Public Health Commons^™

Comorbidity Profile Of Head And Neck Cancer Patients With And Without Depression, Michaela Frenzel

Capstone Experience: Master of Public Health

This population-based retrospective study used SEER-Medicare data from 2002-2010 to assess depression, comorbidity, and substance use in the elderly head and neck cancer population. Out of 3,533 head and neck cancer patients, 10.6% had depression diagnoses two years prior to cancer diagnosis, 8.9% were newly diagnosed with depression within one year after cancer diagnosis, and 44.5% of those with preexisting depression had an additional depression diagnosis within one year following cancer diagnosis. Comorbid conditions (p<0.0001) and substance use (p=0.0017) showed associations with depression prior to cancer diagnosis yet, no significant associations with incidence of depression in this head and neck cancer population. This study affirms the need for continual depression screenings in head and neck cancer patients and suggests the need for increased research into the burden of comorbid conditions and substance use within the head and neck cancer population.

The Lived Experience Of Psychological Occupational Stress In Early Childhood Education, Brooke Fletcher

Capstone Experience: Master of Public Health

Early childhood education (ECE) programs have been recognized by the Institute of Medicine and the Administration for Children and Families as excellent interventions to alleviate the long-term negative effects of poverty in the United States, but the quality of intervention provided and outcomes for the target population are adversely hindered by high occupational stress burdens for ECE teachers. According to Sheridan, Edwards, Marvin, and Knoche, the models used to address this concern are not empirically supported for specific applicability to ECE nonprofit settings. There is a need for deeper understanding of the lived experiences of ECE teachers, including the psychological …

Evaluation Of Family Inc.'S Home Visitation Program, Brooke A. Linnenbrink

Capstone Experience: Master of Public Health

FAMILY, Inc. is a nonprofit that provides public health and family support services to women, children, and families in Pottawattamie and Mills counties. It's home visitation program provides health education information to families in the communities that are expecting a child or have a child less than five years of age. This project looked at FAMILY, Inc.’s database regarding the health of children enrolled in their home visitation program and use that information to help develop health education tools as they prepare to expand their programming to include Early Head Start (EHS). Currently FAMILY uses the Parents as Teachers curriculum, …

Access To Care And Melanoma Incidence And Mortality In Nebraska, Natalia Trinidad

Capstone Experience: Master of Public Health

The purpose of this study is to determine incidence and mortality of melanoma across all counties in Nebraska in the context of access to primary care providers and dermatologists. Crude and age-adjusted incidence rates of melanoma from 2001-2016 by county were calculated for the following year intervals: 2001-2005, 2006-2010, 2011-2016. Variables for melanoma cases were obtained from the Nebraska Cancer Registry and included the case’s zip code at diagnosis, race, ethnicity, sex, age at diagnosis, year, cancer site, vital status, stage of disease, and the ICD-O code for the cancer type. Crude and age-adjusted mortality rates were calculated for the …

Explore Barriers Associated With Not Testing For Hiv Among Men Who Have Sex With Men In Dodoma, City, Tanzania, Maria M. Mushi

Capstone Experience: Master of Public Health

Goal

The goal of the project is to explore barriers associated with not testing for HIV among men who have sex with men (MSM) in Dodoma City, Tanzania.

Objectives

In order to achieve the goal of exploring barriers associated with not testing for HIV among MSM, I will plan and conduct the study, analyze the data, and prepare the final research report.

Methods

A qualitative descriptive study will be conducted in Dodoma City, Tanzania. A total of 10 MSM 19 years of age and above will be purposefully selected by 3 peer educators to be part of the study. I …

Improving Internal Reliability Of A Trauma-Informed Care Program Evaluation Instrument, Ashley A. Raposo-Hadley

Capstone Experience: Master of Public Health

The project has analyzed the recent changes to the trauma-informed care (TIC) curriculum evaluation instrument by assessing the changes in Cronbach’s Alpha scores and effect significance. Data was collected from pre-training and post-training surveys completed at the time of delivery of the TIC curriculum training. Participants included hospital staff and medical or nursing students at Nebraska Medicine, University of Nebraska Medicine Center, and Health Creighton University Medical Center. The three research questions are (1) Did the item edits change item subgroupings? (2) Did the item edits increase instrument reliability? (3) Did the item edits impact statistical significance? 3 subscales, working …

Health Program Quality Evaluation To Identify Program Improvement Opportunities, Sheila V. Phillips

Capstone Experience: Master of Public Health

Abstract

Objective: to identify Health Program improvement opportunities including reducing risk of unplanned visits.

Background: Health Program is a program in a Midwest community assisting persons with diabetes and Medicaid to help patients better self-manage their diabetes and connect with community resources. Communities are challenged with helping a growing number of persons with diabetes with multiple chronic conditions, medications, and increased use of unplanned visits. Information was needed to understand unmet needs of this population associated with unplanned visits to develop program improvements.

