Digital Commons Network^™

Evaluation Of Anemia In Communities Served By Shoulder To Shoulder Global: A Cross-Sectional Study In Santo Domingo, Ecuador, Kevin Mercer

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

BACKGROUND: Shoulder to Shoulder Global (STSG) recognizes anemia as a cause of morbidity among patients in Santo Domingo, Ecuador. Little research has been done to assess targetable anemia risk factors to serve as a foundation for future pharmacotherapeutic interventions. This study sought to identify risk factors for anemia in this population.

METHODS: Data obtained from existing patient records from January 1, 2010 to August 31, 2016 included hemoglobin/hematocrit, age, sex, pregnancy status, and presenting community. Chi-square tests compared means to examine risk factors associated with anemia. Poisson regression and incidence rate ratios (IRR) were used to estimate risk factors associated …

Describing Independent And Chain Pharmacies Within The Kentucky Medicaid Network, Kimber Woodrum

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The shift in healthcare towards cost-savings mechanisms is hindering business operations of pharmacies in Kentucky, especially independent pharmacies. Independent pharmacists have reported that the operations of pharmacy benefit managers within Kentucky Medicaid networks have created financial hardships for their pharmacies and there is a threat of closure that could be associated with a potential access barrier to pharmacy services for Medicaid beneficiaries. During legislative meetings, much focus was on this issue and several bills are currently being drafted to correct this issue. It is important to define independent pharmacy and describe, geographically and in terms of utilization, chain and independent …

Statistical Analysis Of Rabies Submissions In Kentucky And Weather As A Potential Predictor Of Positive Cases, Hannah Free

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background

The rabies virus is a zoonotic pathogen that is nearly 100 percent fatal once symptoms occur. Because it is still active in wildlife populations in Kentucky, the need for preventive measures and surveillance is critical. Temperature and precipitation have been shown to affect rabies. This study examined rabies submissions in Kentucky, weather and geographical distribution to both describe and predict cases.

Methods

Data from the University of Kentucky Veterinary Diagnostics laboratory were used to assess rabies submissions from 2005 through 2015. These submissions were anonymously submitted by the public and the Florescent Antibody Test was used to determine infection …

Wayne County Board Of Education Adaptation Of Love Notes Curriculum For Adolescent Pregnancy Prevention, Allison Shea Merritt

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

West Virginia has the 8^th highest rate of adolescent pregnancy in the United States and the rate in Wayne County is significantly higher. Adolescent pregnancies cause negative health outcomes for both the baby and the mother. Adolescent mothers are at an increased risk of anemia, preeclampsia, and preterm labor and babies born to adolescent mothers are more likely to have a low birth weight and to have cognitive impairment. To address this burden, the school board has decided to use the ADAPT-ITT framework on the evidence-based Love Notes adolescent pregnancy prevention curriculum to adapt it to be more culturally …

The Use Of A Video-Based Intervention To Motivate Gay And Bisexual Men On Prep To Use Condoms, Ethan Cardwell

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Based on need and available resources, gay and bisexual men who have sex with men (GBMSM) in the Castro neighborhood of San Francisco, California represent the target population for this intervention. Through funding by the Center for Disease Control the Strut Clinic in collaboration with the University of California Berkley is proposing a video-based intervention with the following SMART objectives.

Objective 1: Efficiently develop and integrate a video-based intervention in the Strut Clinic within the first six months of the funding cycle.

Objective 2: Sustain an increase of consistent condom use to 30% of participants and up to a 10% …

An Assessment Of Agreement In Detection Methods For Histophilus Somni In Bovine Lungs, Laura Michelle Arnold

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objectives: To examine the inter-laboratory agreement between multiplex realtime quantitative polymerase chain reaction (qPCR) assay results and aerobic culture results on bovine lung samples for detection of Histophilus somni (HS), and to assess associations of laboratory-derived factors on test agreement.

