Medicine and Health Sciences Commons^™

Examining Barriers To Sexual And Reproductive Health Services For Adolescents And Young Adults In Nebraska, Marisa Rosen

Theses & Dissertations

Despite recent declines in unintended pregnancy rates among adolescent and young adult women, barriers to family planning services and contraception continue to exist for young women living in the United States. Various initiatives have been implemented over the years from programmatic interventions to enactment of policies around family planning, yet more work needs to be done to help adolescent and young adult women successfully prevent unintended pregnancy. The Contraceptive Access Project (CAP) is a multi-component initiative in Nebraska to reduce unintended pregnancy among women aged 15-24. This dissertation comprises three separate studies each of which contributes to the overall objective …

An Assessment Of Preparations Made In The United States For Highly Hazardous Communicable Diseases Following The 2014-2016 Ebola Virus Disease Epidemic, Jocelyn J. Herstein

Theses & Dissertations

The 2014-2016 Ebola virus disease (EVD) epidemic in West Africa was unprecedented in magnitude and scope. The threat of imported cases of EVD in the United States prompted the Centers for Disease Control and Prevention (CDC) to establish a tiered network of hospitals to enhance domestic isolation capacity, including the designation of select hospitals as Ebola treatment centers (ETCs). As of spring 2015, no information existed on the capacity, physical infrastructure, staffing models, or infection control protocols of these newly-established ETCs, nor was there information on other highly hazardous communicable diseases (HHCDs) these units would admit. Moreover, no documentation was …

Surveillance, Prevention And Surgical Treatments For Hepatocellular Carcinoma, Kerui Xu

Theses & Dissertations

Liver cancer is the second-leading cause of cancer death, representing roughly 9.1% of all cancer mortality. Of all primary cancers of the liver, hepatocellular carcinoma (HCC) accounts for roughly 85%. HCC has been increasing in the U.S. and other countries. In particular, HCC places a huge burden on the Chinese population, as China alone consists of approximately 50% of the total HCC cases and deaths. In China, chronic hepatitis B virus (HBV) infection is the leading cause for developing HCC. The two challenges in prevention and control of HCC experienced in China are low rates of HCC screening among the …

Increasing Physical Activity To Improve Health Through Primary Care Clinics In Rural Nebraska, Jill Reed

Theses & Dissertations

Addressing the lack of physical activity (PA) in rural adults is vital because of the role it plays in the risk for many chronic diseases. The purpose of the study was to explore the feasibility of conducting a 12-week intervention to increase PA behavior in inactive rural adults recruited from a primary care clinic. Subjects were randomized to the intervention (n=30) or control (n=29) group and wore a Fitbit to track PA. The intervention group completed action plans and received weekly motivational text messages to improve PA behaviors. Semi-structured interviews were conducted with study participants (n=10) and a focus group …

Hearing Loss And Hearing Protection Use Among Midwestern Farmers, Josie J. Ehlers

Theses & Dissertations

Many farmers have noise-induced hearing loss, yet few use hearing protection when working around loud noise. A point source intervention (storing hearing protection devices near sources of noise) was implemented to help farmers overcome accessibility barriers related to using hearing protection. Intervention farmers (n=53) received education and the point source intervention; control farmers (n=36) received education only. During each year of the study, all farmers completed a questionnaire about their perceptions of hearing protection and participated in an audiometric test at their farm. Ambient sound pressure levels were taken during tests. The main objectives of this dissertation were to evaluate …

Descriptive Census Survey Of Community Gardens Supported By The Big Garden, Abigail R. Hughes

Capstone Experience

The goal of this capstone and service learning project is to provide The Big Garden, an Omaha, NE based nonprofit organization, with survey data on the growth of their sites and programming over the past five years along with information on current garden needs and capacity. A census survey of a subsample of gardens supported by The Big Garden will provide leadership with information needed as they plan next steps for the organization and specific programming planning. Surveys were distributed to all gardens within their network to collect data on garden characteristics (e.g., size, length of time in operation), production …

Hearing Conservation In A Meat Processing Facility, Abolore Muinat Idris

Capstone Experience

Introduction: The aim of this study was to evaluate personal noise exposures at a meat processing facility, and educate employees on the proper use of hearing protectors.

