Medicine and Health Sciences Commons^™

Translating A Pediatric Weight Management Intervention Into Medically Underserved Areas, Caitlin Golden

Theses & Dissertations

Despite substantial prevention and treatment efforts, childhood obesity remains a pressing public health concern. Disparities persist in obesity prevalence among children of lower socioeconomic status, racial and ethnic minority groups, and those residing in rural areas. The vast majority of efficacious pediatric weight management interventions (PWMIs) have been based in larger cities and urban areas delivered through inter-disciplinary teams in a hospital or medical center, and the degree to which these or other efficacious PWMIs have been translated to, and are feasible in, typical rural or micropolitan areas is unclear. This dissertation describes a dissemination strategy and a systematic approach …

Grip Characterization Of Protective Gloves, Doris Burns

Theses & Dissertations

In 2014, ASTM International (ASTM), one of the world's largest international standards developing organizations, published a new test method on glove grip performance. This method was adopted by the National Fire Protection Association (NFPA) in some of their specification standards. The method utilized hand torque instead of the pull method previously used by the NFPA to determine the Percent Bare Hand Control Value (%BHCV). The %BHCV, compares torque results of a gloved hand versus a bare hand. In developing this new test method, only four males and one female participated; therefore, it is unclear if statistical significance was attained. In …

Assessing The Methodology, Prevalence, And Associated Factors For Adverse Childhood Experiences (Aces) Among Children And Adolescents In The United States, Kiara L. Lyons

Theses & Dissertations

To comprehensively capture the risk and protective factors of ACE exposure and ACE-related outcomes, we propose to consider a social-ecological model framework. The concept of the Social-Ecological Model was originally introduced in the 1970s by psychologist Urie Bronfenbrenner and designed to theoretically capture the multifaceted influence different personal, social, and environmental factors have on health behaviors and outcomes. Additionally, this would help to determine what prevention and intervention methods would be more appropriate to implement. This conceptual framework had five system levels: microsystem (individual), mesosystem (interpersonal), exosystem (community context), macrosystem (societal and cultural influences), and chronosystem (internal and external elements …

A Systematic Literature Review Of The Prevalence, Distribution, Exposure, And Human Health Risks Of Tire Microplastics And The Contribution Of Their Physicochemically Diverse Properties, Luke Glastad

Theses & Dissertations

The history of synthetic plastics dates back to their first uses in 1907, continues with their expansion through the middle of the century with a diverse array of new polymers, and are so omnipresent today that many label this age of Earth the Plasticene Era. Tire microplastics (TMPs) have been increasingly identified as one of the environment's most bountiful types of microplastics (MPs). TMPs mainly enter the environment as tire-wear particles (TWPs) and recycled tire crumb (RTC). TWPs, in particular, have a high degree of variability, which impacts their distribution, degradation, and risk for adverse human health effects. This review …

Environmental Exposures And Human Health Challenges: Evidence-Based Insights From Health Surveillance Systems, Jagadeesh Puvvula

Theses & Dissertations

Human exposure to environmental hazards is associated with a variety of preventable adverse health outcomes. As the environmental health risks result from the complex interaction between hazard, exposure, and susceptibility, these exposure-outcome associations are heterogeneous across the population. Improving environmental health literacy by advocating evidence-based environmental risk communication could play a role in reinforcing protective behavior against environmental hazards. The use of public health surveillance systems to assess the exposure-response associations is one of the effective ways to quantify the environmental health risks. However, there are several gaps in effectively quantifying environmental health risks. This dissertation aims to address a …

Agrichemicals (Nitrate And Atrazine) In Drinking Water And Adverse Health Outcomes In Children In Nebraska, Balkissa S. Ouattara

Theses & Dissertations

Objectives: This research was conducted to (1) determine the concentrations of atrazine, and nitrate, in Nebraska watersheds and counties; (2) calculate the incidence of pediatric cancers and prevalence of birth defects in Nebraska counties and watersheds, respectively; (3) assess the relationship between the contaminant levels and the incidence rate of pediatric cancers and birth defects prevalence.

