A Comparison Of Post-Concussion Neurocognitive Test Results Of Recently Concussed High School Athletes To Their Neurocognitive Baseline Test Results Prior To Returning To Play, Karen Powers

DNP Projects

PURPOSE: In 2017, an estimated 2.5 million U.S. high school students reported having suffered at least one concussion while participating in sports or physical activity during the previous year. The purpose of this study is to evaluate the incidence of concussion among high school athletes and compare the athletes’ post-injury neurocognitive function to their baseline test results prior to returning to play.

METHODS: A retrospective records review of neurocognitive test scores of high school athletes during the June 2017 – June 2018 sport season was conducted. The records of 696 high school athletes were reviewed, including 30 post-injury test scores. …

Evaluation Of A Palliative Care Initiative On The African Continent: Responsibly Improving Access To Pain Treatment, J. Spencer Hirschi

MPA/MPP/MPFM Capstone Projects

The African continent today faces a crisis of inadequate palliative care, in spite of the growing level of suffering of its citizens who are faced with debilitating diseases and injuries. Much of this problem stems from deeply ingrained attitudes towards opioids: while the American continent grapples with the effects of opioid overprescribing, physicians trained in Africa are taught that opioids are inappropriate for virtually all scenarios, and therefore they come to fear and avoid their use or simply remain untrained on them altogether. Patients fail to advocate for themselves out of submission to the doctor’s authority, governments remain apathetic to …

Evaluating The Impact Of Fine Particulate Matter Pollution Standards On Mortality Rates In The Southeastern United States, Lauren Wice

MPA/MPP/MPFM Capstone Projects

The Environmental Protection Agency (EPA) continuously monitors six criteria pollutants that are known to have impacts on public health and welfare. One of these pollutants, fine particulate matter, or PM_2.5 (which includes particles that are smaller than 2.5 micrometers in diameter), is easily inhalable and can enter the lining of the lungs and the bloodstream, posing a great risk to human health. Standards for allowable concentrations of PM_2.5 were amended in 1997, 2006, and again in 2012, becoming increasingly stringent each time. According to the EPA, health organizations, and other research studies, these particles can specifically contribute to …

Lung Cancer Screening In A Community Setting: Characteristics, Motivations, And Attitudes Of Individuals Being Screened, Margaret M. Byrne, Sarah E. Lillie, Jamie L. Studts

Behavioral Science Faculty Publications

We describe the characteristics of individuals being screened in community settings including factors influencing screening decisions and the level of information sought prior to screening. Individuals from two community-based radiology clinics (N = 27) were surveyed after screening. Screening efficacy and salience were the most important factors in screening decisions, whereas healthcare provider recommendations were rated not important. Half of participants reported no or little conversation about screening with their primary care provider, and 61.5 percent had not sought any information on screening. Individuals being screened in a community setting are unlikely to have sufficient information for an informed …

Improving Access To Antenatal Care In Ngara, Tanzania Through Implementation Of The Lady Health Worker Programme, Alison L. Bailey

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

Maternal mortality is one of the greatest health disparities facing the world today. A disproportionate number of women who die from pregnancy-related complications live in developing countries: the average maternal mortality in developed nations is 12/100,000, compared to 239/100,000 in developing nations; this rate is even higher in several sub-Saharan African nations. Reasons for this disparity include a lack of providers, inaccessibility to care, and poor quality of treatment in developing nations. Women living in the sub-Saharan country of Tanzania face many of these barriers, and as a result the country’s maternal mortality rate is 398/100,000. Antenatal care is an …

Trends In Opioid Use Disorder Among Pregnant Women And Opioid Use During Vaginal Delivery Hospitalization, Ayooluwatomiwa Deborah Adekunle

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

Background: The prevalence of opioid use in pregnancy has increased sharply in recent years. Kentucky is one of the hardest hits states and has seen many babies born with withdrawal symptoms over the past decade. Recent years have seen an increase in efforts to decrease opioid use in both inpatient and outpatient settings. However, Kentucky continues to have high rates of opioid prescription. This study aims at looking at trends in Opioid Use Disorder (OUD) in pregnancy, Neonatal Opioid Withdrawal Syndrome(NOWS) and the use of opioids during delivery hospitalization at a Kentucky tertiary institution.

