Medicine and Health Sciences Commons^™

The Effect Of Agricultural Exposures And Genetics On Respiratory Phenotypes, Lisa W. Boyd

Theses & Dissertations

Agricultural workers are at risk for respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and chronic bronchitis, due to exposures and inflammatory agents found in their work environment. While previous studies have been conducted to examine agricultural effects of chronic respiratory diseases more closely, there are still several significant gaps in the existing literature.

This dissertation explores the relationship between agricultural exposures and respiratory diseases. Utilizing two populations, the Keokuk Country Rural Health Study and the AgLung Study, this research: 1) used principal factor analysis (PFA) to distill exposure data into essential variables characterizing long-term agricultural exposures in order …

Adoption Of Medication Management Technologies By U.S. Acute Care Hospitals After The Hitech Act, Aastha Chandak

Theses & Dissertations

Medication errors and adverse drug events (ADEs) are a significant public health concern in the United States as they pose a threat to patient safety. The medication management process is a complicated process in U.S. acute care hospitals, consisting of a series of steps such as ordering, transcribing, dispensing and administration and each step is prone to medication errors.The use of technology is considered to be an important intervention in improving the medication management process and thereby reducing medication errors and ADEs and further improve patient safety. The Health Information Technology for Economic and Clinical Health (HITECH) Act, implemented in …

Barriers To Pediatric Triage Guideline Compliance: A Survey Of Nebraska Emergency Departments, Jonathon J. Gruba

Theses & Dissertations

Nebraska emergency departments may be underprepared for a mass casualty event involving a large number of children, as indicated by the results from the 2013 Emergency Medical Services for Children’s (EMSC) Pediatric Readiness Project (PRP) report. This was primarily evident by the lack of existence of a pediatric triage policy among Nebraska emergency departments. Utilizing a survey, this study attempted to identify the emergency departments in Nebraska that followed the EMSC guideline of having a pediatric triage policy, as well as to identify possible barriers to guideline adherence among those that did not have the policy.

It was found that …

Behavioral Care For Children In Urban And Rural Integrated Primary Care, David I. Taylor

Theses & Dissertations

Mental, emotional, and behavioral issues in children are a significant concern for the children, their families, and society. Despite the existence of evidence-based treatments, the success of behavioral healthcare to meet the needs of these families will require high quality communication and relationships across a wide range of stakeholders. Integration of care represents a patient-centered strategy to unify these stakeholders into a single cohesive care team. The purpose of this dissertation is to define the behavioral healthcare team in integrated primary care for children in terms of the functional roles involved and to evaluate the quality of relationships and communications …

The Impact Of Electronic Health Records On Healthcare Service Delivery, Patient Safety, And Quality, Kate Elizabeth Trout

Theses & Dissertations

The HITECH Act has provided over $30 billion of support through the Meaningful Use program to implement Electronic Health Records (EHRs) with aims to improve healthcare service delivery, efficiency, quality, and patient safety. New healthcare models, such as pay-for-performance and value-based purchasing, were envisioned to aligning quality with reimbursement mediated with the use of EHRs. It is unclear of how EHRs and Meaningful Use have impacted health service delivery, patient safety, and quality of care. Thus, making it difficult to determine if the specific set of objectives for Meaningful Use have had a positive impact on outcomes, which ultimately is …

Raising The Minimum Legal Sales Age For Tobacco Products In Nebraska, Fernando A. Wilson, Nizar K. Wehbi, Kavita Mosalpuria, Li-Wu Chen

Reports: Center for Health Policy

No abstract provided.

An Overview Of State Criteria For Declaring A Public Health Emergency, Fernando A. Wilson, Nizar K. Wehbi, Kavita Mosalpuria

Reports: Center for Health Policy

No abstract provided.

Race Inclusion Diversity & Equity: The Ride Report, Renaisa S. Anthony, Todd A. Wyatt, Chad Abresch, Maria Teel, Kandy Do, Olubadero Yerokun-Houessou, Talia Mcgill, Angela Benton

Reports: Center for Reducing Health Disparities

The Race, Inclusion, Diversity & Equity (RIDE) Report is presented as a resource to augment, strengthen and support existing and future diversity, inclusion & equity efforts at the University of Nebraska Medical Center (UNMC). It is organized into 7 sections and highlights the voices, perspectives and ideas of over 150 UNMC administrators, students, faculty, staff and community partners (key stakeholders).

