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An Evaluation of Physical Fitness and Accuracy of Resting Metabolic Rate Prediction Equations in Reserve Officers' Training Corps Cadets and Midshipmen
No full textThe Reserved Officers’ Training Corps (ROTC) is a program in which college students receive scholarship funds as well as leadership and physical fitness training in exchange for committed military service. There is limited scientific research describing fitness attributes of ROTC cadets and midshipmen, and no study has previously reported resting metabolic rate (RMR) for this population. The results of this cross-‐‑sectional study established a physical fitness profile of ROTC cadets and midshipmen (n = 17, 24% female; age = 21.0 ± 1.2 years). The characteristics of the sample were the following: body mass index (BMI) = 24.6 ± 2.0 kilograms/meters2 (kg/m2); waist circumference (WC) = 77.2 ± 8.1 centimeters (cm); % body fat = 18.2 ± 5.0%; maximal oxygen consumption (VO2max) = 45.7 ± 4.5 milliliters/kilogram of body weight/minute (mL/kg/min); RMR = 1526 ± 159 kilocalories/day (kcal/day); daily energy intake = 1885 ± 373 kcal/day; and daily intake of fruits and vegetables = 2.9 ± 1.1 cups/day. Percent body fat was measured using bioelectric impedance analysis (BIA). Maximal oxygen consumption and RMR were analyzed using indirect calorimetry. Data on daily energy intake and daily consumption of fruits and vegetables were collected from Block 2005 Food Frequency Questionnaires. This study also evaluated the accuracy of seven RMR prediction equations. Defining RMR for an active person is a fundamental component to diet planning. RMR accounts for the majority of an individual’s daily energy expenditure. Indirect calorimetry is the gold standard for RMR measurement, but it is not a practical option for many nutrition professionals. Therefore, prediction equations exist that incorporate more convenient measures, such as height and weight, to estimate RMR. The most frequently used prediction equations (Harris-‐‑Benedict, Mifflin-‐‑St. Jeor, Owen, and Schofield) and an equation previously validated in athletes (Cunningham) were compared to measured RMR values. This accuracy analysis involved paired t-‐‑tests, Pearson’s correlation coefficients, Bland-‐‑Altman plots, and the percentage of individuals for each equation for whom RMR was predicted within the accepted error range (i.e., ± 10% of the measured RMR). The Owen Weight equation demonstrated the lowest bias (mean difference from measured RMR = + 55 ± 84 kcal/day) and highest accuracy rate (88.2%). The Cunningham equation exhibited the greatest bias (mean difference from measured RMR = + 287 ± 125 kcal/day) and lowest accuracy rate (23.5%). Finally, possible relationships between fitness characteristics and measured RMR were explored using Pearson’s bivariate correlation coefficients. Body weight exhibited the strongest correlation with measured RMR (r = 0.854, p = 0.001). Additional partial correlations controlling for the effects of body weight were performed. Previously significant correlations between measured RMR and height, BMI, WC, and lean body mass were no longer significant after controlling for the effects of weight (p > 0.05). In general, ROTC cadets and midshipmen exhibited normal body weights, healthy body composition profiles, and above average aerobic fitness. Resting metabolic rate was overestimated by all RMR prediction equations (p < 0.05). Future research should consider exploring regression analysis, incorporating body weight and lean body mass as predictors, to develop a RMR prediction equation that is specific and accurate for this population.M.S., Human Nutrition -- Drexel University, 201
Examining Disparities in Breast Cancer Screening Rates in a Program Designed to Provide Free Care to Women in the State of Pennsylvania
Full text linkBackground. Female breast cancer is the most diagnosed cancer in women and the second leading cause of cancer death in women (behind lung cancer) (U.S. Cancer Statistics Working Group, 2013b). The purpose of this research was to examine client and provider level characteristics driving the disparities in morbidity and mortality as it relates to breast cancer screening, thus providing a clear indication of what client and provider factors are essential for successfully reducing disparities in breast cancer screening beyond removing barriers of cost. Specific aims include: (1) To characterize the client population utilizing the services of the Healthy Woman Program in Pennsylvania; (2) To Identify client and provider predictive factors that influence women with an initial screening mammogram to return for rescreening within 24 months; and (3) To use a local case study to explore service delivery factors influencing woman with an initial screening mammogram to return for rescreening. Methods. This study was a retrospective analysis of prospective data from the Healthy Woman Program (HWP), investigating women enrolled in the HWP in Pennsylvania and their rescreening rates. As the HWP dataset primarily contained client-level variables, additional structural provider-level variables were derived from Komen Foundation data, and data from the United States Department of Agriculture (USDA) and the Census, to extend the investigation beyond