Bullying is everybody's problem

Includes bibliographical references

Baseline assessment and cost analysis of a supplementary feeding intervention on Adivasi children in West Bengal, India : How to diversify diets with locally available resources cost-effectively to reduce the burden of child and maternal undernutrition and anaemia?

This dissertation presented and analyzed the living, health and nutrition situation of tribal Adivasi children (aged 6-39 months) as well as of their mothers living in rural Birbhum district, West Bengal, India. It was found that extended families use to have higher incomes (p0.05). Still, non-anaemic mothers showed bigger likelihood of having non-anaemic children than mothers with poorer Hb statuses, and - the other way around - mothers with severe anaemia showed the biggest likelihood of having children with moderate anaemia. It was argued, accordingly, that not only children but also their mothers should be better nourished in order to break the vicious circle of undernutrition - with a focus on lactating mothers who have highest nutritional intake needs. Overall, 94 percent of tribal Adivasi children were found anaemic (n=307, age range: 6-39 months, Hb0.05) and when comparing a group of children who had received a (low dosed) micronutrient sprinkle along with diversified meals (p>0.05). A cost-effectiveness analysis of 425 locally available foods has been conducted in order to work out those foods delivering highest nutrient density in relation to their retail cost (adjusted for edible portion). Foods from the FGs cereals and millets, vegetables, and roots and tubers belonged more often to the top 30 percent of cost-effective foods as per winter-price analysis (p 4th until ≤ 8th percentile), high (>8th until ≤ 9.5th percentile) or very high (> 9.5th percentile) contents. On the basis of knowing most cost-effective locally available foods and assessing also their anti-nutritive elements, a weekly meal schedule has been worked out in cooperation with the nutritionist Caroline Stiller (who was the second PhD candidate in this twin PhD project and knows the local setting well). It became clear that the RDAs of moderately malnourished children and their mothers can hardly be fully covered with locally available foods alone - where a deficit of 20 and more percent of the RDA remained with regard to vitamins A, E, B1 and B2, as well as of zinc and linoleic acid (children), with regard to vitamins A, E, B1, B2 and B9, as well as of potassium and linoleic acid (lactating women), with regard to vitamins B1, B2 and B9, as well as of iron, potassium and linolenic acid (pregnant women), and with regard to vitamins B1 and B2, as well as of iron, potassium and linolenic acid (non-pregnant and non-lactating women). It was further found that the costs associated with the suggested cost-effective and nutrient-dense weekly meal schedule exceeded available family budgets (calculated based on n=66 HHs and with respect to consumed portion sizes of children and mothers) by 217 percent in case of children (with a weekly cost of 267 Rs. rather than the available 144 Rs.), and by 200 percent in case of lactating, pregnant as well as non-pregnant non-lactating mothers. The role of government services (AWCs, the PDS, and the MGNREGA), kitchen gardening/wild plant collection, own fishing activities and crop diversification in covering this deficit was enumerated and it was found that AWCs are able to cover the largest part of the weekly financing deficit (amounting to 34 percent in case of children), followed by kitchen gardens/wild plant collection (24 percent). As breastfeeding is deeply rooted in the Santal Adivasi communities (96 percent of mothers, n=275, were found to breastfeed their youngest child - with a mean age of 21.2 months), it is proposed in this dissertation that lactating women should be included as beneficiaries of AWCs in order to cover their nutrient needs and break - finally - the circle of undernutrition where children and mothers need to be seen together, rather than focusing merely on children in the well-known 1000-days window of opportunity.Diese Dissertation analysiert die Lebens-, Gesundheits-, und Ernährungssituation von Kindern der Urbe-völkerung Indiens im Alter von 6-39 Monaten, die im ländlichen Birbhum