Leisure Time Physical Activity Preferences, Behaviors, And Hypertension: Evidence From The China Health & Nutrition Survey, 2004-2011, Junmin Zhou

Theses & Dissertations

Background: Physical activity has been continuously declining in China. At the same time, prevalence of hypertension has dramatically increased. The associations between leisure time physical activity preference, behavior, and development of hypertension in Chinese adults remained not fully understood and few studies have examined these associations using longitudinal data.

Objectives: This dissertation examined the interrelationships among leisure time activity preference, behavior, and the incidence of hypertension using longitudinal data from 2004 to 2011 in the China Health and Nutrition Survey. It also assessed the urban-rural disparities.

Methods: A total of 2,687 adults were included in the analysis. Multivariate logistic regressions …

Psychological Aspects Of Head And Neck Cancer, Katherine Rieke

Theses & Dissertations

Patients with head and neck cancer may be at increased risk for depression diagnosis when compared to other cancer sites, both before and after their cancer diagnosis. Behavioral risk factors for head and neck cancers, including tobacco and alcohol use, may be indicative of depression before cancer diagnosis. Further, head and neck cancers and their treatments can cause serious morbidity among patients, including physical disfigurement and loss of function. Additionally, these cancers are often accompanied by social stigma, personal shame, and guilt. While there is a significant body of research examining depression in this cancer population, there are still several …

Assessing Change In Baseline Preparedness Knowledge In Long-Term Care Facilities, Heidi L. Wheeler

Theses & Dissertations

With much of the focus and federal resources in recent history going to support hospital preparedness, long-term care facilities have been left behind even though they house one of our most vulnerable populations. Few regulations and standards have required these facilities to keep pace with preparing for an increasingly volatile environment and aging society. This is changing with the proposal of new federal standards and regulations requiring more thorough and robust preparedness planning. These new requirements do not have to be overwhelming or burdensome to facilities but can be included quite simply into routine planning and training. This study looks …

Surveillance Of Non-Fatal Agricultural Injuries Among Farm Operators In The Central States Region Of The United States, Ketki Patel

Theses & Dissertations

Agriculture is a major industry in the U.S. with high rates of fatal and non-fatal occupational injuries. The dynamic nature of the U.S. agriculture industry, regional variations in farming practices, and the diverse workforce make surveillance of injuries challenging. A recent National Academies (U.S.) evaluation reported that data for non-fatal agricultural injury are scarce, and mainly available through national surveys. Limited data are available for employees in the agriculture sector, especially farm owners and operators. The objectives of this study were to- 1) review and evaluate existing survey-based systems for surveillance of non-fatal agricultural injuries on U.S. farms, and 2) …

Aldehyde Adducts And Lung Injury, Muna Sapkota

Theses & Dissertations

From the time of discovery, people have used both alcohol and tobacco in various forms all around the world. Alcohol abuse and cigarette smoking causes thousands of preventable deaths in the US each year. Several lung diseases such as COPD, asthma, respiratory infections, pneumonia, acute respiratory distress syndrome, cancer of neck, throat, mouth and lung are associated with smoking and drinking. Even though some studies have examined the role of alcohol and cigarette smoke in lung diseases, only a few studies have focused on the role of reactive aldehydes generated in the lungs of those who abuse alcohol and smoke …

Modifiable Barriers To Optimal Outcomes In Gout Management, Brian W. Coburn

Theses & Dissertations

Improving patient outcomes in chronic disease is of critical importance to the future of health care. Gout, affecting 4% of the US population, is a highly treatable chronic disease from which patients experience unnecessarily suboptimal outcomes. In this dissertation, I demonstrate how interrelated patient and provider factors affect patient outcomes in gout. First, I describe how only 14% of gout patients know their serum urate (SU) goal for urate lowering therapy (ULT) despite otherwise being knowledgeable about gout and its treatment. I then demonstrate the importance of multiple patient and provider factors in achieving SU goal. Specifically, I demonstrate that …

Global Trends In Cancer Burden Based On Geographic Location, Socio-Economic Status And Demographic Shift, Sanjib Chowdhury