Methods: In a quality evaluation of a single center, a model of baseline prognostic factors associated with …

Formative Evaluation Of An Online Access To Justice Triage And Intake System, Jessica A. Wiens

Capstone Experience: Master of Public Health

The objective of this project is to evaluate the usability of Legal Aid of Nebraska’s LawHelp Nebraska online intake and triage system. A mixed-methods approach consisting of observations, semi-structured interviews, and validated survey were used with 14 participants as they interacted with the system. A convenience sample was used through recruitment of clients at Legal Aid of Nebraska’s Omaha office during legal assistance walk-in hours. To analyze the qualitative data from the semi-structured interviews and retrospective observation forms, researchers used thematic analysis. For quantitative data collected through a survey, researchers used descriptive analysis and validated scoring. The project and results …

Assessing Quality Of Life And Mental Health Differences Among Young Adult Informal Caregivers And Non-Caregivers In Nebraska, Emily L. Frankel

Capstone Experience: Master of Public Health

The goal of this project is to identify differences in quality of life and mental health between younger informal caregivers and non-caregivers, ages 19-40, in Nebraska. To address this goal, a demographic and health assessment battery was disseminated to eligible participants (N=60), comprised of informal caregivers (N=30) and age-, education-, and gender-matched non-caregivers (N=30). The health assessment included reliable and validated questionnaires, including the RAND SF-36, EuroQol 5D, Kessler Psychological Distress Scale, and the General Health Questionnaire. By discovering relationships between quality of life and mental health with the length of time providing care, programming and intervention recommendations can be …

Evaluation Of A Community Health Worker Intervention On Rates Of Measles, Mumps And Rubella Immunization In A Somali Population In Lexington, Nebraska, Melanie Menning

Capstone Experience: Master of Public Health

Measles is a highly contagious viral disease. It remains an important cause of death among young children globally, despite the availability of a safe and effective vaccine.

There have been increasing outbreaks of measles to waning immunization. This study sought to evaluate rates of Measles, Mumps and Rubella (MMR) immunization in a Somali population living in Lexington, Nebraska and to evaluate a community health worker intervention to improve immunization rates. NESIIS data for Lexington Regional Health Center (LRHC) was queried to assess MMR trends for all clinic patients between 15 and 72 months both before and after implementation of the …

Rates Of Sudden Unexpected Infant Death And Potential Risk Factors For Unsafe Sleep Behaviors In Douglas County, Nebraska From 2008 To 2017, Balkissa Ouattara

Capstone Experience: Master of Public Health

Abstract unavailable.

Assessing The Workforce Of The Southwest Nebraska Public Health Department For The Development Of A Workforce Development Plan, Arnel Ramos

Capstone Experience: Master of Public Health

The purpose of this project was to assess the capacity and needs of the Southwest Nebraska Public Health Department (SWNPHD) workforce and to develop a workforce development plan that would meet the accreditation standards of the Public Health Accreditation Board (PHAB). An assessment survey was developed online through the Survey Monkey website using competency skills based on the guidelines established by the Council on Linkages Between Academia and Public Health Practice. The selected competency skills were reviewed and approved for relevance by the SWNPHD leadership and the University of Nebraska Medical Center, College of Public Health, Office of Public Health …

Impact Of Continuing Education In Reducing Perceived Challenges To Treating Patients Co-Prescribed Opioids And Benzodiazepines Among Midwest Clinicians, Kyle Stirewalt

Capstone Experience: Master of Public Health

Goal

The goal of this Capstone project was to provide meaningful Continuing Education (CE) to clinicians in the Midwest to reduce perceived challenges to safely treating patients co-prescribed opioid analgesics and benzodiazepines

Objectives

Using continuing education, increase clinician knowledge of effective alternative non-opioid and non-benzodiazepine therapies for chronic conditions while increasing clinician comfort in tapering patients off opioid analgesics and benzodiazepines

Methods

A one-hour CE presentation was prepared with the assistance of the Nebraska Department of Health and Human Services (NeDHHS) and broadcast to clinicians in the Midwest through a live webinar in coordination with the Great Plains Quality Innovation …

Neighborhood Variability In Obesity In Children In Omaha, Nebraska, Ann Essay

Capstone Experience: Master of Public Health

BACKGROUND: The prevalence of childhood obesity is a serious public health concern in the United States. Although several individual-level factors have been found to be associated with obesity in children, neighborhood environmental and social factors likely play an important role. The main goal of this study was to describe the prevalence of child obesity in Omaha, Nebraska by various demographic subgroups, determine if obesity prevalence varies by neighborhood operationalized as zip code, and examine the association between neighborhood-level child obesity prevalence and neighborhood-level socioeconomic status. It was hypothesized that child obesity prevalence varies by demographic subgroup and by zip code …

