitudinal and intervention research on health disparities in Marshallese residents of the United States.

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Introduction & Background: Pre-eclampsia is a serious complication of pregnancy that is characterized by high blood pressure, swelling, and proteinuria as the primary symptoms. Preeclampsia affects 5-8 percent of pregnancies in the U. S. Medications can help to manage symptoms; however, delivery is the only way to resolve pre-eclampsia. Preterm delivery is sometimes necessary and is dependent on the gestational age of the fetus and the severity of symptoms in the mother. Women who have hypertension, diabetes, kidney disease or are pregnant with multiples are at higher-risk to develop pre-eclampsia. Purpose Statement Question: The purpose of this research was to identify what complications occur in women after a pre-eclampsia diagnosis. A systematic review of the literature was used to identify relevant articles that address complications of pre-eclampsia. Literature Review: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used to guide this systematic review. PubMed, CINAHL, and Google Scholar were used to identify relevant articles. Articles were published with the last 5 years (2018-2023). Search terms were “complications following pre-eclampsia.” A total of 128 results were found and reviewed. Nineteen articles were determined to be eligible for inclusion. Findings: A pre-eclampsia diagnosis comes with considerable risks for women. Short-term risks include elevated blood pressure, preterm delivery, renal dysfunction, and electrolyte imbalance. Longer term complications include chronic hypertension, cardiovascular disorders, stroke, and later memory problems including Alzheimer’s disease. Conclusions: A pre-eclampsia diagnosis confers significant risk to women. Complications can be severe and may affect women and infants long-term.

Abuse is associated with higher depressive symptoms (DS) and coronary heart disease risk (CHD), lower health-related quality of life (HRQOL), and dysregulated levels of cortisol and norepinephrine (NE). In HIV+ women, abuse relates to higher viral load (VL), lower CD4 count, and nonadherence to highly active antiretroviral therapy (HAART). Resilience (adaptive functioning following trauma) and positive self-esteem (PSE) were hypothesized to buffer the impact of abuse and predict better health outcomes. Three studies tested these hypotheses using self-report measures (for abuse, resilience, DS, HRQOL, and HAART use and adherence), autobiographical narratives (for PSE), Framingham Risk Score (for CHD risk), and blood and urinary specimens for cortisol, NE, and HIV disease markers (VL and CD4 count). Study 1 included 138 HIV+ and 64 HIV- women (87% African-American), and investigated the relationships between childhood sexual abuse (CSA), DS, and HRQOL and whether resilience moderated the relationships between CSA and outcomes. Consistent with the hypothesis, multiple regressions indicated that higher resilience related to lower DS and higher HRQOL across both HIV+ and HIV-women, and CSA related to higher DS only for women scoring low in resilience. Study 2 examined how resilience moderated the relationships between abuse history and HAART adherence, VL, and CD4 count in 138 HIV+ women. As predicted, multiple regressions revealed that resilience related to having undetectable VL. Sexual and multiple abuse histories related to lower HAART adherence only for women scoring low in resilience. Study 3 with 53 HIV+ women investigated the relationships among resilience, PSE, abuse histories, NE, cortisol and CHD risk. In partial support of hypotheses, partial correlations showed that higher resilience related to lower cortisol; higher PSE related to lower NE; higher NE/cortisol ratio related to higher CHD risk; histories of abuse related to higher CHD risk, and lower cortisol related to higher CHD risk. The findings suggest that resilience and PSE relate to better health outcomes for HIV+ and HIV- women, and levels of stress hormones in HIV+ women are related in complex ways to abuse, resilience, PSE, and CHD risk. Promoting resilience and PSE may help HIV+ and HIV- women achieve better health outcomes.

