Medicine and Health Sciences Commons^™

Point Of Care Spirometry Assessment For Pediatric Asthma Prevalence In A Family Homeless Shelter In Omaha, Nebraska, Nathaniel Mattison, Dale Agner, Breanne Parets, Haley Mathews, Emily Saliga, Maria Vacha, Jamicah Harris, Ryan Saliga

Graduate Medical Education Research Journal

Abstract:

Introduction: The few studies on pediatric asthma in US homeless shelters describe a 27.9 – 39.8% prevalence, and historically Omaha has had a high incidence of fatal pediatric asthma. Thereby, Clarkson Family Medicine (CFM) residency began a pediatric asthma outreach to a local family-homeless shelter to assess the prevalence of pediatric asthma and follow-up appointment attendance.

Methods: We obtained a voluntary parent-child assessment of the child’s respiratory history and an Asthma Control Test (ACT) between ages 4-18 for children residing at the family-homeless shelter. We obtained a pre-albuterol and post-albuterol mobile spirometer assessment using the Global Initiative for …

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 …

Gender Disparity In Obesity And Lifestyle Characteristics Among Adults In Mississippi, Jalysa M. Edwards

Capstone Experience

Obesity is a primary public health concern and is associated with several chronic health diseases that can have dire consequences. According to the World Health Organization (WHO), there were about 1.9 billion overweight adults aged 18 years and above and at least 650 million adults were obese worldwide in 2016. Adults living in Mississippi are of particular concern, due to the high obesity rate which has continued to increase over the past 25 years. Mississippi’s obesity rate is 37.3%, which is one of the highest rates of adult obesity in the United. While obesity increases the risk of disease outcomes, …

Cadmium And Chromium Evaluation Of Offutt Air Force Base Aircraft Maintenance Bay, Nickolas Lamal

Capstone Experience

The 55th Aircraft Maintenance Squadron is based out of Offutt Air Force Base (AFB). The organization has requested testing of Air Ground Equipment (AGE) maintenance operations for heavy metals, specifically cadmium and chromium while evaluating one break area for the harmful compounds. It is hypothesized that heavy metals may be in excessive limits and could potentially harm staff and their families as take-home toxins. If left uninvestigated and evaluated, excessive exposure to heavy metals could cause injury or illness within the unit’s ranks, decreasing unit effectiveness and efficiency. Sampling methods include preliminary assessments of break area and adjacent glass bead …

Impact Of Local Covid-19 Policies On The Homeless Population: Case Study In Two Montana Counties, Franchesca D. Talbot

Capstone Experience

COVID-19 has had a significant impact on people experiencing homelessness in Montana. In each Montana County, local policies in addition to individual shelter policies determine the requirements for homeless shelters in relation to capacity, distancing, and other public health measures designed to prevent the spread of COVID-19. The policies often differ from county to county, which often lead to different outcomes across the state. This case study analyzed data from multiple sources on the number of COVID-19 cases and deaths among the homeless populations in Missoula and Lewis and Clark Counties in Montana and linked them to the effectiveness of …

Predictors Of Poor Glycemic Control In Diabetic Clients With Mental Health Illness, Community Alliance, Omaha, Nebraska, Rachelle Flick

Capstone Experience

People with severe mental illness tend to die 10-25 years earlier than the general population (WHO). Main contributors to these premature deaths include comorbidities such as hypertension, cardiovascular disease, and diabetes. Diabetes prevalence in mentally ill people is 2 times higher than the general population (WHO). The World Health Organization is taking action to improve the health of people with severe mental illness. These efforts include creating protocols of prevention, identification, assessment, and treatment for mentally ill people, as well as improving access to general health services through the integration of physical and mental health services. Community Alliance, located in …

A Literature Review Of Paid Sick Leave And Disparate Populations In The United States During The Covid Pandemic, Jessica Davies

Capstone Experience

The COVID pandemic is providing many public health and health policy learning opportunities to identify disparities among women, minorities, and underserved/distressed populations and inform subsequent policy-level strategies. It is recommended people stay home when they are sick; yet, not all people have access to paid sick leave. Individuals are left with the unfortunate decision to lose pay or go to work when they are ill. This is disconcerting in any given year with the annual flu illness and other communicable diseases; however, especially concerning during the COVID pandemic given the high virus transmissibility. Paid sick leave is not universally accessible …

