Public Health Commons^™

Mental Health Of Individuals Within Incarceration: A Systematic Literature Review, Steven I. Valladares

Capstone Experience: Master of Public Health

Mental Health Illness is on the rise in the United States. About 90% of incarcerated individuals have at least one mental health condition. The current federal and state incarceration systems do not seem to be well-equipped to transition an incarcerated individual to the civilian life. This is so because the incarceration system focuses too much on the punishment rather than rehabilitation. This framework could be deemed unsafe and dangerous to the civilian world once a prisoner gets released, due to incarcerated individuals not receiving adequate mental health treatment. This literature review highlights the flaws of the current incarceration system mental …

The Effect Of Fiber And Omega-6:Omega-3 Fatty Acid Ratio On Asthma And Asthma-Related Symptoms In An Adult U.S. Population, Korie As Nelson

Capstone Experience: Master of Public Health

Asthma is one of the most common diseases in the world affecting more than 10% of adults in many westernized countries and 339 million globally. Studies have shown a positive association between increased dietary fiber and improvement in asthma-related inflammation. Omega-3 fatty acids have also been shown to help mitigate inflammation in general. No identified studies have looked at the synergistic effect of omega-3 and omega-6 fatty acids alone and as a ratio with fiber on asthma, lung function, and respiratory morbidities. A positive association could mean that dietary interventions of fiber and fatty acids could significantly improve asthma and …

Efficacy Of Vaccine Candidates Against Zika Infection And Congenital Zika Syndrome: A Systematic Review And Meta-Analysis, Hannah Lund

Capstone Experience: Master of Public Health

There have been previous reviews looking into the efficacy of vaccine candidates against Zika infection in non-humans primates, but there hasn’t been a review looking into the efficacy against Congenital Zika Syndrome (CZS).The aim of this project was to systematically review literature on efficacy of vaccine candidates against Zika infection and CZS. A protocol was developed following PRISMA guidelines. English articles published since 2015 were included. Clinical trials (CCTs) that compared the efficacy of four Zika virus vaccine candidates' (PIV, DNA, mRNA, and Adenovirus) against zika infection and CZS in human and non-human primate models were included. Grey literature and …

Impact Of Dietary Fiber And Omega6/3 Intake On Copd Outcomes In U.S. Adults, Jacey Hain

Capstone Experience: Master of Public Health

COPD is the 4^th leading cause of death in the United States and is the leading cause of hospitalizations in adults.¹Although there is no cure for COPD, symptoms can be managed to increase the quality of life of those affected by the disease. Dietary omega-3 and -6 as well as fiber intakes have been noted as mitigating the burden of disease through their anti-inflammatory properties. We set out to look at the synergistic effect of both omega-3,-6, -6:-3 ratio and fiber on COPD, lung function and respiratory morbidities. We used data from the National Heath and Nutritional …

Predicting Suboptimal Care In Insured Nebraskans With Known And Suspected Chronic Conditions., Avery Wallace

Capstone Experience: Master of Public Health

Health insurance companies have a goal of improving population health for their members (people who the company insures). As a health insurance company, [Company] has ample data on the health of its members that can be utilized to improve the health, and by extension lives of the people they insure. Although [Company] does not deliver care, they communicate with their members and physicians to identify ways to improve the health of the member. Of specific interest are members with known chronic conditions who are receiving suboptimal care, as well as members who have undiagnosed chronic conditions. Two chronic conditions were …

Outpatient Visits At A Geriatric Psychiatry Clinic During The Covid-19 Pandemic, Thomas D. Bainter

Capstone Experience: Master of Public Health

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic led to a significant rise in the use of telehealth for healthcare delivery. The University of Nebraska Medical Center (UNMC) outpatient psychiatry clinic began using telehealth for nearly all patient visits shortly after the pandemic began. This project was intended to evaluate the effects of this change on patient visits with the geriatric psychiatry department at UNMC. For the months of April-August 2020 and April-August 2019, when in-person visits were still the norm, the following were compared: (1) no show and cancel frequency; (2) patient visit duration; (3) frequency of patient phone calls …

Workforce Assessment: Measuring The Impacts Of Covid-19 On The Maternal And Child Health Workforce, Ashleigh M. Sutphen