Materials and Methods: We collected full-shift personal dosimetry on thirty-six production floor employees, one quality control employee, and four maintenance employees. These were compared to the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) criteria. We also collected point source noise measurement at eight workstations from precook. We administered a questionnaire to assess production floor employees’ hearing loss perception and non-occupational source of noise exposure. …

An Evaluation Of Implementing Trauma-Informed Care Training In Healthcare Settings, Amanda Kis

Capstone Experience

Background: Trauma-informed care (TIC) has recently become a popular topic in medical science. Many patients’ health conditions have been diagnosed and treated purely as medical issues, yet emerging research indicates that trauma is sometimes the source of many physical and mental conditions. Implementing TIC education in healthcare systems may lead to preventing the onset of symptomology related to undiagnosed, chronic trauma experience.

Objectives: The primary goal of this Capstone project was to implement TIC training developed by Trauma Matters Omaha Coalition and assess preliminary evidence for changes in participants’ confidence, clinical knowledge, professional knowledge, self-awareness, and assumptions and biases regarding …

Examining The Impact Of Hiv Medical And Social Case Management Program On Viral Load For Clients Living With Hiv/Aids In Nebraska, Abdulla Munir

Capstone Experience

Abstract

Case management (CM) is one of the standard practices that has been implemented since 1990 to help people living with HIV/AIDS (PLWHA) in the United States. The program is designed for low-income populations and it aims to address the barriers related to access to health care and improve the HIV outcomes. Previous studies identified a positive association with the provision of CM and improvement in viral outcomes. Increasing the viral suppression rates among HIV diagnosed individuals proved to reduce the risk of transmitting the infection, and disease incidence. Although CM program is provided to Nebraskans diagnosed with HIV, but …

Trends In Childhood Elevated Blood Lead Levels In Nebraska, 2013 – 2017, Ellana Haakenstad

Capstone Experience

This project explored the exposure to lead among children in Nebraska. Using the Nebraska Department of Health and Human Services’ Blood Lead Level database, trends were investigated in screening; demographics; incidence; and prevalence of elevated blood lead levels, statewide and by census tract. The study further explored the geography of lead exposure and elevated blood lead level cases with maps. Based on these results, policy recommendations were made to the Nebraska Department of Health and Human Services’ Childhood Lead Poisoning Prevention Program, particularly about areas of Nebraska with high risk of lead incidence and exposure risk where testing should be …

Characterization Of Cancer Incidence In Chronic Kidney Disease Patients: A Single Center Study, 2008 – 2018, Jagadeesh Puvvula

Capstone Experience

Background: Chronic kidney disease (CKD) is an established risk factor for cardiovascular disease, but the significance of lower Glomerular filtration rate on incidence and mortality from cancer is uncertain. There is evidence that cancer risk and cancer mortality may be increased in individuals with End Stage Renal Disease (ESRD) requiring dialysis or after renal transplantation but whether less severe kidney disease is associated with cancer remains poorly understood.

Some studies indicate that these associations do appear to be organ specific. It has been reported that reduced renal function is associated with an increased risk of cancers of the kidney and …

Factors Associated With Follow-Up Compliance Among Clients Referred By A Local Health Department For Hiv Pre-Exposure Prophylaxis, Lauren R. Cirrincione

Capstone Experience

Background: Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) is a public health strategy to limit HIV infection among at-risk populations. Local health departments (LHDs) promote PrEP initiation by referring patients to private and academic specialty care centers. However, low follow-up compliance remains a challenge in this setting. Between January 2016 and September 2018, Douglas County Health Department, a LHD in Omaha, Nebraska, externally referred 126 clients for PrEP at an academic specialty care center, and only 20 (15%) clients completed a PrEP initiation follow-up appointment. The purpose of this study is to describe the characteristics of clients referred by …

Burden And Risk Factors Associated With Hcv Infection Among People Living With Hiv Infection In Nebraska: Population-Based Cross-Sectional Study From 1997 To 2017, Issaka Kabore

Capstone Experience

Background: Previous studies have shown high prevalence of HCV infection among people living with HIV infection. Coinfected people are at risk of developing liver diseases resulting an increase rate of mortality. Several risk factors for HIV/HCV coinfection have previously been identified with injecting drug users (IDU) as the common route of exposure.

