Public Health Commons^™

The Effect Of Using A Meal Tracking Smartphone Application In Overweight And Obese Adolescents With Prediabetes Or Type 2 Diabetes To Improve Bmi And Hba1c, Lauren Torhorst

Evidence-Based Practice Project Reports

Obesity has become one of the most common chronic pediatric illnesses worldwide and is closely linked to the onset of prediabetes and subsequent Type 2 Diabetes (T2D); therefore, preventing and treating childhood obesity has become a high priority (Hampl et al., 2023). The purpose of this Evidence-Based Practice (EBP) project is to lower Glycosylated Hemoglobin A1c (HbA1C) and Body Mass Index (BMI) in overweight and obese youth with prediabetes and T2D using a meal tracking smartphone application. The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was utilized to pilot this project between two pediatric endocrinology offices located in Southeast Wisconsin. …

Childhood Cancer Survivorship: Navigating A New Normal In Middle Tennessee, Karli M. Beaumont

OTD Capstone Projects

Monroe Carell Jr. Children’s Hospital at Vanderbilt in partnership with Vanderbilt-Ingram Cancer Center offers REACH for Cancer Survivorship, a pediatric cancer survivorship clinic. REACH provides a full range of follow-up care designed to meet the physical, emotional, and practical needs of survivors and continuous surveillance of deleterious effects of cancer and its treatments. The purpose of this project was to meet population and agency needs through research of long- and late-term sequela while advocating for occupational therapy’s role in the oncology population through the proactive therapy and prospective surveillance models. The process of creating this project included synthesizing the literature, …

"Fueling For A Healthy Life:" A Cooking Class For Adolescent And Young Adult Childhood Cancer Survivors, Hope Dominique

Senior Theses

Following cancer treatment, childhood cancer survivors (CCS) are at an increased risk of developing chronic diseases and face an increased risk of health-related death during adulthood. Recent literature demonstrates that modifying lifestyle factors such as nutrition can reduce the risk of late mortality in survivors, suggesting that interventions promoting a healthy lifestyle may improve quality and quantity of life for CCS. However, many adolescent and young adult (AYA) CCS do not adhere to national dietary guidelines and face both real and perceived barriers to adopting healthier eating habits while in a critical period for establishing behaviors that contribute to lifelong …

Understanding Guardian Perceptions Of Whole-Foods Plant-Based Diets As Interventions In Pediatric Medicine, Vijay R. Luthra

Honors Undergraduate Theses

The obesity epidemic is widespread in American society, often affecting children who bear its consequences innocently. Due to a lack of nutrition knowledge, children rely on caregivers to meet their nutritional needs and instill healthy habits. This study examines parents' attitudes, knowledge, and behaviors, as well as perceived barriers to adopting a whole-foods plant-based diet (WFPD) for their children. Using a modified survey instrument by Morton et al., this study focused on parents and children regarding dietary choices. Participants were recruited from the waiting area of a pediatric clinic at the Medical College of Georgia between April and May 2023. …

Assessing Virtual Versus In-Person Experiential Learning And Medical High-Fidelity Simulation In Medical Student Pediatric Clerkship Training, Andrew Mitchell Berry

Electronic Theses and Dissertations

Simulation and experiential training have been incorporated into medical school training for decades. The utilization of medical simulations has become an invaluable tool in healthcare education and training. However, circumstances such as limited resources, geographical constraints, or global health crises may hinder the feasibility of conducting in-person medical simulations. In these scenarios, virtual medical simulations emerge as a compelling alternative. While there are many ways to accomplish experiential-based learning, many faculty and students feel Socratic learning styles provide the best learning experience.

As medical students had just finished a predominantly virtual preclinical year due to the COVID-19 pandemic, the research …

Comparison Of Physical Activity Levels Among School-Age Adolescents In The Rural And Urban Areas Of District Swat Kpk, Pakistan- An Analytical Cross-Sectional Study, Imran Uddin

Theses & Dissertations

Background: Obesity and overweight represent significant global public health concerns. Young adolescents are in particular increasingly experiencing obesity and overweight due to their sedentary lifestyles, excessive electronic media use, and lack of physical activity (PA). This trend is linked to the development of non-communicable diseases in later life. Moreover, data regarding the lack of PA is available in Pakistan, but a gap exists in the comparative analysis of physical activity levels between rural and urban adolescents. Rural and urban areas exhibit distinctions in both geographical settings and technological advancements, potentially influencing the PA levels of their respective inhabitants.
Purpose: The …