Methods- Data on all deliveries between …

Examining The Effects Of Indiana’S Syringe Exchange Program On New Hepatitis C And Hiv Diagnoses From 2015-2017, Katherine Youngen

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

In 2015, a rural Indiana county experienced an outbreak of HIV related to intravenous drug use. 181 people were diagnosed with HIV between Oct. 1, 2014 and Nov. 1, 2015. This outbreak prompted the state legislature to implement a policy that legalized syringe exchange programs for the first time ever in Indiana. This capstone attempts to summarize the situation that led to the creation of this policy and the effects of this policy, Indiana Senate Enrolled Act 461 (IN SEA 461). Finally, this capstone makes recommendations for modifying the existing policy or implementing a similar policy in an area experiencing …

Case-Control Study Of Nutrition And Lung Cancer In Appalachian Kentucky, Afton N. Wright

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

Background and Objectives

Lung cancer is the most common cause of cancer-related deaths world-wide. Recent studies suggest a possible association between nutrition and risk for specific histological subtypes of cancer. We examined the relationship between nutrition and lung cancer histology in Kentucky, a largely rural U.S. state that ranks among the highest in the nation in lung cancer rates, as well as diseases related to diet, such as diabetes and obesity. The objective of this study was to examine the impact of nutrition on lung cancer risk and histology in Kentucky. More specifically, we wanted to investigate potential associations with …

Influence Of Occupation And Geographic Location On Underground Coal Miner Exposure To Respirable Crystalline Silica, Quantez Ramaud Crowe

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

I. Specific Aims:

i. Review potential factors contributing to the resurgence of coal workers’ pneumoconiosis (CWP) in Appalachia and analyze the Mine Safety and Health Administration (MSHA) Complete Quartz dataset for potential contributors of underground (UG) coal miner exposure to silica and coal dust.

Objectives:

1. i. To provide evidence of an association between silica and coal dust exposure and various UG coal miner occupations and mine locations.
2. ii. Explore changes over time in UG coal miner silica exposure, dust exposure, and silica concentration in samples collected.
3. iii. Determine if UG coal miners have experienced an increase in exposure to silica …

Analyzing Differences In Mental Health Treatment Seeking Behavior In Hopkins County, Kentucky, Kathryn Olson Gross

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

Rates of mental illnesses are consistently higher in the corrections system at all levels of incarceration. However, local jails are largely unable to meet the mental health needs of their inmates. Considering that there are several barriers to treatment seeking such as stigma, transportation, or availability of services in rural areas already, the treatment seeking behavior of people in jail differs from those not in jail. The objective of this research is to understand the factors that influence treatment seeking behavior among those in jails, and how those factors differ from those not in jail. Overall people in jail had …

Drugs, Alcohol, And Their Impact On The Severity Of A Traumatic Work-Related Injury, Keisha Mcfarlane

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

Objectives

Traumatic work-related injuries result in thousands of deaths per year in the United States. It is important to determine factors that may contribute to these deaths in order to find ways to decrease the risk of injury. The study objectives were to determine if alcohol and drug (prescription and illicit) use could increase the risk of severe injuries or cause a specific mechanism of injury (being struck by or against an object, a fall, or injured as an occupant in a motor vehicle) when consumed prior to an injury.

Methods

A retrospective, facility-based, case review study of traumatic work-related …

Assessing The Tuberculosis (Tb) Screening Compliance Rates And Treatment Completion Among International Students At The University Of Kentucky, Bongiwe P. Malinga

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

Background: Tuberculosis early screening and diagnosis are cost-effective strategies for infection control. Tuberculosis elimination which is aimed for 2030 requires that both latent tuberculosis and active disease be fully treated. This study measures the tuberculosis screening rates and treatment completion rates among the international students at the University of Kentucky between 2016 and 2018.