the individual woman to specified contextual effects. A local qualitative case study augmented the quantitative analysis to explore more process-oriented contextual effects, with an emphasis on how services are organized to support client outreach and retention, and promising practices for getting clients to return for rescreening. Results. The major predictors of an abnormal mammogram were having a diagnostic mammogram rather than a screening mammogram, being younger than 40, and living in an urban area. The major predictors of a breast cancer diagnosis were being white, being younger than 40, living in a large rural town, and being a current smoker. The major predictors of dropping out after an abnormal mammogram were being white, and having a diagnostic mammogram rather than a screening mammogram. The major predictors of delay in diagnostic work up were Black race and screening mammogram. The major predictors of returning for screening were living in a large rural town, being a non-smoker, having no symptoms prior to the initial mammogram, having a normal result from the initial mammogram, and living with others. Comprehensive breast cancer education, delivered in community settings, and tailored to cultural, social, and literacy issues, results in a robust referral network. More reminders than mandated by HWP Guidance, through multiple channels, rather than the client alone, increase returns for annual rescreening. Conclusions. Prior investigation of rescreening rates among low-income women has focused on client-level factors, yielding a narrow range of targets for systems change. This study investigated both client and provider level characteristics, analyzing them together and separately, to increase understanding of the multifactorial predictors of rescreening and widen the set of potential targets for change. Instituting a protocol of allowing community groups to organize a few women to have screenings in one day and allowing for interpreters who are family or community members would improve rescreening rates. Methods for ensuring patients return should be modified as the HWP sequence may not be enough.Dr.P.H., Public Health -- Drexel University, 201
Experiences of Couples Having a Young Child with Cleft Lip and/or Palate, Comparing Prenatal and Postnatal Diagnosis Groups: A Phenomenological Study
Full text linkThis study was designed to describe the experiences of both mothers and fathers who are currently caring for an infant (12 months old) or young child (up to 4 years old) who was born with cleft lip and/or palate (CL/P). The biopsychosocial approach, the Resiliency Model of Family Stress, Adjustment, and Adaptation, and transcendental phenomenology guided this study. A convenience sample consisted of 17 couples (10 prenatal and 7 postnatal) who previously volunteered for an ongoing longitudinal quantitative study at the Children's Hospital of Philadelphia [PI: Dr. Canice E. Crerand, PhD (2008). Psychosocial adjustment in parents of infants with cleft lip and/or palate: The impact of prenatal versus postnatal diagnosis]. Couples completed a consent form, a demographic self-report survey, and the Revised Dyadic Adjustment Scale and then participated in in-depth interviews. The timing of the CLP diagnosis, the birth, and the initial stages after birth were reported as the most challenging periods for both prenatal and postnatal couples, unless their children still had ongoing developmental delays. The initial stages immediately following the birth were reported as more stressful for the postnatal diagnosis group because they had no time to prepare. Course of treatment, feeding, and social stigma were reported as major sources of stress for all 17 couples. Findings suggest that, regardless of the timing of the diagnosis, couples could benefit from (1) health professional's calm demeanor when first delivering the CL/P diagnosis, because it affects how parents perceive the CL/P, which later determines how they cope and problem solve; (2) an initial information session with both parents at the time of the diagnosis; (3) peer support from other couples to reduce their feelings of isolation; (4) help from health professionals to alleviate any self-blame, especially for the mothers; and (5) help for couples who are more distressed at diagnosis and especially during the first year after birth, such as regular screening and referrals for couple-based interventions to promote secure attachment and better coping. Finally, future research should include more racially and economically diverse samples of couples to develop culturally sensitive intervention programs.Ph.D., Couple and Family Therapy -- Drexel University, 201
Never Married Heterosexual Black Male-Female Intimate Romantic Experiences: A Phenomenological Study
