Medicine and Health Sciences Commons^™

Breast Cancer Screening For African American Women, Jennifer Ross

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

INTRO Breast cancer is the most common type of malignancy among women in the United States (U.S.) and the second leading killer. Despite the availability of effective breast screening tools, a disparity has formed. Specifically, white women over the age of 40 experienced a higher incidence rate of breast cancer, while African American women experience higher related mortality rate. The purpose of this study was to examine SES and ethnicity/race factors that may influence breast cancer screening rates, and specifically explore how those factors may differ between African American and white women.

METHODS Women between the ages of 50-74 who …

Impact Of Kentucky Vaccination Exemption Laws On Pertussis Incidence, Katherine Blain

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Purpose: According to CDC statistics, prior to pertussis vaccine development in the 1940’s, about 200,000 children contracted pertussis annually. Today, although this number has decreased drastically, pertussis cases began trending upward again in the 1980’s. There are several proposed contributory factors, including vaccination exemption. In Kentucky, there are both medical and religious exemptions to mandatory school vaccines. The purpose of this study was to examine possible correlations between reported school vaccination exemptions and pertussis incidence in Kentucky counties between the years 2004-2012.

Methods: This study retrospectively analyzed data from 120 Kentucky counties between 2004-2012. The Commonwealth of Kentucky School Annual …

The Comorbidity And Temporal Relationship Between Anxiety Disorders, Eating Disorders, And Personality Disorders, Mitchell C. Duross

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background - Population-level data on the prevalence of comorbidity between anxiety-, eating-, and personality disorders remain relatively unexplored. Additionally, the potential existence of a temporal relationship among these three classes of mental disorder is also of interest.

Methods - Lifetime prevalence of, and temporal relationships among, anxiety-, eating-, and personality disorders were assessed using Part II WHO Composite International Diagnostic Interview data from the National Comorbidity Survey- Replication, a nationally representative household survey (n=5692).

Results - Lifetime prevalence estimates for any anxiety-, eating-, and personality disorder were 59.8%, 2.8%, and 13.5%, respectively, among those diagnosed with at least one core …

Factors Predicting Beta-Blocker Treatment After Myocardial Infarction In Patients With Type 2 Diabetes, Ryan P. Hickson

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

OBJECTIVE – Beta-blockers remain important for secondary prevention after myocardial infarction (MI). Despite clinical guideline recommendations, the potential for poor glycemic control and masking warning signs of hypoglycemia limit their utilization in type 2 diabetes. This study evaluated factors predicting post-MI beta-blocker initiation among type 2 diabetic patients.

RESEARCH DESIGN AND METHODS – A retrospective cohort of employed, commercially insured individuals was developed using de-identified enrollment files, medical claims, and pharmacy claims from 2007-2009 in the U.S. Inclusion criteria: (1) type 2 diabetes, (2) ≥18 years old, (3) continuous eligibility, (4) MI. Exclusion criteria: (1) females prescribed metformin exclusively without …

Demographic Disparities In Children With Behavioral Or Conduct Disorders, Caitlin Dunworth

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

This study examines the demographic disparities in children with externalizing behavior disorders, such as oppositional defiant disorder and conduct disorder, utilizing secondary data from the 2011/2012 National Survey of Children’s Health (NSCH). Current literature suggests that children with externalizing behavior disorders are more likely to be male, live in a low-­‐income family, receive lower grades in school, and to develop later conditions such as depression. Chi square tests and logistic regression were used to examine the associations of presence of a current behavioral or conduct problems with age group, race/ethnicity, sex, household income level, and insurance type. Additionally, associations were …

Fatal Injuries Among Young Workers In Kentucky, 2005-2014, Allison Christian

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Young workers have been more vulnerable to fatal and nonfatal work injuries. To gain a comprehensive understanding of the injuries that led to fatalities in younger workers, the goal of this study was to compare characteristics of young worker fatal injuries in those aged 16-24 to all workers aged 25 and older in Kentucky using a descriptive analysis.

