Medicine and Health Sciences Commons^™

A Literature Review Of Societal Obesity And Its Impact On United States Military Recruitment, Megan Thibodeaux

Capstone

In recent decades, obesity rates have increased in the United States, raising significant health and societal concerns, especially in terms of military readiness. The ever-rising rates of weight-related health obstacles present a critical national security issue as it impacts the effectiveness of recruitment. This literature review aims to analyze how obesity impacts military recruitment and readiness to serve while utilizing the socio-ecological model to help determine gaps in evidence. Data was drawn from Embase, PubMed, and PsychInfo. Inclusion criteria consisted of academic journals and reports from government and non-profit organizations written in English. They focused only on the United States …

Implementation Of A Doula-Supported Postpartum Wellness Toolkit In A Black Community-Based Maternal Wellness Program, Janice Luethje, Leslie Torres

Doctor of Nursing Practice Projects: College of Nursing

Objective: The objective of this project was to expand the areas of focus within a maternal wellness program at a Black community center and to evaluate the satisfaction levels of the doulas who utilized the material during postpartum home visits. The toolkit covers a range of postpartum topics in the areas of nutrition, exercise, sexual health, mindfulness, and social support as well as a postpartum mental health screening tool.

Design: This quality improvement project included three distinct phases: The pre-implementation phase, the implementation phase, and the post-implementation phase.

Setting: The project location was a Black community center in Lincoln, Nebraska. …

Effects Of An Educational Evidence-Based Website To Improve Breast Health Knowledge And Self-Efficacy Of Breast Self-Examination: Interim Analysis, Mackenzie Koch, Jennifer Cera, Brooke Hancock, Elizabeth Graham

Doctor of Nursing Practice Projects: College of Nursing

Purpose and Aims

Breast disease, whether benign or malignant, encompasses a wide array of diagnoses. Breast self- examination (BSE) is a simple screening assessment that improves early recognition and diagnosis. With changes in the 2021 ACOG practice guidelines from mandatory to optional provider-performed clinical breast examinations (CBE), it is imperative for patients to possess basic breast health knowledge and accurate BSE techniques. Current standard patient education is provided via brochures or pamphlets. An educational multimedia website was created using ACOG guidelines to impart knowledge and demonstrate proper BSE techniques. Aims were to evaluate changes in participant’s (1) breast health knowledge …

How To Evacuate When Disaster Strikes: A Literature Review Of Hospital Evacuations, Grant Orr

Capstone Experience

Hospitals are an essential component of any community’s infrastructure, and due to the nature of their services they are vulnerable when a disaster strikes. If a disaster is severe enough to warrant a hospital evacuation, both hospital and community leaders must decide how to proceed with the resources at their disposal. Organizations such as the World Health Organization, the United Nations, and the United States Department of Health and Human Services offer general guidance, but specifics as to how a hospital should proceed with an evacuation are left to individual hospital leaders and emergency management teams. This capstone project will …

Impact Of Medicaid Redetermination On Underserved Populations In Region 7 States: A Review, Brianna Parr

Capstone Experience

When the COVID-19 Public Health Emergency ended in May of 2023, Medicaid began the process of redetermination across the states and returned to its original eligibility rules. Because of this, the healthcare status of many Americans was affected, resulting in the loss of healthcare coverage for millions of people. Of those who have lost coverage, children make up almost half of the total. This paper assesses the negative effects of Medicaid redetermination on children and other underserved populations in communities across the four states in Region 7 (Nebraska, Iowa, Missouri, and Kansas) and identifies programs that these states can implement …

Physician Burnout In The United States: A Systematic Review Of Organizational And Systemic Approaches And Their Efficacies, 2014-2024, Nicole Butler

Capstone Experience

Physician burnout represents a critical public and clinical health concern in the United States. It compromises patient care and physician safety. Approaches to solve the issue are pervasive, with limited indication of effectiveness. Due to the essential job functions of physicians, the practice of medicine is inherently stressful. However, the introduction of new, more complex stressors, including those exacerbated by the COVID-19 pandemic, and the increase in chronic healthcare conditions have made burnout an unfortunate staple of physician life, with an estimated prevalence of up to 60%. Burnout involves three factors: emotional stress, depersonalization, and reduced job satisfaction. The consequences …

Identifying Barriers To Healthcare Access And Utilization Experienced By Lgbtq+ Adults With Chronic Diseases Through The Lens Of The Social Ecological Model, Devin Mottier

