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Public Health Theses and Dissertations

Theses/dissertations from 2023 2023.

Needs Assessment for a Web-Based Support Resource for Patients with a Pathogenic Variant in LMNA , Dylan M. Allen

Evaluation of a Story-telling Approach to Educate Minority Populations About Inherited Cancer , Celestyn B. Angot

Using the Genetic Counseling Skills Checklist to Characterize Prenatal Genetic Counseling , David A. Cline

Reframing Resistance, Resilience, and Racial Equity in Maternal Health: A Mixed Methods Exploration of Paternal Involvement and the Racial Disparity in Severe Maternal Morbidity , Marshara G. Fross

Student Perceptions of the Nonmedical Use of Prescription Stimulants and Preferences for Health Education , Ana Gutierrez

Relationships between Leading and Trailing Indicators at Construction Sites in Yanbu Industrial City, Saudi Arabia , Anas H. Halloul

Variability of Air Sampling Results Using Air-O-Cell Cassettes , Christina M. Haworth

Use of Silica Dust and Lunar Simulants for Assessing Lunar Regolith Exposure , Layzamarie Irizarry-Colon

The Aging Workforce: How it Relates to Incident Rates within a Distribution Warehouse and a Chemical Manufacturing Building , Elisabeth V. Jones

Fuzzy KC Clustering Imputation for Missing Not At Random Data , Markku A. Malmi Jr.

Piloting a Spanish-language Web-based Tool for Hereditary Cancer Genetic Testing , Gretter Manso

Development of a ddPCR Multiplex to Measure the Immune Response to Borrelia burgdorferi. , Kailey Marie McCain

A Healthcare Claims Investigation of Parasomnia Epidemiology, Associations with Attention Deficit/Hyperactivity Disorder, and REM Sleep Behavior Disorder Correlates , Anh Thy Ha Nguyen

Diet and Salivary Microbiome on Cardiovascular Risk and Glycemic Control in Participants with and without Type 1 Diabetes: The CACTI Study , Tiantian Pang

Evaluation of Two Methods to Estimate Wet Bulb Globe Temperature from Heat Index , Stephi Pofanl

Intimate Conversations: A Mixed-Methods Study of African American Father-Adolescent Sexual Risk Communication , Shanda A. Vereen

Assessment of ISO Heart Rate Method to Estimate Metabolic Rate , Karl Williams

Theses/Dissertations from 2022 2022

Outcomes of a Periodic Exposure Assessment of Workers at a University Campus , Logan M. Armagast

Evaluating the Effect of Public Health Governance Structure and Public Opinion on COVID-19 Disease Control Interventions , Daniel Chacreton

Alpha Synuclein: A therapeutic target and biomarker for Parkinson’s Disease , Max Chase

A Study of Noise Exposures for Amusement Park Employees by Positions and Ride Categories , Danielle M. Dao

Bayesian Network-based Diagnostic Support Tool with Limited Point-of-Care Ultrasound for Work-related Elbow Injuries , Cristina Maria Franceschini Sánchez

Host-Pathogen Coevolution Between Tasmanian Devils (Sarcophilus harrisii) and Devil Facial Tumor Disease , Dylan Garret Gallinson

Measurements of Generalizability and Adjustment for Bias in Clinical Trials , Yuanyuan Lu

Examining the Relationship between Racial Respect among Black Early Childhood Professionals and their Perceptions of Black Children , Kayla Nembhard

Etiology of sterile intra-amniotic inflammation: An exploratory study , Zoe M. Taylor

Evaluating and Improving a Novel Toolkit for Implementation and Optimization of Lynch Syndrome Universal Tumor Screening , Tara M. Wolfinger

Theses/Dissertations from 2021 2021

Exploring Adult Attachment in Intimate Relationships among Women who Were Exposed to Intimate Partner Violence in Childhood: A Convergent Mixed Methods Approach , Ngozichukwuka C. Agu

Comparison of the Effectiveness of Disinfectant-Impregnated Wipes Versus Detergent Wipes for Surface Decontamination , Jacob Amadin

Limited Point of Care Ultrasound Clinical Decision Support Model for Work-related Injuries of the Shoulder Utilizing Bayesian Network , Gwen Marie Ayers

Synthesis of a Multimodal Ecological Model for Scalable, High-Resolution Arboviral Risk Prediction in Florida , Sean P. Beeman

Feasibility of a Virtual Group Nutrition Intervention for Adolescents with Autism Spectrum Disorder , Acadia W. Buro

Defining Codes Based on the Consolidated Framework for Implementation Research in the Context of the Implementing Universal Lynch Syndrome Screening , Jasmine A. Burton-Akright

Americans’ Familiarity, Interest, and Actions with Direct-to-Consumer Genetic Testing , Riley L. Carroll

Does Better A1C Control Worsen Osteoarthritis? An Electronic Health Record Cross-Sectional Study , Sarah C. Cattaneo

Analysis of Post-traumatic Stress Disorder Gene Expression Profiles in a Prospective, Community-based Cohort , Jan Dahrendorff

Differential Privacy for Regression Modeling in Health: An Evaluation of Algorithms , Joseph Ficek

Does Time-Weighted Averaging for WBGT and Metabolic Rate Work for Work-Recovery Cycles? , John W. Flach

Screening of Pregnant Women with Opioid Use Disorder: Identifying Factors Impacting Implementation of Screening Recommendations Using the Theoretical Domains Framework , Tara R. Foti

Epigenetic Potential in an Introduced Passerine , Haley E. Hanson

Face Mask Use to Protect Against COVID-19; Importance of Substrate, Fit, and User Tendencies , Evelyn Kassel

Novel Educational Material for Patients with a Variant of Uncertain Significance (VUS) in a Cancer Risk Gene , Meghan E. Kelley

Mechanisms and Mitigation: Effects of Light Pollution on West Nile Virus Dynamics , Meredith E. Kernbach

Seasonality in Competence to Transmit West Nile Virus for a Widespread Reservoir , Kyle L. Koller

Mealtimes in Early Childhood Education Centers During COVID-19: A Mixed-Methods Assessment of Responsibilities, Interactions, and Best Practices , Joanna Mackie

Development and Validation of an Isothermal Amplification Assay for Eastern Equine Encephalitis Virus , Mikayla D. Maddison

Evaluating the Development and Implementation of Campus-based Sexual and Interpersonal Violence Prevention Programming , Robyn Manning-Samuels

Bait-and-Kill: Targeting a Novel Heme Biochemical Pathway in Hundreds of Cancers , Christopher G. Marinescu

Acclimatization Protocols and Their Outcomes , Ayub M. Odera

Promoting HPV vaccination with vaccine-hesitant parents using social media: a formative research mixed-method study , Silvia Sommariva

Sleep Diagnoses and Low Back Pain in U.S. Military Veterans , Kenneth A. Taylor

Theses/Dissertations from 2020 2020

Journey Mapping the Minority Student’s Path Toward Genetic Counseling: A Holistic Picture , Tatiana E. Alvarado-Wing

Using Observations from the UAW-Ford Ergonomic Assessment Tool to Predict Distal Upper Extremity Musculoskeletal Disorders , Zachariah T. Brandes-Powell

Do Similar Exposure Groups (SEG) differ from Air Force base to Air Force base? A Combat Arms Training and Maintenance (CATM) noise exposure comparison of Moody AFB and MacDill AFB. , Miriam F. Escobar

Predictors of Premature Discontinuation from Behavioral Health Services: A Mixed Methods Study Guided by the Andersen & Newman Model of Health Care Utilization , Shawna M. Green

Non-invasive Sex Determination and Genotyping of Transgenic Brugia malayi Larvae , Santiago E. Hernandez Bojorge

Does Gestational Diabetes Mellitus Increases the Risk of Preeclampsia Among Primigravid Women? , Astha Kakkad

Evaluating Effects of Cancer Genetic Counseling on Several Brief Patient Impact Measures , Alyson Kneusel

Impact of Heat-Related Illness and Natural Environments on Behavioral Health Related Emergency and Hospital Utilization in Florida , Natasha Kurji

The Quantification of Heavy Metals in Infant Formulas Offered by the Florida WIC Program , Naya Martin

Differences in Knowledge Acquisition, Perceived Engagement and Self-Efficacy in Latino Promotores Delivering the Heart Disease Prevention Program Su Corazόn, Su Vida , Samuel Matos-Bastidas

Spatial and Temporal Determinants Associated with Eastern Equine Encephalitis Virus Activity in Florida , Kristi M. Miley

Using Observations from the UAW-Ford Ergonomic Assessment Tool to Predict Low Back Musculoskeletal Disorders , Colins Nwafor

On the Importance of Context: Examining the Applicability of Infertility Insurance Mandates in the United States Using a Mixed-Methods Study Design , Nathanael B. Stanley

Exploration of Factors Associated with Perceptions of Community Safety among Youth in Hillsborough County, Florida: A Convergent Parallel Mixed-Methods Approach , Yingwei Yang

Theses/Dissertations from 2019 2019

The Ability of the U.S. Military’s WBGT-based Flag System to Recommend Safe Heat Stress Exposures , David R. Almario

The Relationship between Continuous Glucose Monitor (CGM) Derived Metrics and Indices of Glycemic Control , Ryan Bailey

“Man plans but ultimately, God decides”: A Phenomenological Investigation of the Contextual Family Planning Beliefs of Recently Resettled Congolese Refugee Women in West Central Florida. , Linda Bomboka Wilson

‘If He Hits Me, Is That Love? I Don’t Think So’: An Ethnographic Investigation of the Multi-Level Influences Shaping Indigenous Women’s Decision-Making Around Intimate Partner Violence in the Rural Peruvian Andes , Isabella Li Chan

An Assessment of the Role of Florida Pharmacists in the Administration of Inactivated Influenza Vaccine to Pregnant Women , Oluyemisi O. Falope

Epidemiological Analysis of Malaria Decrease in El Salvador from 1955 until 2017 , Tatiana I. Gardellini Guevara

Self-Collected Sampling Methods for Chlamydia and Gonorrhea Screening Among College Women: Exploring Patient-Centered Intervention Characteristics , Stacey B. Griner

The Relationship Between Hand and Wrist Musculoskeletal Disorders and Hand Activity and Posture , Warren M. Henry

Speeding Diagnosis and Saving Money Using Point of Care Ultrasound Rather Than MRI for Work-related MSK Injuries , Jared A. Jeffries

Mitigating Barriers to Chronic Disease Risk Factor Prevention and Management in Disadvantaged Communities , Krys M. Johnson

Comparing Family Sharing Behaviors in BRCA Carriers with PALB2 Carriers , Joy E. Kechik

Investigating Air Pollution and Equity Impacts of a Proposed Transportation Improvement Program for Tampa , Talha Kemal Kocak

Exploring Young Women’s Choice to Initiate Use of Long-acting Reversible Contraception: A Mixed Methods Approach , Helen Mahony

Evaluation of Clinical Practices and Needs about Variants of Uncertain Significance Results in Inherited Cardiac Arrhythmia and Inherited Cardiomyopathy Genes , Reka D. Muller

Effects of Medications with Anticholinergic Properties and Opioids on Cognitive Function and Neural Volumetric Changes in Elderly Australians , Malinee Neelamegam

Sundaas Story: A Mixed-Methods Study of Household Sanitation Provisioning in Urban Informal Housing in India , Sarita Vijay Panchang

A Retrospective Study of the Opioid Epidemic and Fentanyl Related Overdose Fatality Cases in a Florida West Coast Medical Examiner District Population , Anne Terese Powell

Using Predicted Heat Strain to Evaluate Sustainable Exposures , Samantha L. Thacker

Isokinetic Sampling Efficiency Differences for Blunt Edge vs Sharp Edge Sampling Probes , Cory A. Treloar

Using the Consolidated Framework for Implementation Research to Investigate Daily Pre-exposure Prophylaxis (emtricitabine/tenofovir DF) Implementation via Community-based HIV Testing Sites in Florida , Deanne E. Turner

“We can learn some things from them, but they can learn some things from us too”: Intergenerational Perceptions of Shared Infant Feeding Information , Alexis L. Woods Barr

Theses/Dissertations from 2018 2018

Comparison of Modeled and Measured Pesticide Concentrations in Air , Trenell Davis Boggans

Effectiveness of Biocide Substitution and Management Plan Implementation for the Control of , Adelmarie Bones

Design, Construction, and Characterization of the University of South Florida Wind Tunnel , Jason S. Garcia

Characterization of Scanning Mobility Particle Sizers For Use With Nanoaerosols , Michael R. Henderson

Validation of the Thermal Work Limit (TWL) Against Known Heat Stress Exposures , Danielle L. Kapanowski

Validation of a New Concept for Measuring Respirable Dusts , Xiao Liu

Occupational Noise Exposure Evaluation of Airline Ramp Workers , Adekunle Ogunyemi

Reduction in Needlestick Injuries Using a Novel Package of Interventions , Kamal Thakor Patel

Ability of the ISO Predicted Heat Strain Method to Predict a Limiting Heat Stress Exposure , Edgar Prieto

Developing the Evidence Base for Mental Health Policy and Services: Inquiries into Epidemiology, Cost-Benefits, and Utilization , Joseph L. Smith

Occupational Sharps Injuries in Medical Trainees at the University of South Florida: A Follow-up Study , Kourtni L. Starkey

Particles in Welding Fumes , Rebecca T. Williams

Theses/Dissertations from 2017 2017

The Effects of Maternal Folate on Fetal Brain and Body Size among Smoking Mothers , Korede K. Adegoke

The Influence of Tropical Forests and Climate Change on the Fates of Select Organic Pollutants in a Jamaican Watershed , Kayon Barrett

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BMC Med Res Methodol

Qualitative research methods in medical dissertations: an observational methodological study on prevalence and reporting quality of dissertation abstracts in a German university

Charlotte ullrich.

Department of General Practice and Health Services Research, University of Heidelberg Hospital, INF 130.3, 69120 Heidelberg, Germany

Anna Stürmlinger

Michel wensing, associated data.

The data of the repository databank is semi-public and can be accessed from the corresponding author upon reasonable request. A data extraction table is available in App. 2.Competing interests and funding: We have no conflicts of interest to disclose and no funding to report.

Qualitative methods offer a unique contribution to health research. Academic dissertations in the medical field provide an opportunity to explore research practice. Our aim was to assess the use of qualitative methods in dissertations in the medical field.

By means of a methodological observational study, an analysis of all academic medical dissertations’ abstracts between 1998 and 2018 in a repository databank of a large medical university faculty in Germany was performed. This included MD dissertations (Dr. med. (dent.)) and medical science dissertations (Dr. sc. hum.). All abstracts including “qualitativ*” were screened for studies using qualitative research methods. Data were extracted from abstracts using a category grid considering a) general characteristics (year, language, degree type), b) discipline, c) study design (mixed methods/qualitative only, data conduction, data analysis), d) sample (size and participants) and e) technologies used (data analysis software and recording technology). Thereby reporting quality was assessed.

In total, 103 abstracts of medical dissertations between 1998 and 2018 (1.4% of N = 7619) were included, 60 of MD dissertations and 43 of medical sciences dissertations. Half of the abstracts ( n = 51) referred to dissertations submitted since 2014. Most abstracts related to public health/hygiene ( n = 27) and general practice ( n = 26), followed by medical psychology ( n = 19). About half of the studies ( n = 47) used qualitative research methods exclusively, the other half ( n = 56) used mixed methods. For data collection, primarily individual interviews were used ( n = 80), followed by group interviews ( n = 33) and direct observation ( n = 11). Patients ( n = 36), physicians ( n = 36) and healthcare professionals ( n = 17) were the most frequent research participants. Incomplete reporting of participants and data analysis was common ( n = 67). Nearly half of the abstracts ( n = 46) lacked information on how data was analysed, most of the remaining ( n = 43) used some form of content analysis. In summary, 36 abstracts provided all crucial data (participants, sample size,; data collection and analysis method).

A small number of academic dissertations used qualitative research methods. About a third of these reported all key aspects of the methods used in the abstracts. Further research on the quality of choice and reporting of methods for qualitative research in dissertations is recommended.

Qualitative research methods offer a unique contribution to health research, particular for exploration of the experiences of patients, healthcare professionals and others [ 1 – 5 ]. While (general) epidemiology primarily addresses health and healthcare in populations and clinical research concentrates on medical interventions and health prognosis, qualitative research methods focus on different actors’ perspectives, experiences and behaviours in health-related contexts. Qualitative research entails a broad spectrum of methods of data conduction and data analysis: individual interviews illuminate individual perceptions [ 6 ], group interviews deliver insights into shared norms and opinions [ 7 ], direct observations facilitate understandings of behaviours in healthcare practice [ 8 – 10 ] and documents can offer insights into discourses and self-representations [ 11 ]. For data analysis, methods combining inductive and deductive steps are most suitable for exploratory research questions utilizing existing results, theories and concepts [ 12 ]. Given these prospects, little is known on the practice of applying qualitative research methods, especially concerning medicine.

In dissertations, a foundation for future scientific work is laid; therefore, guidance and rigour are of special importance [ 13 ]. Dissertations in medical departments provide a good opportunity to explore research practices of students and young academics. In Germany, about 60% of all graduating medical students complete an academic dissertation [ 14 ], which they usually finish parallel to medical school within a full-time equivalent of about a year [ 15 – 18 ]. As a by-product, medical doctoral students are increasingly among the authors of published research, holding first-authorship in about 25% [ 18 – 20 ].

In Germany, basic scientific training is a required part of the medical curriculum and recent policies put even more emphasis on the development of scientific competencies [ 15 , 21 , 22 ]. National regulations specify scientific competencies giving explicit recommendations for quantitative methods. Medical students have rarely received training in qualitative methods. However, health care professions and qualitative methods share a perspective directed to practice and interactions. Interviews and observations are already commonly used as clinical and diagnostic tools.

In addition to the doctoral degrees for medical and dental graduates (Doctor medicinae (dentariae), Dr. med. (dent.)), students with other disciplinary backgrounds (e.g. natural scientists, psychologists and social scientists) complete dissertations at medical faculties in Germany (often labelled Doctor scientiarum humanarum, Dr. sc. hum. or Doctor rerum medicarum, Dr. rer. medic.). Although regulations differ slightly, the degrees are usually situated within and regulated by the same institutional culture and context (e.g. faculty, department, supervision and aspired publications).

The aim of this study was to understand the current practice of applying qualitative research methods helping identify gaps in reporting and need for guidance. By means of a methodological study – a subtype of observational studies that evaluates the design, analysis of reporting of other research-related reports [ 23 ] – we investigated volume and variety of the use of qualitative research methods in dissertations at a German medical faculty. Hereby we wanted to inform methodological advances to health research and outline implications for medical education in scientific competencies training.

Search strategy

Dissertations in the medical field were retrospectively assessed: In a document analysis, all dissertation abstracts at one medical faculty were reviewed. This faculty was chosen as it is one of the oldest and largest medical faculties in Germany, with a strong research tradition and a high dissertation rate among graduating students. All abstracts from 01/01/1998 to 31/12/2018, which were publicly available in the repository databank of the university, were reviewed. This included MD dissertations (Dr. med. (dent.)) and medical science dissertations (Dr. sc. hum.) written in German or English. All types of studies using qualitative research methods, all types of human participants, all types of interventions and all types of measures were eligible. We focused on abstracts, because full text dissertations are not publicly available and are helpful to get an overview of a number of method-related issues. Although serving as a proxy, abstracts should provide a sufficient summary of the dissertation, including crucial information on study design, independently from the full text. In the databank, relevant documents had to be labelled a) “abstract of a medical dissertation” (referring to both degree types). To further identify dissertations using qualitative methods b) the search term “qualitativ*” was used as an inclusion criterium.

