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- All Subjects: public health
- Creators: Maienschein, Jane
Description
This thesis explores concept of "global bioethics" in both its development as well as its current state in an effort to understand exactly where it fits into the larger field of bioethics. Further, the analysis poses specific questions regarding what it may contribute to this field and related fields, and the possibility and scope associated with the continued development of global bioethics as its own discipline. To achieve this, the piece addresses questions regarding current opinions on the subject, the authorities and their associated publications related to global bioethics, and what the aims of the subject should be given its current state. "Global Bioethics" is a term that, while seen frequently in bioethics literature, is difficult to define succinctly. While many opinions are provided on the concept, little consensus exists regarding its application and possible contributions and, in some cases, even its very possibility. Applying ethical principles of health and medicine globally is undoubtedly complicated by the cultural, social, and geographical considerations associated with understanding health and medicine in different populations, leading to a dichotomy between two schools of thought in relation to global bioethics. These two sides consist of those who think that universality of bioethics is possible whereas the opposing viewpoint holds that relativism is the key to applying ethics on a global scale. Despite the aforementioned dichotomy in addressing applications of global bioethics, this analysis shows that the goals of the subject should be more focused on contributing to ethical frameworks and valuable types of thinking related to the ethics health and medicine on a global scale. This is achieved through an exploration of bioethics in general, health as a function of society and culture, the history and development of global bioethics itself, and an exploration of pertinent global health topics. While primarily descriptive in nature, this analysis critiques some of the current discussions and purported goals surrounding global bioethics, recommending that the field focus on fostering valuable discussion and framing of issues rather than the pursuit of concrete judgments on moral issues in global health and medicine.
ContributorsRuffenach, Stephen Charles (Author) / Robert, Jason S (Thesis advisor) / Maienschein, Jane (Committee member) / Hruschka, Daniel J (Committee member) / Arizona State University (Publisher)
Created2011
Description
Influenza has shown its potential to affect and even kill millions of people within an extremely short time frame, yet studies and surveys show that the general public is not well educated about the facts about influenza, including prevention and treatment. For this reason, public perception of influenza is extremely skewed, with people generally not taking the disease as seriously as they should given its severity. To investigate the inconsistencies between action and awareness of best available knowledge regarding influenza, this study conducted literature review and a survey of university students about their knowledge, perceptions, and action taken in relationship to influenza. Due to their dense living quarters, constant daily interactions, and mindset that they are "immune" to fairly common diseases like influenza, university students are a representative sample of urban populations. According to the World Health Organization (WHO), 54% of the world's population lived in cities as of 2014 (Urban population growth). Between 2015 and 2020, the global urban population is expected to grow 1.84% per year, 1.63% between 2020 and 2025, and 1.44% between 2025 and 2030 (Urban population growth). Similar projections estimate that by 2017, an overwhelming majority of the world's population, even in less developed countries, will be living in cities (Urban population growth). Results of this study suggest possible reasons for the large gap between best available knowledge and the perceptions and actions of individuals on the other hand. This may lead to better-oriented influenza education initiatives, more effective prevention and treatment plans, and generally raise excitement and awareness surrounding public health and scientific communication.
ContributorsGur-Arie, Rachel Ellen Haviva (Author) / Maienschein, Jane (Thesis director) / Laubichler, Manfred (Committee member) / Creath, Richard (Committee member) / Barrett, The Honors College (Contributor) / School of Life Sciences (Contributor)
Created2014-12
Description
Human Immunodeficiency Virus, or HIV, is a global epidemic, costing over 9.51 million individuals their lives since 2000. There are different modes of transmission of HIV, one such mode being from an HIV positive woman to her child before, during, or after delivery (SIC Curriculum, 2006). Though a global epidemic, not all countries have the same prevalence of mother to child, or MTC, transmission of HIV. In 2016, over 160,000 children under the age of five were newly infected with HIV in sub-Saharan Africa. That is compared to the United States of America, where it is estimated that fewer than 150 new infant HIV infections occur yearly (Glaser Foundation, 2020). Those differences exist despite both countries having access to preventative medication as of 1998.