Methods: This retrospective cohort study included all J1 and F1 student visa holders enrolling from 2016 fall to 2017 fall. To accommodate the nine months treatment completion, the cohort period overlapped to 2018. Data were provided by the University Health Services and the sample size …

Consultation Experience In Public Health, Zimu Li

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

Nowadays, students safe in violence area is becoming to a huge problems, from the survey- National Youth Risk Behavior Survey we find that the sexual and dating violence rate is increasing during the past few years.For the willing that we try to reduce the risk of dating and sexual violence, we are going to build some programs and publish them to the society especially the schools to protect our teenagers. As we know that the period for students from high school to the university is a very important time to build their right social norms, we start a program called …

Implementing Components Of The Cafeteria Power Plus Project And The Five-A-Day Power Plus Project With The Catch’S Go, Slow & Whoa Program To Increase Fruit And Vegetable Consumption In Community Eligibility Provision Elementary Schools In Lexington, Ky, Kayla Payton Keller

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

Poor diet quality is a leading risk factor for many chronic diseases affecting Americans today. Increasing consumption of fresh fruits and vegetables during childhood helps to protect against chronic diseases in adulthood and overall prolonged healthier habits. Since 1988, trends in fruit consumption remain unchanged in the United States and vegetable consumption has slightly decreased. Communities living under the poverty level have a greater disparity for access to and consumption of fresh fruits and vegetables. This proposal is given by the Lexington Fayette County Health Department (LFCHD) and combines aspects of three evidence-based programs: the 5-a-day Power Plus Project, the …

Women Identifying New Goals Of Safety (Wings) In Conflict Affected Regions Of Ukraine, Maryna Hrudii

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

According to Radio’s Liberty (Radiosvoboda) analyses of data provided by United Nations Population Fund (UNFPA), the National Violence Hotline and the Geneva Center of Democratic Control of Armed Forces (DCAF), there were 1.85 million survivors of intimate partner violence (IPV) in Ukraine in 2014-2017, and of these, only 83,000 contacted the police. IPV and gender based violence (GBV) in Ukraine remain underreported due to the lack of law enforcement investigations, as well as due to stigma and shame. Women in conflict-ridden regions of Ukraine are at heightened risk for GBV/IPV. The project will IPV/GBV in Luhansk and Donetsk regions, where …

Reducing Infant Mortality Through The Nurse Family Partnership Home Visitation Program In Montgomery County, Alabama, Kristyn Hill

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

The mitigation of infant mortality (IM) has long been a public health effort within the United States. And although the rates have dramatically decreased with medical advancements, certain populations remain disproportionately affected. There are various factors that are thought to contribute to our IM rates and the disparities between women of varying demographics. Alabama has the highest rates of infant mortality in our county, and women of color within the state have even higher rates.

Many programs with goals of decreasing the IM rate within the United States have been implemented over time. In particular, home visitation programs have been …

Evaluating The Effects Of Safe Injection Facility Legalization On Fatal And Non-Fatal Overdose And Infectious Disease, Olivia M. Ramirez

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

In 2017, 70,000 lives were lost to fatal drug overdoses with approximately 46,000 of those involving the use of prescription and illicit opioids (CDC, 2018b). Unaddressed, the opioid epidemic is costing large amounts of money, lost productivity and valuable lives.