Distrikt in West Bengalen leben - und präsentiert dabei auch Daten ihrer Mütter. Es zeigte sich, dass Großfamilien signifikant öfter eine höhere Einkommensgruppe erreichen als Kleinfamilien (p0,05). Dennoch zeigten nicht-anämische Mütter eine höhere Wahrscheinlichkeit ein nicht-anämisches Kind zu haben als Mütter mit niedrigem Hb; im selben Sinne zeigten Mütter mit schwerer Anämie die höchste Wahrscheinlichkeit ein Kind mit moderater Anämie zu haben (die häufigste Anämie-Form unter den untersuchten Adivasi-Kindern). Entsprechend gilt es nicht nur die Kinder der indischen Ureinwohner, sondern auch deren Mütter besser zu ernähren, um den Kreislauf der Mangelernährung zu durchbrechen; hierbei gilt es einen Schwerpunkt auf die stillenden Mütter zu legen, die den höchsten Nährstoffbedarf haben. Insgesamt wiesen 94 Prozent der untersuchten Kinder im Alter von 6-39 Monaten eine Anämie auf (n=307, Hb36 Monate eher milde Anämien zeigten - wohingegen Kinder zwischen 6-23 Monaten meist eine moderate Anämie vorwiesen. Der Verzehr von Früchten senkte nachweislich das Vorkommen von moderater und schwerer Anämie unter den Kindern (p0,05); selbiges gilt für den Verzehr eines gering-dosierten Mikronährstoffpulvers (Sprinkle) zusätzlich zu den Mahlzeiten (p>0,05). Innerhalb der vorliegenden Dissertation wurde weiterhin eine Kosten-Effizienz-Analyse durchgeführt, die 425 lokal verfügbare Lebensmittel einbezog und untersuchte, welche dieser Lebensmittel bezogen auf die Kosten die höchste Nährstoffdichte aufweisen? Die Kosten wurden an die tatsächlich essbare Portion angepasst, um etwa Knochen, Schale und Kerne zu berücksichtigen. Lebensmittel der Nahrungsmittel-gruppen (1) Getreide/Hirse, (2) Gemüse und (3) Wurzeln gehörten signifikant öfter zu den Top 30 Prozent der kosteneffizienten Lebensmittel in der Winterpreis-Analyse (p9,5tes Perzentil), hohe (>8tes bis ≤ 9,5tes Perzentil), mittlere (>4tes bis ≤ 8tes Perzentil), und geringe (≤ 4tes Perzentil) Antinährstoffniveaus zu unterscheiden. Basierend auf der Kenn-tnis der lokal verfügbaren kosteneffektiven und antinährstoffarmen Lebensmittel wurde - in Kooperation mit der Ernährungswissenschaftlerin Caroline Stiller - ein wöchentlicher Ernährungsplan für die Adivasi-Kinder ihre Mütter entwickelt. Es zeigte sich, dass die RDAs der moderat mangelernährten Kinder (die höher liegen als die Verzehrsempfehlungen gesunder Kinder!) und ihrer Mütter nicht vollständig durch lokale Lebensmittel alleine gedeckt werden können; es blieb trotz Einsatz der kosteneffektivsten Lebens-mittel ein Defizit von 20 Prozent und mehr der empfohlenen Verzehrsmenge in Bezug auf die Vitamine A, E, B1 und B2, sowie Zink und Linolsäure (Kinder), in Bezug auf die Vitamine A, E, B1, B2 und B9, sowie Kalium und Linolsäure (stillende Frauen), in Bezug auf Vitamine B1, B2 und B9, sowie Eisen, Kalium und Linolsäure (Schwangere), und in Bezug auf Vitamine B1 und B2, sowie Eisen, Kalium und Linolsäure (nichtschwangere, nichtstillende Frauen). Die Dissertation zeigte desweiteren, dass die Kosten der empfohelnen Ernährung das verfügbare Budget der Adivasi-Familien (berechnet auf Basis den Einkommensdaten von n=66 Haushalten und mit Bezug auf die Verzehrsmengen von Kindern und Müttern) um 217 Prozent (Kinder) bzw. um 200 Prozent (Mütter) übersteigen. Das Potential von Regierungsprogrammen (AWCs, PDS, sowie der MGNREGA), Küchengärten, Fischerei und einer diversifizierten Landwirtschaft wurde quantifiziert, wobei die AWC den größten Teil zur Finanzierungslücke einer kosteneffizienten diversifizierten Ernährung beitragen können, gefolgt von Küchengärten. Da das Stillen bei den Adivasi-Müttern weit verbreitet ist (96 Prozent der Mütter, n=275, stillten ihr jüngstes Kind entsprechend des Baseline-Surveys - mit einem mittleren Alter der Kinder von 21,2 Monaten), empfiehlt diese Dissertation stillende Mütter dringend als Nutznießer der AWC einzuschließen, um ihren Nährstoffbedarf besser abzudecken und den Kreislauf der Unterernährung, wo Kinder und ihre Mütter gemeinsam gesehen werden müssen und der alleinige Fokus auf die Kinder in den ersten 1000 Tagen unzureichend ist, schließlich zu durchbrechen

The Effects of Depression, Anxiety, and Stress on College Students: Examining the Role of Mental Health Self-Efficacy on Willingness to Engage in Mental Health Services