Methods: Pediatric cancers and birth defects data were obtained from the Nebraska Department of Health and Human Services. Water quality data were collected and retrieved from the Water Quality Portal and the Nebraska Groundwater Quality Clearinghouse. Geospatial and statistical analyses were conducted at the …

Evaluation Of Awareness, Knowledge, And Preventive Intervention Of Nonalcoholic Fatty Liver Disease Among Chinese Young Adults, Yi Du

Theses & Dissertations

The prevalence of nonalcoholic fatty liver disease (NAFLD) among Chinese young adults (CYA) aged 18-25 years ranges from 4.7% to 15.1% and has kept increasing in recent years. Previous studies reported limited awareness and knowledge of NALFD among middle-aged and older Chinese populations, however, they have not investigated awareness in CYA, for which there is no well-validated questionnaire. There is currently no efficacious educational intervention on NAFLD for CYA.

The objectives were 1) to develop and validate a questionnaire which can be used to assess the awareness and knowledge of NAFLD among CYA; 2) to assess the awareness and knowledge …

Investigation Of Cumulative Genetic Risk And Cc16 In Adult Asthma And Copd Populations, Kelli C. Gribben

Theses & Dissertations

INVESTIGATION OF CUMULATIVE GENETIC RISK AND CC16 IN ADULT ASTHMA AND COPD POPULATIONS

Kelli C. Gribben, Ph.D.

University of Nebraska Medical Center, 2022

Supervisors: Paraskevi A. Farazi and Tricia D. LeVan, Ph.D.

Asthma and Chronic Obstructive Pulmonary Disease (COPD) have complex etiologies and lack biological predictors that can be used for primary prevention, early detection, progression, or monitoring. Genetic risk scores (GRS) aggregate genetic effects from GWAS-identified susceptibility variants associated with a trait. GRS may provide opportunities to improve disease prediction to inform public health and clinical interventions. Asthma GRS studies utilizing multi-ethnic populations are scarce and there is a …

Contextual Factors And Sti/Hiv Sexual Risk Behaviors Among Hispanic Youths Aged 13 To 24 Years, Mariam Taiwo

Theses & Dissertations

Despite the growing population of Hispanics and several efforts to combat the high STI/HIV rates among Hispanic youths aged 13 to 24 years in the United States, this population continues to experience stark disparities in STI/HIV and is underrepresented in STI/HIV research relative to their White peers. This dissertation consists of three distinct studies designed to identify and understand the contextual factors of STI/HIV sexual risk behaviors across the social-ecological model that are pertinent to Hispanic youths.

Results from the first study showed that STI/HIV sexual risk behavior varied by Hispanic youths’ acculturation types and moderated by gender. We found …

1-Check Unmc Mobile App Usage: A Quantitative Analysis Of The Data, Molly Pofahl

Theses & Dissertations

As COVID-19 cases continued to rise in Nebraska, universities and colleges were faced with unique challenges in the effort to continue providing quality education for students. The University of Nebraska Medical Center (UNMC) took on especially difficult challenges due to its status as an academic medical center. By the Fall of 2021, students, faculty, and staff were beginning to return to campus. The 1-Check UNMC app was created to help keep sick people from coming to campus. The UNMC community was expected to screen themselves for COVID-19 using this app each day before coming to campus. This thesis is an …

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 …

Intention To Breastfeed: Breastfeeding Attitudes, Norms, Self-Efficacy, Social Support Network And Community Resources Of African American, Low-Income, Emerging Adult Women, Pregnant For The First Time, Sara E. Brown

Theses & Dissertations

African American (AA) women continue to have the lowest rates of breastfeeding. This continues to create a health disparity even though breastfeeding is extensively recognized in the scientific and health care communities as the optimal feeding choice for infants. This study examined the relationship between the external variables (social support network and community resources) and the explanatory variables (attitudes, norms, and perceived self-efficacy) and intention to breastfeed, for the AA, first time, low-income, emerging adult pregnant woman. The Integrated Behavior Model (IBM) was used as the theoretical framework to guide this study in better understanding the variables influencing breastfeeding intention. …

Giving Birth At A Critical Time: Assessing Perinatal Depression Among Syrian Refugees In Low Resource Settings, Nada Alnaji