Enhancing Adherence To Best Practice Guidelines Related To Pressure Injury Prevention In The Operating Room At A Children's Hospital During Comprehensive Dental Procedures., Alyce Bailey Seaver

Doctor of Nursing Practice Papers

Background: 1,600,000 patients develop a hospital-acquired pressure injury every year, and 23% of these originate during surgery. Research has demonstrated that the incidence of hospital-acquired pressure injuries developing during surgery has risen over the past 5 years. This rise has been attributed to nurse circulators exhibiting poor knowledge regarding best practices for intraoperative patient positioning and intraoperative documentation that does not follow standards of care.

Purpose: This quality improvement project aimed to enhance circulator knowledge on best practices for intraoperative patient positioning and improve documentation of intraoperative patient positioning in the electronic medical record to comply with standards of …

Sociodemographic Factors And The Risk Of Paediatric Out-Of-Hospital Cardiac Arrest, Samina Idrees

Electronic Thesis and Dissertation Repository

Paediatric out-of-hospital cardiac arrest (POHCA) is associated with poor survival and severe neurological sequelae. This thesis aims to explore the relationship between sociodemographic factors and POHCA. The findings from our systematic review indicate that there are racial disparities in POHCA risk and in the provision of bystander cardiopulmonary resuscitation. There was little evidence of sociodemographic disparities in bystander defibrillation, survival and neurological outcome, particularly across adjusted analyses. The findings from our case-control study in Ontario, Canada, indicate that children living in marginalized areas have an elevated risk of experiencing POHCA. We also found that children living in northern urban or …

A Lifestyle Modification Intervention In Hispanic Adolescents With Nonalcoholic Fatty Liver Disease, Brianne Miller

Evidence-Based Practice Project Reports

U.S. population studies have confirmed that the Hispanic population has the highest prevalence and the worst prognosis for non-alcoholic fatty liver disease (NAFLD) (Katz et al., 2021). The purpose of this evidence-based practice project was to implement a multicomponent, lifestyle modification intervention in Hispanic pediatric primary care patients to combat the disease process and sequela of NAFLD. The PICOT question for this project was: In Hispanic adolescents aged 10-21 with obesity and NAFLD (P), what is the effect of a multicomponent, lifestyle modification intervention (I), on alanine aminotransferase (ALT) (O), over a 12-week time period (T)? A comprehensive literature search …

Development Of A Community-Based Plan For An Effective Behavioral Intervention To Reduce Childhood Obesity In A Rural Appalachian Community, Jennifer Stacy Wells

Theses and Dissertations--Nutrition and Food Systems

Rural children experience increased rates of obesity and reduced access to specialized weight management facilities, which makes receiving the recommended frequency of care difficult. Clinical-community partnerships, recommended by the American Academy of Pediatrics (AAP) to expand access, have been shown to be a feasible strategy of care delivery. Examination of literature and stakeholder interviews were used to inform the development of a collaborative pediatric weight management program in a rural, Appalachian community. Screening articles as well as intervention articles were reviewed. Outcomes of screening articles reviewed included BMI measures (3), screening practices (7), and referral practices (4). Common outcomes of …

Quality Improvement: Piloting A Pediatric Obesity Prevention Screening Tool And Intervention In A Family Practice Setting., Erin Shaye Semeyn

Doctor of Nursing Practice Papers

Background: In the United States today, nearly one third of children fall into the category of overweight or obese. Because it is extremely difficult to treat childhood obesity once it occurs, prevention is the optimal approach to childhood overweight and obesity (Brown & Perrin, 2018; Cooper & Mandel, 2020). An ideal time to address obesity prevention health behaviors is during pediatric primary care visits. Since the COVID-19 pandemic began in the United States in 2019, visits to primary care offices, including visits to an urban university-based family practice clinic in Kentucky, dropped as some pediatric patients and their caregivers worried …

A Two-Step Approach To Increase Breastfeeding Adherence In Mothers With Preterm Infants, Jessica J. Glinski