Additionally, the World Health Organization, or WHO, developed three treatment plans for prevention of MTC transmission of HIV, globally available as of 2010 (WHO, 2010). The goal of the WHO was to globally standardize care of HIV-positive pregnant women and their infants in order to decrease the global prevalence of HIV. The first plan was called Option A, then came Option B, and lastly Option B+. While preventative medication has been available for over twenty years and at least one of these theoretically effective treatment plans has been implemented and is readily available in each country of sub-Saharan Africa, the overall prevalence of MTC transmission of HIV in sub-Saharan Africa has continued to be notably high compared to other countries. Thus, the aim of this thesis is to explore some of the significant obstacles to implementation of the WHO’s treatment plans in sub-Saharan Africa that contribute to that high prevalence. I also suggest possible solutions to those barriers in order to effectively decrease the prevalence of MTC transmission of HIV.
Additionally, the World Health Organization, or WHO, developed three treatment plans for prevention of MTC transmission of HIV, globally available as of 2010 (WHO, 2010). The goal of the WHO was to globally standardize care of HIV-positive pregnant women and their infants in order to decrease the global prevalence of HIV. The first plan was called Option A, then came Option B, and lastly Option B+. While preventative medication has been available for over twenty years and at least one of these theoretically effective treatment plans has been implemented and is readily available in each country of sub-Saharan Africa, the overall prevalence of MTC transmission of HIV in sub-Saharan Africa has continued to be notably high compared to other countries. Thus, the aim of this thesis is to explore some of the significant obstacles to implementation of the WHO’s treatment plans in sub-Saharan Africa that contribute to that high prevalence. I also suggest possible solutions to those barriers in order to effectively decrease the prevalence of MTC transmission of HIV.
ContributorsJones, Sierra Hope (Author) / Jacobs, Bertram (Thesis director) / Maienschein, Jane (Committee member) / School of Molecular Sciences (Contributor) / Department of Psychology (Contributor) / Barrett, The Honors College (Contributor)
Created2020-05
Description
Background: Endometriosis is a condition characterized by the growth of the endometrium, or the tissue that lines the uterus, outside of the uterus, and it is diagnosed through the presence of endometriotic lesions in the pelvic region. The disease is most often associated with abnormal and painful vaginal bleeding. Currently, minimal literature exists concerning the management of endometriosis in low and middle-income countries (LMICs), which may influence the lack of a cultural competent understanding of menstruation in LMICs and, therefore, a lack of evidence-based policies concerning menstruation.
Methods: Social and cultural barriers influencing endometriosis reporting and management in LMICs were examined through a systematic literature review. Online databases yielded a list of relevant studies. Then, use of MAXQDA, a qualitative data analysis software program, helped to extract and code specific text segments from each study that pertain to the research topic. In-context analysis of coded segments revealed the most common trends, which were organized into broader themes.
Results: Findings demonstrated that social and cultural ideas regarding vaginal bleeding influenced the lack of disease reporting and management of endometriosis in LMICs. Socioeconomic challenges include a lack of hygiene and sanitation measures and education regarding menstruation and vaginal bleeding. Also, many diseases associated with the abnormal vaginal bleeding are often disregarded and not prioritized in clinical settings. It also became clear that cultural taboos regarding menstruation and vaginal bleeding often create feelings of anxiety and fear in women and girls throughout communities in LMICs. However, further research is needed to examine the ways in which women in those communities treat symptoms of irregular vaginal bleeding related to endometriosis.
Conclusions: Socioeconomic, gender, and sex-related factors may influence the ways in which endometriosis is reported and treated and may affect the way the related diseases are understood. Evidence-based policies using a culturally competent understanding of abnormal vaginal bleeding in LMICs may help positively affect the reproductive health of women and girls in such areas.
Methods: Social and cultural barriers influencing endometriosis reporting and management in LMICs were examined through a systematic literature review. Online databases yielded a list of relevant studies. Then, use of MAXQDA, a qualitative data analysis software program, helped to extract and code specific text segments from each study that pertain to the research topic. In-context analysis of coded segments revealed the most common trends, which were organized into broader themes.