Methods: A retrospective analysis of fatalities among workers under the age of 25 compared to workers aged 25 and older was performed over a ten-year period from 2005-2014 using Kentucky Fatality Assessment and Control Evaluation (FACE) program data.

Results …

The Impact Of Physical And Psychosocial Factors On Workplace Injuries In Nursing Assistants, Colleen Roberts

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective: The objectives of this study were to 1) Describe the nature and prevalence of workplace injuries in nursing assistants (NAs) and 2) Assess the impact of physical and psychosocial works factors on the occurrence of back injuries and muscle strains in these nursing assistants.

Methods: Data for this study are from the 2004 National Nursing Assistant Survey (NNAS), which was conducted as a supplement to the National Nursing Home Survey (NNHS). The original dataset contained 3,017 records. The data were analyzed as a case-control for this study’s purpose. Cases were defined as participants who had experienced a …

The Role Predictors Of Socioeconomic Status Play In Receipt Of The Shingles Vaccination In Adults Aged 50 Years Of Age And Above In The United States, Lesley Williams

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Introduction: Vaccinations help to prevent deleterious diseases or lessen their side effects, saving millions in healthcare expenditures. While we associate most vaccinations with children, there are specific vaccinations that are indicated in the elderly. The shingles, or herpes zoster, vaccination is indicated in all adults over the age of 50 years of age to prevent the development of or lessen the severity of shingles – the re­‐emergence of chickenpox in the form of painful blisters on the body, however, statistics indicate that only around 20% of the indicated population has ever received that vaccination. Why have so few been …

Pulmonary Function Among Latino Thoroughbred Workers - A Pilot Study, John C. Flunker

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background/Objectives

Evidence suggests working in horse barns is associated with adverse respiratory effects among Latino thoroughbred workers, yet no studies to date have measured pulmonary function. We examined the prevalence of self-reported respiratory symptoms, abnormal pulmonary function, and associated occupational factors among Latino thoroughbred farmworkers.

Methods

Participants were recruited via a community-based, purposive sampling strategy and participated in an interview-administered survey and spirometer test. Surveys and spirometry tests were administered to 80 participants by two trained health promoters (Promotoras) in July-September 2014. Pulmonary function (abnormal/normal) was classified by a pulmonologist. Demographic and occupational factors were assessed for associations with respiratory …

Relationship Of Bmi And Weight Perception To Weight Controlling Behaviors In 9th-12th Graders In The United States, Natalie Jones

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Research indicates that high school students constitute the largest portion of those participating in unhealthy weight control behaviors. There is, however, little research that indicates what this behavior is influenced from. This study investigated the relationship of Body Mass Index (BMI) and (discordant or concordant) weight perception to weight control behaviors among 9th-12th graders in the United States. Using data from the 2013 Youth Risk Behavior Surveillance System (YRBSS), over 40 states and 13,000 surveys completed. Multiple Chi-square tests were performed, examining the association between BMI and weight perception in relation to weight control behaviors. We then examined whether perception …

Trends In Drug Use During Suicide, 2005-2012, Kentucky, Jacqueline Seals

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective

With high rates of suicides worldwide more research on suicide is necessary for improved prevention strategies. This study examines the trends of positive drug tests at the time of suicide in Kentucky with respect to region, time, and intrapersonal violence.

Methods

Data from the Kentucky Violent Death Reporting System was used to look at all suicides in Kentucky from 2005 to 2012 amongst individuals 10 or older (n= 4691). Trends of opiates, amphetamines, cocaine, marijuana, benzodiazepine, and barbiturates were examined. The relationship of a positive drug test and time and intrapersonal violence were evaluated with an ANOVA test and …

Variation In Colorectal Screening Rates In Kentucky Since The Development Of The Colon Cancer Screening Program In 2008, Pranav Rane

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective

The purpose of this study is to analyze colorectal cancer (CRC) screening rates post-enactment of KRS 214.540 through 214.540. More specifically this study seeks to highlight the variation in CRC screening rates post-policy vs. pre-policy among the target population: uninsured individuals between the ages of 50 – 64.