Evidence-Based Practice Project Reports

Breastfeeding provides multiple benefits for mothers and infants. An overwhelming amount of evidence indicates that breastmilk optimizes infant growth and develops the immune system (Yu et al., 2018). Apart from the health benefits for infants, the immediate effects of breastfeeding for mothers include a decreased risk for hemorrhage, stress, and postpartum depression (Flemming, 2021). A mother’s psychological state impacts lactation success, mainly by affecting milk ejection (Dabas et al., 2019). Despite evidence suggesting that relaxation techniques are beneficial for all human beings, it is one of the least commonly used approaches for postpartum mothers (Joseph et al., 2019). The PICOT …

Testicular Torsion Education: Improving Awareness Among Boys And Their Caregivers Regarding The Urgency Of Evaluating Scrotal Pain, Abby Taylor

Capstone Experience

Introduction: Testicular torsion is a urologic emergency that requires prompt medical evaluation and surgical intervention. The length of time from onset of the torsion to evaluation in the emergency department is often delayed due to lack of knowledge of the urgency of the situation amongst boys and their caregivers. We hypothesize that an animated educational video will increase awareness of the condition and prompt urgent evaluation in the emergency department.

Methods: A 5-minute animated educational video was created following a boy, Danny, as he develops testicular torsion. Four population groups: boys, parents, school nurses, and pediatricians, completed group-specific pre- and …

Physical Activity As A Predictor Of Obesity In Autistic Children, Cody A. Mullins

MSU Graduate Theses

Research has found autistic children to be 40% more likely to be obese compared to their non-autistic peers. Reduced physical activity (PA) is thought to be a contributing factor to the increased prevalence of obesity in autistic children. This was one of the first studies to investigate the PA behaviors of autistic children during an adapted physical education (APE) class using accelerometry. The purpose of this study was to examine the PA of autistic children and determine the relationship between PA and obesity. Participants were recruited from a school for students with disabilities who participate in a once-weekly APE class …

The Ecology Of Mental Health And The Impact Of Barriers On Mental Health Service Utilization, Alisha Aggarwal

Theses & Dissertations

Mental health has emerged as a major public health concern in recent times with several disparities and barriers related to adequate health service utilization. Different age groups experience diverse symptoms and face distinct barriers in accessing and utilizing healthcare. Policies like Mental Health Parity and Addiction Equity Act and the Patient Protection and Affordable Care Act were launched to improve insurance coverage and delivery of mental health services. However, a large gap of unmet needs exists for adequate mental health service utilization in the country. This dissertation aims to describe the financial and non-financial barriers to mental health service utilization …

Derivation And Validation Of A General Predictive Model For Long Term Risks For Mortality And Invasive Cardiovascular Interventions In Congenital Heart Disease, David A. Danford

Capstone Experience

Introduction. Accurate assessment of prognosis is a key driver of clinical decision making in congenital heart disease (CHD), but is complicated because CHD represents such a diverse collection of conditions. The aim of this investigation is to derive, validate, and calibrate multivariable predictive models for time to surgical or catheter-mediated intervention (INT) in CHD and for time to death in CHD. Methods. 4108 unique subjects were prospectively and consecutively enrolled, and randomized to derivation and validation cohorts. Total follow up was 26,578 patient-years, with 102 deaths and 868 INTs. Accelerated failure time multivariable predictive models for the outcomes, based on …

Association Of New And/Or Progressive Multiple Organ Dysfunction Syndrome With Mortality And New Morbidity Among Children Encountering Septic Shock, Rachel L. Waworuntu

Capstone Experience

Despite reductions in sepsis mortality, there remains a substantial morbidity burden among children who survive sepsis. Furthermore, the majority develop multiple organ ‘group has historically been analyzed as a single cohort. Using the Life After Pediatric Sepsis Evaluation (LAPSE) investigation database, we studied the association of new and progressive multiple organ dysfunction syndrome (NPMODS) with morbidity and mortality among children with septic shock. We hypothesized that NPMODS represents a distinct phenotype based on evolving organ dysfunction. There was evidence of an association but it did not reach the 0.05 level of significance. We also hypothesized and confirmed that children with …

Tiny Tusks Internship: Marketing Towards Breastfeeding: How Marketing Can Either Help Or Hinder How Breastfeeding Is Perceived, Hailey Tremmel