Theses & Dissertations

The global burden of cancer is rising at an alarming rate. It remains as one of the top causes of morbidity and mortality worldwide. It is predicted that within 2020, there will be 15 million new cases of cancer in the world, with cancer-related deaths increasing to 12 million. According to the World Health Organization (WHO), the global cancer burden is expected to surge 57% worldwide in the next 20 years. A significant rise in cancer burden will occur in the low-income and middle-income (developing) countries not only due to demographic shifts, but also by the transition of risk factors …

Exploring Emergency Communication Experiences In Response To The 2010 Haiti Earthquake: Lessons Learned From International Donors And Local Government Agencies, Pierre Marie Barbara Roussel

Theses & Dissertations

Background:

In almost every disaster situation, the use of standardized communication procedures among humanitarian relief agencies has been identified as one of the efficient practices to minimize the mismanagement of resources and thus to maximize the response effort among actors to reduce the incidence impact on the public and to increase their resilience capabilities.

Agencies have access to several guidelines to follow during domestic disasters, but there have been very few manuals developed to guide relief organizations on best practices during international large and complex natural disasters such as the 2010 Haiti earthquake.

Haiti has experienced over its history several …

Essays On Immigration-Related Disparities In Health Behavior And Health Care Utilization, Yang Wang

Theses & Dissertations

The number of immigrants in the United States has recently been increasing significantly. Immigrants may experience some worse health outcomes than natives, due to substantial legal and socioeconomic barriers. Many immigration-related disparities in health behavior and health care utilization still remain unexplored. This dissertation comprises of 3 independent studies examining such disparities across immigration status, including (1) E-cigarette use and acculturation effects; (2) Cancer-related office-based medical provider visits among cancer patients; and (3) Potentially preventable emergency department visits.

Two nationally representative data sources included National Health Interview Survey and Medical Expenditure Panel Survey. We categorized the respondents into three immigration …

Factors And Outcomes Associated With Potentially Inappropriate Medication Use In Rural Community-Dwelling Older Adults, Marcia Y. Shade

Theses & Dissertations

Potentially inappropriate medications (PIMs) use in older adults is a significant public health concern. The use of PIMs to avoid may lead to negative outcomes such as adverse drug events. Prior conceptual analysis of PIMs use and observation of health-related factors in rural adults led to the design of this dissertation study. A sample was recruited from a population of rural community-dwelling older adults to examine the following specific aims: 1) Describe the use of PIMs to avoid, 2) Explore individual demographic characteristics (age, gender, income, education, and rural home location), health experience (comorbidity, number of medications and health providers), …

Using Homeland Security Exercise Evaluation Program To Execute A Mass Prophylaxis Exercise In A Rural Community., Brian K. Smith

Theses & Dissertations

This project explores the execution of point of distribution exercises in a rural community. Harrison County Iowa is a rural county with a population over 15,000 located approximately 45 minutes north of the Omaha metro area. The project explored the existing point of distribution plans and inventory for the Harrison County Home and Public Health Department. Prior to this project, many staff at Harrison County Home and Public Health Department had no experience with table top or full scale exercises. The mass prophylaxis point of distribution plan had not been updated, and staff had not received training on the point …

Establishment Of Comprehensive Training Center In Tajikistan, Umeda Sadykova

Theses & Dissertations

There is a notable increase in the number of natural and manmade disasters all over the world in the past two decades. Emergency preparedness is a field that is drawing increased attention in many countries. Tajikistan is a disaster prone country with unforgiving nature and weak preparedness infrastructure/system. Tajikistan’s weak emergency preparedness system can be attributed to two main reasons; lack of coordination between the government and international emergency organizations, and the paucity of well trained and organized network of emergency professionals. This study drafted a proposal to establish a comprehensive training center in Tajikistan. This training center will be …

Human Papillomavirus And Its Impact On Vulnerable Populations, Harpriya Kaur

Theses & Dissertations

Human papillomavirus (HPV) is the most common sexually transmitted infection. The infection is higher in certain racial/ethnic groups and those who are immunocompromised including pregnant women. Because immune system is suppressed during pregnancy, women are at higher risk of various types of infection including HPV, a known risk factor for pregnancy complications. However, its role in adverse pregnancy outcomes is unclear. Another high risk population is Northern Plain American Indian. In the Northern Plains region, American Indian women have significantly higher rate of HPV infection than white counterparts and are infected with different types of HPVs than the general population. …