Selection and data extraction

All identified abstracts were pre-screened independently by two researchers (AS, LS) and then reviewed by the main research team (KK, AS, CU) excluding abstracts using “qualitativ*” only in respect to non-methods-related issues (e.g. quality of life). Data on a) general characteristics (year, language, degree type), b) discipline, c) study design (mixed methods/qualitative only, data conduction, data analysis), d) sample (size and participants) and e) technologies used (data analysis software and recording technology) (see App. 2) was then extracted independently by two team members (AS, LS) and crossed-checked (KK, CU). Data extraction was initially guided by two widely used reporting guidelines for qualitative health research articles [ 24 , 25 ] and adapted to reflect the abstract format: Abstracts provided comparable information on the set-up of study design and sample. Reporting of results was not assessed due to heterogeneity and briefness. Data extraction forms were piloted and adjusted to inductive findings. Disagreements were discussed, assessed and solved by consensus by the main research team (KK, AS, CU). Extracted data were analysed and reported as absolute and relative frequencies. As all abstracts were available, no further data was obtained from authors.

Search results

Out of a total of 7619 dissertation abstracts, 296 dissertations were initially identified. Of these, 173 abstracts were excluded from the study as “qualitativ*” in these abstracts did not refer to the research method. Additionally, 20 abstracts (12 medicine, 8 medical science) were not further included in the analysis due to an ambiguous and inconclusive use of the label “qualitative methods” and/or restricted comparability with the otherwise pre-dominant interview-based study designs: a) a qualitative research design was stated, but no further information on the approach was given ( n = 7), b) no explicit distinction was made between qualitative research design and a clinical diagnostic approach ( n = 4), c) the qualitative approach comprised of additional free text answers in written questionnaires only ( n = 6), and d) only document analysis or observation was used ( n = 3). In total, 103 abstracts (1.4% of 7619) were included in the analysis.

Low but increasing use

Since 1998, the number of dissertations applying qualitative methods has continually increased while the total number of dissertations remained stable (between n = 314 in 2006 and n = 410 in 1999 and 2008, M (1998–2018) = 362.8, SD = 26.1) (Fig. 1 ). Before 2005 there was yearly not more than one dissertation that used qualitative methods. Since then, the number has steadily raised to more than 10 dissertations per year, equivalent to an increase from 0.28% in 1998 to 3.42% in 2018 of all listed dissertation abstracts per year.

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Number of all dissertations and dissertations using qualitative methods per year between 1998 and 2018

General characteristics

Abstracts nearly equally referred to dissertations leading to an MD degree (Dr. med. n = 57, Dr. med. Dent. n = 3) and medical science degree (Dr. sc. hum. n = 43), respectively. The included dissertation abstracts were based in 12 different sub-specialties , most in general practice ( n = 26), in public health and hygiene ( n = 27) and medical psychology ( n = 19); the Dr. med. (dent.) abstracts having a higher share in general practice ( n = 21) and the Dr. sc. hum. abstracts in public health/hygiene ( n = 16) (s. Table 1 ).

Usage of qualitative research design in dissertations at a medical faculty

Most abstracts followed at least roughly the common structure of background, methods, results and conclusion. The length of the abstracts varied between less than one and more than three pages, with most abstracts being one to two pages long; 77 abstracts were written in German and 26 in English.

Study design

About half of the studies used qualitative research methods exclusively ( n = 47; 60% of Dr. med. (dent.) abstracts, 26% of Dr. sc. hum. abstracts), the other half mixed methods ( n = 56; 40% of Dr. med. (dent.) abstracts, 74% of Dr. sc. hum. abstracts; Table Table1). 1 ). Individual interviews were the most common form of data collection ( n = 80), followed by group interviews ( n = 33) and observation ( n = 11). In total, 23 abstracts indicated the use of a combination of different qualitative methods of data conduction, all of these included individual interviews. For documentation/recording, when reported ( n = 37), audio recording was used in most cases ( n = 3).

Little difference regarding method of data conduction were found between pure qualitative and mixed-methods designs. Mixed methods studies rather included physicians ( n = 21) and used predominantly general content analysis ( n = 14), when reported; whereas qualitative studies rather included patients ( n = 28) and used predominantly both content analysis ( n = 14) and content analysis following Mayring ( n = 12). Overall incomplete reporting was more common in mixed-method studies ( n = 41) than qualitative studies ( n = 26, 55.3%) (see App. 2).

Sample size varied widely: Overall, 67 abstracts provided a sample size. Of those, a median number of 29 people (min-max: 2–136) participated in individual and group interviews. Only in Dr. sc. hum. dissertations using mixed methods, lower median sample sizes were reported for the qualitative part (Md = 22, min-max: 6–110; n = 17) compared to dissertations using qualitative methods only (medical science ( n = 7): Md = 31, min-max: 16–50; MD ( n = 29): Md = 29, min-max: 7–136) and Dr. med. (dent.) dissertations with mixed methods (Md = 30, min-max: 2–62; n = 14). In individual interviews, when sample size was reported ( n = 55, 69% of 80), it distributed roughly equally in the ranges of 1–10, 11–20, 21–30, 31–50 and above 50 (Md = 25; min-max: 2–110). For the 33 dissertations using group interviews, the number of groups is given in 20 abstracts, the number of participants in 15 abstracts. Between 1 and 24 group interviews were conducted with a median total of 24 participants (min-max: 2–65) (see Table Table1 1 ).

Patients ( n = 36) and physicians ( n = 36) were the overall most frequent research participants , followed by other health care professionals ( n = 17), students ( n = 11) and relatives of patients ( n = 7). Other participants ( n = 16) included: representatives of self-help organizations and other experts, educators such as teachers and policy makers. In 33% ( n = 31) of the abstracts, more than one participant group was included, 6.8% ( n = 7) did not specify research participants. While MD dissertations predominantly included physicians ( n = 27) and patients ( n = 19), Dr. sc. hum. dissertations included mostly patients ( n = 17) and other participants ( n = 10).

Data analysis

For data analysis, if reported ( n = 57), content analyses were the most common used method ( n = 42), including the highly deductive approach formulated by Mayring [ 26 ] ( n = 16), mostly used in MD dissertations ( n = 14). Among other reported methods ( n = 15), grounded theory ( n = 5) was the most common approach; rarely mentioned methods include framework analysis and non-specific analysis combining inductive and deductive approaches. Forty-six abstracts did not provide information on the analysis method used (38.3% of MD abstracts, 53% of medical science abstracts). If reported ( n = 24), ATLAS.ti ( n = 14), MAXQDA ( n = 3) and NVivo ( n = 3) were mentioned most frequently as qualitative data analysis programs.

In summary, 36 abstracts provided all crucial data (participants: sample size, characteristics, i.e. healthcare professional/patient; data collection and analysis method). Thus, 58% ( n = 35) of MD dissertation abstracts and 74% ( n = 32) of Dr. sc. hum. dissertation abstracts had at least one missing information.

The results show a low but increasing use of qualitative research methods in medical dissertations. Abstracts nearly equally referred to dissertations leading to an MD degree and medical science doctorate respectively; half of which were submitted since 2011. Qualitative methods were used in several departments, most frequently in those for general practice, public health and medical psychology mirroring an already known affinity between the objective of certain medical disciplines and perspective qualitative methods [ 27 , 28 ].

About half of the studies used qualitative research methods exclusively, the other half mixed methods: While some differences were found, due to short format and sparse information within the abstract a strict differentiation between qualitative approaches alone and combined quantitative and qualitative designs was not made. Little difference according to degree type was observed. This points to a strong shared dissertation culture, that balances and conceals differences in academic training between medical students and graduates from other, quite diverse, disciplines (e.g. from humanities, natural and social sciences) pursuing a doctorate at a medical faculty.

Limited variety in methods used

The results show a strong preference for certain methods in data conduction, research participants and data analysis: Individual and group interviews were predominant as well as content analysis, especially Mayring’s deductive approach. All in all, a limited use of the broad spectrum of qualitative research methods can be observed. Interviews are important to gain insights on actors’ perspective [ 6 ]; however, they have limited information value when it comes to actual processes and practice of health care. To investigates those, additional direct observation would be suitable [ 8 , 9 ]. In group interviews shared norms and opions can be observed, they are not suitable to capture individual perspectices. Group interviews go along with higher time and efforts regarding scheduling, interview guidance and data analysis [ 7 ]. Within the dissertations, documents are rarely used as data within the dissertations, but could be useful readily available documents.

Included research participants were mostly patients and physicians. This might be due to the research questions posed or the availability of participants. However, to reflect the complexity of health care a higher diversity of research questions, expanding participants (e.g. other health care professionals and caregivers) and based on a thorough knowledge of available methods, including qualitative approaches, might be needed.

As for methods of analysis, the results show a predominant use of a form of content analysis, with a strong affinity to quantitative analysis often limited to description forgoing in-depth analysis. As qualitative methods belong to the interpretative paradigm, most qualitative methodologies emphasize inductive analyses (e.g. Grounded Theory) and/or a combination of induction and deduction [ 12 , 29 ]. By using primarily descriptive content analysis the full potential of qualitative research and depth of the data to gain new a insights are thus neglected. Since knowledge about and application of qualitative methods are not part of the medical curriculum, doctoral students lack training in using qualitative methods and grasping the possibilities these methods convey for in-depth original knowledge.

Incomplete reporting

One fundamental principle of good research practice is accurate reporting. For empirical research, reporting on research design and methods is crucial to ensure comparability and reflect reach of research results. Within medicine and other health sciences, while debated [ 30 ], reporting guidelines are increasingly used to guarantee a basic standard. While qualitative research designs differ from clinical and quantitative designs regarding theoretical and methodological background, study aims and research process, rigorous reporting is a shared standard: this includes reporting on data conduction, sampling, participants and data analysis (e.g. COREQ [ 24 ]).

In our study, incomplete reporting regarding research design and methods was common. Especially, information on methods of data analysis was missing in about half of the abstracts reflecting the limited awareness of the plethora of qualitative analysis methods. Additionally, a third of the abstracts did not provide information on sample size. Although the importance of a “sufficient” sample size is controversially discussed, identifying the sources and putting their contributions into perspective is a paramount characteristic of qualitative research [ 31 – 33 ]. All in all, incomplete reporting was common ( n = 67). Additionally, out of 123 initially identified abstracts, 20 had to be excluded from the analysis as comparability was not given mainly due to the inconclusive use of the term qualitative methods.

Several issues should be considered when interpreting the findings from this study. As a case study at one large faculty, which has a strong research orientation, the generalizability of the findings is uncertain. It seems unlikely that the quality of reporting is better in other medical faculties in Germany, but the prevalence of using qualitative methods might be higher. Character and role of the abstracts might not be as apparent as in journal papers, as they serve as a summary of the dissertation and are listed within the online repository databank only. The relation of reporting quality of those abstracts and the full text dissertation or even publication is unknown. Presentation of results was not assessed as information in abstracts were brief and heterogenous. Additionally, insights are limited by the structure of the repository databank itself, i.e. sub-disciplines are combined that sometimes cover distinct research fields or did evolve as separate specialties. All in all, however, the results mirror the critique on the lack of scientific training in medical education [ 17 , 22 , 34 , 35 ] and the want of sufficient reporting in medicine and health science, irrespective of study design [ 36 ].

While recent policies put a strong emphasis on strengthening scientific competences in medical education in Germany [ 15 , 21 , 22 ], especially MD dissertations are only in some degree comparable to dissertation thesis of other disciplines and medical dissertations internationally: In Germany, about 60% of all graduating medical students complete an academic dissertation [ 14 ], which they usually finish parallel to medical school within a full-time equivalent of about a year [ 15 – 18 ]. Graduate programs that exclusively dedicate 1 year for pursuing a dissertation are still discussed as innovative [ 35 ]. Additionally, the expertise of supervisors was not assessed. In a recent opinion paper, Malterud et al. [ 37 ] called for supervisors and dissertation committees holding corresponding methodological skills and experience as well as an academic consensus regarding scientific rigour to ensure high quality theses using qualitative methods. Missing standards in supervision and reporting might have led to the observed results in our study.

Qualitative research methods offer a unique scientific benefit to health care, including medicine. Our results show that within dissertation research, the number of dissertations applying qualitative methods has continually increased mirroring an overall trend in health research. To improve reach and results, a broader spectrum of qualitative methods should be considered when selecting research designs, including e.g. (direct) observation, document and analysis strategies, that combine inductive and deductive approaches. Same holds true for including a more diverse body of research participants. More broadly, reporting and academic practice should be improved.

Reporting guidelines can not only help to improve the quality of reporting but also be used as a tool to supervising graduate students steps commonly associated with qualitative research methods. So far, however, reporting guidelines mainly target full and/or published papers. Still, some reporting guidelines for abstracts are already available [ 38 – 41 ], that could be adapted for dissertation research in health science.

In academic practice, skilled supervision alongside transparent and method-appropriate criteria are the precondition for confident and courageous dissertation research that increases understanding and challenges existing knowledge of health care research. Educational programs strengthening research and reporting skills – within and beyond qualitative methods – should be implemented into medical education more profoundly, at the latest in doctoral training.

Acknowledgements

We would like to thank Laura Svensson for assisting in reviewing the abstracts and data extraction. In addition, we would like to thank the reviewers for their thorough review and constructive comments.

Abbreviations

Authors’ contributions.

CU and KK conceived the idea for this manuscript. CU, KK and AS reviewed, extracted and analyzed the data. KK led the data analysis. CU wrote the first draft of the manuscript. MW provided substantial comments at different stages of the manuscript. CU, KK and MW critically revised the manuscript. All authors read and approved the manuscript for submission.

Open Access funding enabled and organized by Projekt DEAL.

Availability of data and materials

Ethics approval and consent to participate.

Not applicable. In accordance with the scope and design of this study no formal study protocol was written.

Consent for publication

Not applicable.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Charlotte Ullrich, Email: [email protected] .

Anna Stürmlinger, Email: [email protected] .

Michel Wensing, Email: [email protected] .

Katja Krug, Email: [email protected] .

Defense and Dissertation Overview

Once a student’s box is checked, the BPH student should set up a one-on-one “Defense Packet Meeting” with the BPH Associate Director to review the Defense and Dissertation Process, which includes reviewing all required materials, logistics, timing, FAS/Harvard Griffin GSAS Form of the Dissertation, sample forms, and to answer student questions related to these processes.

Defense Committee Chair: One member of the student’s DAC, often the DAC chair, is required to chair the oral defense. This required holdover from the DAC serves the purpose of providing insight to the examiners regarding the path the student has taken in completing the dissertation research. Their primary role is to assess committee satisfaction with the written dissertation, administer the exam, arbitrate any problems that may arise, and make final recommendations for completion of necessary corrections and additions to the dissertation. No other DAC members can serve on the defense committee .
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ORAL DEFENSE PROCEDURES

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Part 2: Private Oral Examination A private oral examination follows the public seminar. Initially, the student will be asked to leave the room for several minutes, along with the dissertation advisor if the dissertation advisor has decided to remain for the private exam. During this time, the committee will discuss the merits of the dissertation, any issues with the dissertation, and areas they may want to focus on during the oral exam. The student (and advisor if present) is then asked back into the room for the exam.

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DEFENSE FORMS AND PAPERWORK

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Published: 10 December 2020

Qualitative research methods in medical dissertations: an observational methodological study on prevalence and reporting quality of dissertation abstracts in a German university

Charlotte Ullrich ORCID: orcid.org/0000-0002-9757-913X 1 ,
Anna Stürmlinger 1 ,
Michel Wensing 1 &
Katja Krug 1

BMC Medical Research Methodology volume 20 , Article number: 301 ( 2020 ) Cite this article

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Qualitative research methods offer a unique contribution to health research, particular for exploration of the experiences of patients, healthcare professionals and others [ 1 , 2 , 3 , 4 , 5 ]. While (general) epidemiology primarily addresses health and healthcare in populations and clinical research concentrates on medical interventions and health prognosis, qualitative research methods focus on different actors’ perspectives, experiences and behaviours in health-related contexts. Qualitative research entails a broad spectrum of methods of data conduction and data analysis: individual interviews illuminate individual perceptions [ 6 ], group interviews deliver insights into shared norms and opinions [ 7 ], direct observations facilitate understandings of behaviours in healthcare practice [ 8 , 9 , 10 ] and documents can offer insights into discourses and self-representations [ 11 ]. For data analysis, methods combining inductive and deductive steps are most suitable for exploratory research questions utilizing existing results, theories and concepts [ 12 ]. Given these prospects, little is known on the practice of applying qualitative research methods, especially concerning medicine.

In dissertations, a foundation for future scientific work is laid; therefore, guidance and rigour are of special importance [ 13 ]. Dissertations in medical departments provide a good opportunity to explore research practices of students and young academics. In Germany, about 60% of all graduating medical students complete an academic dissertation [ 14 ], which they usually finish parallel to medical school within a full-time equivalent of about a year [ 15 , 16 , 17 , 18 ]. As a by-product, medical doctoral students are increasingly among the authors of published research, holding first-authorship in about 25% [ 18 , 19 , 20 ].

Search strategy

Selection and data extraction

Search results

Low but increasing use

Number of all dissertations and dissertations using qualitative methods per year between 1998 and 2018

General characteristics

Study design

About half of the studies used qualitative research methods exclusively ( n = 47; 60% of Dr. med. (dent.) abstracts, 26% of Dr. sc. hum. abstracts), the other half mixed methods ( n = 56; 40% of Dr. med. (dent.) abstracts, 74% of Dr. sc. hum. abstracts; Table 1 ). Individual interviews were the most common form of data collection ( n = 80), followed by group interviews ( n = 33) and observation ( n = 11). In total, 23 abstracts indicated the use of a combination of different qualitative methods of data conduction, all of these included individual interviews. For documentation/recording, when reported ( n = 37), audio recording was used in most cases ( n = 3).

Data analysis

Limited variety in methods used

Incomplete reporting

In our study, incomplete reporting regarding research design and methods was common. Especially, information on methods of data analysis was missing in about half of the abstracts reflecting the limited awareness of the plethora of qualitative analysis methods. Additionally, a third of the abstracts did not provide information on sample size. Although the importance of a “sufficient” sample size is controversially discussed, identifying the sources and putting their contributions into perspective is a paramount characteristic of qualitative research [ 31 , 32 , 33 ]. All in all, incomplete reporting was common ( n = 67). Additionally, out of 123 initially identified abstracts, 20 had to be excluded from the analysis as comparability was not given mainly due to the inconclusive use of the term qualitative methods.

While recent policies put a strong emphasis on strengthening scientific competences in medical education in Germany [ 15 , 21 , 22 ], especially MD dissertations are only in some degree comparable to dissertation thesis of other disciplines and medical dissertations internationally: In Germany, about 60% of all graduating medical students complete an academic dissertation [ 14 ], which they usually finish parallel to medical school within a full-time equivalent of about a year [ 15 , 16 , 17 , 18 ]. Graduate programs that exclusively dedicate 1 year for pursuing a dissertation are still discussed as innovative [ 35 ]. Additionally, the expertise of supervisors was not assessed. In a recent opinion paper, Malterud et al. [ 37 ] called for supervisors and dissertation committees holding corresponding methodological skills and experience as well as an academic consensus regarding scientific rigour to ensure high quality theses using qualitative methods. Missing standards in supervision and reporting might have led to the observed results in our study.