Injection drug use has also become increasingly common in the United States, as it is an efficient means of consuming opioids. Unfortunately, injecting drugs is also an efficient method of transmitting bloodborne diseases. Estimates show that in the United States, 8% of all new HIV infections in 2010 and 22% of all adults and adolescents with HIV resulted from injection …

Seasonality, Atmospheric Conditions, And Variation In Household Radon, 1990-2015, Nicholas Conley

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

_Background:

Radon is a colorless, odorless, and tasteless radioactive gas. Indoor radon exposure is responsible for at least 21,000 lung cancer deaths per year in the U.S. Radon concentrations vary greatly, with atmospheric conditions as one of the major factors contributing to this variation. There is also a link between season of the year and indoor radon values, with higher readings in winter compared with summer months. Seasonality studies are necessary in order to determine the best time for radon exposure screening. The purpose was to determine if atmospheric conditions (i.e., temperature, precipitation and wind) were predictive of observed home …

The Impact Of Medication Donation Repositories: A Policy Analysis, Lacey Brinegar

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

Two major issues surround the U.S. healthcare system: waste and inaccessibility of prescription drug medication. This paper primarily examines the financial impact medication donation repositories have on individuals and the healthcare system overall. Healthcare facilities may act as repositories for donated medications to be dispensed to those otherwise unable to afford them. The specifics of each policy vary from state to state with some policies covering a wider array of acceptable donations than others. Although Kentucky enacted a policy in 2005, the state still lacks any operational programs. By analyzing the policies of multiple states, this paper elucidates the more …

Culminating Experience In The Application Of Biostatistics In Public Health: A Report On My Consultation Experiences, Samantha Kennedy

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

Executive Summary

This portfolio is a compilation of three different consulting experiences that I have had to opportunity to work with as a part of University of Kentucky’s Master of Public Health program with a concentration in biostatistics. My portfolio consists of project descriptions, notes, reports, relevant SAS code and output, and other supporting materials for the three projects I worked with. Each of the projects that I worked with were vastly different, as was my role in them. As such the supporting documents for each are very different as well, but each does have a brief description of the …

Positive Action: Implementing A Social-Emotional And Character Development Program In Marshall County, Kentucky Schools, Mallory Antel

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

Approximately 8% to 10% of children less than 5 years old experience clinically significant mental health problems, and 10–20% of all children and adolescents have a mental health problem of some type. While the prevalence of mental illness is similar between rural and urban residents, the services available differ significantly. Less than half of rural counties have a mental health facility that provides outpatient treatment for children and adolescents, resulting in children and adolescents in these areas being largely underserved. Following family homes, schools are the primary locations responsible for youth development. Research shows that well- designed, well-implemented school-based prevention …

Assessing The Implementation Of Syringe Exchange Programs In Kentucky: A Case Study, Alexandra Miller

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

Problem: There are currently 52 operating syringe exchange programs in Kentucky; a state that has 25% of the highly vulnerable counties for an HIV outbreak. The implementation process of syringe exchange programs can limit the potential for growth. The aims of this study were to identify key barriers and successes to the implementation process of syringe exchange programs in Kentucky. This was assessed by comparing various social and political factors that come into play in local communities.

Methods: The study was conducted using an exploratory case study approach. The researcher conducted interviews with three key informants at the Louisville Metro …

Exploring Methods To Increase Hiv Testing In Kentucky, Chukwudi Yagazie Mbagwu

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

This project was conducted to develop a policy proposal that would increase HIV testing after evaluating current Kentucky Law and Regulations, current health insurance laws, studies on acceptability of different HIV test, barriers to testing from both providers and patients/individuals, and factors associated with positive likelihood of HIV testing. Based on these findings a proposal was developed that would require changing Kentucky regulations on providers communicating test results to patients, change in what form HIV testing would be covered under certain insurances, develop incentives for patients to be tested and report their results to their provider (and hence increasing surveillance …

Second Hand Smoke Exposure And Memory Performance In An Appalachian Pediatric Cohort, Zaynab Al Abdali

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

Background: Smoking rates in Appalachian counties are about two times higher than in non- Appalachian counties. Apart from the detrimental effects smoking has on the smoker, exposure to second-hand smoke (SHS) can have negative health effects on both adults and children. SHS exposure can result in asthma exacerbations and other respiratory difficulties, impaired neuromotor function, neurobehavioral problems, and decreased performance in school.