Capstone Experience

The purpose of this literature review is to comprehensively examine and synthesize existing research on present barriers to health access and utilization that contribute to the disparities in chronic disease prevalence within the adult LGBTQ+ population. In the context of this review, the social-ecological model (SEM) was used to describe the nuanced and multifaceted nature of healthcare access and utilization. This literature review was based upon the following question: ‘Using the social-ecological model, what are the barriers to health access and utilization that contribute to high rates of chronic disease in LGBTQ+ adults?’ Outcome measures of interest included the following …

Examining The Impact Of Racial And Ethnic Disparities In Colorectal Cancer Screening Compliance In The United States And The Potential Of Targeted Interventions., Jessica Ware

Capstone Experience

Objectives:

Examine Colorectal cancer (CRC) screening compliance among racial and ethnic groups in the United States (US) based on the US Preventive Services Task Force (USPSTF) recommendations.

Identify targeted interventions to promote screening compliance, early diagnosis, and CRC survivorship.

Methods: This cross-sectional study utilized 165,878 selected participant responses from the 2022 Behavioral Risk Factor Surveillance System. We modeled and investigated CRC screening compliance based on the USPSTF recommendations as inclusion criteria between racial/ethnic groups in the US while adjusting for covariates using a weighted logistic regression.

Results: With covariates adjustment, Hispanics (POR 1.16 95%CI 1.04-1.29), Asian American …

Improving Intimate Partner Violence Screening In A Women’S Health Practice Through Implementation Of An Evidence-Based Screening Tool, Jasmine Weber

Doctor of Nursing Practice Projects: College of Nursing

The purpose of this quality improvement project was to implement intimate partner violence screening in an outpatient women’s health clinic with no prior screening process in place. Current recommendations are to screen all reproductive age women for intimate partner violence 6 . During a three-month period 170 patients out of 260 eligible patients were screened using the HARK screening tool, 7 of those patients screened positive and were offered referrals to social work. While universal IPV screening was not achieved, a screening rate of 64% is a remarkable improvement from an apparent absence of screening prior to project implementation.

Substance Use Patterns Among High School Students - A Replication Study Of The 2020 Youth Risk Behavior Survey, Haley Irons

Capstone Experience

The study selected for replication is “Prescription Opioid Misuse and Use of Alcohol and Other Substances Among High School Students” by Christopher Jones and colleagues published in the Morbidity and Mortality Weekly Report Supplement in August 2020. The original report used data from the Centers for Disease Control’s 2009-2019 Youth Risk Behavior Survey (YRBS), which is a cross-sectional survey administered every two years to a sample of public- and private-school students in 9th–12th grade in the United States. Researchers from the original report aimed to use the 2009-2019 YRBS data to examine substance use among high school students, characterize the …

Exploring The Mental Health Experience Of Perinatal Military Spouses Based In Sigonella, Italy, Lyndsey Dannenberg

Capstone Experience

The perinatal period can have a profound impact on the mental health of women, their infants, and their families, especially when it comes to depression and anxiety disorders. This study aims to delve into the experiences of perinatal mental health among military spouses stationed overseas, on Naval Air Station Sigonella, Italy, and contribute to the limited research on active-duty military spouses and their perinatal mental health while stationed overseas. The research uses a qualitative phenomenological approach, seeking to provide valuable insights into the lived experiences of military spouses and their perinatal mental health. Risk factors associated with perinatal mental illness …

Associations Between Self-Reported Cognitive Decline And Chronic Diseases: A Cross-Sectional Analysis Of Behavioral Risk Factor Surveillance System (Brfss) 2022, Hailey Child

Capstone Experience

Objective: This study seeks to capture how self-reports measure cognitive decline. The association between chronic conditions and cognition with age consideration in individuals aged 45 and older is investigated.

Methods: Univariate analysis generates frequencies and weighted percentages of 2022 BRFSS data. Chi-square tests and polytomous regressions generate odds ratios for bivariate analyses. A weighted multiple logistic regression model stratified by age group analyzes self-reported cognitive decline.