Methods: This was cross -sectional study using HIV and HCV registries maintained by Nebraska Department of Health and Human Services (NE DHHS) from1997 to 2017. A descriptive analysis was used to characterize the sample. Chi-squared test and Fisher exact test were selected to compare the different groups. …

Nutritional Factors Associated With Thyroid Cancer And Nodules Using The Integrated Cancer Repository For Cancer Research (Icare2), Dong Liu

Capstone Experience

Introduction: The incidence of thyroid cancer in the United States has rising on average 3.1% each year over the last 10 years. Much of this increase is attributed to increased detection using ultrasound. Dietary habits can be an important modifiable risk factors for different types of cancer, but the association between dietary factors and thyroid cancer has not been well studied. The goals of this capstone were to: 1) review the literature for the association between dietary factors and thyroid cancer, 2) describe demographic and behavioral characteristics of patients with thyroid nodules and cancer in a hospital-based registry, and 3) …

Association Of Adverse Birth Outcomes With Maternal Exposure To Nitrate In Private Well Drinking Water: An Action Plan For Prevention, Jessyka R. Johnson

Capstone Experience

Abstract

Goal: The goal of the capstone project is to collect information required to develop an action plan focusing on minimizing exposure to nitrate in pregnant women, which, if implemented, can either prevent or reduce adverse health outcomes associated with nitrate exposure in utero.

Objective: The capstone project objective is to gain a better understanding of what programs to prevent exposure to nitrate from private well drinking water in pregnant women are already in place throughout the United States; to identify any areas of improvement in these programs; and to utilize this information to create a unique action plan in …

Factors Associated With Medical And Dental Compliance For Adults With Diabetes Mellitus, Mahua Saha

Capstone Experience

Background: Over the few decades, diabetes has become one of the most common chronic conditions in the U.S and worldwide. With the increasing number of incidences of diabetes and the cost associated with the treatment, adherence to treatment regimens is one key factor, which immensely affects the success of the diabetes treatment. The American Diabetes Association recommends annual preventive care for diabetes in terms of self-care practices such as daily blood glucose check and daily foot check. An eye examination with pupil dilation and a dental checkup are also recommended as part of annual care for diabetic patients. Considering the …

Factors Associated With Participant Attrition In A Longitudinal, Survey-Based Rheumatic Disease Databank, Kathryn A. Grafel

Capstone Experience

Introduction: Participant attrition is a problem common to many longitudinal studies, and when it occurs nonrandomly, it can impact the study’s validity and generalizability. Identifying factors associated with attrition can help to detect bias and aid in developing targeted interventions to reduce attrition. Methods: Logistic regression and Cox proportional hazards regression models were constructed separately for patients with rheumatoid arthritis, systemic lupus erythematosus, and other rheumatic diseases who participated in the FORWARD study between 1998 and 2018. Results: Patient characteristics associated with attrition included male sex, younger age, non-White race, and less education, each of which was identified in multiple …

Assessing Medication Error Rates In Pediatrics Pre And Post Implementation Of The Handtevy App Within The San Antonio Fire Department, Bailey Cooper

Capstone Experience

Goal: The goal of this project was to determine if the implementation of the Handtevy app reduced medication error rates on calls run by the San Antonio Fire Department in the pediatric population with a diagnosis involving pain management or seizure. Background: Prior to the implementation of the Handtevy app, first responders used a tool called the Broselow tape to estimate a child’s weight and to determine the appropriate medication dose. Run reports were analyzed prior to the implementation of the Handtevy pediatric standard to determine medication error rates for Fentanyl and Versed in pediatric patients 13 years or younger. …