Community And District Empowerment For Scale-Up (Codes): A Complex District-Level Management Intervention To Improve Child Survival In Uganda: Study Protocol For A Randomized Controlled Trial., Peter Waiswa, Thomas O'Connell, Danstan Bagenda, Pricila Mullachery, Flavia Mpanga, Dorcus Kiwanuka Henriksson, Anne Ruhweza Katahoire, Eric Ssegujja, Anthony K. Mbonye, Stefan Swartling Peterson

Journal Articles: Epidemiology

BACKGROUND: Innovative and sustainable strategies to strengthen districts and other sub-national health systems and management are urgently required to reduce child mortality. Although highly effective evidence-based and affordable child survival interventions are well-known, at the district level, lack of data, motivation, analytic and planning capacity often impedes prioritization and management weaknesses impede implementation. The Community and District Empowerment for Scale-up (CODES) project is a complex management intervention designed to test whether districts when empowered with data and management tools can prioritize and implement evidence-based child survival interventions equitably.

METHODS: The CODES strategy combines management, diagnostic, and evaluation tools to identify …

Community And District Empowerment For Scale-Up (Codes): A Complex District-Level Management Intervention To Improve Child Survival In Uganda: Study Protocol For A Randomized Controlled Trial., Peter Waiswa, Thomas O'Connell, Danstan Bagenda, Pricila Mullachery, Flavia Mpanga, Dorcus K. Henriksson, Anne R. Katahoire, Eric Ssegujja, Anthony K. Mbonye, Stefan S. Peterson

Journal Articles: Epidemiology

BACKGROUND: Innovative and sustainable strategies to strengthen districts and other sub-national health systems and management are urgently required to reduce child mortality. Although highly effective evidence-based and affordable child survival interventions are well-known, at the district level, lack of data, motivation, analytic and planning capacity often impedes prioritization and management weaknesses impede implementation. The Community and District Empowerment for Scale-up (CODES) project is a complex management intervention designed to test whether districts when empowered with data and management tools can prioritize and implement evidence-based child survival interventions equitably.

METHODS: The CODES strategy combines management, diagnostic, and evaluation tools to identify …

Depressive And Anxiety Symptoms Predict Sustained Quality Of Life Deficits In Hiv-Positive Ugandan Adults Despite Antiretroviral Therapy: A Prospective Cohort Study., Amara E. Ezeamama, Makhabele N. Woolfork, David Guwatudde, Danstan Bagenda, Yukari C. Manabe, Wafaie W. Fawzi, Mary C. Smith Fawzi

Journal Articles: Epidemiology

The impact of psychosocial status at onset of antiretroviral therapy on changes in quality of life (QOL) and subjectively rated health (SRH) among adults on highly active antiretroviral therapy (HAART) in resource-limited settings is poorly understood. Therefore, we evaluate the association between stigma, anxiety, depression, and social support and change in QOL and SRH in HIV-infected Ugandan adults during an 18-month period.Psychosocial indicators were assessed at enrollment using structured questionnaires. QOL and SRH measures were assessed at months 0, 6, 12, and 18 using the Medical Outcomes Survey-HIV. Linear mixed models determined risk estimated differences in QOL and SRH in …

Depressive And Anxiety Symptoms Predict Sustained Quality Of Life Deficits In Hiv-Positive Ugandan Adults Despite Antiretroviral Therapy: A Prospective Cohort Study., Amara E. Ezeamama, Makhabele N. Woolfork, David Guwatudde, Danstan Bagenda, Yukari C. Manabe, Wafaie W. Fawzi, Mary C. Smith Fawzi

Journal Articles: Epidemiology

The impact of psychosocial status at onset of antiretroviral therapy on changes in quality of life (QOL) and subjectively rated health (SRH) among adults on highly active antiretroviral therapy (HAART) in resource-limited settings is poorly understood. Therefore, we evaluate the association between stigma, anxiety, depression, and social support and change in QOL and SRH in HIV-infected Ugandan adults during an 18-month period.Psychosocial indicators were assessed at enrollment using structured questionnaires. QOL and SRH measures were assessed at months 0, 6, 12, and 18 using the Medical Outcomes Survey-HIV. Linear mixed models determined risk estimated differences in QOL and SRH in …

An Examination Of Private Payer Reimbursements To Primary Care Providers For Healthcare Services Using Telehealth, United States 2009–2013, Fernando A. Wilson, Kate Elizabeth Trout, Sankeerth Rampa, Jim P. Stimpson

Reports: Center for Health Policy

• Half of telehealth-related state policies were implemented in the last five years.
• Although many states permit reimbursements for telehealth services, only seven states have passed statutes mandating parity with reimbursements for non-telehealth services.
• Despite an increasing number of telehealth policies, claims for telehealth services to private insurers are rare.
• Lower average reimbursements for telehealth billings may discourage adoption of telehealth technologies.
• Surveillance of claims data will help identify whether telehealth policies are having their intended impact on the healthcare system.