Assessment Of Hearing Exposures And Personal Protective Equipment Use In Agricultural Workers, Kelsie M. Musil

Capstone Experience: Master of Public Health

Agriculture continues to rank as one of the most hazardous industries in the United States. This is in part due to the high number of hazardous exposures that farmers face, including respiratory and hearing exposures. The danger to workers can be reduced by properly wearing personal protective equipment (PPE). However, it has been shown that agricultural workers wear PPE at a low rate, in part due to inconvenience and poor accessibility of the equipment. There is little knowledge currently about how PPE are stored, maintained, and if they are used in a correct manner in specific exposure conditions by the …

Implementation Of A Survey To Reduce Urine Pregnancy Tests Prior To Gynecology Procedures In Primary Care, Rachel Morgan Budihas

Capstone Experience: Master of Public Health

Excluding pregnancy in individuals prior to initiating contraception is important. The Pregnancy Reasonably Excluded Guide (PREG) uses twelve questions related to a patient’s reproductive history to effectively rule out pregnancy without administering a urine pregnancy screen, saving the patient both time and money. The PREG survey was given at Mayo Clinic in Rochester, MN, from 2015 to 2018 to all patients receiving an Intrauterine Device or Subdermal Implant.

This study examined data from the 2018 collection year to determine if urine screening requests by providers were reduced from the pre-PREG data. It also determined whether urine tests were requested disproportionally …

Effects Of Perioperative Hyperglycemia In Patients With Diabetes Compared To Patients Without Diabetes: A Retrospective Study Of Treatment And Outcomes, Matthew Anderson

Capstone Experience: Master of Public Health

The main goal of this project was to examine the differences in perioperative hyperglycemia treatment received by patients with a diagnosis of diabetes mellitus (DM) and patients without a diagnosis of diabetes (NDM); and how these treatment differences can affect the length of hospital stay. Studies have revealed that, when comparing DM and NDM patients with the same degree of perioperative hyperglycemia, NDM patients suffer worse outcomes. It has been suggested in previous research that this may be because NDM patients receive treatment that does not measure up to the standard of care treatment that DM patients receive. In this …

Do Molecular Subtypes Of Breast Cancer Affect Outcomes Following Hypofractionation Or Conventional Fractionation Radiation Therapy?, Richard Sleightholm

Capstone Experience: Master of Public Health

Introduction

Molecular subtypes of breast cancer (BC) are well-established prognostic markers in early-stage BC patients. The addition of radiation therapy (RT) to breast-conserving surgery has improved outcomes in this patient population, with conventional fractionation (CF) and hypofractionation (HF) regimens displaying comparable morbidity and mortality. However, most studies have not taken into account molecular subtype. Thus, it is still unknown if outcomes are similar between CF and HF for each molecular subtype. Herein, the effects of molecular subtype on the efficacy of CF and HF radiotherapy regimens for early-stage BC patients receiving adjuvant RT was investigated.

Methods

A retrospective review of …

Training For Evidence-Based Youth Physical Activity Leader Practices, A. Jake Larose

Capstone Experience: Master of Public Health

Purpose: From a social ecological viewpoint, the way in which individuals interact with their surrounding environment, has a direct effect on their actions. One approach to modify behavior change is to strive to change the environment, thus driving behavior change. Participating in physical activity (PA) is a behavior to be targeted, due to its numerous health benefits. A population to consider targeting for increasing PA is children, as creating PA habits in childhood has been shown to track into adulthood . Change at a population level should begin by focusing efforts on the environments in which children are spending their …

The Correlates Of The Maternal Fetal Attachment In The Democratic Republic Of The Congo, Orphee L. Tamba

Capstone Experience: Master of Public Health

Maternal-fetal attachment is defined as the relationship of affection that exists between the pregnant woman and her fetus during pregnancy. It increases throughout the pregnancy and predicts not only the attachment style between the mother and the child but also the chances of optimal socioemotional development during infancy. The Maternal Antenatal Attachment Scale measures the Maternal-Fetal Attachment (MFA). Several versions of this scale have been adapted in various parts of the world. However, to date no study has been conducted on the validation of this scale in sub-Saharan Africa and the identification of factors associated with the MFA. This cross-sectional …

Pilot Evaluation Of Oneworld's Education Sessions On Sexually Transmitted Infections For Adolescents And Young Adults In The South Omaha Community, Mariela Bahena

Capstone Experience: Master of Public Health

Background. Rates for sexually transmitted infections (STIs) in Douglas County, specifically gonorrhea and chlamydia, are among the highest in the nation. Adolescents and young adults between the ages of 15 and 24 are one of the most at-risk groups for acquiring either STI. Though not fatal itself, gonorrhea and chlamydia can lead to serious complications and physical discomfort in both males and females. Evidence-based and age-appropriate sexual health education has been proven to reduce the risk of STIs. Studies have shown that comprehensive education programs with a focus beyond abstinence are effective in promoting safe sex practices.