Full text linkThe diminishing rates of marriage and proliferation of individuals who are unmarried in the United States have greatly altered the makeup of heterosexual intimate pair bonding in the general population. For Blacks in the United States, these circumstances are more profound. Over the past decades, the precipitous decline in Black marriages and the salient upsurge of never married Blacks have stimulated much theoretical focus but few empirical research studies on Black adults' heterosexual coupling unions have been undertaken (Camp, 2002; Dixon, 2009; Pinderhughes, 2002; Tucker, 2003). In order to fill the empirical gaps regarding heterosexual coupling unions among Blacks, this qualitative hermeneutic phenomenological study explored the experiences of 26 never married Black men and women (ages 25-35) in their attempts to cultivate and maintain intimate romantic relationships. Through in-depth, open-ended individual interview approach, this phenomenological study, guided with the theoretical frameworks of Africana Womanism (Hudson-Weems, 2008) and Symbolic Interactionism (Charon, 2007), sought to capture and understand how participants described and interpreted their intimate romantic coupling experiences and relationships. The findings illustrated that the overwhelming majority of the participants desired to be married or be involved in a long-term secure and intimate romantic relationship. The majority of the participants felt that the initial stage of cultivating romantic relationships began with strong unspoken connection and passion because of their common Black racial identity, background and culture. Furthermore, participants expressed that their racial location and history in society also contributed to the difficulties that they experienced in maintaining an intimate romantic relationship. Participants contextualized their experiences of cultivating and maintaining intimate romantic relationships within social-historical context of the imposition of whiteness, the residual effects of slavery around skin color and emotional alienation between Black men and women; socio-cultural context of the rarity of long-term, positive quality Black marriages and relationships as well as internalized racial stereotypes; and socio-structural context of gender imbalance in educational, income and career achievements. The findings illustrated that as a result of pairing within these socio-historical, socio-cultural and socio-structural contexts, never married heterosexual Black men and women appeared to be coupling within a shame-based racial context. Participants, therefore, described their experienced coupling processes to be difficult and labor intensive. Given these revealing findings, implications for future research, clinical training and practice, and social policy are provided.Ph.D., Couple and Family Therapy -- Drexel University, 201
Movement Coordination Impairment in Non-Specific Low Back Pain: Understanding Aberrant Patterns of Movement and Our Ability to Change Them
No full textObservation of aberrant movement patterns during active forward bending is one criterion used to identify non-specific low back pain (NSLBP) patients with movement coordination impairment (MCI). Core stabilization exercise is an intervention strategy widely used with NSLBP patients. Evidence supports improvement in clinical outcomes (pain and function) following core stabilization; however, the ability of these exercises to modify trunk and pelvis movement patterns has not been investigated. While the utility of clinical observation of poor movement patterns can assist in identification of patients with MCI, methods to capture, describe, and quantify typical and aberrant trunk and pelvis movement patterns have not been adequately developed. Quantification of movement patterns would allow us to investigate the ability of core stabilization exercises to modify movement coordination and control. The purposes of this study were to 1) characterize temporal and spatial 3-dimensional multi-segmental kinematic patterns that represent typical and aberrant patterns of movement during standing forward bend, and 2) determine the ability of core stabilization exercise to alter trunk and pelvis movement patterns. Findings demonstrated the lumbar spine segment is the key segment to observe for identification of sagittal plane deviation (DEV) and judder (JUD), while coordination between the lumbar spine and pelvis can be used to assess JUD and altered lumbopelvic rhythm (aLPR). Typical and aberrant movement patterns are described and graphical representation presented. Kinematic algorithms developed based on clinical observation and variables that quantify aberrance from a typical movement pattern were tested for reliability and validated with known groups (healthy controls and NSLBP). The algorithms and variables were used to identify each type of aberrant movement pattern and used to investigate the ability of an 8-week core stabilization exercise program to change movement. Results demonstrated significant reduction of DEV and aLPR and a trend toward reducing JUD toward typical patterns with medium effect size. Findings from these studies provide methodology for future studies into movement patterns in NSLBP patients and preliminary evidence for the ability of core stabilization exercise to modify trunk and pelvis movement coordination and control by restoration of appropriate trunk neuromuscular control.Ph.D., Rehabilitation Sciences -- Drexel University, 201
An Arts-Based Study of the Dynamics of Expressing Positive Emotions within the Intersubjective Art Making Process