A Descriptive Analysis And Assessment Of Predictive Factors For Participation In A Clinical Trial As Front-Line Therapy For Patients Enrolled In The Nebraska Lymphoma Study Group Registry, Jonathan L. Tefft

Capstone Experience

Background: Clinical trial participation, especially among cancer clinical trials in adult populations, continues to be low despite the large number of clinical trials available across the U.S. Estimates for clinical trial participation are as low as 5% in some adult cancer populations, however in some lymphoma populations this figure may be as high as 13.9%. This figure can be confusing, given that as much as 70% of Americans are estimated to be willing to participate in a clinical trial. Previous research shows that as much as 95% of surveyed respondents who said they had previously participated in a clinical trial …

The Public Health Lens: An Introduction To Population-Based Care In Athletic Training, Jenna L. Allocco

Capstone Experience

Historically, the athletic training profession has been focused on the individual; however, potential exists to drive large-scale prevention efforts in the athletic community with a population-based, public health approach. Relationship between the two professions has been acknowledged in in previous literature to do with educational competencies and opportunities for research, as well as in policy development involving sudden cardiac death, sport-related concussion and osteoarthritis prevention. Incorporating public health concepts such as the ecological model, health literacy, health behavior and evidence-based program planning and evaluation may improve athletic training health outcomes and prove beneficial to each respective discipline.

Birth Outcomes And Water: A Multidisciplinary Study, Moses New-Aaron, Jane L. Meza, Patrick J. Shea, Martha Rhoades

Posters and Presentations: College of Public Health

Evidence that agrichemicals are associated with the incidence of birth defects is inconsistent. We examined whether nitrate and nitrosatable agrichemicals present in well water are associated with birth defect rates in Nebraska counties. Birth defect data from the Nebraska Department of Health and Human Services, 2005-2014, were merged with well data obtained from the Quality-Assessed Agrichemical Contaminant Database for Nebraska Ground Water (1977-2014). Nebraska counties with higher rates of birth defects had a greater prevalence of agrichemicals in well water. Of the 33 contaminants sampled from different well types, nitrate and atrazine were of interest. Birth defect rates were negatively …

Effect Of N-Nitrosoatrazine On Embryogenesis In Avian Embryos, Nur Firyal Roslan, Moses New-Aaron, Martha Rhoades, Kent Eskridge

Posters and Presentations: College of Public Health

Preliminary studies suggest that the nitrosamine N-nitrosoatrazine (NNAT) is teratogenic and mutagenic. We hypothesized that the embryos exposed to NNAT would have higher mortality and lower growth rate compared to unexposed embryos. In this study, we evaluated growth and mortality in chick embryos after exposure to NNAT dissolved in dimethyl sulfoxide (DMSO). The study was divided into three experiments depending treatment design. First, the effect of DMSO on embryo growth and survival was tested. Second, we compared growth and survival between embryos treated with DMSO, 50:50 DMSO:water and NNAT at 0.245 µmol/l. Finally, we compared growth and survival between …

Economic Implications Of Tobacco Use For The State Of Nebraska Government, Fernando A. Wilson, Nizar K. Wehbi, Ali S. Khan

Reports: Center for Health Policy

We examine smoking-related expenditures for the state Medicaid program and for lost productivity among state government employees. The predicted number of new diagnoses of smoking-related illnesses among government employees ranged from 109 cases of kidney disease to 856 cases of arthritis and related diseases. We estimate over 6,000 lost workdays due to sick leave among currently smoking vs. non-smoking employees. Smoking-related illness is estimated to increase state budgetary expenditures on Medicaid by approximately $114.9 million annually.

Evaluation Of A Competency-Based Health Policy Training Program, Jim P. Stimpson, Kathleen Brandert, Brandon Grimm, Fernando A. Wilson

Reports: Center for Health Policy

No abstract provided.