Reporting guidelines can not only help to improve the quality of reporting but also be used as a tool to supervising graduate students steps commonly associated with qualitative research methods. So far, however, reporting guidelines mainly target full and/or published papers. Still, some reporting guidelines for abstracts are already available [ 38 , 39 , 40 , 41 ], that could be adapted for dissertation research in health science.

Availability of data and materials

Abbreviations

Consolidated criteria for reporting qualitative research

Doctor medicinae

Doctor medicinae dentariae

Doctor scientiarum humanarum

Medical Doctor

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Ullrich, C., Stürmlinger, A., Wensing, M. et al. Qualitative research methods in medical dissertations: an observational methodological study on prevalence and reporting quality of dissertation abstracts in a German university. BMC Med Res Methodol 20 , 301 (2020). https://doi.org/10.1186/s12874-020-01186-6

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Research Topics & Ideas: Public Health

50 Topic Ideas To Kickstart Your Research Project

Public health-related research topics and ideas

If you’re just starting out exploring public health and/or epidemiology-related topics for your dissertation, thesis or research project, you’ve come to the right place. In this post, we’ll help kickstart your research by providing a hearty list of research ideas , including examples from recent studies in public health and epidemiology.

PS – This is just the start…

We know it’s exciting to run through a list of research topics, but please keep in mind that this list is just a starting point . These topic ideas provided here are intentionally broad and generic , so keep in mind that you will need to develop them further. Nevertheless, they should inspire some ideas for your project.

To develop a suitable research topic, you’ll need to identify a clear and convincing research gap , and a viable plan to fill that gap. If this sounds foreign to you, check out our free research topic webinar that explores how to find and refine a high-quality research topic, from scratch. Alternatively, consider our 1-on-1 coaching service .

Public Health-Related Research Topics

Evaluating the impact of community-based obesity prevention programs in urban areas.
Analyzing the effectiveness of public smoking bans on respiratory health outcomes.
Investigating the role of health education in reducing the prevalence of HIV/AIDS in sub-Saharan Africa.
The impact of air pollution on asthma rates in industrial cities.
Evaluating the effectiveness of school nutrition programs on childhood obesity rates.
The role of public health policies in addressing mental health stigma.
Analyzing the impact of clean water access on infectious disease rates in rural communities.
The effectiveness of needle exchange programs in reducing the spread of hepatitis C.
Investigating the impact of social determinants on maternal and child health in low-income neighborhoods.
The role of digital health interventions in managing chronic diseases.
Analyzing the effectiveness of workplace wellness programs on employee health and productivity.
The impact of urban green spaces on community mental health.
Evaluating the effectiveness of vaccination campaigns in preventing outbreaks of infectious diseases.
The role of public health initiatives in reducing alcohol-related harm.
Analyzing the impact of aging populations on healthcare systems.
Analyzing the impact of urbanization on mental health disorders in metropolitan areas.
The effectiveness of telemedicine services in improving healthcare access in remote regions.
Investigating the health impacts of electronic waste recycling practices.
The role of health literacy in managing non-communicable diseases in aging populations.
Evaluating the public health response to opioid addiction in rural communities.
Analyzing the relationship between housing quality and respiratory illnesses.
The effectiveness of community engagement in improving reproductive health services.
Investigating the health effects of long-term exposure to low-level environmental radiation.
The role of public health campaigns in reducing the prevalence of tobacco use among teenagers.
Analyzing the impact of food deserts on nutritional outcomes in urban communities.

Epidemiology Research Ideas (Continued)

Investigating the epidemiology of antibiotic-resistant infections in hospital settings.
The impact of climate change on the spread of vector-borne diseases.
Evaluating the factors contributing to the rise in type 2 diabetes prevalence.
Analyzing the epidemiology of mental health disorders in conflict zones.
The role of epidemiological surveillance in pandemic preparedness and response.
Investigating the link between environmental exposures and the incidence of childhood cancers.
The impact of dietary patterns on the prevalence of cardiovascular diseases.
Evaluating the effectiveness of intervention strategies in controlling obesity epidemics.
Analyzing the spread and control of zoonotic diseases in rural communities.
The role of genetic factors in the epidemiology of autoimmune diseases.
Investigating the socio-economic disparities in cancer incidence and outcomes.
The impact of urbanization on the epidemiology of infectious diseases.
Evaluating the public health consequences of occupational exposures to hazardous substances.
Analyzing the trends and determinants of mental health disorders among adolescents.
The role of lifestyle factors in the epidemiology of neurodegenerative diseases.
Investigating the patterns of mental health service utilization during economic recessions.
The epidemiology of sports-related concussions in youth athletics.
Evaluating the effectiveness of public health interventions in reducing the spread of tuberculosis in high-risk populations.
Analyzing the geographic distribution of Lyme disease in relation to climate change.
The role of international travel in the spread of emerging infectious diseases.
Investigating the demographic predictors of chronic kidney disease in population-based studies.
The epidemiological impact of air pollution on asthma and other respiratory conditions.
Evaluating the long-term health effects of exposure to endocrine-disrupting chemicals.
Analyzing the incidence and risk factors of post-traumatic stress disorder in first responders.
The role of socioeconomic status in the prevalence and management of diabetes.

Recent Studies: Public Health & Epidemiology

While the ideas we’ve presented above are a decent starting point for finding a research topic, they are fairly generic and non-specific. So, it helps to look at actual studies in the public health and epidemiology space to see how this all comes together in practice.

Below, we’ve included a selection of recent studies to help refine your thinking. These are actual studies, so they can provide some useful insight as to what a research topic looks like in practice.

Tutorials in population neuroimaging: Using epidemiology in neuroimaging research (Godina et al., 2022)
Application of Big Data in Digital Epidemiology (Naaz & Siddiqui, 2022)
Response to comment on: Incidence of ocular and systemic disease affecting visual function among state bus drivers (Kohli et al., 2022)
Why epidemiology is incomplete without qualitative and mixed methods (Lane-Fall, 2023)
Teaching epidemiology: An overview of strategies and considerations (Hossain, 2022)
Social Epidemiology: Past, Present, and Future (Roux, 2022)
Population health assessment project: An innovative strategy for teaching principles of epidemiology (Keen et al., 2022)
The functions of veterinary epidemiology in public health (Shaffi, 2023)
Readying the Applied Epidemiology Workforce for Emerging Areas of
Public Health Practice (Daly et al., 2022)
Some Social Epidemiologic Lessons from the COVID-19 Pandemic (Schnake-Mahl & Bilal, 2023)
The Filth Disease: Typhoid Fever and the Practices of Epidemiology in Victorian England by Jacob Steere-Williams (review) (Steere-Williams et al., 2022)
Epidemiology of Adult Obesity, Measurements, Global Prevalence and Risk Factors (Orukwowu, 2022).
Which disciplines form digital public health, and how do they relate to each other? (Pan, 2022)
Information Flow and Data Gaps in COVID-19 Recording and Reporting at National and Provincial Levels in Indonesia (Barsasella et al., 2022). Epidemiology Blog of Neal D. Goldstein, PhD, MBI (Goldstein, 2023)
Sensitivity analysis of SEIR epidemic model of Covid 19 spread in Indonesia (Rangkuti et al., 2022)

As you can see, these research topics are a lot more focused than the generic topic ideas we presented earlier. So, for you to develop a high-quality research topic, you’ll need to get specific and laser-focused on a specific context with specific variables of interest. In the video below, we explore some other important things you’ll need to consider when crafting your research topic.

Get 1-On-1 Help

If you’re still unsure about how to find a quality research topic, check out our Research Topic Kickstarter service, which is the perfect starting point for developing a unique, well-justified research topic.

Research Topic Kickstarter - Need Help Finding A Research Topic?

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Home > Health Sciences > Health Services ETDs

Health Services Research Dissertations

Theses and dissertations published by graduate students in the Program of Health Services Research, College of Health Sciences, Old Dominion University, since Fall 2016 are available in this collection. Backfiles of all dissertations (and some theses) have also been added.

In late Fall 2023 or Spring 2024, all theses will be digitized and available here. In the meantime, consult the Library Catalog to find older items in print.

Theses/Dissertations from 2023 2023

Dissertation: Tobacco Smoking Among Saudi College Students: Validation of an Arabic Health Belief Model Instrument , Saad Abdullah S. Alotaibi

Dissertation: Dental Care Utilization Among U.S. Children Participating in Early Head Start Programs , Ahlam Ibraheem Joufi

Theses/Dissertations from 2022 2022

Dissertation: Examining the Roles of Acculturative Stressors and Cultural Factors in Major Health and Safety Issues Among Hispanic/Latino Farmworkers , Brenda Berumen-Flucker

Theses/Dissertations from 2021 2021

Dissertation: The Assessment of Clinical Reasoning in Preceptors Across the Athletic Training Profession , Gary Wayne Cohen Jr.

Dissertation: Examining the Use of Immersive Clinical Experiences in Athletic Training Education , Bailey Christine Jones

Theses/Dissertations from 2020 2020

Dissertation: Predictors of Dental Students’ Behavioral Intention Use of Teledentistry: An Application of the Unified Theory of Acceptance and Use of Technology (UTAUT) Model , Jafar Hassan Alabdullah

Dissertation: The Determinants of Physical Activity, Self-Monitoring of Blood Glucose, and Poor Glycemic Control Among Individuals Diagnosed With Type 2 Diabetes in Saudi Arabia: A Cross-Sectional Study Based on the Saudi Health Interview Survey (SHIS) , Mohammed Abdulrahman S. Alsuliman

Dissertation: Aging, Gait Variability, and Adaptability , Collin Douglas Bowersock

Dissertation: Nursing Students’ Knowledge and Attitudes About Pain Management and Opioids , Hedieh Hatami Sirjani

Dissertation: A Three Article Study Examining Sexual and Gender Minority Competency of Health Service Providers , Corrine N. Wilsey

Theses/Dissertations from 2019 2019

Dissertation: Examine Predictors of BMI Classification and Perception of Overweght Status of Caregivers of Preschool Children , Beth H. Chopp

Dissertation: Depression Among Expectant and New Mothers: A Multi-Study Investigation of Rates, Correlates, and Training for Healthcare Providers , Molly M. Long

Dissertation: Understanding Young Adult Survivors of Childhood Cancers’ Participation in Late Effects Screening: A Mixed Methods Approach , Kristen Trost Mantlo

Dissertation: Asthma-Related Health Outcomes in New Jersey After a Natural Disaster Event , My Ngoc Thuy Nguyen

Dissertation: Usefulness of an Expanded Health Belief Model With Added Constructs (Self-Efficacy And Ecological System Measures) in Modeling Compliance With Healthy Lifestyle Recommendations in Women With a Recent History of Gestational Diabetes , Phyllis M. Woodson

Theses/Dissertations from 2018 2018

Dissertation: An Examination of Athletic Directors' Perceptions of the Utilization of Athletic Trainers in the Secondary School Setting , Stephanie H. Clines

Dissertation: Behavioral Determinants of Exercise-Related Injury Prevention Program Participation , Emily M. Hartley

Dissertation: Examining the Association of Environmental Degradation and Poor Cardiovascular and/or Respiratory Health Outcomes in a Disadvantaged Community , Khyati Niranjan Kantaria

Dissertation: Sexual Violence Victimization, Mental Health, and University-Based Health Service Use Among College Females , Julie E. Stoner

Theses/Dissertations from 2017 2017

Dissertation: Alcohol and Substance Use Knowledge, Attitudes, Subjective Norms, Self-Efficacy, Perceived Behavioral Control, and Behavioral Intentions Among Omani College Students , Muna S. Bait Ajzoon

Dissertation: Healthcare Outcomes and Resource Utilization Associated with Neonatal Hypoglycemia: Analysis of Data from the HCUP Kid’s Inpatient Database , Brook T. Alemu

Dissertation: Effects of a Collaborative Care for Depression Intervention on Health Service Utilization and Depression Severity , Girlyn Arganza Cachaper

Dissertation: Measuring Outcomes in Competence and Confidence in Clinical Skills Through the Use of Standardized Patients , Jennifer W. Cuchna

Dissertation: Unmet Needs And Service Utilization by Informal Caregivers , Ryan Marie Diduk-Smith

Dissertation: Sleep Disorders and Kidney Transplant Outcomes: Findings From an 18-Year (1997-2015) Historical Cohort Study , Margaret M. Lubas

Dissertation: A Web-Based Interprofessional Education Program for School Nurses and Athletic Trainers: A Pilot Study , Lauren Ashley Welsch

Theses/Dissertations from 2016 2016

Dissertation: The Information-Motivation-Behavioral Skills Model: An Examination of Obesity Prevention Behavioral Change in Children Who Participated In The Afterschool Program Virginia Beach Let’s Move , Marilyn Miroshlava Bartholmae

Dissertation: Application of a Theory-Based Educational Intervention to Increase the Frequency of Performing Oral Health Assessments on Children Among Advanced Practice Registered Nurses and Nurses , Denise Michelle Claiborne

Dissertation: A Model to Predict Pre-Hospital Endotracheal Intubation Success , Leigh Ann Diggs

Dissertation: School Policy, Food and Physical Activity Environment, and Childhood Obesity , Ruicui Liu

Dissertation: A Test of the Behavioral Model of Health Services Use on Non-Emergent Emergency Department Use , Moira Crosby McManus

Dissertation: Response Shift and Functional Outcomes in Individuals with Chronic Ankle Instability , Cameron J. Powden

Theses/Dissertations from 2015 2015

Dissertation: Diabetes Status, Predisposing, Enabling, and Oral Health Illness Level Variables as Predictors of Preventive and Emergency Dental Service Use , Sabha Alshatrat

Dissertation: A Study of a Simulated Infectious Disease on Healthcare Workers' Reaction, Knowledge, Attitudes, and Performance Towards Hand Hygiene , Lydia Wigglesworth-Ballard

Theses/Dissertations from 2014 2014

Dissertation: Utilizing the Technology Acceptance Model to Predict System Use of an Interactive Behavior Change Technology to Deliver Virtual Diabetes Health Education , Koren Sher'Keyer Goodman

Dissertation: Assessing the Fit Between Child Welfare Information Systems and Frontline Workers: Development of a Task-Technology Fit Instrument , Kurt William Heisler

Dissertation: Factors Associated with Quality of Life Among Mothers of Children with Autism Spectrum Disorder , Marian Marconyak

Dissertation: Modeling Solutions for Prevention of Medicare Insolvency for the Baby Boomer Generation (Born 1946 - 1964) , Gregory Thomas Scott

Theses/Dissertations from 2012 2012

Dissertation: Factors That Influence Nonadherence Outpatient Medical Follow-Up by African Americans with HIV/AIDS at an Outpatient Infectious Disease Clinic , Cynthia Burrell Banks

Dissertation: Intimate Partner Physical Violence Against Women in Saudi Arabian Primary Healthcare Clinics , Halah M. Eldoseri

Dissertation: An Examination of Factors Affecting Non-Urgent Use of Emergency Department Services by Patients with "Universal" Healthcare , Gregory Smith Feltenberger

Dissertation: Multilevel Analysis of Physical Activity Among US Adults Across US Census Regions: The Role of Environmental Contexts , Sariyamon Tiraphat

Theses/Dissertations from 2011 2011

Dissertation: Using Modeling and Simulation to Improve Oral Health Services Delivery in Hampton Roads, Virginia , Mohammad J. Alzahrani

Dissertation: Adoption of Electronic Health Records by Admitting Physicians: A Heuristic Model , John Sharon Hudson

Dissertation: The Relationship of Financial Performance, Quality Indicators, and the Role of Nurse Executives in Virginia Nursing Homes , Jeany V. Murphy

Dissertation: Early Diagnosis of Pulmonary Embolism: Review and Cost-Effectiveness Analysis , Efstathios Polychronopoulos

Theses/Dissertations from 2010 2010

Dissertation: Using the Andersen Behavioral Model of Health Services Use to Examine Adult Uninsured Patient Health Services Use at a Community Health Center , Jewel Shonette Goodman

Dissertation: A GIS Analysis of the Environmental Variables Related to Rift Valley Fever Outbreaks , Jacqueline Florette Jackson

Dissertation: Patient Centered Care Approach to Adherence with Cardiovascular Medications: Self-Determination Theory Integration , David S. Li

Dissertation: Predictors of Developmental Screenings for Young Children , Janice Chandler Ranne

Theses/Dissertations from 2009 2009

Dissertation: Test of a Multidisciplinary Health Behavior Model of Medicare Elders' Antihypertensive Acquisitions , Ann Marie Kopitzke

Theses/Dissertations from 2008 2008

Dissertation: Modeling Physical Activity in Working Adults: How Suitable Is the Expanded Parallel Process Model? , Adwoa B-H-Sam

Dissertation: Application of the Interactional Model of Cultural Diversity to Identify Diversity Climate Factors Associated with Organizational Effectiveness in Accredited U.S. Physical Therapist Education Programs , Elizabeth Francis Giles

Dissertation: Identifying Determinants of Physical Activity in Maritime Union Members Using the Theory of Planned Behavior , Susan Atkinson Tweed

Theses/Dissertations from 2007 2007

Dissertation: Changes in Formal-Informal Caregiving in Elderly Stroke Survivors , Holly Anne Beard

Dissertation: Psychometric Evaluation of an instrument for Assessing Policy Outcomes for Families with Children Who Have Severe Developmental Disabilities: The Beach Center Family Quality of Life Scale , Joni Taylor McFelea

Theses/Dissertations from 2006 2006

Dissertation: The Use of the Tripartite Model of Attitudes to Explain EMS Providers' Attitudes About the EMS Agenda for the Future , Carolyn Angela Rinaca

Theses/Dissertations from 2005 2005

Dissertation: Factors That Influence Mammography Use of Community Health Workers , Cynthia M. Kratzke

Dissertation: The Great Pestilence: Yellow Fever in Portsmouth, Virginia, 1855 , Burden Susan Lundgren

Dissertation: Using Social Cognitive Theory to Model Health Behaviors Among Chinese Children , Yan Zhang

Theses/Dissertations from 2003 2003

Dissertation: Predictors of Oral Health Behaviors: Examining the Effect of Patient Perceived Humanistic Attitude in the Context of the Health Belief Model , Linda Leigh Hawkins Carroll

Dissertation: Application of the Traditional Epidemiological Model to Predict Occupational Injury Rates in Manufacturing Industries , Gary A. Morris

Theses/Dissertations from 2001 2001

Dissertation: A Longitudinal Study Examining the Stability of Occupational Stressors Identified by Nursing Home Administrators , Gay Lynne Andrucci-Armstrong

Dissertation: A Study of the Factors That Impact Female Military Beneficiaries Obtaining Preventive Health Services , Cynthia Andrea Chargois

Dissertation: A Health System Analysis Approach to Health Outcomes in Medicare Clients With Chronic Illnesses , Christine A. Elnitsky

Dissertation: An Examinaton of the Enhanced Primary Care Model for the Organization of Team Care in Managing Type 2 Diabetes Mellitus in the Elderly Population , Carolyn Morcom Rutledge

Dissertation: Barrier to Utilization of Primary Healthcare Resources in Children Two Years of Age and Under , Ruth A. Waibel

Theses/Dissertations from 2000 2000

Dissertation: The Pediatric Breathing Survey , Linda J. Galloway

Dissertation: Factors Associated with Asthma Readmissions in Children's Hospitals , Maria Acedo Kronenburg

Dissertation: Explanatory Power of the Behavior Model of Utilization for Pediatric Asthma Health Care in an Urban Managed Care Setting , Kathie Marie Sawyer Zimbro