Full text linkThis arts-based research study explored the dynamics of expressing positive emotions, within the intersubjective art making process. The study addressed a multifaceted problem involving a gap in knowledge about the process of emotional expression through art making, which is key to therapeutic action in art therapy. The design was arts-based research, as art making was the primary means of inquiry. The philosophy and methodology of arts-based research were employed to explore the emotional aspects of intersubjective experience. Following the traditions of arts based research, the meaning-making capacity of creating art was used to illuminate the process of artistic creation in response to the research questions. The research was conducted following approval by the Drexel University IRB. Five English-speaking adults who were professional art therapists were recruited as key informants. The method of data generation involved an initial two hour Art Interview, followed by reflexive memoing and responsive art-making by the researcher and a subsequent second Art Interview with co-researchers. Methodological credibility procedures consisted of member checking and peer review. The data analysis processes involved: 1) traditional use of qualitative data analysis practices, such as the use of MAXQDA-10 software for coding for themes and 2) arts-based research data analysis methods. The analysis of the interview data, artistic data, artistic responses and a creative synthesis addressed the research question in the form of visual art pieces, poetry, a video, three stories, four themes, and a theoretical model. Overall, the verbal and artistic analysis of the data resulted in thematic categories that represent the emergence of emotions within the intersubjective art therapy relationship. Based upon the findings, the emergence of emotions within the intersubjective context was conceptualized as an iterative process beginning with metaphors of life and nature, the development of trust, revelations of emotion, empathic responses, reflexivity and joint artmaking creating and causing destabilization, deconstruction, reconstruction, and reimagining of perceptions and meanings. An emerging, holistic view of emotions and the transformative capacity of artmaking in a context of relational trust were discussed. Clinical applications included consideration of the therapeutic use of response art and joint artmaking. The limitations of the study were also described, as was methodological criteria for arts-based research. Overall, this expanding discourse helped to identify ways art therapy works. The study achieved its aim by contributing knowledge to our understanding of how emotions emerge, are expressed, and assigned meaning within an art therapy relational context.Ph.D., Creative Arts Therapies -- Drexel University, 201
Bridging the Gaps: How Does Anti-Gay Discourse and Legislation Affect the Emotional and Relational Well-Being of African-American Lesbian Women and Family
Full text linkA review of the scholarly literature within the field of Couple and Family Therapy (CFT) revealed a gap in the literature on the lives of African American lesbian women and their families, particularly as it relates to anti-gay legislation and marriage amendments. This has important implications for how clinicians, educators, and researchers come to understand the relational well-being of African American lesbian families within socio-historical, cultural and political contexts. Specifically, it has implications for understanding the effects of anti-gay agendas at the intersections of race, gender, sexual orientation, and class.
This study utilized a phenomenological methodology with an intersectional perspective to explore the effects of anti-gay discourse, legislation and constitutional amendments on the emotional well-being (i.e., how one feels about their sexual orientation and/or sexual identity) and relational well-being (i.e., how the relationships with others are impacted) of African-American lesbian women. Thirty face-to-face interviews were conducted in the homes and/or communities of the participants in the following states: Pennsylvania (8), North Carolina (8), Maryland (8), New Jersey (4) and the District of Columbia (2).
Analysis of the data indicated that the self-identified African American lesbian women who partici-pated in this study were variously affected by anti-gay discourse, legislation and constitutional amendments. The effects of the phenomena ranged from no emotional connection to feelings of a personal affront. The majority of participants felt so disconnected from the movement that, initially, they saw no need to get politi-cally involved. They shared that they did not identify with the marriage equality movement because the issues that were endemic in their lives and the lives of other African Americans in their communities were not a part of the discourse on marriage equality (e.g., economic disparities, afford-able housing and safe communities for their families, equal employment opportunities, quality education for their children, homeless for LGBTQ youth, HIV/AIDS awareness/prevention and legal protections for transgendered individuals). While they sup- ported the main goal of the movement they did not see representations of African American lesbian women and families in the discourse nor in the media campaigns for marriage equality. Therefore, they did not identify with the movement for they viewed it as one based primarily on the agenda of White gay men.