Evaluation Of A Competency-Based Health Policy Training Program, Jim P. Stimpson, Kathleen Brandert, Brandon Grimm, Fernando A. Wilson

Reports: Center for Health Policy

An academic and practice partnership was formed to create and implement a competency-based training program for local health departments in health policy. We evaluated if the training program improved the policy knowledge and competency of participants.

Participants exhibited significant increases for self-assessed policy competency, including substantial improvements in “Critique the feasibility and expected outcomes of potential policy options”, “Identify and assess the strengths and motivations of key stakeholders and potential resistors”, and “Recommend a specific policy change”.

The policy competency instrument developed in this report could be used to measure policy knowledge and competency in future training implementations.

Determining The Adoption And Implementation Of Nutrition Policies At Food Pantries Across The United States, Meagan Helmick

Theses & Dissertations

Food insecurity occurs when there is a lack of access to enough food to live an active, healthy life. Current efforts to address food insecurity include developing and implementing policies, programs, and practices at the federal, state, and local levels. Specifically, local efforts target decreasing food insecurity through emergency food networks including food banks and food pantries. Over the last several years, many food banks and food pantries have worked to improve the nutritional quality of the foods they offer. However, food pantries are smaller and less formal organizations than food banks. Thus, they have limited resources to develop and …

Examining The Relationships Between School Engagement, Physical Activity, And Attention-Deficit Hyperactivity Disorder In Children Using The Ecological Model, Minh Nguyen

Theses & Dissertations

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with onset usually occurring in childhood and adolescence. During these developmental stages, social interactions and external environments can have significant impact on children’s growth and development. Few studies previously used a theoretical model to examine the effects of social and external environments on ADHD. The goal of this dissertation is to apply an ecological perspective to examine the roles of school and community in the development of childhood ADHD through school engagement and physical activity. Three studies were implemented to carry out this goal. Study 1 examined the associations of neighborhood, school, and …

A Multi-Level Assessment Of Healthcare Facilities Readiness, Willingness, And Ability To Adopt And Sustain Telehealth Services, Jamie Larson

Theses & Dissertations

Telehealth technologies are becoming more pervasive throughout the healthcare system as a way to provide services to patients that would otherwise have difficulty with access. Currently, little is known about the current state of telehealth use within clinics and hospital in the US. Most studies evaluating telehealth programs are feasibility or small patient outcome studies from one location. Utilizing a hybrid framework combining the levels of complex socio-technical systems with the theory of ready, willing and able. The theory of ready, willing, and able is founded on the basis that these three preconditions need to be met for a change …

Perspectives, Challenges, And Oral Cancer Screening Practices Of Primary Care Providers At Nebraska Medicine, Nishitha Ponnamaneni

Capstone Experience

Background

High mortality and morbidity associated with oropharyngeal cancer (OPC) are due to delayed diagnosis. Early detection of OPC is possible by incorporating oral cancer screening (OCS) in the annual screening examination protocol of primary care providers (PCPs). The study was aimed to understand the perspectives and barriers of PCPs in screening their patients for OPC.

Objectives

1) To understand challenges PCPs’ face in performing OCS, 2) To determine the factors that influence PCPs’ decision to complete OCS, and 3) To determine if PCPs who received education on OCS are more likely to perform the screening compared to PCPs who …

Evaluating And Increasing Lead Poisoning Prevention Awareness In The Refugee Population Of Douglas County, Ne, Kara Albright

Capstone Experience

Background: Lead poisoning is a major public health concern. It accounted for twelve percent of the global burden for intellectual disabilities, and two and a half percent of the global burden for heart disease and stroke, as well as nearly 500,000 deaths in 2015 (World Health Organization, 2018). While everyone is at risk of lead exposure, refugee and immigrant children are at an increased risk because they have increased access and use of products from outside the United States that have been shown to contain lead (Moser, R., and Brownback, S., 2012; and New York State Department of Health, …