Public Health Commons^™

Factors Associated With Medical And Dental Compliance For Adults With Diabetes Mellitus, Mahua Saha

Capstone Experience: Master of Public Health

Background: Over the few decades, diabetes has become one of the most common chronic conditions in the U.S and worldwide. With the increasing number of incidences of diabetes and the cost associated with the treatment, adherence to treatment regimens is one key factor, which immensely affects the success of the diabetes treatment. The American Diabetes Association recommends annual preventive care for diabetes in terms of self-care practices such as daily blood glucose check and daily foot check. An eye examination with pupil dilation and a dental checkup are also recommended as part of annual care for diabetic patients. Considering the …

Examining The Impact Of Hiv Medical And Social Case Management Program On Viral Load For Clients Living With Hiv/Aids In Nebraska, Abdulla Munir

Capstone Experience: Master of Public Health

Abstract

Case management (CM) is one of the standard practices that has been implemented since 1990 to help people living with HIV/AIDS (PLWHA) in the United States. The program is designed for low-income populations and it aims to address the barriers related to access to health care and improve the HIV outcomes. Previous studies identified a positive association with the provision of CM and improvement in viral outcomes. Increasing the viral suppression rates among HIV diagnosed individuals proved to reduce the risk of transmitting the infection, and disease incidence. Although CM program is provided to Nebraskans diagnosed with HIV, but …

A Descriptive Analysis And Assessment Of Predictive Factors For Participation In A Clinical Trial As Front-Line Therapy For Patients Enrolled In The Nebraska Lymphoma Study Group Registry, Jonathan L. Tefft

Capstone Experience: Master of Public Health

Background: Clinical trial participation, especially among cancer clinical trials in adult populations, continues to be low despite the large number of clinical trials available across the U.S. Estimates for clinical trial participation are as low as 5% in some adult cancer populations, however in some lymphoma populations this figure may be as high as 13.9%. This figure can be confusing, given that as much as 70% of Americans are estimated to be willing to participate in a clinical trial. Previous research shows that as much as 95% of surveyed respondents who said they had previously participated in a clinical trial …

Association Of Adverse Birth Outcomes With Maternal Exposure To Nitrate In Private Well Drinking Water: An Action Plan For Prevention, Jessyka R. Johnson

Capstone Experience: Master of Public Health

Abstract

Goal: The goal of the capstone project is to collect information required to develop an action plan focusing on minimizing exposure to nitrate in pregnant women, which, if implemented, can either prevent or reduce adverse health outcomes associated with nitrate exposure in utero.

Objective: The capstone project objective is to gain a better understanding of what programs to prevent exposure to nitrate from private well drinking water in pregnant women are already in place throughout the United States; to identify any areas of improvement in these programs; and to utilize this information to create a unique action plan in …

Characterization Of Cancer Incidence In Chronic Kidney Disease Patients: A Single Center Study, 2008 – 2018, Jagadeesh Puvvula

Capstone Experience: Master of Public Health

Background: Chronic kidney disease (CKD) is an established risk factor for cardiovascular disease, but the significance of lower Glomerular filtration rate on incidence and mortality from cancer is uncertain. There is evidence that cancer risk and cancer mortality may be increased in individuals with End Stage Renal Disease (ESRD) requiring dialysis or after renal transplantation but whether less severe kidney disease is associated with cancer remains poorly understood.

Some studies indicate that these associations do appear to be organ specific. It has been reported that reduced renal function is associated with an increased risk of cancers of the kidney and …

Burden And Risk Factors Associated With Hcv Infection Among People Living With Hiv Infection In Nebraska: Population-Based Cross-Sectional Study From 1997 To 2017, Issaka Kabore

Capstone Experience: Master of Public Health

Background: Previous studies have shown high prevalence of HCV infection among people living with HIV infection. Coinfected people are at risk of developing liver diseases resulting an increase rate of mortality. Several risk factors for HIV/HCV coinfection have previously been identified with injecting drug users (IDU) as the common route of exposure.