This lack of identification with the movement held true for all of the participants unless they found themselves in the midst of a statewide marriage amendment campaign or they became aware of the limited state a federal benefits attached to their legally recognized relationship status (marriage or civil union). These were the turning points for many of the participants. Nearly 57% of the participants had become so incensed by what they viewed as attempts to legislate discrimination and mislead the public regarding the intent of the proposed amendments that they felt compelled to get involved in community organizing and political advocacy for marriage equality. Some of them testified in front of state legislatures and others worked at the polls on Election Day, held fundraisers, worked at phone banks and developed a website where people were invited to share their thoughts and feelings on marriage equality. The website was linked to other sites where people could go to obtain information on marriage equality and the proposed amendment. The participants were driven by a need to educate themselves and the public on the potential benefits and consequences of proposed legislation and public policies.
The personal accounts of the African American lesbian women who participated in this study invites the reader to analyze the effects of anti-gay legislation from different viewpoints. For in spite of similar intersecting racial, gendered, and sexual identities; the participants' experiences of the phenomena were shaped by their respective sociocultural, historical, political, and legal contexts, the geographic locations that the participants navigated on a daily basis and their life cycle stages (young children, adult children, no children, and their relationship status). The findings also highlighted how instrumental local and national civil rights organizations (e.g., National Black Justice Coalition, the NAACP and the Human Rights Campaign) were in expanding the discourse on marriage equality to ensure that the diverse voices and faces within LGBTQ communities were an integral part of the movement.
The ultimate goal of the study was to center the voices and experiences of African American lesbian women regarding the effects of anti-gay discourses and legislation and to reduce the gap in Couple and Family Therapy professional journals on this segment of the population. Reducing the gap in the literature can contribute to the development of new knowledge on the effects of anti-gay agendas enhancing the ability of clinicians, researchers and social justice advocates to develop culturally sensitive protocols to service the needs of African American lesbian women and their families.Ph.D., Couple and Family Therapy -- Drexel University, 201
African American Heterosexual Men's Experiences of Emotionally and Sexually Intimate Relationships with Women: Implications for Sexual HIV Risk and Protective Behaviors
Full text linkAlthough HIV infection is relatively low among heterosexual men overall compared with other groups of men, HIV infection in heterosexual men is highest among African American heterosexual men. Research has demonstrated that intimate relationships with women among African American heterosexual men have influenced sexual risk behaviors, such as engaging in unprotected sex and having concurrent sexual partnerships; as well as protective behaviors, such as condom use. The Close Relationship Context was utilized to frame this study. This dissertation consisted of secondary data analysis of 30 semi-structured interviews conducted for the qualitative phase of REPRESENT, a mixed methods study conducted in Philadelphia (2007 – 2009). The REPRESENT study was conducted to examine the effects of gender role norms, sexual scripts and structural factors on sexual HIV risk behaviors of low-income African American heterosexual men who reside in Philadelphia. NVivo 10.0 software was used to code narratives stemming from the interviews relevant to sexually and emotionally intimate relationship experiences with women among this sample of men. The codes were subsequently refined to generate themes derived from the data. There were five dominant themes and two non-dominant themes related to relationship experiences that increased sexual risk, and four dominant themes related to relationship experiences protecting against sexual risk. Participants cited trust and length of relationship as reasons for non-condom use with main sexual partners, but cited length of association of sexual partner as reasons for non-condom use with casual sexual partners. Participants cited relationships that have developed over time as reasons for non-condom use with both main and casual sexual partners. Participants identified monogamy and HIV/STI testing in committed relationships serving as protective sexual behaviors. They also cited that having sex with casual sexual partners and complying with partners’ requests and demands to use condoms as reasons to do so with their sexual partners.Dr.P.H., Public Health -- Drexel University, 201
Experiences of immigrant couple and family therapists clinically active in the United States: A Phenomenological Study