Capstone Experience: Master of Public Health

Workforce assessments provide an opportunity to assess, evaluate, and identify the needs of a particular workforce. The use of workforce assessments in the field of maternal and child health (MCH) has been an ongoing and a strongly supported effort by the Health Resources & Services Administration: Maternal and Child Health Bureau (MCHB). The maternal and child health workforce is responsible for providing essential public health services to some of the most vulnerable populations such as mothers, children, and people living with disabilities. Thus, the continuation of providing these essential public health services is critical – even in the midst of …

Conducting A Swot Analysis And Assessing Clinic Roles To Improve Integrated Healthcare, Jessica S. Hicks

Capstone Experience: Master of Public Health

Currently, those with a mental illness are less likely to receive primary care services and are more likely to die sooner than those without a mental illness. Combating this health disparity, integrated healthcare is a holistic approach that treats both mental and physical health. The cooperation and partnership of multiple health disciplines is a whole-person method that improves a patient’s overall wellbeing. Community Alliance is an organization in Omaha, Nebraska that offers integrated health care services through its clinic to community members. With multiple areas of care, roles and responsibilities can become easily obscured creating confusion and mistakes in the …

The Migration Of Carbapenem-Resistant Acinetobacter Baumannii From The Battlefields Of Iraq And Afghanistan To The Healthcare Facilities Of The Veterans Health Administration, Jeffery Rogers

Capstone Experience: Master of Public Health

Multidrug-resistant organisms (MDRO) pose a great threat to health across the globe. That threat is also felt in the Veterans Health Administration (VHA). Wounded warriors returning home from the battlefields of Iraq and Afghanistan may have brought with them MDROs, such as the bacterium Acinetobacter baumannii, as they have transitioned from military service into the VHA facilities. This study investigates the interconnectedness of military service in the Department of Defense (DoD) and a lifetime of care at VHA through a longitudinal tracking of a linked cohort of combat veterans with battlefield injuries and subsequent MDR infections of A. baumannii. …

Nebraska Public Guardianship Of Unbefriended Patients: A Preliminary Review Of Health Outcomes And Cost Savings, Emily N. Berzonsky

Capstone Experience: Master of Public Health

Unbefriended patients often experience an extended length of stay in the hospital while their medical providers await legal appointment of a public guardian to make their medical decisions. The medically unnecessary days the unbefriended patient spends in the hospital equates to high costs for the hospital, but more importantly, negative health outcomes for the patient. The purpose of this study is to provide literature and data to support recommendations for possible changes in Nebraska’s public guardianship appointment process. A literature review seeks to answer: (1) What is the median hospital length of stay for an unbefriended patient without a guardian …

The Epidemiology Of Clostridioides Difficile In Nebraska - A Descriptive Study Between 2018-2020, Storm Keffer

Capstone Experience: Master of Public Health

Objectives: Clostridioides difficile (C. diff) is a common but challenging infection both financially and medically. Due to these difficulties, Clostridioides difficile infection (CDI) caused by C. diff is a mandatory reportable disease in Nebraska and as such has been a priority disease targeted by various disease control practices across many hospitals. All CDI laboratory results are reported electronically through the Nebraska Electronic Disease Surveillance System (NEDSS). However, capturing and conceptualizing the true burden of CDIs in Nebraska has not been adequately accomplished since monitoring of CDIs began. The objective of this study is to examine the trends of …

Impact Of Proton Pump Inhibitor Use On Effectiveness Of Immune Checkpoint Inhibitors In Advanced Cancer Patients, Ken Chen

Capstone Experience: Master of Public Health

Background: Gut microbiome plays a critical role in modulating therapeutic effect of immune checkpoint inhibitors (ICIs). Proton pump inhibitors (PPIs) may affect the gut microbiome by altering gut pH.

Objective: To evaluate if concurrent use of PPI 0-30 days before or after initiation of ICIs (nivolumab or pembrolizumab) is associated with poorer overall survival (OS) and progression-free survival (PFS) for patients with stage IV non-small cell lung cancer (NSCLC), melanoma, renal cell carcinoma, transitional cell carcinoma or head and neck squamous cell carcinoma compared with no PPI use.