Results: Findings demonstrated that social and cultural ideas regarding vaginal bleeding influenced the lack of disease reporting and management of endometriosis in LMICs. Socioeconomic challenges include a lack of hygiene and sanitation measures and education regarding menstruation and vaginal bleeding. Also, many diseases associated with the abnormal vaginal bleeding are often disregarded and not prioritized in clinical settings. It also became clear that cultural taboos regarding menstruation and vaginal bleeding often create feelings of anxiety and fear in women and girls throughout communities in LMICs. However, further research is needed to examine the ways in which women in those communities treat symptoms of irregular vaginal bleeding related to endometriosis.
Conclusions: Socioeconomic, gender, and sex-related factors may influence the ways in which endometriosis is reported and treated and may affect the way the related diseases are understood. Evidence-based policies using a culturally competent understanding of abnormal vaginal bleeding in LMICs may help positively affect the reproductive health of women and girls in such areas.
ContributorsSantora, Emily (Author) / Maienschein, Jane (Thesis director) / Abboud, Carolina (Committee member) / Hagaman, Ashley (Committee member) / School of Human Evolution and Social Change (Contributor) / School of Social Transformation (Contributor) / Barrett, The Honors College (Contributor)
Created2019-05
Description
This dissertation critically evaluated methodologies and devices for assessing and protecting the health of human populations, with particular emphasis on groundwater remediation and the use of wastewater-based epidemiology (WBE) to inform population health. A meta-analysis and assessment of laboratory-scale treatability studies for removing chlorinated solvents from groundwater found that sediment microcosms operated as continuous-flow columns are preferable to batch bottles when seeking to emulate with high fidelity the complex conditions prevailing in the subsurface in contaminated aquifers (Chapter 2). Compared to monitoring at the field-scale, use of column microcosms also showed (i) improved chemical speciation, and (ii) qualitative predictability of field parameters (Chapter 3). Monitoring of glucocorticoid hormones in wastewater of a university campus showed (i) elevated stress levels particularly at the start of the semester, (ii) on weekdays relative to weekend days (p = 0.05) (161 ± 42 μg d-1 per person, 122 ± 54 μg d-1 per person; p ≤ 0.05), and (iii) a positive association between levels of stress hormones and nicotine (rs: 0.49) and caffeine (0.63) consumption in this student population (Chapter 4). Also, (i) alcohol consumption determined by WBE was in line with literature estimates for this young sub-population (11.3 ± 7.5 g d-1 per person vs. 10.1 ± 0.8 g d-1 per person), whereas caffeine and nicotine uses were below (114 ± 49 g d-1 per person, 178 ± 19 g d-1 per person; 627 ± 219 g d-1 per person, 927 ± 243 g d-1 per person). The introduction of a novel continuous in situ sampler to WBE brought noted benefits relative to traditional time-integrated sampling, including (i) a higher sample coverage (93% vs. 3%), (ii) an ability to captured short-term analyte pulses (e.g., heroin, fentanyl, norbuprenorphine, and methadone), and (iii) an overall higher mass capture for drugs of abuse like morphine, fentanyl, methamphetamine, amphetamine, and the opioid antagonist metabolite norbuprenorphine (p ≤ 0.01). Methods and devices developed in this work are poised to find applications in the remediation sector and in human health assessments.
ContributorsDriver, Erin Michelle (Author) / Halden, Rolf (Thesis advisor) / Conroy-Ben, Otakuye (Committee member) / Kavazanjian, Edward (Committee member) / Krajmalnik-Brown, Rosa (Committee member) / Arizona State University (Publisher)
Created2018
Description
Vaccinations are important for preventing influenza infection. Maximizing vaccination uptake rates (80-90%) is crucial in generating herd immunity and preventing infection incidence. Vaccination of healthcare professionals (HCP) against influenza is vital to infection control in healthcare settings, given their consistent exposure to high-risk patients like: those with compromised immune systems, children, and the elderly (Johnson & Talbot, 2011). Though vaccination is vital in disease prevention, influenza vaccination uptake among HCP is low overall (50% on average) (Pearson et al., 2006). Mandatory vaccination policies result in HCP influenza vaccination uptake rates substantially higher than opt-in influenza vaccination campaigns (90% vs. 60%). Therefore, influenza vaccination should be mandatory for HCP in order to best prevent influenza infection in healthcare settings. Many HCP cite individual objections to influenza vaccination rooted in personal doubts and ethical concerns, not best available scientific evidence. Nevertheless, HCP ethical responsibility to their patients and work environments to prevent and lower influenza infection incidence overrules such individual objections. Additionally, mandatory HCP influenza vaccination policies respect HCP autonomy via including medical and religious exemption clauses. While vaccination as a prevention method for influenza is logically sound, individuals’ actions are not always rooted in logic. Therefore, I analyze HCP perceptions and actions toward influenza vaccination in an effort to better explain low HCP uptake rates of the influenza vaccine and individual objections to influenza vaccination. Such analysis can aid in gaining HCP trust when implementing mandatory HCP influenza vaccination policies. In summary, mandatory HCP influenza vaccination policies are ethically justified, effective, scientifically-supported method of maximizing HCP influenza vaccine uptake and minimizing the spread of the influenza virus within healthcare settlings.