Theses & Dissertations

Refugee mothers are at an increased risk of suffering from stress and mental health conditions during the first year after giving birth to a child. The objective of this study is to enhance the early identification of treatable mental health conditions among perinatal women living within humanitarian settings. The central hypothesis is that a culturally specific approach can be helpful for the long-term success of mental health efforts. In this study, we use qualitative interview methods to understand the cultural paradigms and predisposing factors for perinatal depression related to being a Syrian refugee in Lebanon during the COVID-19 pandemic. In …

Use Of Telehealth In Home-Based End-Of-Life Care For Children In Rural Regions, Meaghann S. Weaver

Theses & Dissertations

A national shortage in pediatric-trained providers results in certain geographies, primarily rural, where children with special needs are not able to access home-based care at their end-of-life. Advances in technology have made the use of telemedicine a potential modality for palliative care subspecialty clinicians to provide clinical care and support for adult-trained hospice teams. This dissertation utilizes four approaches to consider telehealth as an unexplored opportunity in care delivery: (1) a systematic review of telehealth measures and instruments to select the Technology Acceptance Model as a validated metric of telehealth acceptance uniquely now applied to pediatric care; (b) a pilot …

Investigation Of Environmental Lead Exposures In Children At A Midwestern City With Superfund Site, Zijian Qin

Theses & Dissertations

Childhood exposure to lead is known to cause a host of adverse health effects in children, with no safe blood lead level indicated. Environmental lead contamination is prevalent throughout the United States and remains a threat to the healthy development of children living in these areas, including children in Omaha, Nebraska. The overall objectives of this dissertation were to characterize potential sources of lead in the community – where children play and where children live through the use of environmental exposure sampling. This dissertation also provides insight into current Nebraska children's blood lead levels and identifies local populational attributes that …

Perinatal Periods Of Risk: Examination Of Data Quality & Inclusion Criteria, New Unbiased Reference Groups, And A Nationwide County-Level Analysis, Carol S. Gilbert

Theses & Dissertations

Records of births, infant deaths, and fetal deaths are compiled by the US Vital Records System and used to monitor population health and guide health policy. The Perinatal Periods of Risk Approach (PPOR) relies on vital records data to address fetal and infant mortality in US cities. It uses reference groups to estimate preventable mortality by risk period. To avoid biased analyses due to poor data quality for small and early infant and fetal deaths, an expert committee recommended that PPOR analyses exclude fetal deaths delivered at gestational age (GA) <24 >weeks, and infant deaths and live births with birthweights (BW) …

Health Service Utilization And Expenditure In Cardio-Metabolic Conditions In The United States Adults, Kavita Mosalpuria

Theses & Dissertations

Metabolic syndrome is multicomponent risk factor for cardiovascular diseases (CVD) and type 2 diabetes that reflects the clustering of at least 3 cardiometabolic risk factors, among hypertension, impaired glucose regulations, hypercholesterolemia, and obesity. CVD are the leading cause of death in the U.S. CVD occur at earlier age and is a major cause of death and disability among people with diabetes. As compared to Japan, 13.3% to 44% of the excess CVD mortality in the U.S. can be explained by the metabolic syndrome. The prevalence of metabolic syndrome was 34.3% in 2007 to 2014 and it increases with age. Metabolic …

An Explanatory Sequential Mixed Methods Nutrition And Physical Activity Intervention Study On Changes In Knowledge, Self-Efficacy, And Outcome Expectations Of Fathers, Sarah Hortman

Theses & Dissertations

Overweight and obesity rates are a continuing concern resulting in poor health outcomes and annual healthcare costs in the billions of dollars. An upstream approach of health promotion is critical to change the focus from treatment and management to prevention of chronic disease. Preventing chronic disease through evidence-based health promotion practices incorporating educational interventions aimed at dietary and physical activity behaviors will preclude negative health outcomes including cardiovascular disease, type 2 diabetes, and hypertension.