Methods: This was a single-center retrospective cohort study of advanced cancer patients …

The Spatial-Temporal Model Of Covid-19 Tests, Cases, And Deaths In The State Of Nebraska, Makayla Schissel

Capstone Experience: Master of Public Health

The goal of this project was to illustrate the spread of COVID-19 tests, cases, and deaths within the state of Nebraska and identify non-random clusters using a spatial-temporal model. This project is pertinent and innovative, as few spatial-temporal models in the United States revolving around COVID-19 offer information at the county, let alone, the state level. De-identified data was extracted from the State of Nebraska’s Department of Health and Human Services COVID-19 dashboard, transformed and prepared for analysis using SAS coding language. Clusters were identified though SaTScan software using a space-time permutation model. The model identified 5 different clusters related …

Factors Affecting The Mortality Rate Of Older Patients With Covid-19 In Nebraska: A Retrospective Cohort Study, Erin Johnson

Capstone Experience: Master of Public Health

The pandemic spread of COVID-19 is a continued global health emergency. The objectives of this paper were to examine Factors affecting the mortality rate of older patients with COVID-19 in Nebraska. A longitudinal analysis of data gathered from the Nebraska Electronic Disease Surveillance System (NEDSS) was performed. Included were 322 individuals who tested positive for COVID-19 in the month of October 2020. The Kaplan-Meier method was used to estimate the time to death of individuals over the age of 65 after a positive COVID-19 diagnosis and the probability of survival to any given time point. The effect of multiple risk …

A Deeper Look: The Impacts Of Covid-19 Among Latinos In Omaha, Diana Molina

Capstone Experience: Master of Public Health

The COVID-19 pandemic has manifested worldwide distress, affecting the lives of all population groups. Racial disparities are evident as minority populations are being disproportionately affected by the impacts of COVID-19. Data indicate that the Latino population may experience more severe cases of COVID-19 and have a higher mortality rate. However, little is known about the effects that the pandemic is having on day-to-day life. Thus, the purpose of this study is to investigate COVID-19's impact on life aspects including employment situation, finances, mental health, and experiences of discrimination among the Omaha Latino community. A survey collected data from 311 participants …

Health Belief Model Implications For Cervical Cancer Screening Among Refugee Women In Omaha, Nebraska, Na-Omi Hassane Dan Karami

Capstone Experience: Master of Public Health

Literature gap

According to the World Health Organization (2020), cervical cancer is among the top four most common cancers in women. However, refugee women are the least screened for cervical cancer. There is limited research examining the uptake of cervical cancer screenings among refugee women using the health belief model. Little is known about barriers and facilitators associated with the uptake of cervical cancer screening among refugee women in Nebraska.

Objectives:

The purpose of the study is to assess the health behavior of refugee women in Omaha towards cervical cancer screening via the health belief model and to determine the …

Assessing Occupational Stress And Preparedness Among Campus Safety Officers And Dental School Employees At An Academic Medical Center During Covid-19, Decature Banker, Lorena Baccaglini, Miriam Mccann, Chandran Achutan

Capstone Experience: Master of Public Health

Job stress can lead to adverse physical and emotional health effects in employees and is worse during an emergency or pandemic. The complexity of the coronavirus disease 2019 (COVID-19) pandemic is taking a toll on the healthcare systems and their employees. This cross-sectional study looked at two different groups of academic medical center employees, Campus Safety Officers and Dental School employees, who’s work puts them at risk for COVID-19 exposure. We hypothesized that Campus Safety Officers and Dental School employees who felt adequately trained to conduct COVID-19 related work would not feel more stressed during the COVID-19 pandemic than they …

Effect Of Climate Change On Lyme Disease Cases In 4 New Jersey Counties, Meredith Olson

Capstone Experience: Master of Public Health

Since its discovery more than 40 years ago, there has been an increasing occurrence of Lyme disease. Lyme disease is a tick-borne illness found predominantly in the Northeastern region of the United States. Studies have shown that environmental factors play an important role on the life cycle of ticks. Due to the complexity of environmental changes as well as the life cycle of different tick species, the variety of factors that could influence the increase in Lyme disease can be different depending on tick species and region. This study compared different regions of New Jersey, a highly Lyme disease endemic …

A Qualitative Analysis Of Omaha Healthy Kids Alliance’S Client Educational Attainment, Shelby Larson