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Tiny Tusks Breastfeeding and Infant Support is a program run by faculty and students in the Eleanor Mann School of Nursing program that allows for breastfeeding mothers in attendance at the University of Arkansas sporting events to have a place to pump or provide care to their infant. How marketing towards breastfeeding is portrayed has a huge impact on helping breastfeeding mothers to feel properly educated and supported about the decision to breastfeed. The purpose of this literature review is to demonstrate how marketing tactics can affect the view of breastfeeding, whether that be positive or negative. The results found …

Overcoming Obesity: Provider Reminders And Education In Pediatrics, Michelle Warren

Evidence-Based Practice Project Reports

The prevalence of pediatric overweight and obesity is rising globally (Di Cesare et al., 2019) and results in lifelong chronic health problems and an estimated annual healthcare cost of $14.1 billion (Trasande & Chatterjee, 2009). The purpose of this evidence-based practice project was to address overweight and obesity in patients between the ages of five and 12 years through the provision of provider reminders, education, and guidelines. Primary outcomes included frequency of diagnosis, frequency of patient referrals, return to see times, and frequency of patient nutrition and activity education while secondary outcomes included patient weight, body mass index (BMI), and …

Perceptions Of Integrated Mental And Behavioral Health In Pediatric Specialty Care Settings: A Mixed-Methods Study, Desireé Nicole Williford

Graduate Theses, Dissertations, and Problem Reports

Pediatric patients are at an increased risk of experiencing mental and behavioral health concerns, which have direct associations with HRQOL, physiological health, and likelihood that youth will engage in health promoting behavior. Researchers and practitioners have increased their awareness of these concerns and identified strategies for improving the mental and behavioral health of these youth, specifically via implementing organizational efforts (i.e., task forces) and guidelines around integrating psychosocial screening and other services into routine practice. Despite this, there are several identified barriers to families receiving mental/behavioral health care in these settings. These barriers exist at all levels, including at the …

Perinatal Substance Use Screenings In Marin County: A Brief Overview Of Screening Protocols And Identifying Gaps In Care, Breanna Wiliams

Master's Projects and Capstones

Introduction

Perinatal substance use continues to be a major public health issue in women’s health. The purpose of this study was to determine the frequency of substance use screenings in care and assess how well the existing services in Marin County are serving the needs of pregnant and parenting women and identifying the gaps and/or weaknesses in current practice.

Methods

Data for this study was collected via semi-structured interviews with five professionals that worked at the local community clinic, hospital and a non-profit agency. Some questions were slightly modified to be configured toward the participant’s specific profession.

Results

Results from …

Prevention Of Pediatric Mortality Associated With Malaria: An Exhaustive Literature Review, Taylor Mosley

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Malaria, a disease that is preventable yet frequently fatal, disproportionately affects pediatric African populations at a rate that results in a child under the age of 5 dying every two minutes. Since 1955, the World Health Organization has contributed to a significant reduction in the morbidity and mortality of malaria; however, progress has stalled in recent years. In some countries, particularly those in sub-Saharan Africa, cases have increased since 2015. This literature review seeks to identify factors associated with this incline, as well as what interventions can have the greatest impact to prevent pediatric mortality in areas with the largest …

Accuracy Of Rn Visual Quantification Of Emesis Volumes In The Neonatal Intensive Care Unit, Stephen Stoever

Seton Hall University DNP Final Projects

An important component of nursing assessment of feeding tolerance in the neonatal intensive care unit (NICU) for both low-risk and high-risk babies, is the quantification of emesis volumes. While some nurses attempt to weigh the items saturated in emesis in order to quantify volume loss (QEV), there is no or limited consistency in this practice across nurses in this unit. Rather, volumes are “best-guessed” or estimated (EEV) and reported to the practitioner for decision-making. Often feed advances are paused or limited due to perceived feeding intolerance connected to emesis events in neonates.