Theses/Dissertations from 1999 1999

Dissertation: Classification of Participants Into Two Health Resource Utilization Groups By the Health Enrollment Assessment Review (HEAR) Survey , Jody W. Donehoo

Dissertation: A Study of the Knowledge and Attitudes of Physicians Toward Victims of Spouse Abuse , Ramani N. Garimella

Dissertation: Factors Which Affect Post-Hospital Resource Use and Patient Health Outcomes Among Taiwanese Older Adults , Chouh-Jiaun Lin

Theses/Dissertations from 1998 1998

Dissertation: Measurement of Hospital Performance: Environmental and Organizational Factors Associated with Cost , Debra Kay Dierksmeier Anderson

Theses/Dissertations from 1997 1997

Dissertation: The Effects of a Maternal Childhood Lead-Poisoning Education Program on Knowledge, Health Beliefs, and Compliance , Sylvia Elaine Johnson

Dissertation: Coping Processes Used by Mothers of Triplets , Susan Mullen Kaplan

Dissertation: The Detoxification of Petroleum Contaminated Coastal Plain Sandy Soil Using an Amended Vermicomposting Approach , John Charles Kraemer

Dissertation: A Survey of Health Care Personnel's Perceptions Toward Diversity in the Workplace , Jacqueline Elaine Sharpe

Dissertation: A Comparison of Factors Associated With Referrals, Service Placements and Length of Service for African-American and Caucasian Youth With Serious Emotional and Behavioral Disturbances Served Through the Comprehensive Services Act in Virginia , Vanessa B. Sheppard

Theses/Dissertations from 1995 1995

Dissertation: An Assessment of the Descriptors and Determinants of Academic Success of Selected Allied Health Students in Virginia , Theodora Christine Gordon

Dissertation: A Comparison of the Utilization of Health Services in the Presence or Absence of Prescriptive Drug Insurance in a Managed Care Environment , Martha Groblewski

Dissertation: The Association Between Perceived Family Support and Psychological Well-Being in Infertile Couples , Linda Marquardt Mintle

Dissertation: Effect of Nutrition Intervention on the Outcomes of Pregnancy: A Rural Urban Comparison , Ranjita Misra

Dissertation: The Influence of National Culture on Work-Related Values and Job Satisfaction Between American and Filipino Registered Nurses , Karin Polifko-Harris

Dissertation: The Effects of Partial Hospitalization on Acute Psychiatric Hospital Readmission Days , William E. Turner III

Theses/Dissertations from 1994 1994

Dissertation: Psychosocial Determinants of Age-Appropriate Immunizations of Infants in Norfolk, Virginia , Hoda Youssef Atta

Dissertation: The Contribution of Selected Cognitive and Noncognitive Variables to the Academic Success of Medical Technology Students , Mildred Keels Fuller

Dissertation: An Assessment of Personal Characteristics, Job Satisfaction and Semantic Descriptors of Virginia Acute and Tertiary Care Hospitals' Chief Executive Officers , Justin C. Matus

Dissertation: The Effect of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Education Program on Knowledge, Attitudes and Sexual Behavior of Selected College Students , Arlene Jaine Jackson Montgomery

Dissertation: Immunologic Evaluation of Ectopic Gestation , Tawfig Amin Nasser

Dissertation: An Assessment of Management Practices Among Virginia Acute Care Hospitals , Ogbonnia Godfrey Ochonma

Theses/Dissertations from 1993 1993

Dissertation: A Multiple Case Study of Selected Individuals Who Facilitate the Successful Adoption of Environmental Public Policy , John H. Austin

Dissertation: A Comparison of the Effectiveness of Two Types of Clinical Instruction on Selected Variables Among Urban Baccalaureate Nursing Students , Janice Parks Hylton

Dissertation: The Relationship of Locus-of-Control and Altruism to Prehospital Emergency Medical Care Providers Universal Precaution Practices , Joanne L. Wakeham

Theses/Dissertations from 1992 1992

Dissertation: A Comparison of Two Theories of Resistance to Innovation in Medical Record Administration Baccalaureate Degree Programs , Joyce Brown-Harvey

Theses/Dissertations from 1991 1991

Dissertation: History and Analysis of Food Guides in the United States , Barbara B. Carlson

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Ph.D. Dissertation
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Health Services Doctor of Philosophy
Program Experience: Health Services Ph.D.

UW Health Services Ph.D. students are required to write a dissertation that significantly advances the state of knowledge in their chosen field. Dissertation topics are chosen by the student in consultation with their faculty mentor or dissertation chair and must represent independent — though collaborative — design and analysis and rigorous discussion and recommendations.

The dissertation must demonstrate an understanding of the theory, content, and methods in each student’s topic area and must conform to department, UW School of Public Health, and UW guidelines. Students may choose to collect primary data, analyze existing data, or a combination of the two. Papers reporting the results of research, novel methods, systematic reviews, or meta-analysis are acceptable.

Dissertation Examples

Dissertation topics vary substantially, as do methods, and target journals. Dissertations and theses from health services students are available in the UW Library Research Archives.

Publications

Health Services Ph.D. students write three publishable journal articles from their dissertation research. By the time of their final dissertation defense, it is recommended, and also typical, that students have submitted two papers for publication, with a third ready.

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Research Summary: Social Determinants of Health

Social determinants of health are the non-medical factors that influence health outcomes.
This pages provides an overview of CDC research on social determinants of health.
This searchable list of peer-reviewed articles is categorized according to the Healthy People 2030 framework.

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Doctoral Dissertation Research: An Ethnographic Study of Patient-Activism and an Emerging Illness

Project Number 1947077 Agency/Funding Organization NSF Funding Year 2020 View Full Project Details for Doctoral Dissertation Research: An Ethnographic Study of Patient-Activism and an Emerging Illness

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AYSPS Dissertations

The intersection of aging, health, & correctional systems: an exploration of experiences, approaches, & policies using a person-centered framework.

Victoria Helmly , Georgia State University

Author ORCID Identifier

https://orcid.org/0000-0002-9474-2739

Date of Award

Spring 5-6-2024

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Criminal Justice

First Advisor

William J Sabol

Second Advisor

Elizabeth Beck

Third Advisor

Thaddeus Johnson

Fourth Advisor

Dean Dabney

This dissertation consists of three interconnected papers that study the intersection of correctional systems and aging in the United States, specifically in prisons and community supervision. The papers examine existing policies and the experiences of older adults using a person-centered framework. The first two papers explore data collected through semi-structured interviews with community supervision officers and people with experience under community supervision. The first paper investigates a person-centered community supervision model and highlights how it applies specifically to older adults, defined as those aged 50 or older. There is evidence of the implementation of this model, but there is an opportunity for further development. The data presented underscores the need for a more precise definition of a person-centered approach in community supervision and more attention to the age-related needs of people under supervision. The second paper explores the unique challenges of people aged 50 or older who are under community supervision, such as adapting to technology, securing stable housing, and managing chronic health conditions. It further reveals the gaps in knowledge of officers concerning aging-specific resources and the universal experiences pertinent to all age groups. The third paper is a content analysis of end-of-life decision-making policies in U.S. departments of corrections. It underscores the variability in accessibility and specificity of such policies, advocating for a more person-centered model that aligns with community standard quality of care. The research signifies that current prison systems have opportunities for enhancing policy and potentially affecting the quality of end-of-life care in prisons. Collectively, these papers emphasize potential improvement and growth in person-centered approaches for correctional systems and the opportunities to address the challenges of a growing older adult population. These findings highlight the need for additional research and collaboration between the fields of criminal justice and gerontology. The relevance extends beyond research to practitioners and policymakers in criminal justice and aging services whose work directly impacts this population.

https://doi.org/10.57709/36982201

Recommended Citation

Helmly, Victoria, "The Intersection of Aging, Health, & Correctional Systems: An Exploration of Experiences, Approaches, & Policies Using a Person-centered Framework." Dissertation, Georgia State University, 2024. doi: https://doi.org/10.57709/36982201

Since May 15, 2024

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15 May 2024

Neglecting sex and gender in research is a public-health risk

Sue Haupt 0 ,
Cheryl Carcel 1 &
Robyn Norton 2

Sue Haupt is an honorary senior research fellow at Peter MacCallum Cancer Centre in Melbourne, Australia, and a research associate at The George Institute for Global Health, Women’s Health Program, Centre for Sex and Gender Equity in Health and Medicine, University of New South Wales (UNSW) Sydney, Australia.

You can also search for this author in PubMed Google Scholar

Cheryl Carcel is the head of the brain health programme at The George Institute for Global Health UNSW Sydney, Australia.

Robyn Norton is a founding director of The George Institute for Global Health, a professor of public health at UNSW Sydney and chair of global health at Imperial College London, UK.

Illustration: Sophi Gullbrants

You have full access to this article via your institution.

In 2022, clinical trials indicated that a drug called lecanemab could slow cognitive decline in people with Alzheimer’s disease; soon after the results were published, the global Alzheimer’s community heralded lecanemab as a momentous discovery. However, closer inspection of the data by independent investigators revealed that the drug might significantly help men, but not women 1 .

The finding is a reminder that, even though tremendous advances are being made in the clinical application of cutting-edge technologies, such as gene editing and artificial intelligence (AI), there is a remarkable lack of understanding about how many aspects of human health are affected by variables as seemingly basic as sex and gender.

Sex and gender in science

Over the past decade or so, funders and publishers have made extensive efforts to encourage researchers to address the effects of sex and, in human studies, gender where appropriate. Thanks in part to these efforts, more insights are beginning to emerge. For Alzheimer’s and many other diseases that are common causes of death, including cardiovascular diseases, cancer, chronic respiratory conditions and diabetes, a person’s sex and gender can influence their risk of developing the disease, how quickly and accurately they are diagnosed, what treatment they receive and how they fare.

But even for the most-studied conditions, many questions remain. Few investigators have begun to probe the interrelationships between sex and gender , for example. And in cases in which researchers are managing to unpick the multifaceted effects of sex, this knowledge is not being sufficiently incorporated into the design of clinical trials or adequately changing the practice of medicine.

The consideration of sex and, where appropriate, gender in biological research must become routine — especially as molecular genetics, biomedical engineering and AI open up possibilities for treatments that are better tailored to the needs of individuals. Likewise, the culture of medicine must be transformed so that approaches to treatment evolve in response to the data. This will require further engagement from funders and publishers, but action from many other players, too. Pharmaceutical companies and intergovernmental organizations, among others, must acknowledge three things: how sex and gender can have huge effects on health outcomes; how these effects are often disregarded in basic research and clinical trials; and that change can come only through increasing awareness among all stakeholders of the importance of shifting the dial.

Health outcomes affected

In most human clinical records so far, sex is reported by physicians or participants in studies ticking one of two boxes: ‘female’ or ‘male’. In those clinical studies in which data are collected on chromosomes, hormone levels, reproductive anatomy or other sex characteristics, these features will frequently reflect a person’s sex assigned at birth. But this is not always the case. Added to this, sex and gender have often been used interchangeably, but they are not the same and they do not always align. Current definitions of gender include the social, psychological, cultural and behavioural aspects of being a man or woman (whether cisgender or transgender), non-binary or identifying with one or more other evolving terms 2 .

In several countries, new recommendations about how researchers should obtain data on people’s sex and gender should mean that, in the future, investigators will be able to more-accurately probe the roles of both in human health. But in general, there has been incomplete capture of information for sex and gender so far, including for individuals whose sex characteristics and/or gender identities don’t fall into a binary categorization scheme.

A medical worker transports a patient on a wheeled stretcher from an ambulance

Women are more likely to die after a severe heart attack than are men. Credit: Simon Dawson/Reuters

In this article, consistent with much of the published population-wide data, we refer to a woman as someone who identifies with that gender and was assigned female sex at birth (a cis woman), and a man as someone who identifies with that gender and was assigned male sex at birth (a cis man). But we recognize that participants in the studies we describe might not have been asked about both their gender and their sex.

For all sorts of non-communicable diseases, there are differences between men and women in the average age at which they are diagnosed, the average age at which they die and even in their rates of death.

We need more-nuanced approaches to exploring sex and gender in research

Such variations, from the earlier onset of cardiovascular diseases in men to the more frequent occurrence of Alzheimer’s disease in women, might stem from differences in biology, which can affect people’s likelihood of developing a disease and how they respond to treatment. Or these discrepancies might stem from variation in people’s exposure to the environmental factors that trigger the disease, how they manage their condition, how they are treated by carers and so on, all of which can be influenced by a person’s gender. Often, a combination of factors will be at work.

Take heart attacks. Studies conducted over the past decade have revealed extensive sex differences in the expression of certain genes in heart tissue, which in turn affect the type and function of the cells that make up the heart.

Such variation could help to explain why men are likely to have a heart attack for the first time around six years earlier than women — in the United States, at 65.6 years old in men compared with 72 years old in women 3 — and why (in Australia, at least) heart attacks are at least twice as common in men relative to women of comparable ages (see go.nature.com/3qbvrxq ). Likewise, although mechanisms are yet to be fully understood, it is plausible that differences in people’s biology help to explain why women are more likely to experience pain between their shoulder blades, nausea or vomiting and shortness of breath during a heart attack; why men are more likely to experience chest pain and increased sweating; and why women are nearly twice as likely as are men to die after a severe heart attack.

Yet, when it comes to the risk of dying, social and environmental factors — shaped by gender — also seem to be important.

Tobacco consumption increases a person’s risk of having a heart attack, and smoking is much more common among men globally. Worldwide, around 37% of men smoke compared with around 8% of women . Also, in part because health-care professionals and others are more familiar with the heart attack symptoms commonly seen in men, when women have a heart attack, they are more likely to delay seeking help, and carers are often slower to intervene 4 . In fact, in a study of more than 500,000 people who experienced a heart attack and were admitted to hospital in the United Kingdom between 2004 and 2013, women were 37% more likely to receive an incorrect initial diagnosis after a severe heart attack than were men 5 . Even when women tell their physicians that they have chest pain, they are two to three times less likely to be referred to a cardiologist than are men 6 .

A similarly complicated picture has been emerging in relation to strokes 7 — another cardiovascular disease — and, in the past few years, in relation to cancer.

Three men smoke cigarettes at a designated outdoor smoking area in Tokyo

Smoking is more common among men than women globally. Credit: Behrouz Mehri/AFP/Getty

Most cancers that occur in non-reproductive organs develop earlier in men than they do in women. In the United States, oesophageal cancer is 4.5 times more likely to occur and cause death in men than in women, for example, and lung cancers, the most common drivers of cancer-associated deaths worldwide, kill around 40% more men than women 8 .

Just as with heart disease and stroke, some of this variation seems to stem from behavioural differences. Tobacco consumption increases a person’s risk of developing several cancers 7 . For thyroid cancers, however, women are more likely to develop the disease than are men — three times more likely in some places — which suggests that other factors might drive the different rates of this particular cancer in women and men 9 . But tumours typically arise because of problems with cells’ genetic-repair systems, together with inadequate damage clearance, and genetic differences between men and women that affect cancers are beginning to emerge.

Male–female comparisons are powerful in biomedical research — don’t abandon them

Much more research is needed to understand how sex affects the rate at which genes mutate, cells’ capacities to repair and clear damaged DNA, and when genetic damage starts causing disease. Yet research led by one of us (S.H.) on lung adenocarcinoma, the most common type of lung cancer, suggests that women can survive for longer than men after they are diagnosed, in part thanks to cancer-defence genes in women driving more-robust immune responses 10 . X chromosomes encode many genes that are linked to immunity, and women with two X chromosomes might express these genes at higher levels than men with XY chromosomes.

Responses to cancer treatments also differ between men and women. Chemotherapies tend to work better in women than in men. This could be because it can take longer for women’s bodies to clear certain drugs, which could partly explain why women are also 34% more likely than men to experience harmful side effects 11 . Moreover, women with lung cancer typically have better outcomes after surgery, which they undergo more often than men 8 . This is probably due, at least in part, to women having less advanced disease when they are diagnosed than men do 12 . But the generally stronger immune responses in women might also help their recovery 8 .

Too often ignored

Despite these compelling indications that sex and gender matter, when it comes to many diseases that are leading causes of death, many researchers and health practitioners still fail to adequately take sex and gender into account. They might also be influenced by conscious or unconscious bias.

In the case of heart disease, the differences in gene expression and cellular make-up and activity found in men and women’s hearts highlight the need for sex-specific cardiac tissue models, sustained by sex-appropriate vasculature 13 . (Women on average have smaller hearts with narrower vessels compared with men.) Currently, researchers tend to construct heart models using either animal or human cells, but without necessarily ensuring that cells are sourced from individuals of only one sex per model. In fact, identifying sex disparities in basic heart biology is crucial to engineering relevant heart models with stem cells, for example, which investigators are now developing to aid the study of heart disease 13 .

For both heart disease and stroke, because of decades of under-representation of women in clinical trials, many of today’s standard treatments are based on studies of what happens in men who weigh around 70 kilograms. In clinical trials conducted for stroke and heart conditions between 2010 and 2017, women worldwide were under-enrolled relative to the prevalence of these diseases in the general population — by around 20% 14 . There is also significant underfunding of research for many conditions that are more prevalent in women compared with those that are more common in men (see ‘Disparities in health and disease’).

Disparities in health and disease. Stacked bar chart showing the overfunding totals for female and male-dominated diseases and conditions and how more is overspent on male-dominated diseases.

Source: A. A. Mirin J. Womens Health 30 , 956–963 (2021).

Basic research on cancer is similarly riddled with problems. Take the sex of the cell lines that are stored in commercial cell banks, which have been studied for decades and are the source of much of today’s textbook knowledge. For lung cancers, male lines outnumber female lines by two to one. For liver cancers, the ratio is seven to one. Until a few years ago, few researchers studying cancer in cultured cells in the lab even considered the sex of the cells they were studying. Also, the standard media in which cells are grown is frequently supplemented with fetal calf serum from a mixture of male and female calves, and so contains both male and female sex hormones. And phenol red, a dye commonly used to monitor the pH of tissue culture media mimics the hormone oestrogen 8 .

To add to the difficulties, research findings that emerge from the use of these cell lines are often tested in mice of only one sex. The results of these studies are then used to guide human trials that include both men and women participants. And in oncological clinical trials, just as with stroke and heart disease, women are still under-enrolled relative to the burden of disease they experience 7 .

Inclusivity in human trials will ensure the best possible outcomes for all participants, including cis and trans women and men, gender-diverse and intersex people (see ‘Inclusivity in practice’). Studies are showing, for example, that circadian rhythms — which can affect heart function and might impact how drugs are metabolized — differ between men and women 15 . So how might they compare in non-binary or transgender people? Likewise, knowledge about the immune responses of people with atypical numbers of sex chromosomes is likely to be crucial when it comes to the use of immune checkpoint inhibitors and other immune therapies for treating cancer. Those with Klinefelter syndrome, for example, who, similar to cis women, are at a higher risk of developing breast cancer than are cis men, have multiple X chromosomes that are rich in genes involved in the immune response.

Inclusivity in practice

How researchers include diverse groups of people in clinical trials with enough participants to be able to uncover between-group differences is a challenge.

Women represent nearly half of the population, but they are still under-represented in many clinical trials for numerous diseases, even in cases in which disease prevalence for women has been measured. For smaller population groups, such as transgender people, there are not enough data to even know what representative inclusion looks like. In fact, even if participation does reflect the prevalence of disease in the broader population in any one trial, teasing out effects might require combining the results of multiple studies in meta-analyses.