Objective: The objective of this study was to determine whether SHS exposure, as measured by serum cotinine, is associated with learning and memory in children, as measured by the California Verbal Learning Test – Children's Version.

Methods: Children …

Ky Stroke Encounter Quality Improvement Project: An Evaluation Of The Differential Administration Of Tpa In Acute Ischemic Stroke, Payton Malone

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

No abstract available

Impact Of Prescription Opioid Access Restrictions On Alcohol-Induced Mortality In Kentucky, Changwe Park

MPA/MPP/MPFM Capstone Projects

Prescription drug monitoring programs (PDMPs) are state policy tools to combat risky opioid prescribing. Since 2012, several states began to mandate PDMP use. As mandating use laws have settled down, evaluating potential adverse events becomes possible.

In this study, I focus on alcohol-induced mortality as a potential unintended consequence via substituting alcohol for prescription opioids, since alcohol and opioids are often concurrently misused as a part of pain self-management. Therefore, the aim of this study is to analyze the unintended consequences of prescription opioid access restrictions on alcohol-induced mortality.

I compare the alcohol-induced mortality among adults during pre- and post-revision …

Evaluating Ways To Reduce Errors In Medication Reconciliations Performed By Nurses In A Rural Hospital Setting, Kalen T. Freeman

MPA/MPP/MPFM Capstone Projects

Medication reconciliation, also known as “med recs”, are an important part of a patient’s care during their hospitalization. A med rec is when hospital personnel generate a list of the medications the patient takes at home. Med recs are vital in the hospital admission process because home medications need to be restarted at appropriate times to fully care for the patient. Also, mistakes in a home medication list can lead to serious consequences in the patient’s health. This study focuses on med recs being performed at Marcum and Wallace Hospital in Irvine, Kentucky. More specifically, the study explores the different …

Everybody’S Working (But The Weakened): An Assessment Of Medicaid Work Requirements And Their Administrative Burdens, Samuel Misleh

MPA/MPP/MPFM Capstone Projects

Although Medicaid work requirements are currently halted in both Arkansas and Kentucky, this analysis utilizes the data available to make an assessment and estimate of what Kentucky’s Medicaid enrollment will look like if work requirements similar to those Arkansas had are ever implemented. The relative severity of the administrative burden of such requirements provide a tool for comparison, and a difference-in-differences analysis of the change in Medicaid enrollment between Arkansas and West Virginia, a state that has not implemented and currently has no plans to implement Medicaid work requirements, provide the bases for this estimate. After coding the work requirements …

Impact Of Area-Under-The-Curve Monitoring For Vancomycin On Incidence Of Acute Kidney Injury In Orthopedic Patients, Kelli R. Keats

MPA/MPP/MPFM Capstone Projects

Vancomycin is an antibiotic used regularly in hospitals across the world. The most concerning adverse effect of vancomycin is its documented effect on kidney function. This study examines the impact of two dosing strategies of vancomycin on patients’ kidney function at the University of Kentucky Albert B. Chandler Medical Center. It specifically focuses on patients on the orthopedic service because these patients traditionally receive higher doses of vancomycin for longer periods of time due to the severity of their infections, which puts them at an increased risk of vancomycin-induced nephrotoxicity compared to other patients.

This study will serve as a …

The Effect Of Narrative Medicine Combined With Medication Assisted Treatment On Decreasing The Desire To Use Intravenous Substances In Hospitalized Patients With Infective Endocarditis, Paula Works

DNP Projects

Substance abuse is a significant problem that spans the nation. Of particular concern is the growing population of patients at UK HealthCare who have endocarditis as a complication from IV substance abuse.

PURPOSE: The aims of this study were

1. To assess the effect of narrative medicine combined with MAT, compared to MAT alone, on desire to use in hospitalized patients with a history of IV substance use
2. To examine the changes in quality of life before and after the introduction of narrative medicine in hospitalized patients with a history of IV substance abuse using The Quality of Life Scale (QOLS). …