Full text linkImmigration continues to be an important source of demographic growth in the United States (US Census Bureau, 2012). Mental health disciplines in general, and couple and family therapy in particular are paying more attention to immigration as an experience that can profoundly affect the identity and relationships of individuals and families. However, the impact of immigration has been addressed predominantly for immigrant clients. In the extant literature, much less attention has been paid to immigrants as couple and family therapists regarding how their experiences of immigration can affect clinical encounters with clients in the US. In order to fill this gap, this phenomenological dissertation study was designed to examine the clinical experiences of couple and family therapists who were born and raised outside of the US and who are clinically active in this country. Symbolic interactionism (Blumer, 1969; Mead, 1934) and the multicultural perspective as defined by Hardy and Laszloffy (2002) guided the development of this qualitative study which followed the stages and tasks of transcendental phenomenology (Moustakas, 1994). Thirteen immigrant couple and family therapists who were clinically active in the US volunteered for in-depth interviews. Interviews were transcribed verbatim, and the transcriptions were analyzed with the assistance of MaxQDA and using conventional content analysis (Hsieh & Shannon, 2005) to identify frequent and notable themes. The following major themes emerged from the data analysis: (a) the experience of immigration, (b) immigrant therapists and their clients, (c) development as a clinician, (d) relationships with colleagues and other professionals, and (e) a name for ourselves. The five major themes suggest that the exposure to different cultures during therapeutic encounters in the US and working in the midst of cultural differences affected participants’ clinical work. First, findings supported previous literature that described immigrant therapists as capable of having an outsider perspective, being more aware of their assumptions, being more flexible in their definitions, and experiencing discrimination by clients and other professionals in the US. Second, findings suggest that the therapeutic encounter is a relationship where meanings between therapists and clients are exchanged which facilitates identity transformations, the debunking of stereotypes, and the negotiation of new meanings. Regarding implications, findings from this study suggest that feedback from clients, supervisors, colleagues and faculty members affect the formation of immigrant CFTs’ evolving professional identities. Supervisors and faculty members in training programs should develop a more balanced view of immigrant CFT students and professionals that more closely attends to their needs and nurtures their strengths. CFT training programs and clinical supervisors should teach diversity and multiculturalism in a way that recognizes human diversity without promoting rigid categorization and divisiveness. Future research should pay closer attention to the strategies that immigrant CFTs develop that helps them clinically work in the midst of cultural differences with clients in the US.Ph.D., Couple and Family Therapy -- Drexel University, 201
Transforming the System of Care for Adolescents in Ghana: Preliminary Investigation of Adolescent Friendly Health Services Implementation in Two Administrative Districts of the Ghana Health Service
Full text linkBackground -- The younger generation is the wealth and future of humanity; their health and wellbeing deserve utmost attention. Adolescent Friendly Health Services (AFHS) aim at providing accessible, developmentally appropriate and comprehensive evidence based promotional, preventive, therapeutic, and rehabilitative health care to adolescents via well trained professionals and well equipped health facilities. This study sought to explore adherence of health facilities in Ghana to the World Health Organization (WHO) AFHS concept. The study also identified obstacles the facilities faced in implementing the program, innovative measures taken to overcome them and any other approaches to enhance AFHS delivery to the adolescent population. Methods -- Using a cross sectional (observational) study design with a multi informant, mixed method survey, the study assessed adherence to AFHS criteria among health facilities providing AFHS oriented care in the Akwapim North and South Districts of Ghana. Results -- Health facilities identified as early adopters had significantly higher AFHS implementation compared to late adopters, and the association of adopter category with AFHS implementation did not vary by location (urban vs. rural). Organizational characteristics of clinical care infrastructure, logistics monitoring, and capacity building, were significantly associated with implementation. Major barriers to AFHS implementation included care provider attitude/behavior towards adolescents, community attitudes about adolescents receiving sexual and reproductive health services like family planning, and health care costs (affecting adolescents and health facilities). Conclusions -- The Ghana Ministry of Health initiative to transform the system towards AFHS appears to be successful, as early adopters have higher rates of implementation than late adopters, but it is important to note that a transformation of this nature takes time. The change towards AFHS implementation is supported by organizational changes to clinical care infrastructure, logistics monitoring, and capacity building, suggesting that the addition of a training and technical assistance program may speed the change process. Finally, while facility structure and process issues are important for transforming the Ghana Healthy System towards AFHS, it appears that successful transformation also depends, in part, upon provider and community attitudes, available resources for work, and health care policies related to costs, highlighting the importance of working with health care professional organizations, community leaders, and other stakeholders to institute full system-wide change.Dr.P.H., Public Health -- Drexel University, 201