Advisory governing boards for pharmaceutical companies, such as the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, funders and regulatory agencies could help with this by ensuring that terminology is adequately and consistently defined, and that populations are properly profiled.

Heightened awareness

Routinely taking sex and gender into account in research and using that knowledge to change health care could benefit billions of people. So what’s needed to make this happen?

Policy changes — such as the US National Institutes of Health’s 2016 call for the inclusion of male and female sexes in studies involving cells, tissues and animals — are crucial. But for many researchers, such calls seem burdensome, especially because studying more than one sex can increase costs. ( Sample sizes might need to be increased to achieve sufficient statistical power when comparing groups.)

Alongside initiatives from funders and publishers, awareness must be built — among students, researchers, clinicians, medical ethics committees, research governance bodies and community groups — of the ramifications of failing to consider sex and gender, and how to correct the problem.

Accounting for sex and gender makes for better science

Efforts led by the Canadian Institutes of Health Research (CIHR) are encouraging. Even though the permeation of knowledge from research to health care has been glacial, between 2011 and 2019, the proportion of all research grant applications submitted to the CIHR that took sex into consideration increased from around 22% to 83%. Gender as a variable is now also included in many of the human studies funded by the CIHR .

Several initiatives have contributed to this. As an example, as well as asking grant applicants to include a section in their research proposals on whether they are considering sex and gender and how they will do so, or why this is not considered applicable, the CIHR has provided training for scientists and organized workshops involving researchers and specialists in sex and gender. Applicants are more likely to receive funding if they provide a satisfactory rationale for their choices.

Convincing people in leadership roles — in governments, laboratories, medical ethics boards, education and so on — of the importance of including sex and gender in research is especially crucial. More studies demonstrating the financial costs of not doing so could help. Between 1997 and 2000, for instance, eight prescription drugs were retracted from the US market because inadequate clinical testing in women had failed to identify that the drugs put women at greater risk of developing health problems than men. This error cost pharmaceutical companies and taxpayers an estimated US$1.6 billion per drug 16 .

The scale of transformation needed will also require more engagement from global players.

Even as far back as 2007, the 60th World Health Assembly — the decision-making body of the World Health Organization (WHO) — passed a resolution to urge researchers to split their data according to sex and to include gender analyses where appropriate. Steps to improve care for transgender people or those with diverse genders are also starting to be taken; in December last year, the WHO established a Guideline Development Group, to provide recommendations on how to address the health of transgender and gender-diverse people . But more extensive efforts, comparable to all United Nations member states committing to target 5.b of the 2015 Sustainable Development Goals by 2030, will be crucial. (This target is to “enhance the use of enabling technology, in particular information and communications technology, to promote the empowerment of women”.)

Lastly, under the guidance of regulatory bodies such as the European Medicines Agency and the scientific entrepreneur community, the pharmaceutical industry must do more to ensure that preclinical work is robust, and that products are tested on enough people of different sexes and genders. Many leading pharmaceutical companies acknowledge on their websites the importance of including diverse groups in clinical trials , but evidence of actions to address the issue is only just emerging.

Awareness of the problems around sex and gender is growing fast. And although many are concerned that medical applications of AI will perpetuate already existing biases 17 , promising developments are emerging in the use of machine learning to make diagnoses that are appropriate for people’s sex and gender.

For decades, for instance, physicians worldwide have been determining whether a person has had a heart attack by using the Global Registry of Acute Coronary Events (GRACE) score, which was derived from trials mainly involving men. In 2022, the application of machine learning to data that had been split for men and women refined the predictors for women. And these revised predictors did a better job of matching individuals to appropriate interventions 18 .

Greater awareness, the wealth of data now emerging and the possibilities presented by new tools, from AI to gene editing, could mean a new era for research and medicine.

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Cultural Relativity and Acceptance of Embryonic Stem Cell Research

Article sidebar.

Main Article Content

There is a debate about the ethical implications of using human embryos in stem cell research, which can be influenced by cultural, moral, and social values. This paper argues for an adaptable framework to accommodate diverse cultural and religious perspectives. By using an adaptive ethics model, research protections can reflect various populations and foster growth in stem cell research possibilities.

INTRODUCTION

Stem cell research combines biology, medicine, and technology, promising to alter health care and the understanding of human development. Yet, ethical contention exists because of individuals’ perceptions of using human embryos based on their various cultural, moral, and social values. While these disagreements concerning policy, use, and general acceptance have prompted the development of an international ethics policy, such a uniform approach can overlook the nuanced ethical landscapes between cultures. With diverse viewpoints in public health, a single global policy, especially one reflecting Western ethics or the ethics prevalent in high-income countries, is impractical. This paper argues for a culturally sensitive, adaptable framework for the use of embryonic stem cells. Stem cell policy should accommodate varying ethical viewpoints and promote an effective global dialogue. With an extension of an ethics model that can adapt to various cultures, we recommend localized guidelines that reflect the moral views of the people those guidelines serve.

Stem cells, characterized by their unique ability to differentiate into various cell types, enable the repair or replacement of damaged tissues. Two primary types of stem cells are somatic stem cells (adult stem cells) and embryonic stem cells. Adult stem cells exist in developed tissues and maintain the body’s repair processes. [1] Embryonic stem cells (ESC) are remarkably pluripotent or versatile, making them valuable in research. [2] However, the use of ESCs has sparked ethics debates. Considering the potential of embryonic stem cells, research guidelines are essential. The International Society for Stem Cell Research (ISSCR) provides international stem cell research guidelines. They call for “public conversations touching on the scientific significance as well as the societal and ethical issues raised by ESC research.” [3] The ISSCR also publishes updates about culturing human embryos 14 days post fertilization, suggesting local policies and regulations should continue to evolve as ESC research develops. [4] Like the ISSCR, which calls for local law and policy to adapt to developing stem cell research given cultural acceptance, this paper highlights the importance of local social factors such as religion and culture.

I. Global Cultural Perspective of Embryonic Stem Cells

Views on ESCs vary throughout the world. Some countries readily embrace stem cell research and therapies, while others have stricter regulations due to ethical concerns surrounding embryonic stem cells and when an embryo becomes entitled to moral consideration. The philosophical issue of when the “someone” begins to be a human after fertilization, in the morally relevant sense, [5] impacts when an embryo becomes not just worthy of protection but morally entitled to it. The process of creating embryonic stem cell lines involves the destruction of the embryos for research. [6] Consequently, global engagement in ESC research depends on social-cultural acceptability.

a. US and Rights-Based Cultures

In the United States, attitudes toward stem cell therapies are diverse. The ethics and social approaches, which value individualism, [7] trigger debates regarding the destruction of human embryos, creating a complex regulatory environment. For example, the 1996 Dickey-Wicker Amendment prohibited federal funding for the creation of embryos for research and the destruction of embryos for “more than allowed for research on fetuses in utero.” [8] Following suit, in 2001, the Bush Administration heavily restricted stem cell lines for research. However, the Stem Cell Research Enhancement Act of 2005 was proposed to help develop ESC research but was ultimately vetoed. [9] Under the Obama administration, in 2009, an executive order lifted restrictions allowing for more development in this field. [10] The flux of research capacity and funding parallels the different cultural perceptions of human dignity of the embryo and how it is socially presented within the country’s research culture. [11]

b. Ubuntu and Collective Cultures

African bioethics differs from Western individualism because of the different traditions and values. African traditions, as described by individuals from South Africa and supported by some studies in other African countries, including Ghana and Kenya, follow the African moral philosophies of Ubuntu or Botho and Ukama , which “advocates for a form of wholeness that comes through one’s relationship and connectedness with other people in the society,” [12] making autonomy a socially collective concept. In this context, for the community to act autonomously, individuals would come together to decide what is best for the collective. Thus, stem cell research would require examining the value of the research to society as a whole and the use of the embryos as a collective societal resource. If society views the source as part of the collective whole, and opposes using stem cells, compromising the cultural values to pursue research may cause social detachment and stunt research growth. [13] Based on local culture and moral philosophy, the permissibility of stem cell research depends on how embryo, stem cell, and cell line therapies relate to the community as a whole . Ubuntu is the expression of humanness, with the person’s identity drawn from the “’I am because we are’” value. [14] The decision in a collectivistic culture becomes one born of cultural context, and individual decisions give deference to others in the society.

Consent differs in cultures where thought and moral philosophy are based on a collective paradigm. So, applying Western bioethical concepts is unrealistic. For one, Africa is a diverse continent with many countries with different belief systems, access to health care, and reliance on traditional or Western medicines. Where traditional medicine is the primary treatment, the “’restrictive focus on biomedically-related bioethics’” [is] problematic in African contexts because it neglects bioethical issues raised by traditional systems.” [15] No single approach applies in all areas or contexts. Rather than evaluating the permissibility of ESC research according to Western concepts such as the four principles approach, different ethics approaches should prevail.

Another consideration is the socio-economic standing of countries. In parts of South Africa, researchers have not focused heavily on contributing to the stem cell discourse, either because it is not considered health care or a health science priority or because resources are unavailable. [16] Each country’s priorities differ given different social, political, and economic factors. In South Africa, for instance, areas such as maternal mortality, non-communicable diseases, telemedicine, and the strength of health systems need improvement and require more focus. [17] Stem cell research could benefit the population, but it also could divert resources from basic medical care. Researchers in South Africa adhere to the National Health Act and Medicines Control Act in South Africa and international guidelines; however, the Act is not strictly enforced, and there is no clear legislation for research conduct or ethical guidelines. [18]

Some parts of Africa condemn stem cell research. For example, 98.2 percent of the Tunisian population is Muslim. [19] Tunisia does not permit stem cell research because of moral conflict with a Fatwa. Religion heavily saturates the regulation and direction of research. [20] Stem cell use became permissible for reproductive purposes only recently, with tight restrictions preventing cells from being used in any research other than procedures concerning ART/IVF. Their use is conditioned on consent, and available only to married couples. [21] The community's receptiveness to stem cell research depends on including communitarian African ethics.

c. Asia

Some Asian countries also have a collective model of ethics and decision making. [22] In China, the ethics model promotes a sincere respect for life or human dignity, [23] based on protective medicine. This model, influenced by Traditional Chinese Medicine (TCM), [24] recognizes Qi as the vital energy delivered via the meridians of the body; it connects illness to body systems, the body’s entire constitution, and the universe for a holistic bond of nature, health, and quality of life. [25] Following a protective ethics model, and traditional customs of wholeness, investment in stem cell research is heavily desired for its applications in regenerative therapies, disease modeling, and protective medicines. In a survey of medical students and healthcare practitioners, 30.8 percent considered stem cell research morally unacceptable while 63.5 percent accepted medical research using human embryonic stem cells. Of these individuals, 89.9 percent supported increased funding for stem cell research. [26] The scientific community might not reflect the overall population. From 1997 to 2019, China spent a total of $576 million (USD) on stem cell research at 8,050 stem cell programs, increased published presence from 0.6 percent to 14.01 percent of total global stem cell publications as of 2014, and made significant strides in cell-based therapies for various medical conditions. [27] However, while China has made substantial investments in stem cell research and achieved notable progress in clinical applications, concerns linger regarding ethical oversight and transparency. [28] For example, the China Biosecurity Law, promoted by the National Health Commission and China Hospital Association, attempted to mitigate risks by introducing an institutional review board (IRB) in the regulatory bodies. 5800 IRBs registered with the Chinese Clinical Trial Registry since 2021. [29] However, issues still need to be addressed in implementing effective IRB review and approval procedures.

The substantial government funding and focus on scientific advancement have sometimes overshadowed considerations of regional cultures, ethnic minorities, and individual perspectives, particularly evident during the one-child policy era. As government policy adapts to promote public stability, such as the change from the one-child to the two-child policy, [30] research ethics should also adapt to ensure respect for the values of its represented peoples.

Japan is also relatively supportive of stem cell research and therapies. Japan has a more transparent regulatory framework, allowing for faster approval of regenerative medicine products, which has led to several advanced clinical trials and therapies. [31] South Korea is also actively engaged in stem cell research and has a history of breakthroughs in cloning and embryonic stem cells. [32] However, the field is controversial, and there are issues of scientific integrity. For example, the Korean FDA fast-tracked products for approval, [33] and in another instance, the oocyte source was unclear and possibly violated ethical standards. [34] Trust is important in research, as it builds collaborative foundations between colleagues, trial participant comfort, open-mindedness for complicated and sensitive discussions, and supports regulatory procedures for stakeholders. There is a need to respect the culture’s interest, engagement, and for research and clinical trials to be transparent and have ethical oversight to promote global research discourse and trust.

d. Middle East

Countries in the Middle East have varying degrees of acceptance of or restrictions to policies related to using embryonic stem cells due to cultural and religious influences. Saudi Arabia has made significant contributions to stem cell research, and conducts research based on international guidelines for ethical conduct and under strict adherence to guidelines in accordance with Islamic principles. Specifically, the Saudi government and people require ESC research to adhere to Sharia law. In addition to umbilical and placental stem cells, [35] Saudi Arabia permits the use of embryonic stem cells as long as they come from miscarriages, therapeutic abortions permissible by Sharia law, or are left over from in vitro fertilization and donated to research. [36] Laws and ethical guidelines for stem cell research allow the development of research institutions such as the King Abdullah International Medical Research Center, which has a cord blood bank and a stem cell registry with nearly 10,000 donors. [37] Such volume and acceptance are due to the ethical ‘permissibility’ of the donor sources, which do not conflict with religious pillars. However, some researchers err on the side of caution, choosing not to use embryos or fetal tissue as they feel it is unethical to do so. [38]

Jordan has a positive research ethics culture. [39] However, there is a significant issue of lack of trust in researchers, with 45.23 percent (38.66 percent agreeing and 6.57 percent strongly agreeing) of Jordanians holding a low level of trust in researchers, compared to 81.34 percent of Jordanians agreeing that they feel safe to participate in a research trial. [40] Safety testifies to the feeling of confidence that adequate measures are in place to protect participants from harm, whereas trust in researchers could represent the confidence in researchers to act in the participants’ best interests, adhere to ethical guidelines, provide accurate information, and respect participants’ rights and dignity. One method to improve trust would be to address communication issues relevant to ESC. Legislation surrounding stem cell research has adopted specific language, especially concerning clarification “between ‘stem cells’ and ‘embryonic stem cells’” in translation. [41] Furthermore, legislation “mandates the creation of a national committee… laying out specific regulations for stem-cell banking in accordance with international standards.” [42] This broad regulation opens the door for future global engagement and maintains transparency. However, these regulations may also constrain the influence of research direction, pace, and accessibility of research outcomes.

e. Europe

In the European Union (EU), ethics is also principle-based, but the principles of autonomy, dignity, integrity, and vulnerability are interconnected. [43] As such, the opportunity for cohesion and concessions between individuals’ thoughts and ideals allows for a more adaptable ethics model due to the flexible principles that relate to the human experience The EU has put forth a framework in its Convention for the Protection of Human Rights and Dignity of the Human Being allowing member states to take different approaches. Each European state applies these principles to its specific conventions, leading to or reflecting different acceptance levels of stem cell research. [44]

For example, in Germany, Lebenzusammenhang , or the coherence of life, references integrity in the unity of human culture. Namely, the personal sphere “should not be subject to external intervention.” [45] Stem cell interventions could affect this concept of bodily completeness, leading to heavy restrictions. Under the Grundgesetz, human dignity and the right to life with physical integrity are paramount. [46] The Embryo Protection Act of 1991 made producing cell lines illegal. Cell lines can be imported if approved by the Central Ethics Commission for Stem Cell Research only if they were derived before May 2007. [47] Stem cell research respects the integrity of life for the embryo with heavy specifications and intense oversight. This is vastly different in Finland, where the regulatory bodies find research more permissible in IVF excess, but only up to 14 days after fertilization. [48] Spain’s approach differs still, with a comprehensive regulatory framework. [49] Thus, research regulation can be culture-specific due to variations in applied principles. Diverse cultures call for various approaches to ethical permissibility. [50] Only an adaptive-deliberative model can address the cultural constructions of self and achieve positive, culturally sensitive stem cell research practices. [51]

II. Religious Perspectives on ESC

Embryonic stem cell sources are the main consideration within religious contexts. While individuals may not regard their own religious texts as authoritative or factual, religion can shape their foundations or perspectives.

The Qur'an states:

“And indeed We created man from a quintessence of clay. Then We placed within him a small quantity of nutfa (sperm to fertilize) in a safe place. Then We have fashioned the nutfa into an ‘alaqa (clinging clot or cell cluster), then We developed the ‘alaqa into mudgha (a lump of flesh), and We made mudgha into bones, and clothed the bones with flesh, then We brought it into being as a new creation. So Blessed is Allah, the Best of Creators.” [52]

Many scholars of Islam estimate the time of soul installment, marked by the angel breathing in the soul to bring the individual into creation, as 120 days from conception. [53] Personhood begins at this point, and the value of life would prohibit research or experimentation that could harm the individual. If the fetus is more than 120 days old, the time ensoulment is interpreted to occur according to Islamic law, abortion is no longer permissible. [54] There are a few opposing opinions about early embryos in Islamic traditions. According to some Islamic theologians, there is no ensoulment of the early embryo, which is the source of stem cells for ESC research. [55]

In Buddhism, the stance on stem cell research is not settled. The main tenets, the prohibition against harming or destroying others (ahimsa) and the pursuit of knowledge (prajña) and compassion (karuna), leave Buddhist scholars and communities divided. [56] Some scholars argue stem cell research is in accordance with the Buddhist tenet of seeking knowledge and ending human suffering. Others feel it violates the principle of not harming others. Finding the balance between these two points relies on the karmic burden of Buddhist morality. In trying to prevent ahimsa towards the embryo, Buddhist scholars suggest that to comply with Buddhist tenets, research cannot be done as the embryo has personhood at the moment of conception and would reincarnate immediately, harming the individual's ability to build their karmic burden. [57] On the other hand, the Bodhisattvas, those considered to be on the path to enlightenment or Nirvana, have given organs and flesh to others to help alleviate grieving and to benefit all. [58] Acceptance varies on applied beliefs and interpretations.

Catholicism does not support embryonic stem cell research, as it entails creation or destruction of human embryos. This destruction conflicts with the belief in the sanctity of life. For example, in the Old Testament, Genesis describes humanity as being created in God’s image and multiplying on the Earth, referencing the sacred rights to human conception and the purpose of development and life. In the Ten Commandments, the tenet that one should not kill has numerous interpretations where killing could mean murder or shedding of the sanctity of life, demonstrating the high value of human personhood. In other books, the theological conception of when life begins is interpreted as in utero, [59] highlighting the inviolability of life and its formation in vivo to make a religious point for accepting such research as relatively limited, if at all. [60] The Vatican has released ethical directives to help apply a theological basis to modern-day conflicts. The Magisterium of the Church states that “unless there is a moral certainty of not causing harm,” experimentation on fetuses, fertilized cells, stem cells, or embryos constitutes a crime. [61] Such procedures would not respect the human person who exists at these stages, according to Catholicism. Damages to the embryo are considered gravely immoral and illicit. [62] Although the Catholic Church officially opposes abortion, surveys demonstrate that many Catholic people hold pro-choice views, whether due to the context of conception, stage of pregnancy, threat to the mother’s life, or for other reasons, demonstrating that practicing members can also accept some but not all tenets. [63]

Some major Jewish denominations, such as the Reform, Conservative, and Reconstructionist movements, are open to supporting ESC use or research as long as it is for saving a life. [64] Within Judaism, the Talmud, or study, gives personhood to the child at birth and emphasizes that life does not begin at conception: [65]

“If she is found pregnant, until the fortieth day it is mere fluid,” [66]

Whereas most religions prioritize the status of human embryos, the Halakah (Jewish religious law) states that to save one life, most other religious laws can be ignored because it is in pursuit of preservation. [67] Stem cell research is accepted due to application of these religious laws.

