Matching Items (5)
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Extreme hot-weather events have become life-threatening natural phenomena in many cities around the world, and the health impacts of excessive heat are expected to increase with climate change (Huang et al. 2011; Knowlton et al. 2007; Meehl and Tebaldi 2004; Patz 2005). Heat waves will likely have the worst health

Extreme hot-weather events have become life-threatening natural phenomena in many cities around the world, and the health impacts of excessive heat are expected to increase with climate change (Huang et al. 2011; Knowlton et al. 2007; Meehl and Tebaldi 2004; Patz 2005). Heat waves will likely have the worst health impacts in urban areas, where large numbers of vulnerable people reside and where local-scale urban heat island effects (UHI) retard and reduce nighttime cooling. This dissertation presents three empirical case studies that were conducted to advance our understanding of human vulnerability to heat in coupled human-natural systems. Using vulnerability theory as a framework, I analyzed how various social and environmental components of a system interact to exacerbate or mitigate heat impacts on human health, with the goal of contributing to the conceptualization of human vulnerability to heat. The studies: 1) compared the relationship between temperature and health outcomes in Chicago and Phoenix; 2) compared a map derived from a theoretical generic index of vulnerability to heat with a map derived from actual heat-related hospitalizations in Phoenix; and 3) used geospatial information on health data at two areal units to identify the hot spots for two heat health outcomes in Phoenix. The results show a 10-degree Celsius difference in the threshold temperatures at which heat-stress calls in Phoenix and Chicago are likely to increase drastically, and that Chicago is likely to be more sensitive to climate change than Phoenix. I also found that heat-vulnerability indices are sensitive to scale, measurement, and context, and that cities will need to incorporate place-based factors to increase the usefulness of vulnerability indices and mapping to decision making. Finally, I found that identification of geographical hot-spot of heat-related illness depends on the type of data used, scale of measurement, and normalization procedures. I recommend using multiple datasets and different approaches to spatial analysis to overcome this limitation and help decision makers develop effective intervention strategies.
ContributorsChuang, Wen-Ching (Author) / Gober, Patricia (Thesis advisor) / Boone, Christopher (Committee member) / Guhathakurta, Subhrajit (Committee member) / Ruddell, Darren (Committee member) / Arizona State University (Publisher)
Created2013
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Background: Heart failure is the leading cause of hospitalization in older adults and has the highest 30-day readmission rate of all diagnoses. An estimated 30 to 60 percent of older adults lose some degree of physical function in the course of an acute hospital stay. Few studies have addressed the

Background: Heart failure is the leading cause of hospitalization in older adults and has the highest 30-day readmission rate of all diagnoses. An estimated 30 to 60 percent of older adults lose some degree of physical function in the course of an acute hospital stay. Few studies have addressed the role of posture and mobility in contributing to, or improving, physical function in older hospitalized adults. No study to date that we are aware of has addressed this in the older heart failure population.

Purpose: To investigate the predictive value of mobility during a hospital stay and patterns of mobility during the month following discharge on hospital readmission and 30-day changes in functional status in older heart failure patients.

Methods: This was a prospective observational study of 21 older (ages 60+) patients admitted with a primary diagnosis of heart failure. Patients wore two inclinometric accelerometers (rib area and thigh) to record posture and an accelerometer placed at the ankle to record ambulatory activity. Patients wore all sensors continuously during hospitalization and the ankle accelerometer for 30 days after hospital discharge. Function was assessed in all patients the day after hospital discharge and again at 30 days post-discharge.

Results: Five patients (23.8%) were readmitted within the 30 day post-discharge period. None of the hospital or post-discharge mobility measures were associated with readmission after adjustment for covariates. Higher percent lying time in the hospital was associated with slower Timed Up and Go (TUG) time (b = .08, p = .01) and poorer hand grip strength (b = -13.94, p = .02) at 30 days post-discharge. Higher daily stepping activity during the 30 day post-discharge period was marginally associated with improvements in SPPB scores at 30 days (b = <.001, p = .06).