The family environment is an important consideration in the prevention of chronic disease including obesity. Parents are role models for their children, including fathers who are …

Clinical Consequences And Determinants Of False Positive Blood Cultures In Adult Hospitalized Patients, Sidra Liaquat

Theses & Dissertations

Blood cultures are the gold standard for detecting blood stream infections. However, in the US, 0.6-6% of all blood cultures get contaminated leading to adverse clinical outcomes such as unnecessarily prolonged hospital stay and antibiotic therapy. Using electronic medical records, we explored the clinical outcomes and patient-specific risk factors of contaminated blood cultures in an era where rapid blood culture testing was being utilized to provide blood culture results within hours. Rapid blood culture test results can help clinicians in early and more effective management of patients with contaminated blood cultures, thus improving clinical outcomes. We also studied the impact …

Fire Service Covid-19 Infection Prevention And Control Policy Comparison, Saaddedine Dichari

Theses & Dissertations

To date, there have been over 2.7 million deaths and more than 126 million cases attributed to the COVID-19 pandemic (JHU, 2021). This pandemic has affected nearly every aspect of daily life. Among those impacted are U.S. firefighters, as they provide many services beyond simply extinguishing structure fires and are frequently dual certified as emergency medical technicians. Many of the victims of this pandemic have relied on first responders to provide them with emergency medical care and hospital transport. When caring for these infected patients, firefighters have an increased risk of exposure and must be provided with adequate …

Neurocognitive Impairment In People Living With Human Immunodeficiency Virus (Hiv): Risk Factors And Mortality, Zaeema Naveed

Theses & Dissertations

Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) persists in people living with HIV (PLWH) with clinical and public health implications. Studies have generated inconsistent results regarding etiological factors for NCI in PLWH and a brief user-friendly predictive tool is desirable in clinical practice to assess the probability of having NCI in PLWH. Furthermore, factors associated with clinically meaningful decline in neurocognitive status and survival disadvantage for patients with NCI are understudied in the post-cART era. The goal of this dissertation was to investigate factors associated with baseline NCI and neurocognitive decline and the association …

Examination Of Access, Utilization, And Barriers To Care Among Special Populations In The United States, Jed R. Hansen

Theses & Dissertations

Utilizing healthcare services is a complex phenomenon in the United States. While system-level barriers and facilitators of care, along with individual consumer choices, are known to affect access and subsequent use of services, the interaction among the factors that lead to utilization remains unknown. Examining access and utilization of healthcare services using a consumer framework incorporating both access barriers and facilitators and consumer-level dimensions that affect choice in seeking care may inform access and utilization research. The purposes of this dissertation were 1) to explore the presence of facilitators and barriers to care in ambulatory healthcare locations for non-emergent care …

From Pipeline To Health Equity: A Case Study Of Health Profession Pipeline Students, Sonja F. Tutsch

Theses & Dissertations

Health equity arises from the social determinants of health. Access to culturally and linguistically competent health services is a major determinant of health. Despite health profession pipeline intervention efforts spanning more than 50 years, diversity in the health professions has not been achieved, and disparities in health among members of minority groups remain prevalent. Health profession pipeline programs came into existence to help grow minority representation among health professionals serving in underserved, disadvantaged, communities, where disparities in health are most prevalent. One underlying assumption was that minority students from underserved communities understand the needs of these communities best and are …

Utilization Of Nurse Practitioners In States With Full Practice Authority: Does Geography Matter?, Jana Zwilling

Theses & Dissertations

Background: Over 80 million Americans reside in or are part of a population designated as Health Professional Shortage Areas (HPSAs). Of the primary medical HPSA areas designated in the U.S., 66.74% are located in rural or partially rural areas (HRSA, 2020). To combat this shortage, 23* states and Washington, D.C. have enacted full practice authority laws for nurse practitioners (NP). Over 60% of NPs work in communities of less than 250,000.