Methods: This was cross -sectional study using HIV and HCV registries maintained by Nebraska Department of Health and Human Services (NE DHHS) from1997 to 2017. A descriptive analysis was used to characterize the sample. Chi-squared test and Fisher exact test were selected to compare the different groups. …

The Public Health Lens: An Introduction To Population-Based Care In Athletic Training, Jenna L. Allocco

Capstone Experience: Master of Public Health

Historically, the athletic training profession has been focused on the individual; however, potential exists to drive large-scale prevention efforts in the athletic community with a population-based, public health approach. Relationship between the two professions has been acknowledged in in previous literature to do with educational competencies and opportunities for research, as well as in policy development involving sudden cardiac death, sport-related concussion and osteoarthritis prevention. Incorporating public health concepts such as the ecological model, health literacy, health behavior and evidence-based program planning and evaluation may improve athletic training health outcomes and prove beneficial to each respective discipline.

Hearing Conservation In A Meat Processing Facility, Abolore Muinat Idris

Capstone Experience: Master of Public Health

Introduction: The aim of this study was to evaluate personal noise exposures at a meat processing facility, and educate employees on the proper use of hearing protectors.

Materials and Methods: We collected full-shift personal dosimetry on thirty-six production floor employees, one quality control employee, and four maintenance employees. These were compared to the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) criteria. We also collected point source noise measurement at eight workstations from precook. We administered a questionnaire to assess production floor employees’ hearing loss perception and non-occupational source of noise exposure. …

An Evaluation Of Implementing Trauma-Informed Care Training In Healthcare Settings, Amanda Kis

Capstone Experience: Master of Public Health

Background: Trauma-informed care (TIC) has recently become a popular topic in medical science. Many patients’ health conditions have been diagnosed and treated purely as medical issues, yet emerging research indicates that trauma is sometimes the source of many physical and mental conditions. Implementing TIC education in healthcare systems may lead to preventing the onset of symptomology related to undiagnosed, chronic trauma experience.

Objectives: The primary goal of this Capstone project was to implement TIC training developed by Trauma Matters Omaha Coalition and assess preliminary evidence for changes in participants’ confidence, clinical knowledge, professional knowledge, self-awareness, and assumptions and biases regarding …

Factors Associated With Participant Attrition In A Longitudinal, Survey-Based Rheumatic Disease Databank, Kathryn A. Grafel

Capstone Experience: Master of Public Health

Introduction: Participant attrition is a problem common to many longitudinal studies, and when it occurs nonrandomly, it can impact the study’s validity and generalizability. Identifying factors associated with attrition can help to detect bias and aid in developing targeted interventions to reduce attrition. Methods: Logistic regression and Cox proportional hazards regression models were constructed separately for patients with rheumatoid arthritis, systemic lupus erythematosus, and other rheumatic diseases who participated in the FORWARD study between 1998 and 2018. Results: Patient characteristics associated with attrition included male sex, younger age, non-White race, and less education, each of which was identified in multiple …

Trends In Childhood Elevated Blood Lead Levels In Nebraska, 2013 – 2017, Ellana Haakenstad

Capstone Experience: Master of Public Health

This project explored the exposure to lead among children in Nebraska. Using the Nebraska Department of Health and Human Services’ Blood Lead Level database, trends were investigated in screening; demographics; incidence; and prevalence of elevated blood lead levels, statewide and by census tract. The study further explored the geography of lead exposure and elevated blood lead level cases with maps. Based on these results, policy recommendations were made to the Nebraska Department of Health and Human Services’ Childhood Lead Poisoning Prevention Program, particularly about areas of Nebraska with high risk of lead incidence and exposure risk where testing should be …

Nutritional Factors Associated With Thyroid Cancer And Nodules Using The Integrated Cancer Repository For Cancer Research (Icare2), Dong Liu