Methods: A survey of records from the University of Kentucky Veterinary Diagnostic Laboratory (UKVDL) was conducted to evaluate test results from grossly pneumonic bovine lung samples submitted during the period April 1, 2015 through August 31, 2018. Cohen’s kappa coefficient with 95% confidence interval (CI) was calculated to describe the extent of agreement. Animal, environmental and laboratory factors were examined …

Microclinic International Social Network Behavioral Health Intervention In Mongolia, Kalli A. Beasley

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Diabetes is a chronic communicable disease that is projected by 2030 to be the seventh leading cause of death worldwide. In Mongolia diabetes and cardiovascular disease are the number one reason for disability-adjusted life years and trends of diabetes is starting to be observed in the poorer populations. Diabetes in countries like Mongolia are extremely costly to treat using insulin, costing $200 USD per month while the average annual income sits only at $1,466.85 USD. Mongolia has a total population of 2,959,000 and half of its population resides in the capital city of Ulaanbaatar. 60% of residents in capital live …

Evaluation Of A Pharmacist Led Medication Reconciliation Process In Primary Care, Benjamin T. Gatlin

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Medication safety should be at the forefront of public health initiatives. Medication reconciliations in primary care are key to successful, accurate, and safe medication use. Pharmacists are well positioned and educated to have an impact on medication safety by conducting reconciliations in primary care centers. Guidelines for training pharmacists on how to conduct medication reconciliations would be a useful tool for any health board striving to improve medication safety. This study uses observations from pharmacists currently conducting medication reconciliations in primary care to propose such guidelines in the form of a flow sheet. The resulting flow sheet and observations are …

Prospective Policy Analysis Of The Kentucky Health Demonstration Waiver, Keahna Akins

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

In January 2018, the Centers for Medicare & Medicaid Services approved Kentucky’s Section 1115 Medicaid demonstration waiver, which gave the state approval to require work/community engagement as a condition of Medicaid eligibility, charge premiums of up to 4% household income, and add an incentive account for dental and vison services. The waiver projected nearly 100,000 fewer enrollees and $2.4 billion less in spending over the five-year demonstration period. Two days short of the waiver July 1st implementation date a federal judge ruled the waiver invalid. This finding held that the Health and Human Services Secretary’s judgement was arbitrary and capricious. …

A Program Evaluation Of A Colon Cancer Screening Program Using At-Home Fecal Immunochemical Tests With Certified Patient Navigators, Candace E. H. Brunk

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Colorectal cancer is the second leading cause of cancer-related death in this country, but 33% of these deaths could be prevented by screening. While colonoscopy is an effective screening tool, it is expensive, invasive, and prone to encounter considerable patient resistance. An alternative is to first screen those at-risk using at-home fecal immunochemical test (FIT) kits. This study determined factors associated with the return of these kits distributed by Kentucky CancerLink, a non-profit organization, and its affiliates to participants in a colon cancer prevention program.

Objectives: To identify factors associated with: completing a FIT kit, completing the kit with minimal …

Identifying Veterans With Opioid Use Disorder That Could Benefit From Referral For Evidence-Based Medication-Assisted Treatment, Emily Hampton

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Current treatment guideline recommendations published by the American Society of Addiction Medicine for Opioid Use Disorder (OUD) include both psychotherapy and Medication- Assisted Treatment for optimal management of this chronic medical illness. Military veterans are at an increased risk for fatal outcomes related to opioid overdoses due to a higher prevalence of depression/Post-Traumatic Stress Disorder (PTSD) and self-medicated substance use compared to their civilian counterparts. Additionally, many have been diagnosed with OUD but are not being treated in accordance with current treatment recommendations.