Capstone Experience: Master of Public Health

Housing and physical health are inextricably linked. Environmental hazards such as lead poisoning, radon, and mold negatively impact the health of a home’s occupants, particularly children. Omaha Healthy Kids Alliance (OHKA) was founded in 2006 to address these environmental hazards through education and construction interventions with the mission “to improve children’s health through healthy homes.” OHKA clients are primarily served through two direct service programs and are evaluated pre- and post-intervention for changes in educational attainment, behavioral outcomes, environmental characteristics, quality of life, and health. A program evaluation was conducted to 1) determine how OHKA clients utilize environmental education post-intervention, …

Effects Of Climate Change On The Epidemiology Of Flood-Related Waterborne Disease: A Systematic Literature Review, Sarah M. Cadarette

Capstone Experience: Master of Public Health

Natural disasters, such as flooding related to extreme precipitation, can lead to many adverse health effects (i.e. waterborne disease). Several outbreaks of waterborne disease have been linked to extreme precipitation, and gastrointestinal infection has been shown to increase after floods. Climate change is likely to lead to a higher frequency of waterborne disease through increases in extreme precipitation and associated flooding affecting water and sanitation infrastructure. This review sought to answer 2 research questions: 1. Has the epidemiology of waterborne disease related to floods changed over time? 2. Can this difference be related to climate change? A literature search was …

Agricultural Injuries Among Central State Region Operators Over A 5-Year Period: Cs-Cash Farm And Ranch Health And Injury Survey 2011-2015, Anthony Johnson Jr

Capstone Experience: Master of Public Health

Background The high risk of occupational fatalities in agriculture is well documented, but information on non-fatal injuries is lacking due to challenges in injury surveillance. This surveillance study explored the frequency, characteristics, and risk factors for non-fatal injuries among farmers and ranchers in the central United States.

Methods The Central States Center for Agricultural Safety and Health (CS-CASH), in collaboration with the USDA National Agricultural Statistics Service (NASS), conducted annual surveys (n=34,777 sent) during 2011-2015 covering a seven-state region (Iowa, Kansas, Minnesota, Missouri, North Dakota, Nebraska, and South Dakota).

Results The average response rate was 32% in the five consecutive …

Development Of A Web-Based Agriculture Health Risk Assessment Tool For Military Veteran Farmers And Ranchers, Alyssa Damke

Capstone Experience: Master of Public Health

In the U.S., significant health disparities exist among rural populations compared to their urban counterparts. These disparities can be compounded in agricultural workers due to the dangerous and unpredictable nature of their work. Agricultural producers who are also military Veterans may experience additional health pressures that are often overlooked in the healthcare setting. Over 2.5 million Veteran Health Administration (VHA) patients reside in rural areas and the healthcare infrastructure to care for these Veterans may not include an agricultural occupational approach. To address healthcare disparities in Veteran farmers and ranchers, this study, in collaboration with AgriSafe Network, will be used …

Perceptions Of Voice Health, Voice Health Care, And Voice Health Education In The Performance Community, Katelyn Nelson

Capstone Experience: Master of Public Health

There is a medical consensus that proper voice health precautions can protect the voice and decrease the occurrence and severity of voice disorders in vocal performers. Similarly, seeking medical treatment for voice disorders can speed recovery time and preserve the voice. Voice disorders are common in performance students and professionals because of demanding curricula and frequent voice use, but little is known about their voice care needs, preferred voice care resources, and clinical care. The purpose of this study was to add to the research on voice health by interviewing faculty members in the College of Communication, Fine Arts, and …

Non-Emergency Utilization Of Ems: Contributing Factors And Strategies To Promote Effective Care With Appropriate Resources, Jason Jones

Capstone Experience: Master of Public Health

Non-emergency use of EMS resources can impose a substantial burden on emergency response systems and the communities they serve by reducing the response capacity for time-sensitive and life-threatening situations and through the subsequent diversion of funding that could be used to more effectively address health disparities. National EMS response data suggest that a large proportion of EMS patient encounters are for non-emergent reasons. Despite being a nation-wide issue, inadequate research has been conducted to understand why non-emergency and frequent use occurs and what strategies may be effective in mitigating avoidable use. Community paramedicine (CP), an emerging specialty in EMS that …

A Preliminary Analysis Of Project Ag Aware: Sbirt In Agricultural Work Settings, Rachel L. Rutt

Capstone Experience: Master of Public Health

Background: An increasing number of individuals are being negatively affected by substance abuse in the U.S. and Nebraska communities. These communities are seeing immense increases in opioid prescribing rates, especially in rural areas. The aims of this study are to 1) describe the study population of agricultural workers in Nebraska; 2) estimate the prevalence of alcohol misuse, illegal drug use, and anxiety among agricultural workers in Nebraska; and 3) examine factors associated with alcohol misuse among agricultural workers in Nebraska.