Capstone Experience: Master of Public Health

Introduction: The incidence of thyroid cancer in the United States has rising on average 3.1% each year over the last 10 years. Much of this increase is attributed to increased detection using ultrasound. Dietary habits can be an important modifiable risk factors for different types of cancer, but the association between dietary factors and thyroid cancer has not been well studied. The goals of this capstone were to: 1) review the literature for the association between dietary factors and thyroid cancer, 2) describe demographic and behavioral characteristics of patients with thyroid nodules and cancer in a hospital-based registry, and 3) …

Health Professional Treatment Practices For Pediatric Sickle Cell Disease In Nigeria, Natalie Wichelt

Capstone Experience: Master of Public Health

Abstract

Sickle cell disease (SCD) is caused by a genetic defect that results in abnormal hemoglobin genes that can cause devastating health effects like chronic hemolytic anemia and vaso-occlusive crises. Additionally, sickle cell disease can cause defects in the immune system, leaving those with the disease highly susceptible to a variety of different infections. In the pediatric population specifically, the complications of sickle cell disease contribute significantly to the under-five mortality rate of Nigeria. In response to the Millennium Development Goals 4, 5 and 6, as well as with growing national concern over the challenges faced by sickle cell disease …

Perspectives, Challenges, And Oral Cancer Screening Practices Of Primary Care Providers At Nebraska Medicine, Nishitha Ponnamaneni

Capstone Experience: Master of Public Health

Background

High mortality and morbidity associated with oropharyngeal cancer (OPC) are due to delayed diagnosis. Early detection of OPC is possible by incorporating oral cancer screening (OCS) in the annual screening examination protocol of primary care providers (PCPs). The study was aimed to understand the perspectives and barriers of PCPs in screening their patients for OPC.

Objectives

1) To understand challenges PCPs’ face in performing OCS, 2) To determine the factors that influence PCPs’ decision to complete OCS, and 3) To determine if PCPs who received education on OCS are more likely to perform the screening compared to PCPs who …

Equity Of Care Analysis At Chi Health Hospitals And Clinics In The Omaha Metro Area., Lindsey Cork

Capstone Experience: Master of Public Health

The goal of the project is to identify if health disparities exist between patient groups based on race, ethnicity, language, payer type, and location of residence who received healthcare services from CHI Health system in the Omaha Metro area during January 2017 – March 2018. The health outcomes of interest are HPV vaccination rates, diabetes control rates, breast cancer screening rates, colorectal cancer screening rates, and 30-day hospital readmissions. Patient data from six Omaha area clinics and five hospitals was analyze in this study.

Among the six CHI Health clinics in this study, Lakeside had the highest rates of A1c …

Collaboration Between University Centers For Excellence In Developmental Disabilities (Ucedds) And Independent Living Networks, Sarah Swanson

Capstone Experience: Master of Public Health

In every state and U.S. Territory, there is a University Center for Developmental Disabilities (UCEDD), which is part of the state Developmental Disabilities network and an Independent Living (IL) Network, composed of Centers for Independent Living and Statewide Independent Living Councils. Each of these receive federal funding (and frequently state funding) to support people with disabilities and their families. However, each has different federal funding sources, different origins within federal legislation and different requirements. Through discussions with IL and UCEDD leadership it is clear that there are collaborations between the two, yet this is not widely recognized. This research proposal …

Protecting And Serving Yourself: The Mental Health Of Police Officers In Kaukauna, Wisconsin, Caina Weiner

Capstone Experience: Master of Public Health

The service learning hours performed at the Kaukauna Police Department served as a valuable learning experience to better understand an organization that is involved in public health. Although some may view this as non-traditional, the police department is quite involved in the community’s health. They work closely with public health officials and are also involved in certain public health programs, such as drug and alcohol programs. The health of a police officer must also be considered as a public health topic. A police officer is part of a vulnerable population of individuals that are “first responders.” These individuals are at …