Derivation And Validation Of A General Predictive Model For Long Term Risks For Mortality And Invasive Cardiovascular Interventions In Congenital Heart Disease, David A. Danford

Capstone Experience

Introduction. Accurate assessment of prognosis is a key driver of clinical decision making in congenital heart disease (CHD), but is complicated because CHD represents such a diverse collection of conditions. The aim of this investigation is to derive, validate, and calibrate multivariable predictive models for time to surgical or catheter-mediated intervention (INT) in CHD and for time to death in CHD. Methods. 4108 unique subjects were prospectively and consecutively enrolled, and randomized to derivation and validation cohorts. Total follow up was 26,578 patient-years, with 102 deaths and 868 INTs. Accelerated failure time multivariable predictive models for the outcomes, based on …

Occupational Injuries Associated With Workplace Violence In An Academic Medical Center, Rebecca J. Bonacci

Capstone Experience

Violence is a major source of workplace injury in the medical profession. Peer reviewed literature is lacking for workers that have injuries through violence from clients who have intellectual disabilities. Literature for hospital security is also lacking. In this study of workplace violence, we compared injuries among the occupational groups at an academic medical center from 2017-2020. We hypothesized that violence will be similar across the years. Occupational injury and illness data was obtained from an academic medical center. The number of violence cases was divided by the total number of injury cases and reported as a percentage. We found …

Population-Level Prevalence Of Depression And Summary Statistics Of Women With At Least A Year Post-Final Menstruation With And Without Hysterectomy, Happiness Kingi

Capstone Experience

Background: Depression is associated with estrogen hormonal changes. There are few comparisons studies on the population-level prevalence of depression in women at least a year post final menstruation with and without hysterectomy.

Objectives: 1) To determine the population-level prevalence of depression in women with at least a year post final menstruation with and without hysterectomy and 2) to calculate the summary statistics of women with at least a year post final menstruation with and without hysterectomy

Methods: A population-based cross-sectional design was used. Respondents were female participants of the U.S. National Health and Nutrition Examination Survey (NHANES) …

Evaluating Nebraska Ems Providers' Ability And Willingness To Respond To Bioterrorism Emergencies, Ryan Houser

Capstone Experience

Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack, and identify factors that predict preparedness and willingness among Nebraska Emergency Medical Service providers, who are key to resilience in the face of an attack. The survey was available for one month in 2021 during which 190 EMS providers responded to the survey. The subjects included Registered Nurses, doctors, EMTs, and paramedics. Only 10% of the respondents are both …

Developing And Piloting An E-Learning Module On Respiratory Protection, Emily Girard

Capstone Experience

Respiratory diseases are one of the most common causes of occupational illnesses in the United States. Many occupations use personal protective equipment (PPE) in the form of respirators to protect against respiratory hazards when other control methods are not effective. However, some workers may not have had adequate training on their use. An e-learning module was developed to provide information about respirators and their use in agriculture. The interactions of matching, sorting, and review questions require the user to be an active participant with the goal of reinforcing the information. It was hypothesized the average summative assessment score would increase …

Factors Contributing To Trust Of Occupational Healthcare Services In Meatpacking Plants, Gabriella Ochoa

Capstone Experience

Meatpacking refers to the slaughtering of livestock and processing and packaging it into meat and other byproducts. Meatpacking is a large industry employing thousands of workers from various racial and socioeconomic backgrounds in Nebraska. These workers have experienced disparities in accessing occupational health services such as language barriers, fear of job loss, or deportation due to immigration status if these services were used. The purpose of this study was to investigate how trust in occupational health services varied among employees at a meatpacking plant in Nebraska by demographic characteristics, particularly by ethnicity, gender, and English language proficiency.