Medicaid Expansion In Indiana, Jim P. Stimpson, Fernando A. Wilson, Anh T. Nguyen, Kelly Shaw-Sutherland

Reports: Center for Health Policy

No abstract provided.

Ebola Virus Disease And Critical Illness, Aleksandra Leligdowicz, William A. Fischer, Timothy M. Uyeki, Thomas E. Fletcher, Neill K.J. Adhikari, Gina Portella, Francois Lamontagne, Christophe Clement, Shevin T. Jacob, Lewis Rubinson, Abel Vanderschuren, Jan Hajek, Srinivas Murthy, Mauricio Ferri, Ian Crozier, Elhadj Ibrahima, Marie-Claire Lamah, John S. Schieffelin, David Brett-Major, Daniel G. Bausch, Nikki Shindo, Adrienne K. Chan, Tim O'Dempsey, Sharmistha Mishra, Michael Jacobs, Stuart Dickson, G. Marshall Lyon, Robert A. Fowler

Journal Articles: Epidemiology

As of 20 May 2016 there have been 28,646 cases and 11,323 deaths resulting from the West African Ebola virus disease (EVD) outbreak reported to the World Health Organization. There continue to be sporadic flare-ups of EVD cases in West Africa.EVD presentation is nonspecific and characterized initially by onset of fatigue, myalgias, arthralgias, headache, and fever; this is followed several days later by anorexia, nausea, vomiting, diarrhea, and abdominal pain. Anorexia and gastrointestinal losses lead to dehydration, electrolyte abnormalities, and metabolic acidosis, and, in some patients, acute kidney injury. Hypoxia and ventilation failure occurs most often with severe illness and …

Factors Underlying Ebola Virus Infection Among Health Workers, Kenema, Sierra Leone, 2014-2015, Mikiko Senga, Kimberly Pringle, Andrew Ramsay, David Brett-Major, Robert A. Fowler, Issa French, Mohamed Vandi, Josephine Sellu, Christian Pratt, Josephine Saidu, Nahoko Shindo, Daniel G. Bausch, Sierra Leone Kenema District Task Force And Kenema Government Hospital

Journal Articles: Epidemiology

BACKGROUND: Ebola virus disease (EVD) in health workers (HWs) has been a major challenge during the 2014-2015 outbreak. We examined factors associated with Ebola virus exposure and mortality in HWs in Kenema District, Sierra Leone.

METHODS: We analyzed data from the Sierra Leone National Viral Hemorrhagic Fever Database, contact tracing records, Kenema Government Hospital (KGH) staff and Ebola Treatment Unit (ETU) rosters, and burial logs.

RESULTS: From May 2014 through January 2015, 600 cases of EVD originated in Kenema District, including 92 (15%) HWs, 66 (72%) of whom worked at KGH. Among KGH medical staff and international volunteers, 18 of …

Social Disparities In Exposure To Point-Of-Sale Cigarette Marketing, Mohammad Siahpush, Evi A. Farazi, Jungyoon Kim, Tzeyu L. Michaud, Aaron Yoder, Ghada Soliman, Melissa Tibbits, Minh N. Nguyen, Raees A. Shaikh

Journal Articles: Epidemiology

While most ecological studies have shown that higher levels of point-of-sale (POS) cigarette marketing are associated with larger proportions of residents from lower socioeconomic and minority backgrounds in neighborhoods, there are no studies that examine individual-level social disparities in exposure to POS cigarette marketing among smokers in the United States. Our aim was to examine these disparities in a Midwestern metropolitan area in the United States. We conducted a telephone survey to collect data on 999 smokers. Cigarette marketing was measured by asking respondents three questions about noticing advertisements, promotions, and displays of cigarettes within their respective neighborhoods. The questions …