Title X Family Planning Secondary Data Analysis Needs Assessment, Laura Triplett

Capstone Experience: Master of Public Health

The goal of the Title X Needs Assessment is to ‘Provide individuals the information and means to exercise personal choice in determining the number and spacing of their children', prevent unintended pregnancies, and reduce the number of abortions.’ Objectives include but are not limited to family involvement, abstinence and safer sex practice, intimate partner violence, human trafficking, contraceptive services, pregnancy testing and counseling, achieving pregnancy, basic infertility services, preconception health, STI/STD testing and treatment and HIV testing, Well Women/Men Exams; screening for breast cancer, cervical cancer, and testicular cancer in males. Sexual health education and reproductive life planning will be …

A Characterization Of The Medical-Legal Partnership (Mlp) Of Nebraska Medicine, Jordan Pieper

Capstone Experience: Master of Public Health

This research study was completed at Legal Aid of Nebraska’s Health, Education, and Law Project through the partnership it has formed working with Nebraska Medicine and Iowa Legal Aid. Traditionally, health and disease have always been viewed exclusively as "healthcare" issues. But with healthcare consistently growing towards holistic approaches to help patients, we now know there are deeper, structural conditions of society that can act as strong driving forces of a person's poor daily living conditions that can negatively impact health. The importance of a Medical-Legal Partnership is that it considers a patient's social determinants of health (SDHs). The goal …

Evaluating And Increasing Lead Poisoning Prevention Awareness In The Refugee Population Of Douglas County, Ne, Kara Albright

Capstone Experience: Master of Public Health

Background: Lead poisoning is a major public health concern. It accounted for twelve percent of the global burden for intellectual disabilities, and two and a half percent of the global burden for heart disease and stroke, as well as nearly 500,000 deaths in 2015 (World Health Organization, 2018). While everyone is at risk of lead exposure, refugee and immigrant children are at an increased risk because they have increased access and use of products from outside the United States that have been shown to contain lead (Moser, R., and Brownback, S., 2012; and New York State Department of Health, …

Transvaginal Cervical Length Surveillance Frequency And The Management Of Spontaneous Preterm Delivery In Twin Gestations, Ashley Janssen

Capstone Experience: Master of Public Health

Strategies to prevent preterm birth in multifetal gestation remain a high-priority in the United States. In women with a history of spontaneous preterm birth (sPTB) and singleton gestation, transvaginal cervical length (TVCL) surveillance and subsequent treatment is associated with a reduction in spontaneous preterm birth, however, there is limited data on the role of TVCL surveillance in twin gestation. The goal of this study is to determine if an association exists between TVCL and spontaneous preterm birth in twin gestations. Additionally, our research will assess whether TVCL surveillance impacts the timing of antenatal corticosteroids (ACS), magnesium sulfate administration, and maternal …

Massage Therapy Intervention For Pediatric Palliative Care Patients And Their Families, Taelyr Weekly

Capstone Experience: Master of Public Health

This study examined the feasibility and acceptability of a massage therapy intervention for pediatric palliative care patients and their adult caregivers to reduce their symptom impact at an urban pediatric hospital in Omaha, NE. Potential symptoms to be impacted by massage included stress for caregivers and pain, nausea, dyspnea, and anxiety for children. One hundred and thirty five massages were delivered to patients and caregivers in the PICU, NICU, and the inpatient hospital floor during the course of this non-randomized, pre-post study. Validated instruments were used to collect objective data from patients and caregivers, while observations were used to record …

A Strategic Approach To Employee Retention At Nebraska Families Collaborative, Rachel Walters

Capstone Experience: Master of Public Health

Nebraska Families Collaborative (NFC) is a nonprofit organization that supports children and families who are at risk, in eastern Nebraska. They offer a variety of services with the goal of moving children toward safety, permanency and well-being. Organizations such as NFC rely heavily on the commitment of the employees to carry out their mission, as do many other non-profit social service agencies across the country. The overall goal of the project was to identify reasons for high turnover and to identify potential solutions to reduce turnover and increase retention in the workplace at NFC. The main objectives were to analyze …