Methods

Behavioral Risk Factor Surveillance System (BRFSS) was utilized to obtain individual-level data regarding CRC screening in Kentucky from 2004-2012. Statistical Analysis System (SAS) version 9.1 was utilized to compile data and the variables for home blood-stool and for sigmoid/colonoscopy were combined into one variable to identify individuals who had received …

Regional Differences Of Hepatitis C Virus Infection In Kentucky, Yvette N. Achuo-Egbe

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective: Few studies have been conducted in Kentucky to investigate the statewide prevalence of HCV infection and its associated risk factors. The purpose of this study was to examine the factors related to HCV infection in the state, and specifically to investigate geographical differences of HCV infection between those residing in Appalachian vs. Non-Appalachian counties in Kentucky.

Methods: The study sample (n =5205) was selected from a pool of 8300 high-risk individuals participating in a pilot cross-sectional study on HCV conducted by the Kentucky Department for Public Health. The pilot study involved serologically testing participants for antibodies against HCV infection …

Assessment Of Breastfeeding Policies In A Sample Of Inner City Child-Care Centers In North-Central Kentucky, Ana Maria Machado

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Protection, promotion, and support of breastfeeding (BF) are critical public health needs. Breastfeeding has been proven to provide the healthiest start in life and has been shown to have a myriad of health benefits for infants, mothers and society at large. Exclusive and long term breastfeeding has been found to have protective function against the prevalence of obesity as well as many other adverse health outcomes. Higher levels of breastfeeding support in the child-care setting have been associated with higher likelihood of duration of breastfeeding for mothers and infants. The primary objective of this study was to assess the current …

Correlates Of Depression And Poor Respiratory Health: A Cohort Study In A Rural County, Stephanie Courtney

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective

High rates of depression are widespread globally and are among the leading causes of disability. To better understand the effects of depression on health outcomes, more research is necessary. This study examines the associations between depression and adverse respiratory outcomes among a cohort of Iowa residents living in a rural county. This study also investigates differences in the reporting of chronic and incident respiratory outcomes.

Methods

Data were obtained from the Keokuk County Rural Health Study (1994-2004) for individuals 18 years of age or older (N=1012). The primary outcome, poor respiratory health (PRH), was based on self-reported diagnoses for …

Salmonellosis In Kentucky Cattle - 2003-2014, Azia Elizabeth Ramirez

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The group of bacteria known collectively as Salmonella has historically been a major cause of both health and economic hardships. In particular, Salmonella in bovine has been estimated to cause the economy to lose billions of dollars annually, both due to the increased morbidity and mortality rates of the cattle themselves and the indirect loss of potential profits, and also results in the spread of the bacteria to humans to ill effect. Salmonella thus can be quite taxing to agricultural communities, the animals upon which they rely, and the consumers that buy said communities’ commodities. Thus, the importance of an …

Enhancing The Value Care Of Lung Cancer Treatment For Medically Underserved Population In Kentucky, Morita Sari

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background

For many years Kentucky has had the nation’s highest lung cancer incidence. Kentucky is one of the thirteen states in Appalachia in which the difference in wealth is a key determinant of health, since residents of Appalachia do not have access to the same financial resources as the rest of the US population. The disparities in lung cancer mortality within the Commonwealth of Kentucky are not completely clear, but some postulate that poor access to care or substandard care may contribute. In this study the value of lung cancer treatment for a medically underserved population (Appalachia) will be evaluated …

Outbreak Severity Index: The International Response To The Global Outbreaks, Mohamed A. Abofaye

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Outbreaks are emergency situations that carry hazards of death, disability, loss of home and property, and variety of other calamities. With technological advancement, not only people and commodities are easy to transfer but also disease outbreaks. However, outbreaks are dealt with by different countries based on the differences in their healthcare systems and their ability to achieve effective control of the outbreak. SARS, MERS, and Ebola are example of such outbreaks that traveled around the globe and successful control was different according to the virulence of outbreak agent and to the effectiveness of local health system control measures. This capstone …

Injury Prevention In An Industrial Environment Via Strategic Job Placement, Michelle Cooper

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objectives. This study investigated the effects of an injury prevention program, specific to work related musculoskeletal disorders (WMSDs), which placed employees into jobs based on their physical abilities compared to the physical demands of their prospective jobs.