We recognize that all religions contain subsets and sects. The variety of environmental and cultural differences within religious groups requires further analysis to respect the flexibility of religious thoughts and practices. We make no presumptions that all cultures require notions of autonomy or morality as under the common morality theory , which asserts a set of universal moral norms that all individuals share provides moral reasoning and guides ethical decisions. [68] We only wish to show that the interaction with morality varies between cultures and countries.

III. A Flexible Ethical Approach

The plurality of different moral approaches described above demonstrates that there can be no universally acceptable uniform law for ESC on a global scale. Instead of developing one standard, flexible ethical applications must be continued. We recommend local guidelines that incorporate important cultural and ethical priorities.

While the Declaration of Helsinki is more relevant to people in clinical trials receiving ESC products, in keeping with the tradition of protections for research subjects, consent of the donor is an ethical requirement for ESC donation in many jurisdictions including the US, Canada, and Europe. [69] The Declaration of Helsinki provides a reference point for regulatory standards and could potentially be used as a universal baseline for obtaining consent prior to gamete or embryo donation.

For instance, in Columbia University’s egg donor program for stem cell research, donors followed standard screening protocols and “underwent counseling sessions that included information as to the purpose of oocyte donation for research, what the oocytes would be used for, the risks and benefits of donation, and process of oocyte stimulation” to ensure transparency for consent. [70] The program helped advance stem cell research and provided clear and safe research methods with paid participants. Though paid participation or covering costs of incidental expenses may not be socially acceptable in every culture or context, [71] and creating embryos for ESC research is illegal in many jurisdictions, Columbia’s program was effective because of the clear and honest communications with donors, IRBs, and related stakeholders. This example demonstrates that cultural acceptance of scientific research and of the idea that an egg or embryo does not have personhood is likely behind societal acceptance of donating eggs for ESC research. As noted, many countries do not permit the creation of embryos for research.

Proper communication and education regarding the process and purpose of stem cell research may bolster comprehension and garner more acceptance. “Given the sensitive subject material, a complete consent process can support voluntary participation through trust, understanding, and ethical norms from the cultures and morals participants value. This can be hard for researchers entering countries of different socioeconomic stability, with different languages and different societal values. [72]

An adequate moral foundation in medical ethics is derived from the cultural and religious basis that informs knowledge and actions. [73] Understanding local cultural and religious values and their impact on research could help researchers develop humility and promote inclusion.

IV. Concerns

Some may argue that if researchers all adhere to one ethics standard, protection will be satisfied across all borders, and the global public will trust researchers. However, defining what needs to be protected and how to define such research standards is very specific to the people to which standards are applied. We suggest that applying one uniform guide cannot accurately protect each individual because we all possess our own perceptions and interpretations of social values. [74] Therefore, the issue of not adjusting to the moral pluralism between peoples in applying one standard of ethics can be resolved by building out ethics models that can be adapted to different cultures and religions.

Other concerns include medical tourism, which may promote health inequities. [75] Some countries may develop and approve products derived from ESC research before others, compromising research ethics or drug approval processes. There are also concerns about the sale of unauthorized stem cell treatments, for example, those without FDA approval in the United States. Countries with robust research infrastructures may be tempted to attract medical tourists, and some customers will have false hopes based on aggressive publicity of unproven treatments. [76]

For example, in China, stem cell clinics can market to foreign clients who are not protected under the regulatory regimes. Companies employ a marketing strategy of “ethically friendly” therapies. Specifically, in the case of Beike, China’s leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has “the unintended consequence of shifting questionable activities to another node in Beike's diffuse network.” [77] In contrast, Jordan is aware of stem cell research’s potential abuse and its own status as a “health-care hub.” Jordan’s expanded regulations include preserving the interests of individuals in clinical trials and banning private companies from ESC research to preserve transparency and the integrity of research practices. [78]

The social priorities of the community are also a concern. The ISSCR explicitly states that guidelines “should be periodically revised to accommodate scientific advances, new challenges, and evolving social priorities.” [79] The adaptable ethics model extends this consideration further by addressing whether research is warranted given the varying degrees of socioeconomic conditions, political stability, and healthcare accessibilities and limitations. An ethical approach would require discussion about resource allocation and appropriate distribution of funds. [80]

While some religions emphasize the sanctity of life from conception, which may lead to public opposition to ESC research, others encourage ESC research due to its potential for healing and alleviating human pain. Many countries have special regulations that balance local views on embryonic personhood, the benefits of research as individual or societal goods, and the protection of human research subjects. To foster understanding and constructive dialogue, global policy frameworks should prioritize the protection of universal human rights, transparency, and informed consent. In addition to these foundational global policies, we recommend tailoring local guidelines to reflect the diverse cultural and religious perspectives of the populations they govern. Ethics models should be adapted to local populations to effectively establish research protections, growth, and possibilities of stem cell research.

For example, in countries with strong beliefs in the moral sanctity of embryos or heavy religious restrictions, an adaptive model can allow for discussion instead of immediate rejection. In countries with limited individual rights and voice in science policy, an adaptive model ensures cultural, moral, and religious views are taken into consideration, thereby building social inclusion. While this ethical consideration by the government may not give a complete voice to every individual, it will help balance policies and maintain the diverse perspectives of those it affects. Embracing an adaptive ethics model of ESC research promotes open-minded dialogue and respect for the importance of human belief and tradition. By actively engaging with cultural and religious values, researchers can better handle disagreements and promote ethical research practices that benefit each society.

This brief exploration of the religious and cultural differences that impact ESC research reveals the nuances of relative ethics and highlights a need for local policymakers to apply a more intense adaptive model.

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Culturally, autonomy practices follow a relational autonomy approach based on a paternalistic deontological health care model. The adherence to strict international research policies and religious pillars within the regulatory environment is a great foundation for research ethics. However, there is a need to develop locally targeted ethics approaches for research (as called for in Alahmad, G., Aljohani, S., & Najjar, M. F. (2020). Ethical challenges regarding the use of stem cells: interviews with researchers from Saudi Arabia. BMC medical ethics, 21(1), 35. https://doi.org/10.1186/s12910-020-00482-6), this decision-making approach may help advise a research decision model. For more on the clinical cultural autonomy approaches, see: Alabdullah, Y. Y., Alzaid, E., Alsaad, S., Alamri, T., Alolayan, S. W., Bah, S., & Aljoudi, A. S. (2022). Autonomy and paternalism in Shared decision‐making in a Saudi Arabian tertiary hospital: A cross‐sectional study. Developing World Bioethics , 23 (3), 260–268. https://doi.org/10.1111/dewb.12355 ; Bukhari, A. A. (2017). Universal Principles of Bioethics and Patient Rights in Saudi Arabia (Doctoral dissertation, Duquesne University). https://dsc.duq.edu/etd/124; Ladha, S., Nakshawani, S. A., Alzaidy, A., & Tarab, B. (2023, October 26). Islam and Bioethics: What We All Need to Know . Columbia University School of Professional Studies. https://sps.columbia.edu/events/islam-and-bioethics-what-we-all-need-know

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[41] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a

[42] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a

[43] The EU’s definition of autonomy relates to the capacity for creating ideas, moral insight, decisions, and actions without constraint, personal responsibility, and informed consent. However, the EU views autonomy as not completely able to protect individuals and depends on other principles, such as dignity, which “expresses the intrinsic worth and fundamental equality of all human beings.” Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3

[44] Council of Europe. Convention for the protection of Human Rights and Dignity of the Human Being with regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine (ETS No. 164) https://www.coe.int/en/web/conventions/full-list?module=treaty-detail&treatynum=164 (forbidding the creation of embryos for research purposes only, and suggests embryos in vitro have protections.); Also see Drabiak-Syed B. K. (2013). New President, New Human Embryonic Stem Cell Research Policy: Comparative International Perspectives and Embryonic Stem Cell Research Laws in France. Biotechnology Law Report , 32 (6), 349–356. https://doi.org/10.1089/blr.2013.9865

[45] Rendtorff, J.D., Kemp, P. (2019). Four Ethical Principles in European Bioethics and Biolaw: Autonomy, Dignity, Integrity and Vulnerability. In: Valdés, E., Lecaros, J. (eds) Biolaw and Policy in the Twenty-First Century. International Library of Ethics, Law, and the New Medicine, vol 78. Springer, Cham. https://doi.org/10.1007/978-3-030-05903-3_3

[46] Tomuschat, C., Currie, D. P., Kommers, D. P., & Kerr, R. (Trans.). (1949, May 23). Basic law for the Federal Republic of Germany. https://www.btg-bestellservice.de/pdf/80201000.pdf

[47] Regulation of Stem Cell Research in Germany . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-germany

[48] Regulation of Stem Cell Research in Finland . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-finland

[49] Regulation of Stem Cell Research in Spain . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-spain

[50] Some sources to consider regarding ethics models or regulatory oversights of other cultures not covered:

Kara MA. Applicability of the principle of respect for autonomy: the perspective of Turkey. J Med Ethics. 2007 Nov;33(11):627-30. doi: 10.1136/jme.2006.017400. PMID: 17971462; PMCID: PMC2598110.

Ugarte, O. N., & Acioly, M. A. (2014). The principle of autonomy in Brazil: one needs to discuss it ... Revista do Colegio Brasileiro de Cirurgioes , 41 (5), 374–377. https://doi.org/10.1590/0100-69912014005013

Bharadwaj, A., & Glasner, P. E. (2012). Local cells, global science: The rise of embryonic stem cell research in India . Routledge.

For further research on specific European countries regarding ethical and regulatory framework, we recommend this database: Regulation of Stem Cell Research in Europe . Eurostemcell. (2017, April 26). https://www.eurostemcell.org/regulation-stem-cell-research-europe

[51] Klitzman, R. (2006). Complications of culture in obtaining informed consent. The American Journal of Bioethics, 6(1), 20–21. https://doi.org/10.1080/15265160500394671 see also: Ekmekci, P. E., & Arda, B. (2017). Interculturalism and Informed Consent: Respecting Cultural Differences without Breaching Human Rights. Cultura (Iasi, Romania) , 14 (2), 159–172.; For why trust is important in research, see also: Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent? Research Ethics , 13 (1), 23-41. https://doi.org/10.1177/1747016116650235

[52] The Qur'an (M. Khattab, Trans.). (1965). Al-Mu’minun, 23: 12-14. https://quran.com/23

[53] Lenfest, Y. (2017, December 8). Islam and the beginning of human life . Bill of Health. https://blog.petrieflom.law.harvard.edu/2017/12/08/islam-and-the-beginning-of-human-life/

[54] Aksoy, S. (2005). Making regulations and drawing up legislation in Islamic countries under conditions of uncertainty, with special reference to embryonic stem cell research. Journal of Medical Ethics , 31: 399-403.; see also: Mahmoud, Azza. "Islamic Bioethics: National Regulations and Guidelines of Human Stem Cell Research in the Muslim World." Master's thesis, Chapman University, 2022. https://doi.org/10.36837/ chapman.000386

[55] Rashid, R. (2022). When does Ensoulment occur in the Human Foetus. Journal of the British Islamic Medical Association , 12 (4). ISSN 2634 8071. https://www.jbima.com/wp-content/uploads/2023/01/2-Ethics-3_-Ensoulment_Rafaqat.pdf.

[56] Sivaraman, M. & Noor, S. (2017). Ethics of embryonic stem cell research according to Buddhist, Hindu, Catholic, and Islamic religions: perspective from Malaysia. Asian Biomedicine,8(1) 43-52. https://doi.org/10.5372/1905-7415.0801.260

[57] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[58] Lecso, P. A. (1991). The Bodhisattva Ideal and Organ Transplantation. Journal of Religion and Health , 30 (1), 35–41. http://www.jstor.org/stable/27510629 ; Bodhisattva, S. (n.d.). The Key of Becoming a Bodhisattva . A Guide to the Bodhisattva Way of Life. http://www.buddhism.org/Sutras/2/BodhisattvaWay.htm

[59] There is no explicit religious reference to when life begins or how to conduct research that interacts with the concept of life. However, these are relevant verses pertaining to how the fetus is viewed. (( King James Bible . (1999). Oxford University Press. (original work published 1769))

Jerimiah 1: 5 “Before I formed thee in the belly I knew thee; and before thou camest forth out of the womb I sanctified thee…”

In prophet Jerimiah’s insight, God set him apart as a person known before childbirth, a theme carried within the Psalm of David.

Psalm 139: 13-14 “…Thou hast covered me in my mother's womb. I will praise thee; for I am fearfully and wonderfully made…”

These verses demonstrate David’s respect for God as an entity that would know of all man’s thoughts and doings even before birth.

[60] It should be noted that abortion is not supported as well.

[61] The Vatican. (1987, February 22). Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation Replies to Certain Questions of the Day . Congregation For the Doctrine of the Faith. https://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html

[62] The Vatican. (2000, August 25). Declaration On the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells . Pontifical Academy for Life. https://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20000824_cellule-staminali_en.html ; Ohara, N. (2003). Ethical Consideration of Experimentation Using Living Human Embryos: The Catholic Church’s Position on Human Embryonic Stem Cell Research and Human Cloning. Department of Obstetrics and Gynecology . Retrieved from https://article.imrpress.com/journal/CEOG/30/2-3/pii/2003018/77-81.pdf.

[63] Smith, G. A. (2022, May 23). Like Americans overall, Catholics vary in their abortion views, with regular mass attenders most opposed . Pew Research Center. https://www.pewresearch.org/short-reads/2022/05/23/like-americans-overall-catholics-vary-in-their-abortion-views-with-regular-mass-attenders-most-opposed/

[64] Rosner, F., & Reichman, E. (2002). Embryonic stem cell research in Jewish law. Journal of halacha and contemporary society , (43), 49–68.; Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[65] Schenker J. G. (2008). The beginning of human life: status of embryo. Perspectives in Halakha (Jewish Religious Law). Journal of assisted reproduction and genetics , 25 (6), 271–276. https://doi.org/10.1007/s10815-008-9221-6

[66] Ruttenberg, D. (2020, May 5). The Torah of Abortion Justice (annotated source sheet) . Sefaria. https://www.sefaria.org/sheets/234926.7?lang=bi&with=all&lang2=en

[67] Jafari, M., Elahi, F., Ozyurt, S. & Wrigley, T. (2007). 4. Religious Perspectives on Embryonic Stem Cell Research. In K. Monroe, R. Miller & J. Tobis (Ed.), Fundamentals of the Stem Cell Debate: The Scientific, Religious, Ethical, and Political Issues (pp. 79-94). Berkeley: University of California Press. https://escholarship.org/content/qt9rj0k7s3/qt9rj0k7s3_noSplash_f9aca2e02c3777c7fb76ea768ba458f0.pdf https://doi.org/10.1525/9780520940994-005

[68] Gert, B. (2007). Common morality: Deciding what to do . Oxford Univ. Press.

[69] World Medical Association (2013). World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA , 310(20), 2191–2194. https://doi.org/10.1001/jama.2013.281053 Declaration of Helsinki – WMA – The World Medical Association .; see also: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research . U.S. Department of Health and Human Services. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html

[70] Zakarin Safier, L., Gumer, A., Kline, M., Egli, D., & Sauer, M. V. (2018). Compensating human subjects providing oocytes for stem cell research: 9-year experience and outcomes. Journal of assisted reproduction and genetics , 35 (7), 1219–1225. https://doi.org/10.1007/s10815-018-1171-z https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063839/ see also: Riordan, N. H., & Paz Rodríguez, J. (2021). Addressing concerns regarding associated costs, transparency, and integrity of research in recent stem cell trial. Stem Cells Translational Medicine , 10 (12), 1715–1716. https://doi.org/10.1002/sctm.21-0234

[71] Klitzman, R., & Sauer, M. V. (2009). Payment of egg donors in stem cell research in the USA. Reproductive biomedicine online , 18 (5), 603–608. https://doi.org/10.1016/s1472-6483(10)60002-8

[72] Krosin, M. T., Klitzman, R., Levin, B., Cheng, J., & Ranney, M. L. (2006). Problems in comprehension of informed consent in rural and peri-urban Mali, West Africa. Clinical trials (London, England) , 3 (3), 306–313. https://doi.org/10.1191/1740774506cn150oa

[73] Veatch, Robert M. Hippocratic, Religious, and Secular Medical Ethics: The Points of Conflict . Georgetown University Press, 2012.

[74] Msoroka, M. S., & Amundsen, D. (2018). One size fits not quite all: Universal research ethics with diversity. Research Ethics , 14 (3), 1-17. https://doi.org/10.1177/1747016117739939

[75] Pirzada, N. (2022). The Expansion of Turkey’s Medical Tourism Industry. Voices in Bioethics , 8 . https://doi.org/10.52214/vib.v8i.9894

[76] Stem Cell Tourism: False Hope for Real Money . Harvard Stem Cell Institute (HSCI). (2023). https://hsci.harvard.edu/stem-cell-tourism , See also: Bissassar, M. (2017). Transnational Stem Cell Tourism: An ethical analysis. Voices in Bioethics , 3 . https://doi.org/10.7916/vib.v3i.6027

[77] Song, P. (2011) The proliferation of stem cell therapies in post-Mao China: problematizing ethical regulation, New Genetics and Society , 30:2, 141-153, DOI: 10.1080/14636778.2011.574375

[78] Dajani, R. (2014). Jordan’s stem-cell law can guide the Middle East. Nature 510, 189. https://doi.org/10.1038/510189a

[79] International Society for Stem Cell Research. (2024). Standards in stem cell research . International Society for Stem Cell Research. https://www.isscr.org/guidelines/5-standards-in-stem-cell-research

[80] Benjamin, R. (2013). People’s science bodies and rights on the Stem Cell Frontier . Stanford University Press.

Mifrah Hayath

SM Candidate Harvard Medical School, MS Biotechnology Johns Hopkins University

Olivia Bowers

MS Bioethics Columbia University (Disclosure: affiliated with Voices in Bioethics)

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Final Report Summary of Outcome

The Los Angeles County Jail system [LACJ] is the largest sprawl of carceral facilities in the United States. Its central facility the Twin Towers Correctional Facility and phsycially adjoined Men?s Central Jail Facility have inadvertently become de facto the largest locked mental health facility in the world?bigger than any hospital. Between 2017 and March 2023 between 5000 and 6000 detainees were locked up in the LACJ and that number of inmates with mental illness diagnoses continues to be rising despite a reduced total jail population since the advent of the Covid pandemic. Most of these inmates/patients are currently confined to cramped, solitary or dual occupancy cells and are caught in a revolving door of homelessness, co-ccurring substance use and psychosis spectrum disorders and chronic incarceration.

This project collected in-depth participant-observation ethnographic data (fieldnote observations, semi-structured interviews and conversational contextual interviews) both inside the LACJ and across the sprawling neighborhoods of Los Angeles County. It also reviewed an extensive gray literature of reports and agency documents relevant to mental health reform and ?Alternatives to Incarceration? Mental Health Reform? that was taking place in Los Angeles during the fieldwork years and is ongoing. Los Angeles continues to be in the midst of a conflictive attempt to expand community-based services and clinical care that claims to be prioritizing increasing the scarce services currently available to homeless individuals with psychosis spectrum disorders.