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Introduction: Beverages influence diet quality, however, beverage intake among youth with obesity is not well-described in literature. Dietary pattern analysis can identify how beverages cluster together and enable exploration of population characteristics. Objectives: 1) Assess the frequency of children and youth with obesity who fail thresholds of: no sugar-sweet beverages (SSB), <1 serving/week of SSB, ≥2 servings/day of milk and factors influencing the likelihood of failing to meet these cut-offs. 2) Derive patterns of beverage intake and examine related social and behavioural factors and health outcomes at entry into Canadian pediatric weight management programs. Methods: Beverage intake of youth (2–17 years) enrolled in the CANPWR study (n=1425) was reported at baseline visits from 2013-2017. Beverage thresholds identified weekly SSB consumers and approximated Canadian recommendations. The relationship of sociodemographic (income, guardian education, race, household status) and behaviours (eating habits, physical activity, screen time) to the likelihood of failing cut-offs was explored using multivariable logistic regression. Beverage patterns were derived using Principal Component Analysis. Related sociodemographic, behavioural and health outcomes (lipid profile, fasting glucose, HbA1c, liver enzymes) were evaluated with multiple linear regression. Results: Nearly 80% of youth consumed ≥1 serving/week of SSB. This was more common in males, lower educated families and was related to eating habits and higher screen time. Two-thirds failed to drink ≥2 servings milk/day and were more likely female, demonstrated favourable eating habits and lower screen time. Five beverage patterns were identified: 1) SSB, 2) 1% Milk, 3) 2% Milk, 4) Alternatives, 5) Sports Drinks/Flavoured Milks. Patterns were related to social and lifestyle determinants; the only related health outcome was HDL. Conclusion: Many children and youth with obesity consumed SSB weekly. Fewer drank milk twice daily. Beverage intake was predicted by sex, socioeconomic status and other behaviours, however most beverage patterns were unrelated to health outcomes. / Thesis / Master of Science (MSc) / Beverage intake can influence diet and health outcomes in population-based studies. However, patterns of beverage consumption are not well-described among youth with obesity. This study examined beverage intake and relationships with sociodemographic information, behaviours and health outcomes among youth (2-17 years) at time of entry into Canadian pediatric weight management programs (n=1425). In contrast to current recommendations, 80% of youth consumed ≥1 serving/week of sugar-sweetened beverages and 66% consumed 2 servings/day of milk. Additionally, five distinct patterns of beverage intake were identified using dietary pattern analysis. Social factors (age, sex, socioeconomic status) and behaviours (screen time, eating habits) were related to the risk of failing to meet recommendations and to beverage patterns. Identifying sociodemographic characteristics and behaviours of youth with obesity who fail to meet beverage intakes thresholds and adhere to certain patterns of consumption may provide insight for clinicians to guide youth to improved health in weight management settings.

While limited health literacy has been associated with poorer health decisions and poorer health outcomes, there remains a gap in the literature related to the influence of health literacy on weight and weight-related behaviors. The primary aim of this study is to examine the influence of child and parent health literacy status on childs body mass index (BMI) and health behaviors, within an adapted evidence-based family-based childhood obesity intervention, iChoose, implemented in the medically underserved Dan River Region (DRR). Previously developed measures were used to assess health literacy and health behaviors. iChoose consisted of 101-parent-child dyads. Using the New Vital Sign (NVS), 46% of children and 13% of parents had low to limited health literacy levels at baseline. Younger children and parents who were African American, had no high school diploma, and earned <$25,000/year were significantly more likely to have low health literacy when compared to their counterparts. Health literacy levels for these individuals ranged between 0 to 3, which is considered low to limited health literacy. Health literacy levels were further examined between health outcomes. However, BMI, fruit and vegetable intake, sugar-sweetened beverages (SSB), minutes of moderate to vigorous physical activity, and screen time did not differ by health literacy levels at baseline. Among children, improvements in the NVS was significantly correlated with decreases in SSB consumption (r = -.275, p < .05), but with no other outcomes. There were no significant correlations among changes in parent NVS score and changes in child health behaviors. Results from this study fill a gap in understanding the associations in health literacy and weight and weight-related behavioral outcomes in children. It also provides insights into the opportunities and challenges in measuring health literacy among children. Future research is needed to explore further health literacy measurement issues among children and the influence of both child and parent health literacy in family-based childhood obesity treatment efforts. Additional efforts are also needed to assist community and health care providers in finding more effective strategies to guide children with low health literacy to better health outcomes. / Master of Science

Research in animal personality has been increasing over the last decade, as scientists realise its importance to a variety of health outcomes. In particular, personality has been shown to have an effect on immune function, stress, infant survival, overall well-being, morbidity, and mortality. Because of this, personality can play an important role in captive management, especially as stress is often a problem for captive animals. Research has already shown that personality affects captive breeding efforts, enclosure grouping, and stress regulation in some species. Only a few studies have focused on felids, but these have shown that there are possible applications for personality in that taxon. Because most felids are endangered, and because many of them face special challenges in captivity due to their size and biology, this work aimed to increase knowledge on felids, using personality as a framework, with implications for captive management as a target. Focusing on five species, I assessed the personality of domestic cats, Scottish wildcats, clouded and snow leopards, and African lions, and the well-being of the four latter species. With the exception of the domestic cat, there has been little to no personality work in these species, and none on well-being. I then compared the data within and among these species. I found three main personality factors among the species, including dimensions I labelled Neuroticism, Dominance, and Impulsiveness, with some differences, including an Agreeableness factor in some species, and elements of Openness. As in other species, well-being was negatively related to Neuroticism in most of the study species. Taking into consideration each species’ biology, natural history, and genetics, I discuss the implications and importance of using these species’ personality and well-being assessments in both captive management and conservation efforts. The results indicate that, like in humans, a targeted, individual approach to care is the best use of personality for captive animals.