Methods. Employee injury data (N=3550) from a large auto manufacturer in the U.S. was analyzed to examine changes in injury rates for employees that were hired pre versus post-strategic placement. Bivariate and multivariate analyses were used to determine dependence between placement, injury within 120 days of hire and gender.

Results. Chi-square tests of independence revealed that injury rates and job placement may be …

Using Public Health Accreditation (Phab) Standards To Improve Efficiency And Effectiveness In A Local Health Department (Bourbon County, Kentucky), Helen Karrick Sauer

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objectives: Small and rural local health departments face unique challenges in maintaining their operations amongst budget cuts. Accreditation of local health departments by the Public Health Accreditation Board (PHAB) has been identified as a strategy to help struggling health departments improve their efficiency and effectiveness. These health departments may be able to enjoy the benefits of accreditation even without ultimately achieving it by deliberately aligning themselves with PHAB standards. Methods: This capstone report presents a case study of the Bourbon County Health Department (BCHD). Using PHAB accreditation standards as a playbook, the public health director (PHD) reorganized BCHD to focus …

Organizational Effectiveness Frameworks In Public Health Nonprofit Systems: A Case Study, Morgan Floyd

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Problem: Nonprofits, especially in public health, have become more and more prevalent in recent years. With that increase in support, come greater awareness from stakeholders evaluate nonprofits as effective and impactful on the communities they serve. Frameworks of Organization Effectiveness allow investigators to predict how effective an organization might be in their work. The aims of this study were to identify key Organizational Effectiveness frameworks that could be used to evaluate Nonprofits and use them in practice. Therefore, individuals wishing to become involved with effective nonprofits will be empowered to make good investments of volunteer time and donations

Method: This …

Policy Analysis Of Kentucky Senate Bill 192, Sierra Nicole Dantzler

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Needle sharing has become an important factor in the prevalence of HIV and viral hepatitis rates as injection drug use of illicit substances, such as heroin and prescription opioids, has increased across the United States. Kentucky, much like the rest of the nation, has also been devastated by the recent surge of injection drug use. In 2010, drug overdose rates ranked Kentucky as the third highest state in the nation. Hepatitis B (HBV) and Hepatitis C (HCV) rates within Kentucky have been consistently higher than the national rate since 2007 and 2003, respectively. Hospital discharge costs related to HCV infections …

Concealed Weapon Proliferation And The Impact On Firearm-Related Fatalities And Injuries Due To Assault In Kentucky, 2005-2013, Travis Young

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objectives: The objective of our research was to look broadly at firearms and health in the state of Kentucky, where annual gun purchases are rising and laws eliminating restrictions on concealed carry have empowered more than 300,000 citizens to carry firearms in virtually any public setting. As guns become more prevalent, and more readily accessible, will violent crime decrease as some have predicted, or will the potential for conflict escalation cause the opposite effect?

Methods: Utilizing death records for firearm-related homicides and hospitalization and emergency department visit data for injuries occurring due to firearm-related assault, we correlated the rate of …

The Use Of Local Tax Dollars In Kentucky Local Health Departments To Sustain Programs From 2009-2013, Crystal A. Miller

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

This is a descriptive “case” study of public health finance in Kentucky, no data from other states were examined. The data used in this study were provided by the Kentucky Department for Public Health (KDPH). The data used in this study are longitudinal (2009-2013) and the core focus of this study is on: 1) changes in funding from the state to the 57-61 local health departments (single county and multi-county district departments) 2009-13, 2) changes in restricted and un-restricted fund reserves among local health departments, and 3) an examination of the local taxing districts and greater reliance on use of …

Tier 1 Genomic Applications: A Kentucky State Needs Assessment, Andrea L. Durst

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Paper 1: An Assessment of Kentucky Cancer Registry Data for Appropriate Referral to Genetic Services for Hereditary Breast and Ovarian Cancer Syndrome and Lynch Syndrome, 2009-2012