In an effort to increase access to treatment and combat the opioid epidemic, the Lexington VA Medical …

The Financial Impact Of A Healthy Eating Intervention In A Government Worksite Cafeteria, Andrew M. Wheeler

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Unhealthy eating habits are associated with a greater risk of obesity and many chronic diseases. Historically, public health nutrition interventions have focused on education of the individual to induce dietary behavior change. However, given that many factors influence food choices, more comprehensive interventions that address these multiple factors are needed. Worksite cafeterias provide a unique opportunity to intervene at multiple levels of influence on employees eating habits. In this paper we used cafeteria sales data to evaluate the changes in purchases and the financial impact of implementing a healthy eating intervention using an environmental change and various promotional efforts to …

Overdose Prevention And Naloxone Distribution In Jefferson County, Brittany Coleman

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The United States in battling an opioid epidemic, and rates of overdose fatality have soared to record highs. Kentucky is among the states with highest rates of opioid overdose fatality, and Jefferson County is responsible for about a quarter of all cases. Overdose Prevention and Naloxone Distribution (OPND) programs have been shown to decrease fatality rates by providing a medication that literally reverses opioid overdose. The programs provide other services such as education and connection to recovery facilities.

Currently, the Kentucky Harm Reduction Coalition provides naloxone kits to the residents of Jefferson County, but they do not have a regular …

“You’Re Not Alone In This”: Navigating Patients To Colorectal Cancer Screening In Appalachian Kentucky Communities, Audrey Bachman

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

In eastern Kentucky, some communities experience colorectal cancer (CRC) mortality rates as high as 25.9 deaths per 100,000 people as compared to the national rate of 14.8 deaths per 100,000 people (NCI, 2018; Kentucky Cancer Registry, 2018). Innovative screening mechanisms, coupled with patient navigation services, may be the key to increasing screening rates and preventing unnecessary deaths in the region. The current study focuses on the accounts of patient navigators (n = 9) to identify the essential ingredients for addressing barriers to CRC screening cited by Appalachian Kentucky patients. Using the core tenants of effective patient navigation programs (Freeman & …

The Impact Of Adjuvant Chemotherapy On Survival For Patients With Stage Ii Colon Cancer Portfolio, Li Ding

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

This capstone project describes the results of a consultative experience in biostatistics.

Epidemiology Of Young Adult Renal Cell Carcinoma In Kentucky: Incidence, Clinicopathologic Features, And Cancer-Specific Survival, Jason R. Bylund

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction:

Renal cell carcinoma (RCC) is an important cause of morbidity and mortality in our country. Previously reported data suggest that the overall incidence of RCC continues to rise and may be accelerating even faster among younger adult patients.

Methods:

Data for analysis included the combined NPCR-SEER USCS public use database and the Kentucky Cancer Registry dataset. Incidence rates and trends by age group and location were calculated and tested. Clinicopathologic features of disease among Kentucky cases were analyzed by age group. Cancer-specific survival (CSS) analysis was performed, along with Cox proportional hazards regression to test for association of younger …

Community Of Hope: A Comprehensive Suicide Prevention Intervention At Mit, Kyra Patel

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Suicide is the second leading cause of death for most age groups in the United States. The current rate of suicide among college students is 7.5 per 100,000 with the rate remaining fairly steady over the past 30 years. While the rate is lower on college campuses, compared to the general population ages 18-24, the issue is still much larger on a college campus due to suicide bereavement or the number of people affected and to what degree they were impacted. As of 2015, MIT (Massachusetts Institute of Technology) had the highest suicide of all reporting colleges. The primary objective …

Environmental Exposure To Atrazine And Birth Defects: An Ecological Study In Kentucky, 2005-2014, Maria Dimitrios Politis

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Atrazine is one of the most widely used pesticides in the United States. Studies have shown that pesticides, in particular herbicides such as atrazine, may be associated with birth defects. The purpose of this study is to evaluate the association between potential environmental exposures to atrazine in water systems and prevalence rates of birth defects for the state of Kentucky. An ecological study using the Kentucky Birth Defects Registry Surveillance and the Kentucky Geological Survey databases from 2005 to 2014 was conducted. Poisson regression was used to estimate crude and adjusted rate ratios of the association between agricultural exposure metrics …