The graduate student?s primary findings were:

Long term care with housing and treatment for co-occurring serious mental illness and substance use disorders remain largely inaccessible across Los Angeles County. Services are sabotaged by public-private partnerships that dysfunctionally incentivize (both formally and de facto) mental health providers to "cherry pick" easy clients. Consequently, the most vulnerable and most distressed homeless individuals whose psychosis-spectrum disorders sometimes manifest violently. These are precisely the individuals most vulnerable to chronic and/or long-term incarceration.
A remarkably therapeutic inmate-staffed peer-support program of Mental Health Assistants [MHA] who do not have mental health diagnoses managed to expand by over 300% (from a fledgling pilot program in two 16 bed pods totaling approximately 34 inmate/patients in 2019 to over 150 inmates/patients by Fall 2023). The MHA program was supported by Los Angeles Sheriff Department leadership but was inconsistently facilitated and hamstrung by infrastructural and personnel limitations inherent to correctional facilities prioritizing punishment/security rather than rehabilitation. These mission priorities are compounded by chronic shortages of Correctional Health Services psychiatrists, social workers and health techs (despite LA county increasing funding for expansion of mental health and allied medical care services).
Effective ethical clinical care can be delivered despite its location inside a facility that is institutionally toxic to mental health stability and that has historically been notoriously dominated by prison gangs and violence.
Active gang members (thankfully) were not able to infiltrate MHA Units because of careful triage and monitoring by MHA streetwise inmate trainers.
Incidents of self-harm/suicides decreased exponentially in MHA peer-support units compared to incidents occurring quasi-routinely among inmates/patients with mental health diagnoses in units that do not receive MHA peer-support services.
Observable quality of life improved dramatically, and formerly routine incidents of extreme distress ceased (including prolonged shrieking, flooding, feces smearing, fetid odors and forcible cell extractions) despite those incidents continuing to occur quasi-routinely in mental health units without MHA
Recidivism rates among inmates with psychosis spectrum disorders (according to official agency reports) were quantum levels higher than those of general jail population inmates without mental health diagnoses. Similarly, ~80% of the inmates/patients that the MHA trainers were able to follow via LACJ official administrative records were re-arrested shortly after release when their mandatory community-based services/treatment alternatives programs were completed.
The continued survival/expansion of the peer-support program requires that sufficient practitioners inside jail be actively committed to providing empathetic treatment and willing to coordinate with ancillary social services. This requires ongoing dialogue with community-based services and interlocutors committed to providing/expanding/improving long-term safe and secure community-based supportive housing.
Spatial infrastructural and personnel constraints impede the administration of care in correctional settings.
Non-professionally trained clinical partners must be continually located and trained because of jail population transiency via courtroom adjudication.
External agencies must continue oversight, evaluation and collaboration with committed correctional leadership and front-line staff inside LACJ.
The graduate student co-authored four peer review scholarly medical journal and social science publications presenting these findings to the public.

Please note: The UCLA grants disbursement infrastructure proved incapable of dispersing any of the NSF funds because of bureaucratic software dysfunction and returned 100% of the project?s NSF funds. The graduate student and supervising faculty Co-PI conducted the research and supervision (respectively) on a voluntary self-funded basis. They take this opportunity to thank the NSF peer review committee and its administrative staff for their positive reviews and research advice and for having deemed the project worthy of NSF funding.

Last Modified: 09/29/2023 Modified by: Philippe I Bourgois

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Basic Research Powers the First Medication for Postpartum Depression

May 14, 2024 • Feature Story • 75th Anniversary

At a Glance

Postpartum depression (PPD) is a common mental disorder that many women experience after giving birth.
Onset of PPD coincides with a dramatic drop in levels of a brain-derived steroid (neurosteroid) known as allopregnanolone.
Decades of research supported by NIMH illuminated the role of neurosteroids like allopregnanolone in mental illnesses.
In 2019, brexanolone—a medication that acts by mimicking allopregnanolone—became the first approved drug to treat PPD.
Able to significantly and rapidly reduce PPD symptoms, brexanolone was a major leap forward in depression treatment.

Joshua A. Gordon, M.D., Ph.D., a practicing psychiatrist at the time, would never forget the call he received one night from a distraught mother.

Mom with head in hand sitting on couch and holding crying baby, while dad sits beside them and looks on with worry..

“She was plagued with a deep, inescapable hopelessness—so depressed she was afraid she was going to hurt her month-old daughter. I helped her get to the hospital, where she spent the next 2 months in an in-patient program trying every available treatment to recover,” said Dr. Gordon, now the Director of the National Institute of Mental Health (NIMH).

Unfortunately, this experience is not uncommon among women and other postpartum people who may feel intense sadness, anxiety, and loss of interest after giving birth. These symptoms can be signs of a clinical disorder known as postpartum depression (PPD) . Unlike the "baby blues" or feelings of sadness many new mothers experience in the days after delivery, PPD is more intense and long-lasting, with damaging impacts on health and well-being.

More than the blues: Impacts of PPD on women's mental health

Depression is a common but serious mood disorder. According to the Centers for Disease Control and Prevention (CDC), rates of depression are high—and rising—among postpartum women. Using data from the 2018 Pregnancy Risk Assessment Monitoring System , the CDC found that about 1 in 8 postpartum women had symptoms of depression, while another CDC study showed rates of PPD that were seven times higher in 2015 compared to 2000.

Graph showing rising rates of depressive disorders each year from 2000 to 2015.

Depression can happen to anyone, and it's especially tough for new moms dealing with the physical challenges of childbirth and the stresses of caring for a young child. When women experience PPD, they often have strong feelings of sadness, anxiety, worthlessness, and guilt. Their sleep, eating, thoughts, and actions can all change noticeably. These mood and behavior changes can be highly distressing and even life-threatening, making it difficult for a woman to do everyday things and take care of herself or her child. In extreme cases, women with PPD may be at risk of hurting themselves or their child or attempting suicide.

Fast-acting, effective treatment for PPD can be life-changing and potentially lifesaving. However, for too long, such care was hard to reach, leaving many women to struggle with depression at a pivotal point in life. Despite some similarities, PPD is not the same as major depression at other times in life. Because of this, usual depression treatments are much less effective in managing the symptoms of PPD.

“PPD is very difficult to treat,” said Mi Hillefors, M.D., Ph.D., Deputy Director of the NIMH Division of Translational Research. “It is usually treated with medications originally approved for major depression—despite limited evidence that they are effective in treating PPD. Standard depression treatments, including antidepressants, psychotherapy, and brain stimulation therapy, can also take weeks or longer to work.”

PPD’s unique risk factors reflect the physical changes of pregnancy and the postpartum period, which include dramatic changes in levels of many hormones and other molecules.

These biological changes had long been seen as a possible source of postpartum mood disorders like depression. But could they also be a solution?

Unlocking the power of allopregnanolone through basic research

Some psychiatric medications owe their discovery to chance. Not so with brexanolone, the first-ever medication to specifically treat PPD. Brexanolone culminated a long series of research studies, much of it funded by NIMH as part of its commitment to understand and support women’s mental health .

Thanks to NIMH-supported basic research, brexanolone was developed by design—a design centered around a molecule called allopregnanolone .

Allopregnanolone is a steroid naturally produced in the brain and with important actions there, such as regulating neurotransmitter activity and protecting neurons from damage. Its impact extends to mental health, with higher levels linked to better mood, lower anxiety, and reduced depression .

Chemical formula of allopregnanolone (C21 H34 O2) and visualization of allopregnanolone molecule.

Allopregnanolone is also important to pregnancy , during which its levels are extremely high. This happens because of the enhanced production of a hormone called progesterone, which prepares the body for pregnancy and childbirth.

In the last few months of pregnancy, the ovaries and placenta make more progesterone, causing a huge rise in allopregnanolone levels. These levels then drop rapidly after birth. Because allopregnanolone plays a crucial role in mood, these ups and downs can impact a woman’s mental health during and after pregnancy.

Researchers had been aware of brain-derived steroids like allopregnanolone as far back as the 1940s. But the journey to a new PPD treatment began within NIMH's Intramural Research Program (IRP) . At the helm was the NIMH Scientific Director at that time, Steven Paul, M.D., who collaborated with researchers in the NIMH Clinical Neuroscience Branch and at other NIH institutes, including the National Institute of Neurological Disorders and Stroke (NINDS). The researchers sought to understand how the steroids work, change over time, respond to stress, and ultimately relate to health and disease.

Early discoveries came in the 1980s. Paul, working with Maria Majewska, Ph.D., Jacqueline Crawley, Ph.D., A. Leslie Morrow, Ph.D., and other researchers showed that hormones such as progesterone and molecules derived from them have calming and anxiety-reducing effects . Extensive research by Paul’s lab showed that these anxiolytic effects come from enhancing the activity of GABA by binding to specific sites on its receptor. As the main inhibitory neurotransmitter (chemical messenger), GABA reduces the activity of neurons, making them less likely to fire. When molecules bind to its receptor, GABA becomes more potent at inhibiting electrical activity in the brain, with calming effects on behavior.

Paul and IRP colleague Robert Purdy, Ph.D., used the term “ neuroactive steroids ,” or neurosteroids, to describe these molecules able to bind to receptors in the brain to rapidly alter neuronal excitability. Their work in animals confirmed that allopregnanolone is synthesized in the brain . They also showed the effects of allopregnanolone on GABA receptors in humans. Moreover, they found that allopregnanolone affects the response to stress , with acute stress leading the neurosteroid to increase to levels that alter GABA activity. These findings suggested that neurosteroids play an important role in helping animals “reset” and adaptively respond to stressful life events.

Together, this IRP-conducted research established the importance of neurosteroids via their presence in the brain, ability to reduce neuronal activity, and release during stress. Although much of this work was conducted in animals, it would spotlight neurosteroids—and allopregnanolone in particular—as promising targets for treating mental disorders, eventually opening the door to their therapeutic use in humans.

Bridging the gap to advance clinical intervention

While NIMH intramural researchers were making remarkable strides, researchers at other institutions were also conducting work bolstered by funding from NIMH. Among them were Alessandro Guidotti, M.D., at the University of Illinois at Chicago; Istvan Mody, Ph.D., at the University of California, Los Angeles; and Charles Zorumski, M.D., at Washington University in St. Louis. Their NIMH-funded research propelled understanding of inhibitory neurosteroids and their importance in reducing the adverse effects of stress. This work would be the impetus for homing in on allopregnanolone as a treatment for PPD.

Guidotti and colleagues conducted several NIMH-funded studies. Their research in rodents confirmed that allopregnanolone is produced in the brain and helps regulate neuronal excitability by acting on GABA receptors. They also built on the knowledge that neurosteroids are affected by stress. However, unlike acute stress, a stressor lasting multiple weeks led to a decrease in allopregnanolone in brain areas involved in anxiety- and depression-like behaviors.

Importantly, their NIMH-funded work offered some of the earliest evidence that allopregnanolone contributes to depression by showing significantly lower levels in people with depression compared to people without the disorder, a rise in levels (but not that of other neurosteroids) after treatment with antidepressant medication , and a link between increased levels and reduced depression symptoms .

NIMH and NINDS funded multiple studies by Mody and colleagues on interactions of neurosteroids, stress, and GABA receptors. This research was integral to understanding a mechanism in the brains of mice that might explain why some people become depressed after childbirth. Their NIMH-supported research showed changes in GABA receptors in the brain, where neurosteroids are active, that impaired the body’s ability to adapt to hormonal fluctuations. Animals with an irregular GABA receptor component lacking sensitivity to neurosteroids showed depression-like behaviors and reduced maternal care; treating them with a drug that restored the receptor’s function reversed those changes.

Another study by Mody and colleagues revealed changes in GABA expression during pregnancy that led to greater neuronal activity in the brain—but could be brought down by allopregnanolone. This finding opened the door to future studies exploring whether a postpartum drop in the neurosteroid contributed to the risk for mood disorders after birth.

Zorumski led a team in extensively studying neurosteroids as well. Among their seminal findings was identifying the mechanisms by which inhibitory neurosteroids like allopregnanolone affect GABA receptor activity . Their NIMH-funded work dramatically augmented knowledge of how neurosteroids alter GABA receptors to contribute to the risk for mental disorders like PPD.

“The accumulated evidence from these studies established the necessary bridges to justify examining a potential therapeutic role for allopregnanolone in women with PPD,” said Peter Schmidt, M.D., Chief of the NIMH Behavioral Endocrinology Branch.

By the 2010s, researchers had a much better understanding of how allopregnanolone is linked to PPD. Studies showed decreased allopregnanolone in pregnant and postpartum women with symptoms of depression and higher allopregnanolone associated with a lower risk of PPD . The possibility that PPD might be caused by the downregulation of GABA receptors in response to low levels of allopregnanolone after birth inspired researchers to put that theory to the test in clinical studies with human participants.

Taking allopregnanolone from bench to bedside

Extensive research, supported by NIMH and other NIH institutes, found that neurosteroids play a key role in how people deal with stress. They also contribute to the development of mood disorders like anxiety and depression. For allopregnanolone, evidence that it sharply decreases after pregnancy and regulates GABA activity gave rise to the notion that it contributes to PPD—and inspired hope it could be used to treat the disorder.

The biopharmaceutical company Sage Therapeutics utilized this basic research to develop brexanolone. Administered intravenously by a health care professional in a doctor’s office or clinic, brexanolone mimics the effects of allopregnanolone, increasing the inhibitory actions of GABA receptors.

Stephen Kanes, M.D., Ph.D., at Sage Therapeutics and Samantha Meltzer-Brody, M.D., MPH, at the University of North Carolina led several randomized clinical trials to measure the effectiveness of the medication in treating PPD and evaluate its safety and tolerability. The studies, which recruited adult women with PPD from hospitals, research centers, and psychiatric clinics across the United States, measured the effects of brexanolone compared to a placebo over 4 weeks.

The trials were a success. Brexanolone significantly and meaningfully reduced PPD symptoms , and it had only mild side effects. Compared to usual depression treatments, brexanolone brought about a faster response and greater improvement . Whereas most antidepressants take weeks to work, brexanolone improved symptoms and functioning in women with PPD within a few hours to days. And the effects lasted up to a month after the treatment stopped. Not only was brexanolone more effective, but it also worked faster than other depression medications.

Bar graph showing the percentage of patients with remission of symptoms in the placebo and brexanolone groups at each hour from baseline to day 30.

“The dramatic impact of basic research on real-world health outcomes has been inspiring. The fact that NIMH-supported studies contributed to successful drug development in a matter of decades is a remarkable feat and a powerful demonstration of the potential of this foundational research,” said Dr. Gordon.

Based on this promising evidence, the U.S. Food and Drug Administration (FDA) gave brexanolone priority review and breakthrough therapy designation in September 2016. Then, in March 2019, the FDA approved brexanolone , making it the first drug to treat PPD.

Brightening the future for women with PPD

For women with PPD, brexanolone was a long-awaited reason to celebrate. For NIMH, it was a testament to discoveries made through the decades of research it supported. Although some barriers to treatment persisted, women now had greater hope for treating depression symptoms after pregnancy.

“The approval of brexanolone was an important milestone. Finally, an effective, fast-acting medication specifically to treat PPD,” said Dr. Hillefors. “It was also a victory for psychiatric neuroscience because basic and translational research—by design, not chance—led to a truly novel and effective treatment for a psychiatric disorder.”

Without NIMH-supported studies providing the foundational knowledge of neurosteroids, researchers may have never made the connection between allopregnanolone and treating PPD. “That’s why the approval of brexanolone is such a cause for celebration for mental health research: It represents a true bench-to-bedside success,” said Dr. Gordon.

The success of brexanolone has continued to open the door to exciting advancements in mental health care. For instance, researchers and clinicians are investigating ways to make brexanolone work better for all postpartum people. Researchers are also testing how neurosteroids can be used to treat other forms of depression and other mental health conditions.

Just the beginning of treatment advances for PPD

Brexanolone is only the start of what will hopefully be a new future for PPD treatment. In August 2023, the FDA approved zuranolone as the first oral medication for PPD. Zuranolone acts via similar biological mechanisms as brexanolone. Its approval reflects the next step in NIMH-supported basic research being translated into clinical practice with real-world benefits.

The success of the drug, which is taken in pill form, was shown in two randomized multicenter clinical trials . Women with severe PPD who received zuranolone showed statistically significant and clinically meaningful improvements in depression symptoms compared to women who received a placebo. These effects were rapid, sustained through 45 days, and seen across a range of clinical measures. The benefits were mirrored in patients’ self-assessment of their depression symptoms.

According to Dr. Schmidt, “The approval of zuranolone to treat PPD provides women with a rapid and effective treatment that avoids some of the limitations of the original intravenous medication.”

And the journey is far from over. Researchers, clinicians, and industry are continuing to innovate new treatments for PPD to increase access and availability to ensure all people can receive help for their postpartum symptoms.

“While I will never forget that phone call from my patient, the development of these effective medications brings us hope for helping people with PPD and for the overall impact of basic research to truly make a difference in people’s lives,” concluded Dr. Gordon.

Publications

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Perinatal Depression (NIMH brochure)
Depression in Women: 4 Things You Should Know (NIMH health topic page)
Depression (NIMH health topic page)
Major Depression (NIMH statistics page)
Women and Mental Health (NIMH health topic page)
A Bench-to-Bedside Story: The Development of a Treatment for Postpartum Depression (NIMH Director’s Message)
Bench-to-Bedside: NIMH Research Leading to Brexanolone, First-Ever Drug Specifically for Postpartum Depression (NIIMH press release)
Population Study Finds Depression Is Different Before, During, and After Pregnancy (NIMH research highlight)
FDA Approves First Treatment for Post-Partum Depression (FDA news release)
FDA Approves First Oral Treatment for Postpartum Depression (FDA news release)

Environmental Pollution in the Moscow Region According to Long-term Roshydromet Monitoring Data

Published: 02 November 2020
Volume 45 , pages 523–532, ( 2020 )

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G. M. Chernogaeva 1 , 2 ,
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Yu. A. Malevanov 1 ,
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G. V. Pleshakova 3 &
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Long-term Roshydromet monitoring data (2009–2018) on the pollution of the atmosphere, soil, and surface water are considered for the Moscow region (Moscow city within its new boundaries and the Moscow oblast). The air quality in the megacity (Moscow) and in background conditions (Prioksko-Terrasny Reserve) is compared.

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Chernogaeva, G.M., Zhuravleva, L.R., Malevanov, Y.A. et al. Environmental Pollution in the Moscow Region According to Long-term Roshydromet Monitoring Data . Russ. Meteorol. Hydrol. 45 , 523–532 (2020). https://doi.org/10.3103/S1068373920080014

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'Surprisingly' high number of adults in the U.S. at risk of heart syndrome

Nearly 90% of adults over age 20 in the United States are at risk of developing heart disease , an alarming new study suggests.

While the unexpectedly high number doesn't mean that the majority of adults in the U.S. have full-blown heart disease, it does indicate that many are at risk of developing the condition, even younger people.

Researchers identified people at high risk using a recently defined syndrome that takes into account the strong links between heart disease, obesity, diabetes and kidney disease, according to the research published Wednesday in JAMA.

The American Heart Association alerted doctors in October about cardiovascular-kidney-metabolic (CKM) syndrome , a condition which affects major organs in the body, including the brain, heart, liver and kidneys. CKM is diagnosed in stages ranging from zero — no risk factors for heart disease — to 4 — people with diagnosed heart disease plus excess body fat, metabolic risk factors such as hypertension and diabetes, or kidney disease.