Results: Respondents ages 45 to 54 with three or more chronic diseases have the highest odds (OR = 6.81; 95% CI = 4.42, 10.48) of cognitive decline. Respondents 75 and older …

Ordinal Logistic Regression Analysis Of The Frequency Of Marijuana Use Among Adult Informal Caregivers In 20 U.S. States, Behavioral Risk Factor Surveillance System (Brfss) 2021, Athena Plichta

Capstone Experience

Objectives. To examine the association between frequency of marijuana use among informal caregivers of persons with dementia (PWD) and other health conditions compared to non-caregivers in 20 U.S. states.

Methods. We used complex survey data from the optional modules Caregiver and Marijuana Use of the 2021 BRFSS survey. Univariate and bivariate analyses were performed to determine the frequency and distribution of sample population characteristics and calculate crude relationships. Ordinal logistic regression modelled the relationship between the three-level outcome and covariates.

Results. Frequency of marijuana use and caregiver status were not associated. There was no difference in increased use among individuals …

Evaluating Lack Of Access To Secondary Prevention-Based Healthcare Services Between Racial/Ethnic Groups In The United States: A Logistic Regression Analysis Using 2022 Brfss Cross-Sectional Data, Samuel Ortiz Severiano

Capstone Experience

Objective: To determine whether racial/ethnic minorities have reduced access to preventive healthcare services in the United States, with participation in routine checkups serving as the metric for access. Methods: Performing logistic regression analysis comparing the length of time since the last routine checkup between different racial/ethnic groups in the study population. Those who haven’t had a routine checkup in at least 12 months served as the comparison group. Results: Black populations were 66% less likely to not have access to preventive care compared to White populations, while Asian, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander populations were 8.5% more likely …

Examining The Relationship Between Adverse Childhood Experiences And Covid-19 Vaccine Status Using 2022 Brfss Data: A Cross-Sectional Study, Cristhian A. Chau-Valdivia

Capstone Experience

Abstract:

Objective.To determine the association between adverse childhood experiences (ACEs) scores with COVID-19 vaccination outcomes before and after adjusting for demographic variables.

Methods. Data were from 2022 Behavioral Risk Factor Surveillance System (BRFSS) surveys regarding 13 categories of ACEs, COVID-19 vaccination, and demographic variables. Data was weight adjusted for survey respondent data. This complex design combined the core and optional modules. Participants who received at least one dose of the COVID-19 vaccine were categorized as vaccinated. The sample size is 12,514.

Results. Participants who were female (OR=1.35, 95% CI: [1.19,1.52]), greater than or equal to 65 years old (OR=4.76, 95% …

Mental Health Perceptions Among Us Veterans And Non-Veterans: 2022 Behavioral Risk Factor Surveillance System, Nicole Frederickson

Capstone Experience

Objective. To determine the association between veteran status and perceived mental health in US adults.

Methods. 2022 Behavioral Risk Factor Surveillance System cross-sectional telephone survey data were used. Analyses were adjusted for confounding sociodemographic and health-related characteristics. Weighted multinomial logistic regression was used to determine the association between veteran status and reporting 0, 1-13, or 14+ poor mental health days.

Results. A total of 430,653 individuals were included in this analysis. Veteran status was associated with decreased odds of reporting 1-13 poor mental health days than nonveterans (OR=0.81; 95% CI 0.77, 0.86) but greater odds of reporting 14+ poor mental …

Association Between Frequent Mental Distress And Insurance Status Using The 2022 Brfss, Christina Clayson

Capstone Experience

Objectives

Determine if there is a direct relationship between frequent mental distress and health insurance coverage.

Methods

Data from the 2022 BRFSS was used to calculate adjusted percentages. Crude odds ratios for both mental distress and insurance coverage. Multivariate analysis calculated crude and adjusted odds ratios for frequent mental distress by insurance coverage with income as a covariate.

Results

Individuals reporting frequent mental distress had lower income, less education, and were younger. Individuals without health insurance were more likely to be younger, Hispanic, and not have graduated high school. There was no significant association between frequent mental distress and not …

Strategies To Encourage Recall And Prevent Relapse After Full Mouth Rehabilitation Under General Anesthesia In Children, Claire Koukol

Capstone Experience

Background: Dental caries are preventable. Dentists utilize many prevention strategies in the office and provide at-home education to families. However, once a child develops Early Childhood Caries (ECC), especially in more severe cases, they may need general anesthesia (GA) to complete treatment. While this is an effective way to achieve full mouth dental rehabilitation (FMDR), this burdens the healthcare systems and families and does not come without risk to the patient. Patients with high caries experience remain at high risk of caries relapse after FMDR under GA, sometimes necessitating additional FMDR under GA. While there has been a significant amount …