BACKGROUND: It is estimated that over 1 million people in the United States have Hereditary Breast and Ovarian Cancer syndrome (HBOC) or Lynch syndrome (LS). Evidence-based guidelines for identifying individuals with HBOC and LS are available, and the CDC has developed a toolkit to provide guidance for the implementation of programs to increase identification of patients appropriate for cancer genetic services. However, most individuals with HBOC and LS remain undiagnosed. While some state public …

Do Air Pollutant Emissions Lead To An Increase In Total Personal Health Care Costs By State?, Dana Jespersen

MPA/MPP/MPFM Capstone Projects

Total personal health care costs are increasing in the United States every year. Currently personal health care costs are predicted to increase at a national average rate of 6.5 percent. This is on track with the historical data. The increase has returned to the 6.0 percent mark after falling down to an increase of 3.7 percent in 2013. Recovering from the recession and the implementation of the Affordable Care Act has contributed to the steady increase back up to the average 6 percent increase per year. When looking at individual states, all averaged around the 6 to 8 percent increase …

Mechanisms Of Therapeutic Resistance In Castration Resistant Prostate Cancer, Sarah Katherine Martin

Theses and Dissertations--Molecular and Cellular Biochemistry

Taxane based chemotherapy is an effective treatment for castration-resistant prostate cancer (CRPC) via stabilization of microtubules. Progression to castration-resistant prostate cancer is characterized by increased androgen receptor (AR), elevated intra-prostatic androgens and activated AR signaling despite castrate levels of androgens.

Previous studies identified that the inhibitory effect of microtubule targeting chemotherapy on AR activity was conferred by interfering with AR intracellular trafficking. The N-terminal domain (NTD) of AR was identified as a tubulin interacting domain that can be effectively targeted by the novel small molecular inhibitor, EPI. Taken together, this evidence provided the rationale that targeting AR nuclear translocation and …

Clinical Applications Of Cyp Genotyping In Psychiatry, Edoardo Spina, Jose De Leon

Psychiatry Faculty Publications

A critical review of the limited available evidence and the authors’ experience and judgment are used to summarize the role of cytochrome P450 (CYP) genetic variants in the pharmacokinetics of and clinical response to psychotropic medications. CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6 and CYP3A4 genetic polymorphisms and their contributions to the metabolism of psychotropic drugs are reviewed. CYP1A2, CYP2B6 and CYP3A4 genotyping have limited current clinical utility. CYP2C9 genotyping has no utility in psychiatry. Psychiatrists should master tricyclic antidepressant (TCA) prescription, and if they use TCAs, they should have expertise in CYP2D6 and CYP2C19 genotyping and in TCA therapeutic drug monitoring …

Evaluation Of Chlorhexidine Bathing Practices In Trauma/ Surgical Intensive Care Units, Kara Willett

DNP Projects

Central venous catheters (CVC) are vital in present-day medical practice, particularly in the intensive care unit (ICU). However, their use puts patients at risk for developing central line-associated bloodstream infections (CLABSIs) which are a major concern in today’s health care system. CLABSIs are a significant source of patient mortality, increased length of stay, and healthcare spending. The heightened awareness of these infections along with their escalating cost has amplified implementation of preventative protocols.This practice inquiry project includes three manuscripts, each of which discusses relevant aspects of CLABSIs prevention utilizing daily whole body chlorhexidine gluconate bathing inlcuding a review of literautre …

Treatment Outcomes For Opiate Addicted Pregnant Women, Jennifer L. Roth Parr

DNP Projects

The problem of opiate addiction is complex enough but compounded when the patient is pregnant. Substance use during pregnancy produces harmful and costly effects to both the mother and the fetus (Veilleux, Colvin, Anderson, York & Hines, 2010). The rate of opiate addiction among pregnant women in the U.S. has been increasing in epidemic numbers since the beginning of the 21st century. This paper looks at research on the origin of the problem, the demographics of the average pregnant opiate addicted patient, the effects on the woman and her unborn child, and available treatment options.