For the new study, researchers analyzed almost a decade’s worth of data from more than 10,000 people who were participating in the National Health and Nutrition Examination Survey (NHANES).

“We absolutely were surprised that almost 90% of people met the criteria,” said study co-author Dr. Rahul Aggarwal, a cardiology fellow at Brigham and Women’s Hospital, Harvard Medical School, in Boston. “It was much higher than we anticipated in a database that included younger adults.”

Especially concerning was the finding that almost 50% of the NHANES participants were at stage 2 of CKM, meaning that they were at moderate risk because they had either high blood sugar, hypertension, high cholesterol or chronic kidney disease, Aggarwal said.

Just more than a quarter of the group — people listed as stage 1 — were at increased risk of developing heart disease because of being obese or overweight, having excess belly fat and fat around their organs, but didn't have specific symptoms.

The researchers found that 15% of the participants had advanced disease, a number that remained fairly constant between 2011 and 2020.

“I think one of the biggest factors contributing to the fact that the percentage of people in advanced stages is not improving is obesity, which is very prevalent in the U.S.,” Aggarwal said, adding that 40% of people in America are obese. Another 32% are overweight based on body mass index calculations , according to the Centers for Disease Control and Prevention.

Carrying excess pounds increases the likelihood a person will have high blood pressure, high blood sugar and high cholesterol, although some have metabolic risk factors even if they are at a healthy weight.

Participants older than 65 were more likely to be at an advanced stage than people between 45 to 64. But being young wasn’t as protective as one might assume. Only 18% of people ages 20 through 44 were at stage zero. That is, they had no risk factors.

The new findings show that health care providers need to be picking up on these conditions earlier “before they lead to downstream effects,” such as increased risk of heart attack, heart failure and stroke, Aggarwal said. “We need to diagnose earlier and be more aggressive at treating people.”

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Adopting lifestyle changes, such as improved diets and increased activity, can help protect against heart attack and stroke.The findings also show that “young adults, those younger than 45, are not as healthy as we thought they were,” Aggarwal said.

Experts were also surprised by the high rates of CKM.

“It is alarming that 90% of the population is at least stage 1 and only 10% have no risk factors,” said Dr. Sripal Bangalore, a professor of medicine and director of invasive and interventional cardiology at NYU Langone Health in New York City.

He blames the epidemic of overweight and obesity for those numbers.

“We have a lot of work to do to reduce the rates of overweight and obesity,” Bangalore said. “If we can do that, then hopefully we can reduce the number of people who progress to stage 2 and also move the needle down for higher stages.”

The inclusion of kidney disease in the risk assessments for cardiovascular disease makes a lot of sense, said Dr. Adriana Hung, a kidney specialist and epidemiologist and a professor of medicine at the Vanderbilt University Medical Center in Nashville, Tennessee.

“Kidney disease magnifies cardiovascular disease,” she said. “Some studies show that a patient has as much as six times the risk of dying from cardiovascular disease if kidney disease is also present.”

The new, broader approach to heart disease is likely to help identify more people who are at risk, said Dr. Robert Rosenson, director of lipids and metabolism for the Mount Sinai Health System in New York City.

“The main message from this study should be that many common behaviors are leading to an accumulation of diseases over one’s lifetime, which will impact quality of life and survival,” he said.

The large numbers of people with CKM in this study are related to overweight and obesity, insulin resistance and a diet that is high in fat and salt, Rosenson added.

People need to realize that it’s not just the heart that is being harmed by unhealthy diets and lack of exercise, he said, but that lifestyle factors also have an effect on cognition.

Linda Carroll is a regular health contributor to NBC News. She is coauthor of "The Concussion Crisis: Anatomy of a Silent Epidemic" and "Out of the Clouds: The Unlikely Horseman and the Unwanted Colt Who Conquered the Sport of Kings."

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Why writing by hand beats typing for thinking and learning

Jonathan Lambert

A close-up of a woman's hand writing in a notebook.

If you're like many digitally savvy Americans, it has likely been a while since you've spent much time writing by hand.

The laborious process of tracing out our thoughts, letter by letter, on the page is becoming a relic of the past in our screen-dominated world, where text messages and thumb-typed grocery lists have replaced handwritten letters and sticky notes. Electronic keyboards offer obvious efficiency benefits that have undoubtedly boosted our productivity — imagine having to write all your emails longhand.

To keep up, many schools are introducing computers as early as preschool, meaning some kids may learn the basics of typing before writing by hand.

But giving up this slower, more tactile way of expressing ourselves may come at a significant cost, according to a growing body of research that's uncovering the surprising cognitive benefits of taking pen to paper, or even stylus to iPad — for both children and adults.

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In kids, studies show that tracing out ABCs, as opposed to typing them, leads to better and longer-lasting recognition and understanding of letters. Writing by hand also improves memory and recall of words, laying down the foundations of literacy and learning. In adults, taking notes by hand during a lecture, instead of typing, can lead to better conceptual understanding of material.

"There's actually some very important things going on during the embodied experience of writing by hand," says Ramesh Balasubramaniam , a neuroscientist at the University of California, Merced. "It has important cognitive benefits."

While those benefits have long been recognized by some (for instance, many authors, including Jennifer Egan and Neil Gaiman , draft their stories by hand to stoke creativity), scientists have only recently started investigating why writing by hand has these effects.

A slew of recent brain imaging research suggests handwriting's power stems from the relative complexity of the process and how it forces different brain systems to work together to reproduce the shapes of letters in our heads onto the page.

Your brain on handwriting

Both handwriting and typing involve moving our hands and fingers to create words on a page. But handwriting, it turns out, requires a lot more fine-tuned coordination between the motor and visual systems. This seems to more deeply engage the brain in ways that support learning.

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"Handwriting is probably among the most complex motor skills that the brain is capable of," says Marieke Longcamp , a cognitive neuroscientist at Aix-Marseille Université.

Gripping a pen nimbly enough to write is a complicated task, as it requires your brain to continuously monitor the pressure that each finger exerts on the pen. Then, your motor system has to delicately modify that pressure to re-create each letter of the words in your head on the page.

"Your fingers have to each do something different to produce a recognizable letter," says Sophia Vinci-Booher , an educational neuroscientist at Vanderbilt University. Adding to the complexity, your visual system must continuously process that letter as it's formed. With each stroke, your brain compares the unfolding script with mental models of the letters and words, making adjustments to fingers in real time to create the letters' shapes, says Vinci-Booher.

That's not true for typing.

To type "tap" your fingers don't have to trace out the form of the letters — they just make three relatively simple and uniform movements. In comparison, it takes a lot more brainpower, as well as cross-talk between brain areas, to write than type.

Recent brain imaging studies bolster this idea. A study published in January found that when students write by hand, brain areas involved in motor and visual information processing " sync up " with areas crucial to memory formation, firing at frequencies associated with learning.

"We don't see that [synchronized activity] in typewriting at all," says Audrey van der Meer , a psychologist and study co-author at the Norwegian University of Science and Technology. She suggests that writing by hand is a neurobiologically richer process and that this richness may confer some cognitive benefits.

Other experts agree. "There seems to be something fundamental about engaging your body to produce these shapes," says Robert Wiley , a cognitive psychologist at the University of North Carolina, Greensboro. "It lets you make associations between your body and what you're seeing and hearing," he says, which might give the mind more footholds for accessing a given concept or idea.

Those extra footholds are especially important for learning in kids, but they may give adults a leg up too. Wiley and others worry that ditching handwriting for typing could have serious consequences for how we all learn and think.

What might be lost as handwriting wanes

The clearest consequence of screens and keyboards replacing pen and paper might be on kids' ability to learn the building blocks of literacy — letters.

"Letter recognition in early childhood is actually one of the best predictors of later reading and math attainment," says Vinci-Booher. Her work suggests the process of learning to write letters by hand is crucial for learning to read them.

"When kids write letters, they're just messy," she says. As kids practice writing "A," each iteration is different, and that variability helps solidify their conceptual understanding of the letter.

Research suggests kids learn to recognize letters better when seeing variable handwritten examples, compared with uniform typed examples.

This helps develop areas of the brain used during reading in older children and adults, Vinci-Booher found.

"This could be one of the ways that early experiences actually translate to long-term life outcomes," she says. "These visually demanding, fine motor actions bake in neural communication patterns that are really important for learning later on."

Ditching handwriting instruction could mean that those skills don't get developed as well, which could impair kids' ability to learn down the road.

"If young children are not receiving any handwriting training, which is very good brain stimulation, then their brains simply won't reach their full potential," says van der Meer. "It's scary to think of the potential consequences."

Many states are trying to avoid these risks by mandating cursive instruction. This year, California started requiring elementary school students to learn cursive , and similar bills are moving through state legislatures in several states, including Indiana, Kentucky, South Carolina and Wisconsin. (So far, evidence suggests that it's the writing by hand that matters, not whether it's print or cursive.)

Slowing down and processing information

For adults, one of the main benefits of writing by hand is that it simply forces us to slow down.

During a meeting or lecture, it's possible to type what you're hearing verbatim. But often, "you're not actually processing that information — you're just typing in the blind," says van der Meer. "If you take notes by hand, you can't write everything down," she says.

The relative slowness of the medium forces you to process the information, writing key words or phrases and using drawing or arrows to work through ideas, she says. "You make the information your own," she says, which helps it stick in the brain.

Such connections and integration are still possible when typing, but they need to be made more intentionally. And sometimes, efficiency wins out. "When you're writing a long essay, it's obviously much more practical to use a keyboard," says van der Meer.

Still, given our long history of using our hands to mark meaning in the world, some scientists worry about the more diffuse consequences of offloading our thinking to computers.

"We're foisting a lot of our knowledge, extending our cognition, to other devices, so it's only natural that we've started using these other agents to do our writing for us," says Balasubramaniam.

It's possible that this might free up our minds to do other kinds of hard thinking, he says. Or we might be sacrificing a fundamental process that's crucial for the kinds of immersive cognitive experiences that enable us to learn and think at our full potential.

Balasubramaniam stresses, however, that we don't have to ditch digital tools to harness the power of handwriting. So far, research suggests that scribbling with a stylus on a screen activates the same brain pathways as etching ink on paper. It's the movement that counts, he says, not its final form.

Jonathan Lambert is a Washington, D.C.-based freelance journalist who covers science, health and policy.

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Cdc Grants For Public Health Research Dissertation R36
(PDF) Thesis or dissertation: Essentiality for a postgraduate Medical
Health Essay Sample
Example of a Well-Written Research Proposal: Clinical Research
(PDF) Dissertation: Mental Health Mobile Applications in Counselor

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Who can take part in health and care research
Faculty of Health Sciences 2-Minutes Dissertation Competition
Faculty of Health Sciences 2-Minutes Dissertation Competition
Health and Well-being Matter: a Discussion on the Intersections Between Art and Health
How to Write an MBA Dissertation ?
How to Choose a Dissertation Topic

COMMENTS

Public Health Theses and Dissertations
Theses/Dissertations from 2022. PDF. Outcomes of a Periodic Exposure Assessment of Workers at a University Campus, Logan M. Armagast. PDF. Evaluating the Effect of Public Health Governance Structure and Public Opinion on COVID-19 Disease Control Interventions, Daniel Chacreton.
Recent Dissertation Titles
Approaches to Measuring Non-Fatal Health Outcomes: Disability at the Iganga-Mayuge Demographic Surveillance System in Uganda. A National Burden of Disease Study for The United Arab Emirates (UAE): Quantifying Health Differentials Between Nationals and Migrants. Johns Hopkins Bloomberg School of Public Health.
100+ Healthcare Research Topics (+ Free Webinar)
Finding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you've landed on this post, chances are you're looking for a healthcare-related research topic, but aren't sure where to start. Here, we'll explore a variety of healthcare-related research ideas and topic thought-starters across a ...
Dissertations
Dissertations. The following is a complete listing of successful PHS PhD dissertations to-date, including: Field of Study. Cohort Year. Last/First Names of Doctoral Degree Recipients. Dissertation Titles. Faculty Advisor/Doctoral Committee Chairs.
PDF Understanding Mental Health Care Use and Outcomes Among Individuals
health and substance use disorders (50.6% among gender minorities versus 10.3% among non- ... Thank you to the communities upon which this research is based. This dissertation used deidentified health care claims data from over 30,000 individuals who are transgender, gender
Qualitative research methods in medical dissertations: an observational
Results. In total, 103 abstracts of medical dissertations between 1998 and 2018 (1.4% of N = 7619) were included, 60 of MD dissertations and 43 of medical sciences dissertations.Half of the abstracts (n = 51) referred to dissertations submitted since 2014.Most abstracts related to public health/hygiene (n = 27) and general practice (n = 26), followed by medical psychology (n = 19).
PDF Essays in Health Economics
Dissertation Advisor: Thomas McGuire. Monica Farid. Essays in Health Economics Abstract This dissertation consists of three chapters that relate to the following broad areas in health. economics: care provision for vulnerable populations, challenges in efficient insurance market.
PhD Program in Biological Sciences in Public Health
In addition to a compendium of the student's research, including detailed methods and results, the dissertation must contain a thoughtful discussion of the conclusions, impact, and limitations of the research. The completed work should be critically reviewed by the dissertation advisor before being submitted to the Dissertation Defense Committee.
Full article: Excellence in PhD dissertations in health professions
The dissertation studies may typically expand the field by adding to existing theory or development of new theoretical insights. Health professions education is not a basic science, so applicable products may be legitimate part of the dissertation, such as guidelines, curriculum development, instructional strategies, and methods of assessment.
Qualitative research methods in medical dissertations: an observational
Qualitative methods offer a unique contribution to health research. Academic dissertations in the medical field provide an opportunity to explore research practice. Our aim was to assess the use of qualitative methods in dissertations in the medical field. By means of a methodological observational study, an analysis of all academic medical dissertations' abstracts between 1998 and 2018 in a ...
Recent Dissertation Titles
Recent Dissertation Titles. Antibiotic Resistant E. coli in Children in Rural Tanzania: Characterizing Spatial and Temporal Patterns and Risk Factors for Resistance. The Assessment of Efficient and Sustainable Tools for Cholera Detection and Intervention in Low Resource Settings. Epidemiology, Diagnosis, and Careseeking Related to Risk Factors ...
Public Health Research Topics & Ideas (Includes Free Webinar)
If you're just starting out exploring public health and/or epidemiology-related topics for your dissertation, thesis or research project, you've come to the right place. In this post, we'll help kickstart your research by providing a hearty list of research ideas, including examples from recent studies in public health and epidemiology.. PS - This is just the start…
Health Services Research Dissertations
Health Services Research Dissertations. Theses and dissertations published by graduate students in the Program of Health Services Research, College of Health Sciences, Old Dominion University, since Fall 2016 are available in this collection. Backfiles of all dissertations (and some theses) have also been added.
AHRQ Grants for Health Services Research Dissertation Program (R36)
The AHRQ Grants for Health Services Research Dissertation Program (R36) provides dissertation grants for doctoral candidates. This program supports dissertation research that addresses AHRQ's mission and priorities and welcomes any areas of health services research as dissertation project topics. Eligibility and Requirements* Candidates must:
(PDF) A Systematic Review of Research on Dissertations in Health
The purpose of this review was to systematically assess. research on the psychology doctoral dissertation, particularly in the health service fields of clinical, counseling, and school psychology ...
The Impact of Social Media on Mental Health: a Mixed-methods Research
Electronic Theses, Projects, and Dissertations Office of Graduate Studies 6-2020 THE IMPACT OF SOCIAL MEDIA ON MENTAL HEALTH: A MIXED-METHODS RESEARCH OF SERVICE PROVIDERS' AWARENESS Sarah Nichole Koehler Bobbie Rose Parrell Follow this and additional works at: https://scholarworks.lib.csusb.edu/etd ...
Ph.D. Dissertation
UW Health Services Ph.D. students are required to write a dissertation that significantly advances the state of knowledge in their chosen field.Dissertation topics are chosen by the student in consultation with their faculty mentor or dissertation chair and must represent independent — though collaborative — design and analysis and rigorous discussion and recommendations.
Research Summary: Social Determinants of Health
What CDC is doing. CDC conducts and publishes research on the social determinants of health (SDOH). This page offers a searchable list of recent peer-reviewed articles written by CDC researchers on various SDOH topics. These are organized according to the Healthy People 2030 place-based framework:
Doctoral Dissertation Research: An Ethnographic Study of Patient
Doctoral Dissertation Research: An Ethnographic Study of Patient-Activism and an Emerging Illness ... Site created and maintained by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the NIH Library as a government created work. This website is marked Public Domain under Creative Commons.
The Intersection of Aging, Health, & Correctional Systems: An
This dissertation consists of three interconnected papers that study the intersection of correctional systems and aging in the United States, specifically in prisons and community supervision. The papers examine existing policies and the experiences of older adults using a person-centered framework. The first two papers explore data collected through semi-structured interviews with community ...
Neglecting sex and gender in research is a public-health risk
Sue Haupt is an honorary senior research fellow at Peter MacCallum Cancer Centre in Melbourne, Australia, and a research associate at The George Institute for Global Health, Women's Health ...
Cultural Relativity and Acceptance of Embryonic Stem Cell Research
Specifically, in the case of Beike, China's leading stem cell tourism company and sprouting network, ethical oversight of administrators or health bureaus at one site has "the unintended consequence of shifting questionable activities to another node in Beike's diffuse network."[77] In contrast, Jordan is aware of stem cell research's ...
Doctoral Dissertation Research: Mental Health and Recidivism ...
A remarkably therapeutic inmate-staffed peer-support program of Mental Health Assistants [MHA] who do not have mental health diagnoses managed to expand by over 300% (from a fledgling pilot program in two 16 bed pods totaling approximately 34 inmate/patients in 2019 to over 150 inmates/patients by Fall 2023).
Basic Research Powers the First Medication for Postpartum Depression
"The dramatic impact of basic research on real-world health outcomes has been inspiring. The fact that NIMH-supported studies contributed to successful drug development in a matter of decades is a remarkable feat and a powerful demonstration of the potential of this foundational research," said Dr. Gordon.
Environmental Pollution in the Moscow Region According to Long-term
The present study analyzes the chemical pollution of the atmosphere, precipitation, soil, and surface water in urbanized and background areas of the Moscow region based on long-term Roshydromet monitoring data which are provided in detail in the information materials by the Central Administration for Hydrometeorology and Environmental Monitoring (Central AHEM) and Izrael Institute of Global ...
MAPS psychedelics research for MDMA therapy comes under scrutiny ...
Lykos sponsored the clinical trials of MDMA. The results are included in the company's application to the FDA seeking approval to market the drug for therapy-assisted PTSD treatment. Researchers ...
Chicago teen earns doctorate at 17 years old from Arizona State
Dorothy Jean Tillman II spoke at her commencement this month at Arizona State University. She successfully defended her dissertation to earn a doctorate in integrated behavioral health last December.
90% of adults in the U.S. at risk of heart disease. What to know about
Nearly 90% of adults over age 20 in the United States are at risk of developing heart disease, an alarming new study suggests. While the unexpectedly high number doesn't mean that the majority of ...
As schools reconsider cursive, research homes in on handwriting's brain
As schools reconsider cursive, research homes in on handwriting's brain benefits : Shots - Health News Researchers are learning that handwriting engages the brain in ways typing can't match, ...
2024
Posted on April 18, 2024. Audrey Conn, Clinical Professor and Director of Field Education, was celebrated on April 17th as a recipient of an Academic Staff Mid-Career Award from the UW-Madison College of Letters and Science. Audrey's nomination was supported …. Posted in News, Research news.