Bronchiolitis In The Bluegrass: Epidemiology, Disease Burden And Resource Utilization At Kentucky Children’S Hospital, Ashwin Krishna

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Every year Kentucky Children’s Hospital (KCH) admits infants and toddlers with respiratory disease due to viral bronchiolitis. This disease is characterized by viral-induced inflammation and edema of the lower airways. The resulting disease is characterized by increasing mucus production, acute bronchospasm, necrosis of the respiratory epithelium and functional obstructive lung disease. Patients usually present with symptoms consistent with an upper respiratory tract infection, but can progress to marked respiratory distress and ultimately respiratory failure, as well as poor oral intake and dehydration. While Respiratory Syncytial Virus (RSV) is the pathogen classically described cause of viral bronchiolitis, other viruses have …

Retrospective Policy Analysis On The Efficacy Of The Army Hearing Program, Ahmad Brandelle Alexander

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The present study (1) examined the Army Hearing Program (AHP) and (2) provided a retrospective policy analysis on several of the policies embedded within the AHP, more specifically the hearing readiness policy, to determine their efficacy and impact regarding noise-induced hearing loss (NIHL). The Beaufort Longest Framework was the analytic framework for this project. It was also used to structure the writing and formatting of this report. An extensive literature review of Army Medical Department (AMEDD) journals and Public Health journals were used in addition to several published Army Regulations and Pamphlets for guidance within conducting the Methods section of …

Implementing Counseling African Americans To Control Hypertension Intervention In Louisville Metro, Raven Robbins

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Hypertension disproportionately affects Africans Americans more than their White counterparts. Counseling African Americans to Control Hypertension (CAATCH) is an intervention program that is targeted at African American adults to decrease uncontrolled hypertension. The CAATCH intervention has three components, which includes 1) computerized hypertension education, 2) at home blood pressure monitoring, and 3) behavioral counseling. The CAATCH intervention will be implemented in three sites in the northwest portion of Jefferson County in Louisville, KY. The overall goals of the CAATCH intervention are to decrease the number of participants who suffer from uncontrolled hypertension, increase knowledge of hypertension among participants, increase the …

Increasing Colorectal Cancer Screening In Kentucky’S Buffalo Trace Area Development District With A Mailed Fit Program, Carrie Anne Burt

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

This program involves a partnership among eight primary care clinics in the Buffalo Trace Area Development District (BTADD) of Kentucky and proposes implementing a mailed Fecal Immunochemical Test (FIT), or FIT Pack, program to increase colorectal cancer screening (CRCS) rates in this region. Mailing FIT tests to eligible patients is an evidence-­‐based program that has been shown to increase CRCS among patients included in studies. The program will occur at the clinic level. Clinics will mail FITs and information leaflets to patients based on patient eligibility criteria identified in clinic electronic health records. The program’s short-­‐term goals are to increase …

Commercial Driver License Examinees’ Misreport On Their Federal Motor Carrier Safety Administration Certification Evaluation, Adam Pascoe

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Commercial Driver’s License (CDL) examinees report their medical history during their Federal Motors Carriers Safety Administration (FMCSA) medical certification exams ≤2 years. When the examinees report diagnoses which may impact the control and operation of commercial motor vehicles (CMV), they face scrutiny with decreased medical certification or may be Adam PascoePascoe Page 2 7/18/2018 considered unfit to control and operate a CMV. Medical examiners may have access to the examinees’ electric medical records (EMRs) to generate a deeper appreciation, independent from the examinees’ self-report, of their risk for sudden and/or gradual incapacitation. We do not know how often diagnoses are …

Latino Worker Reported Respiratory Symptoms And Stall Bedding On Thoroughbred Horse Farms, Lacy Jinks

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective: The purpose of this study is to assess the association between self-reported respiratory symptoms in Latino workers and bedding type used in stalls on thoroughbred horse farms.