Barriers And Facilitators To Enrollment For Free And Reduced Price Meals In The School Nutrition Program Among Lawrence Public School Families, Emily Brinkman

Capstone Experience

Many low-income families are facing nutrition insecurity, meaning they do not have consistent and equitable access to healthy, safe, affordable foods to meet needs for optimal health and well-being. The impact of nutrition insecurity is especially concerning for children as they are more likely to face adverse outcomes that can limit physical, intellectual, and emotional potential across the lifespan. The U.S. Department of Agriculture administers the School Nutrition Programs that can help improve access to nutritious foods. Eligible families can apply for their children to receive free or reduced-price school meals based on income level and household size. However, many …

Geospatial Distribution Of Pharmacist Diabetes Management Within A Patient Centered Medical Home Model In Omaha, Nebraska, Anthony Donovan

Capstone Experience

Patients with uncontrolled diabetes, defined as a hemoglobin A1c value greater than 9%, are at an increased risk of diabetes progression. Primary care is often the first point of contact where patients with uncontrolled diabetes are identified and treated. Pharmacists are utilized in diabetes medication management of patients with uncontrolled diabetes as one component of primary care multidisciplinary models of care. This descriptive project describes the geospatial distribution of patients with uncontrolled diabetes from a single institution in the Omaha, Nebraska area who were exposed to pharmacists within a Patient Centered Medical Home (PCMH) model of care compared to those …

Assessing How Children Modify The Impact Of Having Health Insurance On Smoking Status Using The 2021 Behavioral Risk Factor Surveillance System Survey, Zak Lippert

Capstone Experience

Objective: To understand if children living in the home modify the relationship between health insurance and smoking.

Methods: This analysis used the 2021 Behavioral Risk Factor Surveillance System Survey. The outcome was being a current smoker with health insurance as the exposure. The analysis was stratified by children to determine if children changed how having health insurance impacted smoking. The odds ratios for each stratum were compared to determine if children was a modifying factor.

Results: Children had a modifying effect on health insurance. For someone with children, if they had insurance, their odds of smoking were 0.91 (95% CI: …

From Vapor To Vice: Unraveling The Links Between Vaping And Traditional Substance Abuse Among Youth, Ayana Powell

Capstone Experience

ABSTRACT:

Objective: To evaluate whether vaping or using e-cigarettes is associated with the use of traditional substances, such as cigarettes, alcohol, and marijuana.

Methods: Using data from the Monitoring the Future surveys, a multivariable logistic regression model was performed, and prevalent odds ratio were calculated to evaluate the association between vaping and traditional substances.

Results: Vaping use among U.S. adolescents and teenagers was found to be an associated with use of traditional substances (cigarette use [OR]= 6.36 [CI]= 4.84, 8.38; alcohol use [OR]=5.80 [CI]= 5.28, 6.38; and marijuana use [OR]= 7.77 [CI]= 6.95, 8.70).

Conclusion: This study will assist …

Spotlight On Mental Health On A Healthcare Campus: An Assessment Of Psychological Trauma Awareness, Training, And Treatment In The University Of Nebraska Medical Center College Of Public Health Community, Jenny E. Mueller

Capstone Experience

Background: Psychological trauma has been recognized as a public health concern of epidemic proportions globally. Public health community awareness of and education in trauma is likely to be integral to preparing future public health professionals to work effectively and safely in the field. Currently, the extent of trauma awareness, training, and treatment on the University of Nebraska Medical Center College of Public Health (UNMC COPH) campus is not known.

Aims: The aims of this project are to investigate and assess the level of psychological trauma awareness, training, and treatment on the UNMC COPH campus; and to provide recommendations for actions …

Nurse Initiated Standing Orders: A Process Improvement At An Emergency Department In Interior Alaska, Justin D. Melberg

Capstone Experience

Emergency Departments (EDs) are a valuable and limited public health resource. In addition to treating acute medical emergencies, EDs bridge the gaps in urgent care and primary care accessibility, operating twenty-four hours a day, seven days a week, providing care regardless of an individual’s ability to pay. EDs across the country operate at or above capacity regularly, and overcrowding is projected to increase due to decreased facilities and available inpatient beds. Innovative measures are necessary to increase patient throughput and decrease length of stay while maintaining quality care. Nurse initiated standing orders, also known as nurse driven protocols, standing orders, …

Adverse Childhood Experiences As Individual Predictors Of Subjective Cognitive Decline: Analyzing The 2022 Behavioral Risk Factor Surveillance System, Ruthie Schmitt

Capstone Experience

Objectives. This study explored the association of Adverse Childhood Experiences (ACEs) and Subjective Cognitive Decline (SCD). This study aimed to determine within the United States which ACEs have a stronger association with SCD after 45 years of age by analyzing all 13 ACEs individually with SCD.