Aim. This project …

Great Plains Behavioral Risk Factor Surveillance System Project, Florence G. Duran

Capstone Experience: Master of Public Health

Background: Great Plains American Indians/Alaska Natives (AI/ANs) experience higher mortality rates than Non-Hispanic Whites from the same region. The National Behavioral Risk Factors Surveillance System (BRFSS) survey can have limitations of the estimates the health risks behaviors and services from one Tribal community to another. Goals and Objectives: The goal of this project is to address the lack of Tribal specific data among AI/ANs in the Great Plains region (ND, SD, NE, IA) by using Great Plains Tribal BRFSS data that captured information for three tribes in the Great Plains region. Tribal specific data will allow tribes to access, …

Domestic Violence Shelters For Survivors- A Needs Assessment, Tanushree Ojha

Capstone Experience: Master of Public Health

Background: Domestic violence (DV) is a serious public health issue in the United States, and globally. It includes physical violence, sexual violence, threats, emotional abuse, stalking, and psychological aggression (including coercive acts) by a current or former intimate partner. It is a serious, preventable public health problem that affects millions of Americans (CDC, 2017b). There is an alarming number of domestic violence cases encountered each year. Globally, 1 in 3 women has experienced some domestic violence in their lifetime. Globally, as many as 38% of women are murdered by an intimate male partner because of violence against an intimate female …

Creation Of Evaluation Tools For Workforce Development Opportunities Within A Local Health Department, Nancy Ann Esch

Capstone Experience: Master of Public Health

Improving the skills and competencies of the Central District Health Department’s (CDHD) workforce is essential in assuring the public’s health. However, to develop the desired skills and competencies of the workforce requires effective training programs. CDHD provides professional development funds to all staff to attend workforce development opportunities that can be used on specific training relevant to their position. Approved trainings at CDHD, however, are not evaluated for effectiveness. This capstone project aimed to develop evaluation tools to help determine the effectiveness of training programs at the CDHD. Kirkpatrick’s Four Levels of Training Evaluation (2016) was used to help build …

Initiation Of A Roundtable Meeting To Determine Safety Hazards And Provide Education To Range Bison Herd Workers, Lucia Finocchiaro

Capstone Experience: Master of Public Health

This capstone project serves as an important piece of greater project studying bison handling. Bison production is both a growing and dangerous industry. As a new enterprise in many parts of the country and on tribal lands, significant numbers of untrained employees may be hired. This project undertakes methods to better understand the risks associated with bison handling and to thereby improve handling procedures and increase safety. Herd managers (from tribal and non-tribal sites), researchers, safety experts, and stakeholders were brought together for a roundtable meeting in Omaha. This meeting was designed to provide stakeholders a forum to discuss common …

The Association Between Neurocognitive Impairment And Health-Related Quality Of Life Among People Living With Human Immunodeficiency Virus (Hiv)., Philip S. Amara

Capstone Experience: Master of Public Health

Background: Despite the use of combination antiretroviral therapy, HIV associated neurocognitive impairment (NCI) persists in HIV seropositive persons, albeit in milder forms than before therapy was available. Nevertheless, the relationship between NCI and health-related quality of life (HRQoL) is not well known.

Method: Baseline data from the CHARTER study was used to investigate the association between NCI and HRQoL. Factor analysis was employed to summarize the 35-item Medical Outcome Survey questionnaire into physical and mental HRQoL scores. General linear models were employed to investigate the association between NCI, as measured by global deficit scores (GDS), and HRQoL, and to control …

Examining The Prevalence Of Urban American Indians With Uncontrolled Diabetes In Nebraska., Nasreen Wahab Maiwandi

Capstone Experience: Master of Public Health

Diabetes is a major public health problem in American Indian Alaska Native (AI/AN) population which contributes to an increased number of morbidity and mortality.

Diabetes was largely unknown in AI/AN communities before the World War II but soon after the WWII Indian Health Service (IHS) providers began reporting diabetes among this population. (McLaughlin, 2010). A group of researchers in 1963 identified the first type II diabetes epidemic in Pima Indiana community of Arizona among AI/AN population. (Shultz, LO, et al, 2006). Soon, cases of diabetes in AI/AN more than doubled in prevalence rate compared to the general U.S. population, resulting …

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

Capstone Experience: Master of Public Health

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

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

Capstone Experience: Master of Public Health

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

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

Capstone Experience: Master of Public Health

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