ContributorsGur-Arie, Rachel (Author) / Maienschein, Jane (Thesis advisor) / Hurlbut, Ben (Thesis advisor) / Ellison, Karin (Committee member) / Arizona State University (Publisher)
Created2016
Description
In the fifteen years between the discovery of fetal alcohol syndrome (FAS) in 1973 and the passage of alcohol beverage warning labels in 1988, FAS transformed from a medical diagnosis between practitioner and pregnant women to a broader societal risk imbued with political and cultural meaning. I examine how scientific, social, moral, and political narratives dynamically interacted to construct the risk of drinking during pregnancy and the public health response of health warning labels on alcohol. To situate such phenomena I first observe the closest regulatory precedents, the public health responses to thalidomide and cigarettes, which established a federal response to fetal risk. I then examine the history of how the US defined and responded to the social problem of alcoholism, paying particular attention to the role of women in that process. Those chapters inform my discussion of how the US reengaged with alcohol control at the federal level in the last quarter of the twentieth century. In the 1970s, FAS allowed federal agencies to carve out disciplinary authority, but robust public health measures were tempered by uncertainty surrounding issues of bureaucratic authority over labeling, and the mechanism and extent of alcohol’s impact on development. A socially conservative presidency, dramatic budgetary cuts, and increased industry funding reshaped the public health approach to alcoholism in the 1980s. The passage of labeling in 1988 required several conditions: a groundswell of other labeling initiatives that normalized the practice; the classification of other high profile, socially unacceptable alcohol-related behaviors such as drunk driving and youth drinking; and the creation of a dual public health population that faced increased medical, social, and political scrutiny, the pregnant woman and her developing fetus.
ContributorsO'Neil, Erica (Author) / Maienschein, Jane (Thesis advisor) / Hurlbut, James (Committee member) / Ellison, Karin (Committee member) / Wetmore, Jameson (Committee member) / Arizona State University (Publisher)
Created2016
Description
Intake of alcohol, tobacco, and illicit substances such as marijuana and methamphetamine during pregnancy can have significant deleterious effects on a developing fetus and the resulting infant. The existence of substance-exposed newborns also has negative impacts on society as a whole; these include financial burdens placed on taxpayers and the additional time and resources required by health care professionals, social workers, and law enforcement authorities to properly care for such infants. Existing literature show a strong correlation between prenatal care and improved birth outcomes, including abstinence from or reduction of prenatal substance abuse. The Health Start Program in the state of Arizona attempts to mitigate the incidence of substance-exposed newborns, among other goals, by employing community health workers who identify high-risk pregnant and postpartum women, inform these women about how to receive prenatal care services, educate them on appropriate prenatal and neonatal care, and provide program and referral services to both pregnant and postpartum women. Community health workers interact directly with women most at-risk for prenatal substance abuse and should be well-versed in the understanding of the complex issues related to substance-exposed newborns. In an attempt to discover, analyze, and compile those complex issues with which community health workers should be knowledgeable, this project explores existing federal regulations regarding substance-exposed newborns, compares Arizona’s regulations to Minnesota’s, Virginia’s, and Washington’s, and analyzes prevailing literature in the field about the various implications associated with screening and reporting substance-exposed newborns to law enforcement authorities. After an intensive literature review, this project concludes that the Health Start Program needs a comprehensive resource document which enumerates federal and select state policies, landmark cases involving substance-abusing pregnant women and the precedence set by each, and recommendations from medical and public health experts. The document should also provide clear guidelines by which each stakeholder should abide and why, and recommend potential best practices the state of Arizona could adopt into law based on other state policies which have proven to be effective.