Methods: Adult agricultural workers (N=1,206) completed a paper or online survey for Project Ag Aware. Alcohol misuse, illegal drug use, …

Developing A Community Innovation Grant In Response To Increasing Rural Critical Incidents In Agricultural Mental Health And Wellbeing, Community Trauma, And Natural Disasters, Chessa S. Quenzer

Capstone Experience: Master of Public Health

Spink Area Support Network (SASN) is a skilled team of community volunteers that facilitate rural critical incident response services in an effort to prevent a critical incident and offer structured support during the aftermath. SASN was developed in response to identified gaps in rural critical incident response and risk reduction through prevention in Spink County, South Dakota. SASN utilizes a collaborative team approach to fill in gaps between first responder silos and establish community interventions by providing support and resources while utilizing critical incident stress management methods. SASN requires funding to maintain response resources, training, prevention education, and follow-up services. …

Developing A Program Evaluation Plan For Medicaid Prenatal Care Management Programs, Shardae Sims

Capstone Experience: Master of Public Health

Prenatal care management (PNCM) is an intervention that targets women during the perinatal period to improve birth outcomes. PNCM has the potential to address social determinants of health issues and gaps or barriers to care that could lower incidences of adverse birth outcomes in Nebraska. There is currently a gap in the literature for studies that fully assess the impact of prenatal care management programs and the program’s ability to reach set goals. The purpose of this research is to develop an evaluation plan and potential implementation strategies that can be utilized by the Medicaid PNCM program in Nebraska. The …

Developing A Rabies Prevention Program Based On Rabies Exposure Data In Nebraska, Jill Oatman

Capstone Experience: Master of Public Health

Eighty-nine percent of Nebraska’s towns are considered rural, with populations of less than 3,000 people and with many towns having less than 1,000 residents. Rural areas consist of crop ground, livestock facilities and regions inhabited by wildlife. Nebraska has two large urban cities, Lincoln and Omaha. Animal and human health in these communities can be greatly impacted by infectious diseases that are transmitted between animals and humans, known as zoonotic diseases. One zoonotic disease of great concern is rabies. Zoonotic diseases not only impact the health of animals and humans, but the social well-being of communities and result in increased …

Evaluation Of The Humoral Immune Response As A Potential Indicator Of Disease Severity For Patients Hospitalized With Covid-19, Spencer Sterling

Capstone Experience: Master of Public Health

Members of the family Coronaviridae, including the severe acute respiratory syndrome coronaviruses (SARS-CoV-1 and SARS-CoV-2), Middle East respiratory syndrome coronavirus (MERS-CoV) and seasonal human coronaviruses (HCoV-HKU1and HCoV-OC43), are highly communicable respiratory viruses; SARS-CoV-1, SARS-CoV-2, and MERS can cause severe disease, while seasonal human coronaviruses present with mild to moderate illness. Coronavirus envelope spike (S) glycoproteins are involved in receptor binding and cell fusion, and are the primary target for a neutralizing humoral response. The S protein is comprised of the S₁ and S₂ subunits; the S₁ subunit contains the receptor-binding domain (RBD), while the S_{2 …}

Structural Magnetic Resonance Imaging As A Diagnostic Biomarker Of Hiv-Associated Neurocognitive Disorders (Hand), Mikki Schantell

Capstone Experience: Master of Public Health

Objective: The goal of this study was to do an exploratory analysis to determine if gray matter brain volumes and cortical thickness measures obtained from structural magnetic resonance imaging (sMRI) can discriminate people with HIV-associated neurocognitive disorders (HAND), neurocognitively unimpaired people with HIV (NU PWH), and HIV-negative controls (HIV- controls) using linear discriminant analyses.

Methods: A total of 231 participants, including 110 PWH and 121 HIV- controls, completed a neuropsychological (NP) battery and an sMRI protocol. The bilateral gray matter volumes and cortical thickness brain regions were analyzed using 18 linear discriminant models to assess the discriminability of gray matter …