Methods: Self-reported community-based questionnaire data from 225 Latino horse farm workers in the southeastern US collected from October 2013-April 2014 were used to investigate associations between upper and lower respiratory symptom prevalence and the type of bedding used in stalls (straw, sawdust, or straw plus wood shavings or sawdust). Analysis was performed by chi-square to compare frequencies of symptoms and demographic and exposure risk factors. Logistic regression was used to adjust …

Influence Of Depression On Treatment And Survival: A Population-Based Study In Patients With Breast Cancer In Kentucky, Feitong Lei

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

This capstone project describes the results of a consultative experience in biostatistics.

Estimating The Effects Of Z-Drugs On The Risk Of Cognitive Impairment, Xuan Zhang

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Dementia and sleep disorders are two significant health problems in older adults. Studies suggest that sleep disorders and their treatment might associate with the risk of dementia. Z-drugs are one of the most widely used prescription hypnosedatives in the United States (US) for insomnia in addition to benzodiazepines (BZDs). Studies have shown that BZDs are associated with dementia among senior users. Study Aim: The purpose of this study is to evaluate the association between Z-drug initiation and cognitive impairment among the elderly in the US. Study Design and Data Source: We conducted a retrospective cohort study with a new …

Modeling The Impact Of 13rs-Hb358: Hpv Vaccination For School Entry In A High-Prevalence State, Stacy Lee Ware

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Prophylactic cancer vaccination presents novel opportunities to improve the health and well-being of populations. Since the approval of a cervical cancer vaccine against human papillomavirus (HPV) in 2006, only three states have passed legislation adding it to their school-entry schedules of required vaccinations. Despite ample evidence of its safety and efficacy, the vaccine remains controversial, and national vaccination rates among both girls and boys remain low. Risk for HPV-related cancers varies by population, and Appalachian Kentucky has among the highest HPV-related morbidity and mortality in the nation. Annual attempts to pass HPV vaccine legislation in Kentucky have so far failed …

Impact Of The School Health Innovations Grant Act On Healthcare Access, Outcomes, And Cost In The District Of Columbia, Robert West

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

This paper provided a prospective policy analysis of the Washington, D.C. School Health Innovations Grant Act. This act establishes a grant program to facilitate the formation of school-based telehealth centers to provide mental health services to District school children. The purpose of this act is to improve access to mental health services for children, especially children in disadvantaged populations, such as those low-income, predominantly African American neighborhoods in eastern Washington, D.C., where a high burden of need is compounded by a shortage of health professionals.

This analysis was guided by the Bardach framework of policy analysis. The various factors affecting …

Association Between Reproductive Factors And Breast Cancer Subtypes: A Meta-Analysis, Xihua Mao

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction: Hormone-related reproductive factors have been reported to be associated with breast cancer subtypes. However, the direction and magnitude of these associations were inconsistent. Additionally, for breast cancer defined by estrogen receptor (ER) and progesterone receptor (PR): ER+PR+, ER+PR-, ER-PR+, and ER-PR- subtypes, no meta-analysis was available for ER+PR-and ER-PR+ subtypes. For ER+PR+ and ER-PR- subtypes, only a few reproductive risk factors have been examined in meta-analyses.

Methods: Primary studies published from 2011 to 2017 were retrieved from PubMed, Embase, and Scopus. Following PRISMA guidelines, a total of 98 eligible studies investigated the association between reproductive factors and breast cancer …

Evaluation Of Barriers For Small-Scale Fruit And Vegetable Growers In Kentucky, Amanda Schroeder Hege

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The food system in the United States has witnessed significant challenges resulting in food security and safety concerns, environmental damage, economic distress, and a decline in our population’s health. While the last fifty years showed a drop in land and workforce dedicated to farming, industrialized farms are producing an overabundance of cheap corn that directly supplies inexpensive, unhealthy foods leading to American’s diets falling short of recommendations for good health, thus contributing to the obesity epidemic. This study utilizes an upstream approach to learn from farmers’ ability to grow good food that promotes healthy people, environments, and communities. Specifically, the …