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 …

Re-Aim Evaluation Of Workplace Weight Management Interventions: A Systematic Review, Adrienne Gothard

Capstone Experience

Overweight/Obesity is a major public health concern that affects nearly a third of the world’s population. In addition to personal health effects such as cardiovascular disease, cancer, and diabetes, obesity can take a toll on an employer’s bottom line, specifically healthcare costs and absenteeism. Many employers promote intervention programs targeted at lifestyle and behavioral factors to improve workforce health. A 2016 systematic review by Weerasekara et al. compared several of these intervention programs based on the effectiveness of the program, measured in participant’s weight changes from baseline to post-intervention. While this information can be valuable to employers who are interested …

How The Covid-19 Pandemic May Have Impacted Hospital Acquired Infection Rates, Mackenzie Lecy-Schoenherr

Capstone Experience

Background: Hospital Acquired Infections (HAIs) are preventable; however, they continue to occur. Many HAI’s can be prevented by adhering to the Centers for Disease Control and Prevention (CDC) Healthcare Infection Control Guidelines. In late 2019 a novel virus, known as SARS-CoV-2, or COVID-19, emerged and spread across the globe. CDC recommended additional infection prevention and control practices during the COVID-19 pandemic, in addition to standard practices. This study will compare HAI rates before and during the COVID-19 pandemic as well as between COVID and non-COVID units.

Methods: HAI data collected pre-COVID-19 and during COVID-19 will be compared to determine …

Barriers Associated With Mental Health Services For People With Refugee Background In Douglas County, Mustapha Barry

Capstone Experience

INTRODUCTION: The United States of America has been one of the leading countries where refugees from all over the world seek safety and security under the refugee resettlement program. Research suggests that refugees underutilize mental health services throughout the United States, despite the higher rates of mental health issues among refugees.

OBJECTIVE: This study explored barriers, support services, and factors associated with mental health services utilization among people with refugee backgrounds in Douglas County, Nebraska.

METHODS: Data from 30 participants were collected through a telephone survey and analyzed to determine participant’s level of mental health services utilization, barriers to mental …

Association Of New And/Or Progressive Multiple Organ Dysfunction Syndrome With Mortality And New Morbidity Among Children Encountering Septic Shock, Rachel L. Waworuntu

Capstone Experience

Despite reductions in sepsis mortality, there remains a substantial morbidity burden among children who survive sepsis. Furthermore, the majority develop multiple organ ‘group has historically been analyzed as a single cohort. Using the Life After Pediatric Sepsis Evaluation (LAPSE) investigation database, we studied the association of new and progressive multiple organ dysfunction syndrome (NPMODS) with morbidity and mortality among children with septic shock. We hypothesized that NPMODS represents a distinct phenotype based on evolving organ dysfunction. There was evidence of an association but it did not reach the 0.05 level of significance. We also hypothesized and confirmed that children with …

Evaluating A Community-Based Breastfeeding Support Organization In Nebraska, Katelyn Elaine Goodroe

Capstone Experience

Specific Aims: The aims of this evaluation plan are to investigate the role of the Nebraska nonprofit organization, MilkWorks, in promoting breastfeeding and family support programming and to identify future internal and external growth opportunities through an assessment of the organizational practices using stakeholder perspectives and marketing structure to better promote infant and parental health.

Significance: As a best practice, evaluation of MilkWorks is critical to providing proper services for promoting infant development and parental health in urban and rural Nebraska communities.

Background: MilkWorks was founded in Lincoln, Nebraska, by mothers with the intention of promoting breastfeeding by offering support …

The Impact Of Obesity On Covid-19 Outcomes In A High-Risk, Majority Hispanic Community Sample, Maxwell A. Lawlor

Capstone Experience

The novel coronavirus disease 2019 (COVID-19) pandemic has caused over 33.7 million cases and 605,000 deaths in the United States¹. Factors associated with increased odds for hospitalization, death, and other poor outcomes include age, comorbid conditions like cardiovascular disease and lung disease, and obesity. COVID-19 has also disproportionately affected Hispanic communities across the United States and in Omaha. Potential explanations for this disparity include social determinants of health, particularly occupational factors, structural challenges to access healthcare services, and increased medical comorbidities including obesity. In this retrospective cohort study, we used patient data from April to May 2020 (N=1,000) …

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 …