Problem: The variability and extent of utilization of NPs in states with full practice authority (FPA) is unknown. To ensure access to quality healthcare, nurse practitioners need to be …

Identifying, Adapting, And Implementing A Weight Management Program In Rural Primary Care, Gwenndolyn Porter

Theses & Dissertations

Rural adults are at heightened risk for obesity, yet evidence‐based interventions lack consistent translation into clinical practice. This multi-phase study addresses this gap. First, a systematic review and meta-analysis of rural adult weight loss interventions were conducted to assess overall impact. Though few studies reported participant representativeness, meta‐analyses revealed a significant weight reduction among interventions. Second, 10 focus groups were conducted with primary care (PC) staff to determine the feasibility of implementing a weight-management program through PC. Differences in responses among rural, micropolitan, and metropolitan was also assessed. Thematic analyses revealed rural PC currently lacks the capacity to manage patient …

Reducing Adverse Outcomes In Hepatocellular Carcinoma Patients Undergoing Hepatectomies, Yongyue Qi

Theses & Dissertations

The incidence and mortality of liver cancers are increasing in the United States. In addition to the classic risk factors of hepatic viral infection and high alcohol consumption, non-alcoholic Fatty Liver Disease (NAFLD), has emerged as a risk factor for hepatocellular carcinoma (HCC). The most effective curative treatment for HCC is liver resection (hepatectomy), however, hepatectomy is a major operation with potential risks of mortality, hospital readmission and other adverse outcomes such as postoperative complications and longer hospital stay. The reported 90-day mortality and 30-day readmission rates following a hepatectomy vary widely across studies, most of which have limitations due …

The Escape Pod: Utilizing Escape Room Methodologies To Train Public Health Volunteers On Open Point-Of-Dispensing Operations, Melanie R. Thompson

Theses & Dissertations

Mobilizing Points-of-Dispensing (PODs) during a mass dispensing of medication event at a local health department will require a large amount of personnel, both staff and volunteers. Training the volunteers prior to this type of event is ideal to ensure that POD operations flow quickly and properly. This project aimed to create an affordable and fun training that engaged volunteers and other interested stakeholders while increasing their knowledge of POD operations. Methodologies used in commercial escape rooms were employed in this training to enhance the participants’ understanding of POD operations. Participants to worked in groups to solve puzzles and challenges in …

Exploring Paramedic Students’ Level Of Preparedness For Disaster Response In Hajj 2019, Nawaf Albaqami

Theses & Dissertations

Objectives: 1) to gain further understanding of the paramedic students' level of preparedness before their clinical training at Hajj. 2) To shed more light on what paramedic students need when responding to a disaster. 3) To determine the need to recommend a change in the current practice with respect

Method: The data collection for this study was a cross-sectional survey using the REDCap electronic data capture tools. It was a convenience sample of 40 respondents. For the analyses, descriptive statistics, including frequencies and percentages, were used, and the Mann Whitney U test.

Results: The main findings in this study were …

The Evolving Management Of Aortic Valve Disease: Trends In The Utilization And Cost Of Savr, Tavr, And Medical Therapy, Andrew Goldsweig

Theses & Dissertations

Aortic stenosis (AS) and regurgitation (AR) may be treated with surgical aortic valve replacement (SAVR), transcatheter AVR (TAVR), or medical therapy (MT). Data are lacking regarding usage and cost of SAVR, TAVR, and MT for patients hospitalized with aortic valve disease. From the Nationwide Readmissions Database, we determined utilization and cost trends for SAVR, TAVR, and MT in patients with aortic valve disease admitted 2012-2016 for valve replacement, heart failure, unstable angina, non-ST-elevation myocardial infarction, or syncope. From 2012 through 2016, there was a 48.1% increase in the number of patients hospitalized for aortic valve disease annually. Overall, 19.9%, 6.7%, …

Planning And Facilitating The Training Of Emergency Medical Services On The Safe Transport Of Patients With Highly Infectious Diseases, Mohammed Alhallaf

Theses & Dissertations

Emergency Medical Services (EMS) personnel are the first line of treatment and are the first exposed health care workers to infectious diseases (IDs). Consequently, the EMS setting is a relatively vulnerable environment for disease transmission and cross-contamination. Also, serious and emerging IDs, such as highly pathogenic viral hemorrhagic fevers and novel Coronaviruses, in a time of increased globalization, require comprehensive EMS training and preparedness. This project had the objective of identifying best practices for the EMS transport of patients with IDs. The methods for this project were done in two phases. In the first stage, we …