Relative to younger ages, mental health problems are more prevalent among college students (Pedrelli et al., 2015) and nearly 20% of U.S college students are diagnosed each year with a mental health problem (Blanco et al., 2008). College students’ self-efficacy may influence mental health outcomes by impacting an individual’s decision to change their behavior and execute a course of action (Bresó et al., 2011). Mental health may also be influenced by the degree of willingness that an individual possesses, such that those who are more willing to seek mental health treatment are also more likely to follow through and seek help (Segal et al., 2005). Participants in the present study were first-year freshman college students who completed an online survey. Specifically, it was predicted that mental health symptoms would be negatively associated with mental health self-efficacy, and that higher mental health self-efficacy would be associated with greater willingness to engage in mental health services. Additionally, it was hypothesized that mental health self-efficacy would mediate the relationship between mental health problems and willingness to engage in mental health services. Mental health symptoms were negatively associated with mental health self-efficacy; however, mental health self-efficacy was not significantly associated with willingness to engage in mental health services. Lastly, mental health self-efficacy did not significantly mediate the relationship between mental health symptoms and willingness to engage in mental health services. Results from this study highlight the importance of increasing access to mental health prevention and intervention programs to assist college students with mental health problems who may be hesitant to seek services

Health Care and Policy Interventions to Improve the Health of Patients Experiencing Homelessness

Indiana University-Purdue University Indianapolis (IUPUI)Housing instability and homelessness are associated with significant health burdens, including high rates of chronic and infectious disease, disproportionate vulnerability to violence and injury, and increased risk of premature death and disability. In addition, between 28-57% of nonelderly homeless adults lack health insurance coverage. Consequently, homelessness is associated with reduced access to outpatient primary care services and increased rates of emergency department (ED) visits, which are costly and inefficient for both health systems and patients. In the context of mounting emphasis on value-based reimbursement structures, health systems and policymakers have a vested interest in reducing high-cost utilization and addressing social determinants of health, including housing. Therefore, in this dissertation, I address three research questions at the intersection of housing needs and the United States health care delivery system. The first study is a systematic review of the peer-reviewed literature evaluating interventions to reduce ED utilization among adults who experience homelessness. The second study uses state-level panel data to examine the impact of Medicaid expansion on rates of adult homelessness by comparing states that opted to expand their Medicaid eligibility requirements under the Affordable Care Act (ACA) with states that did not. Finally, the third study uses multiple years of national data to assess clinical quality performance among a subset of federally qualified health centers that received Health Care for the Homeless (HCH) funding from 2014-2017 to provide homeless-tailored primary care services. Key findings include the need for larger, more generalizable studies with rigorous designs to assess the effectiveness of strategies to reduce ED use among homeless patients; expanding Medicaid eligibility may mitigate the impact of large or unexpected medical expenses among families with children who are at risk of homelessness; and finally, HCH-funded health centers have demonstrated improvements on several clinical quality indicators over time and have distinct organizational characteristics that are associated with performance on these indicators. Collectively, these studies sought to answer timely health policy and management questions about individuals who experience housing needs, a group that comprises one of the most under-resourced and socially disadvantaged patient populations in the United States

The Effect of Minority Stress on Sexual Minority College Students\u27 Mental Health: The Role of General Social Support and Sexuality-Specific Social Support

Sexual minority (SM) college students continue to face greater mental health problems relative to their heterosexual peers (Woodford et al., 2014; Wilson & Liss, 2022). According to minority stress theory, SM individuals face distal (e.g., heterosexist discrimination) and proximal (e.g., expectations of rejection, internalized homophobia, and concealment) stressors related to their SM identity which can have negative effects on their mental health (Douglass & Conlin, 2020; Meyer, 2003). However, social support has been hypothesized to help protect against the effects of minority stress experienced by SM individuals (Cohen & Wills, 1985; Moody & Smith, 2013). Most of the existing research with SM college students has examined social support more broadly, and less empirical attention has been given to sexuality-specific support, which attends to the specific range of stressors related to one’s sexual identity (Doty et al., 2010; Sheets & Mohr, 2009). Thus, the current study had three aims: 1) to examine if distal stress (i.e., heterosexist discrimination) and proximal stress (i.e., internalized homophobia) were associated with mental health symptoms among SM college students, 2) to examine if general social support moderated the associations between distal minority stress (i.e., heterosexist discrimination) and proximal minority stress (i.e., internalized homophobia) and mental health symptoms among SM college students, and 3) to examine if sexuality-specific social support moderated the associations between distal minority stress (i.e., heterosexist discrimination) and proximal minority stress (i.e., internalized homophobia) and mental health symptoms, among SM college students. A total of 268 undergraduate college students who self-identified as a sexual minority individual completed a survey assessing minority stress, social support, and mental health symptoms. Distal minority stress (i.e., heterosexist discrimination) was directly associated with mental health symptoms. General social support moderated the link between proximal minority stress (i.e., internalized homophobia) and mental health symptoms, and this association was strongest for individuals with more general social support. Clinicians should consider utilizing interventions to increase social support to address the psychological impact of minority stress and universities should adopt anti-discrimination policies and curricula to promote LGBTQ+ acceptance. Suggestions for improving social support, reducing discrimination, and creating an inclusive campus environment are discussed