Methods. Data were obtained from the 2022 BRFSS. An analytic sample of 42,509 adults over 45 years of age from seven states was analyzed using binary and multivariate logistic regression. The outcome variable investigated in this study was SCD, and the explanatory variables were 13 ACEs.

Results. Of the respondents, 10.4% reported experiencing SCD …

Associations Between Long Covid And Healthcare Access: A Cross-Sectional Analysis Of The Behavioral Risk Factor Surveillance System (Brfss) 2022, Tiffany Elliott

Capstone Experience

Objective. To evaluate the association of healthcare access with Long COVID and clinical and sociodemographic factors.

Methods. Data were from the CDC's 2022 Behavioral Risk Factor Surveillance System (BRFSS) surveys regarding four measures of healthcare access and Long COVID. There were 25,549 respondents who reported Long COVID and 95,830 respondents who did not report Long COIVD.

Results. 25,549 (22.0%) of respondents reported Long COVID. Significant associations were found in respondents with public health insurance and delayed medical care due to cost. Those with chronic health conditions were more likely to report Long COVID. Women, certain racial/ethnic groups, …

Environmental Exposure Effects To Humans And Trends Of Harmful Algal Blooms In Nebraska, Ericka Sanders

Capstone Experience

Harmful algae blooms (HAB) are becoming more of a human health concern. Humans are exposed to harmful algae blooms from freshwater bodies used for recreational activities. The presence of harmful algae blooms has been increasing across the United States. Aerosol, dermal, and ingestion routes of exposure are ways humans can develop an illness when around a HAB. Environmental exposure to humans above 8 ppb per liter of surface water can cause mild to severe symptoms and, in rare cases, may be fatal. Exposure can be acute or chronic. The Nebraska Department of Environment and Energy (NDEE) has implemented a monitoring …

A Cross-Sectional Analysis Of Adverse Childhood Experience Exposure On Cancer Diagnosis Utilizing The 2022 Behavioral Risk Factor Surveillance Survey Data, Emma Zipperer

Capstone Experience

Objective: To determine the association between Adverse Childhood Experiences (ACEs) and cancer diagnosis based on ACE exposure levels.

Methods: We utilized data collected in the 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey. The study population (n=54,148) was restricted to states that reported on the optional model of experiencing ACEs and those who responded about cancer diagnosis. A univariate analysis, bivariate analysis and a multivariate logistic regression were performed. Odds of cancer diagnosis among those with differing ACE exposure levels were calculated.

Results: High ACE exposure had 20% higher odds of cancer diagnosis when compared to low ACE exposure. White, …

Examining The Impact Of Adverse Childhood Experiences (Aces) On Breast And Colorectal Cancer Screening Behaviors In Adulthood, Meagan A. Kraft

Capstone Experience

Objective: To investigate the relationship between adverse childhood experiences (ACEs) and screening for breast and colorectal cancer in adulthood.

Methods: This cross-sectional study utilized nationwide survey data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS). Data regarding ACEs and compliance with breast and colorectal cancer screening guidelines were analyzed from 12 states. Weighted logistic regression models were used to assess the relationship between ACEs and breast cancer screening compliance in a population of 18,369 women, and colorectal cancer screening compliance in a population of 30,884 men and women. Screening compliance among those with a high ACE score was compared …

The Power Of An Effective Safety Culture, Justin B. Negley

Capstone Experience

Workplace injuries and illnesses have continued to decrease significantly through increased regulations, awareness, and technological advances. These enhancements are not enough to continue to drive these rates lower. A robust safety culture within an organization is required to truly affect change that will continue to diminish the occurrence of injuries and illnesses within the workplace. This project seeks to define the key aspects and elements that are fundamental to a culture of safety as a top priority amongst competing demands. The foundations of a robust safety culture were identified through a systematic literature review, a site comparison example of safety …