ContributorsTantibanchachai, Chanapa (Author) / Maienschein, Jane (Thesis advisor) / Ellison, Karin (Thesis advisor) / Coursen, Cristi (Committee member) / Arizona State University (Publisher)
Created2015
Description
Sexual violence, as defined by the Rape, Abuse, Incest National Network (RAINN), is used as an all-encompassing term to include crimes of sexual assault, rape, and sexual abuse (RAINN, 2016). There are numerous negative impacts of sexual violence on a victim. Victims of sexual violence experience negative health impacts, such as physical injuries from the result of sexual violence and unwanted reproductive consequences, such as the risk of sexually transmitted infections or unwanted pregnancy (Shahali et. al, 2016). They also suffer from long-term psychological impacts, such as long-term emotional trauma and post-traumatic stress disorder (PTSD) (Reddington & Kriesel, 2005). The long-term consequences of sexual violence on a victim can result in loss of steady employment and engaging in high-risk behaviors, like drug and alcohol abuse, as well as suicidal thoughts and feelings of hopelessness (Mulla, 2014, NAESV, 2011). The negative impacts of sexual violence indicate the various needs of a victim of sexual violence. One method to address the needs of a victim of sexual violence is to put them in contact with resources that address the physical and psychological impacts of sexual violence by providing services and care to victims. The purpose of this thesis is to determine what kinds of resources are available in Arizona and how these resources are being used to help the needs of victims of sexual violence. Through expert interviews and information collected through public online resources, I created a visual aid, a map, that organizes and categorizes the resources that are available in Arizona. I then provide separate descriptions of a list of resources. This was to determine how this set of resources are being used to provide services and care to victims of sexual violence as a means to better understand a local approach to the issues of sexual violence.
ContributorsKim, Grace (Author) / Maienschein, Jane (Thesis advisor) / Ellison, Karin (Committee member) / Roe-Sepowitz, Dominique (Committee member) / Arizona State University (Publisher)
Created2017
Description
According to traditional Chinese medicine, the month following childbirth is an important period marked by an imbalance of two opposing forces that together make up one’s health and wellbeing. A set of specialized practices called zuoyuezi (sitting the month) aid both the woman’s recovery and restoration of the balance, and require the help of someone else, usually the woman’s mother or mother-in-law. While studies conducted on the practice’s psychosocial and physical benefits have produced varied results, zuoyuezi continues to persist in Hong Kong, China, and Taiwan. Since the late twentieth century, professional zuoyuezi centers have become very popular as a commercial health care business. While the month experiences of Taiwanese and Chinese women have been widely studied, there is little research on physicians’ opinions regarding the practice, especially in Western medical settings. Taiwanese physicians, who have been trained in the Western medical tradition, present interesting case studies as both experts in Western medicine and citizens in traditional Taiwanese society. The purpose of this project is to observe how Taiwanese physicians negotiate primarily cultural practices with their professional training, and whether there is a conflict between physicians’ beliefs about zuoyuezi and physicians’ personal experiences with the practice. Twenty-seven semi-structured interviews of Taiwanese physicians were conducted at two sites in Taiwan regarding their perspective and understanding of zuoyuezi and their personal experiences with it. Following qualitative analysis, the findings showed that physicians used their Western medical training to explain the traditional worldview that holds zuoyuezi. Secondly, physicians acknowledged the benefits of zuoyuezi and the influence of culture as two primary factors in its continued existence. Finally, physicians incorporated zuoyuezi into their personal lives while modifying the traditional practices. Overall, Taiwanese physicians did not appear to have direct conflict with the cultural practice, zuoyuezi, using their medical expertise to rationalize its existence while becoming active participants and co-creators in the practice.
ContributorsChou, Cecilia (Author) / Maienschein, Jane (Thesis advisor) / Gaughan, Monica (Committee member) / Ellison, Karin (Committee member) / Arizona State University (Publisher)
Created2017