The distribution of Sarracenia purpurea (pitcher plant) in Southeastern Wisconsin fens: The influence of pH and nutrients

Temperature, pH, alkalinity, total-N, total-P, K, Na, Ca and Mg levels were measured in groundwater at the Pickerel Lake and Ottawa Lake calcareous fens and the Cedarburg Bog patterned fen. The two calcareous fens were similar in all chemical characteristics. Alkalinity, pH and Mg were significantly lower in the patterned fen when compared to the calcareous fens, while the other chemical parameters were similar. Each of these southeastern Wisconsin fens supported Sarracenia purpurea (pitcher plant). When the characteristics of the groundwater of the areas that supported S. purpurea were compared with those of areas that did not support S. purpurea, it was evident that distribution of S. purpurea was not correlated with the measured groundwater characteristics. Eleocharis rostellata (spike rush) was dominant in the calcareous fens, while Rhynchospora alba (beak rush) was the dominant plant of the patterned fen. S. purpurea often occurred in association with various mosses and, in the two calcareous fens, usually grew near spring seeps

Stories Have the Power to Save us: A Neurological Framework for the Imperative to Tell Stories

The evolutionary advantage of humans is in our unique ability to process stories – we have highly evolved ‘narrative organs.’ Through storytelling, vicarious knowledge, even guarded knowledge, is used to help our species survive. We learn, regardless of whether the story being told is ‘truth’ or ‘fiction.’ Humans place themselves in stories, as both observer and participant, to create a ‘neural balance’ or sweet spot that allows them to be immersed in a story without being entirely threatened by it – and this involvement in story leads to the formation of empathy – an empathy that is integral to forging a future humanity. It is through empathy, we argue, that stories have the power to save us. The hippocampi process narrative details. Situated alongside are the amygdalae – organs that place the reader in the story. The temporal lobes store ‘story nuggets.’ Finally there’s the frontal cortex to inhibit full participation in narrative, so that the story can be experienced vicariously

Interdisciplinary Dissertation Research Among Public Health Doctoral Trainees, 2003-2015

Given the call for more interdisciplinary research in public health, the objectives of this study were to (1) examine the correlates of interdisciplinary dissertation completion and (2) identify secondary fields most common among interdisciplinary public health graduates. METHODS: We analyzed pooled cross-sectional data from 11 120 doctoral graduates in the Survey of Earned Doctorates, 2003-2015. The primary outcome was interdisciplinary dissertation completion. Covariates included primary public health field, sociodemographic characteristics, and institutional attributes. RESULTS: From 2003 to 2015, a total of 4005 of 11 120 (36.0%) doctoral graduates in public health reported interdisciplinary dissertations, with significant increases observed in recent years. Compared with general public health graduates, graduates of environmental health (odds ratio [OR] = 1.74; P < .001) and health services administration (OR = 1.38; P < .001) doctoral programs were significantly more likely to report completing interdisciplinary dissertation work, whereas graduates from biostatistics (OR = 0.51; P < .001) and epidemiology (OR = 0.76; P < .001) were less likely to do so. Completing an interdisciplinary dissertation was associated with being male, a non-US citizen, a graduate of a private institution, and a graduate of an institution with high but not the highest level of research activity. Many secondary dissertation fields reported by interdisciplinary graduates included other public health fields. CONCLUSION: Although interdisciplinary dissertation research among doctoral graduates in public health has increased in recent years, such work is bounded in certain fields of public health and certain types of graduates and institutions. Academic administrators and other stakeholders may use these results to inform greater interdisciplinary activity during doctoral training and to evaluate current and future collaborations across departments or schools