For this project, 158 NICU nurses at a …

The Use Of Animal-Assisted Therapeutic Interventions In The Hospital Setting During The Covid-19 Pandemic, Alicia Cesare

MSU Graduate Theses

Handlers of therapy and/or facility dogs working within hospital settings have experienced various barriers and challenges within their practice during the COVID-19 pandemic. Animal-assisted interventions, specifically therapeutic working dogs, are a valued source of support to individuals, communities, hospital settings, and disaster sites during times of community distress. The purpose of this study was to identify barriers and solutions to the continued use of animal-assisted therapeutic interventions in support of patients and families within the hospital setting during the COVID-19 pandemic. This researcher’s position within the research is the knowledge and experience of being a facility dog handler within the …

Unplugging: An Evidence-Based Project To Reduce Screen Time And Improve Healthy Media Use In The Adolescent Population, Erica Persichetti

Doctor of Nursing Practice Final Manuscripts

Abstract

Background:Excessive media use is an emerging health concern amongst the pediatric population. The American Academy of Pediatrics (AAP) recommends less than 2 hours per day of recreational screen time, yet the national average is between 7 to 9 hours per day for adolescents. A media-saturated lifestyle has consequences on a child’s mental, physical, and emotional health. Despite guidelines stating media use should be assessed at annual well-visits, only 16% of providers are following this recommendation. This gap in care leaves many families with a limited understanding of the impact of media on their child's health and represents a …

Polysubstance Exposure And Its Relationship To Pharmacological Treatment Characteristics, Parker Miller

Undergraduate Honors Theses

Neonatal Abstinence Syndrome (NAS) remains an ever-growing public health issue and a continued avenue for future research. The research question for this retrospective study was whether polysubstance exposure is related to the dose of medication the infant received or to the number of opioid-medications required to treat the infants’ withdrawal symptoms? The hypothesis for the retrospective study was there will be a significant relationship between polysubstance exposure and the dose of medication the infant received as well as the number of opioid-medications required to treat the infants’ withdrawal symptoms. A bivariate correlational indicated that there was not a significant association …

You're Not Forgotten: Effects Of Screening For Postpartum Depression Within A Pediatric Setting, Marrisa S. Culver

Evidence-Based Practice Project Reports

Postpartum depression (PPD) is depression that occurs in women following childbirth occurring during the postpartum period and affects 1 in 7 women (The United States Preventive Services Task Force, 2019). The American Academy of Pediatrics [AAP] (2019), recommends that pediatric healthcare providers utilize their position to screen for PPD. The purpose of this evidence-based practice (EBP) project was to implement a PPD screening intervention within a pediatric healthcare setting using the Edinburgh Postnatal Depression Scale (EPDS). The Academic Center for Evidence-Based (ACE) Practice Star Model guided this EBP project with evidence-based interventions developed after a comprehensive literature search. Implementation of …

Identification And Management Of Adolescent Alcohol Use: Screening And Motivational Interviewing, Kelsie L. Berger

Evidence-Based Practice Project Reports

Adolescent alcohol consumption is a serious health problem in the United States. Alcohol is the most widely used substance, and it continues to be the drug of choice for adolescents (CDC, 2018). Over 7 million adolescents and approximately 30 percent of high school students in the U.S. that admit to drinking more than a few sips of alcohol in the past 30 days (NIAAA, n.d.). Underage alcohol use can lead to many complications such as social, school, and legal problems, and when initiated early in life is associated with the development of alcohol use disorder (NIAAA, n.d.). The purpose of …

Development Of Hospital-Wide Policy For Pediatric Needle Procedures At An Academic Medical Center, Katherine J. Rose

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Needle procedures are traumatic experiences for pediatric patients, and have been linked to formation of phobias and lifelong decreased healthcare utilization.^1,2 Pain management during needle procedures and hospital wide standardization of needle procedures are known to increase patient satisfaction, while decreasing long-term adverse outcomes related to seeking health care.^3,4 The purpose of this project was to develop a hospital-wide standardized policy for pediatric needle procedures at an academic medical center.

Methods: Those performing pediatric needle procedures were electronically surveyed to identify full spectrum issues regarding adoption of a pediatric needle policy. Based on survey findings …

The Impact Of The Fda Warning On Post-Tonsillectomy Opioid Prescribing In Publicly And Privately Insured Children, Dianna J. Soelberg

Theses and Dissertations

Due to reports of significant adverse events, the U.S. FDA placed a Boxed Warning on the opioid codeine in February 2013 – contraindicating its use in pediatric patients undergoing tonsillectomy and/or adenoidectomy. Studies conducted in privately insured children showed a reduction in codeine prescribing and a slight increase in alterative opioid prescribing following the FDA warning, yet the extent to which the FDA warning impacted prescribing in publicly insured children is unknown. Using a quasi-experimental interrupted time series design, this study evaluated codeine and alternative opioid prescribing before and after the FDA warning in both publicly and privately insured children …