Conclusion: For older heart failure patients, increased time lying while hospitalized is associated with slower walking time and poor hand grip strength 30 days after discharge. Higher daily stepping after discharge may be associated with improvements in physical function at 30 days.
ContributorsFloegel, Theresa A (Author) / Buman, Matthew P (Thesis advisor) / Hooker, Steven (Committee member) / Dickinson, Jared (Committee member) / DerAnanian, Cheryl (Committee member) / McCarthy, Marianne (Committee member) / Arizona State University (Publisher)
Created2015
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Description

Within the pediatric hospitalization experience, fear and anxiety are two emotions commonly felt by children of all ages. Hospitalized children can greatly benefit from interventions designed to help them cope with these emotions throughout their medical experiences. This study draws on each of our clinical experiences as volunteers at Phoenix

Within the pediatric hospitalization experience, fear and anxiety are two emotions commonly felt by children of all ages. Hospitalized children can greatly benefit from interventions designed to help them cope with these emotions throughout their medical experiences. This study draws on each of our clinical experiences as volunteers at Phoenix Children’s Hospital, and uses a qualitative analysis of three semi-structured interviews with currently employed Child Life Specialists to understand and analyze the use of medical play, a form of play intervention with a medical theme or medical equipment. We explore the goals and benefits of medical play for hospitalized pediatric patients, the process of using medical play as an intervention, including the activity design process, the assessments and adjustments made throughout the child’s hospitalization, and the considerations and limitations to implementing medical play activities. Ultimately, we found that the element of fun that defines play can be channeled into medical play activities implemented by skilled Child Life Specialists, who are experts in their field, in clinical settings to promote several different and beneficial goals, including pediatric patient coping.

ContributorsGarciapena, Danae (Co-author) / Aguiar, Lara (Co-author) / Loebenberg, Abby (Thesis director) / Swanson, Jodi (Committee member) / College of Health Solutions (Contributor) / School of Mathematical and Natural Sciences (Contributor) / Barrett, The Honors College (Contributor)
Created2021-05
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Description

Within the pediatric hospitalization experience, fear and anxiety are two emotions commonly felt by children of all ages. Hospitalized children can greatly benefit from interventions designed to help them cope with these emotions throughout their medical experiences. This study draws on each of our clinical experiences as volunteers at Phoenix

Within the pediatric hospitalization experience, fear and anxiety are two emotions commonly felt by children of all ages. Hospitalized children can greatly benefit from interventions designed to help them cope with these emotions throughout their medical experiences. This study draws on each of our clinical experiences as volunteers at Phoenix Children’s Hospital, and uses a qualitative analysis of three semi-structured interviews with currently employed Child Life Specialists to understand and analyze the use of medical play, a form of play intervention with a medical theme or medical equipment. We explore the goals and benefits of medical play for hospitalized pediatric patients, the process of using medical play as an intervention, including the activity design process, the assessments and adjustments made throughout the child’s hospitalization, and the considerations and limitations to implementing medical play activities. Ultimately, we found that the element of fun that defines play can be channeled into medical play activities implemented by skilled Child Life Specialists, who are experts in their field, in clinical settings to promote several different and beneficial goals, including pediatric patient coping.

ContributorsAguiar, Lara (Co-author) / Garciapeña, Danae (Co-author) / Loebenberg, Abby (Thesis director) / Swanson, Jodi (Committee member) / School of Life Sciences (Contributor) / Sanford School of Social and Family Dynamics (Contributor) / Barrett, The Honors College (Contributor)
Created2021-05
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Description

Background: Vulnerability mapping based on vulnerability indices is a pragmatic approach for highlighting the areas in a city where people are at the greatest risk of harm from heat, but the manner in which vulnerability is conceptualized influences the results.

Objectives: We tested a generic national heat-vulnerability index, based on a

Background: Vulnerability mapping based on vulnerability indices is a pragmatic approach for highlighting the areas in a city where people are at the greatest risk of harm from heat, but the manner in which vulnerability is conceptualized influences the results.

Objectives: We tested a generic national heat-vulnerability index, based on a 10-variable indicator framework, using data on heat-related hospitalizations in Phoenix, Arizona. We also identified potential local risk factors not included in the generic indicators.

Methods: To evaluate the accuracy of the generic index in a city-specific context, we used factor scores, derived from a factor analysis using census tract–level characteristics, as independent variables, and heat hospitalizations (with census tracts categorized as zero-, moderate-, or highincidence) as dependent variables in a multinomial logistic regression model. We also compared the geographical differences between a vulnerability map derived from the generic index and one derived from actual heat-related hospitalizations at the census-tract scale.

Results: We found that the national-indicator framework correctly classified just over half (54%) of census tracts in Phoenix. Compared with all census tracts, high-vulnerability tracts that were misclassified by the index as zero-vulnerability tracts had higher average income and higher proportions of residents with a duration of residency < 5 years.

Conclusion: The generic indicators of vulnerability are useful, but they are sensitive to scale, measurement, and context. Decision makers need to consider the characteristics of their cities to determine how closely vulnerability maps based on generic indicators reflect actual risk of harm.

ContributorsChuang, Wen-Ching (Author) / Gober, Patricia (Author)
Created2015-06-01