Quality Improvement: Assessing The Gaps In Education And Training Among Staff At Health, Education, And Law Project Hospital Sites In Nebraska, Michael Sauter

Capstone Experience: Master of Public Health

This research study was completed at Legal Aid of Nebraska’s Health, Education, and Law Project. The goal of this quality improvement study was to enhance the effectiveness of future Health, Education, and Law Project (HELP) training sessions for staff members of HELP sites in Nebraska. Through the use of an online survey tool, we received staff members’ input on the current training program, assessed their knowledge on relevant topics, and gave respondents an opportunity to include any appropriate suggestions. By means of this study, we were able to conclude that although staff members seemed to appreciate the training sessions overall, …

Macra Legislation (Medicare Access And Chip Reauthorization Act) And The Quality Provider Payment Program: Policy Analysis And Educational Program Evaluation, Katie Joseph-Johnson

Capstone Experience: Master of Public Health

ABSTRACT

Goal: The goal of this Service Learning/Capstone Experience is to provide an in-depth policy analysis and interpretation of the 2018 proposed changes in the Quality Payment Plan (QPP) as part of the 2015 MACRA legislation for the purpose of developing organizational training material.

Objectives: The key objectives of this project are 1) to complete a policy review of the current and proposed Quality Payment Program legislation from the Centers for Medicare and Medicaid Services (CMS), including June 2017 proposed updates and the November 2017 final rule updates; 2) to gain physician and hospital administrator’s perspective on realized …

Examining The Benefits And Client Satisfaction Of The Open Arms Of Minnesota Meal Service Program, Carlie Rhinehart

Capstone Experience: Master of Public Health

Chronic disease can leave individuals incapable of caring for themselves, leading to a low quality of life. Public health researchers have proven how crucial medically tailored meals are to those fighting such chronic diseases. Open Arms is a local nonprofit that started in 1986. They make and deliver meals, free of charge, to people with life-threatening illnesses.

The goal of this study is to examine the benefits of the meal services provided by Open Arms of Minnesota to clients who are chronically ill. To learn about the benefits, analysis was conducted on the client satisfaction survey data collected. The anonymous …

Hipaa Compliant Patient-Provider Communication: Student-Clinician Perceptions, Rachel Wenzl

Capstone Experience: Master of Public Health

Purpose: To evaluate the service learning clinical training facility’s HIPAA training by assessing student-clinician knowledge of the clinic’s HIPAA Compliance Plan and the impact of its training on student-clinician perceptions toward HIPAA-compliant patient-provider communication (PPC). For example, do student-clinicians feel it is important to be HIPAA-compliant and are they confident in discussing health-related activities and programs with patients or caregivers? The purpose of this project is not, at this time, to measure student-clinician intention to perform the behavior.

Methods: This project employed a mixed-methods, non-experimental cross-sectional study design using a retrospective post-test survey and group interview. The survey …

Mental Health Provider Perceptions On The Implementation Of Behavioral Health Interventions To Increase Access To Mental Health Care Services In Rural Nebraska, Grant Brueggemann

Capstone Experience: Master of Public Health

Abstract

Rural Nebraska communities are influenced by socioeconomic conditions and lack health care resources which contributes to the prevalence of mental health. As such, there is a need to implement effective intervention programs and evaluate current programs to reduce morbidity and mortality associated with mental health.

Goals: To assess the perceptions of mental health practitioners regarding public health programs and support services. This project also intends to gauge the effectiveness and viability of specific programs as potential solutions for increasing access and use of rural mental health care services. Furthermore, this project aims to inquire perceptions about the role …

Winnebago County Dryhootch Outreach Program, Greg Brittnacher

Capstone Experience: Master of Public Health

Abstract

Winnebago County Veterans Dryhootch Outreach Program

Aims: The Dryhootch Outreach Program focused on increasing behavioral activation through social interaction in a population of military veterans with Post Traumatic Stress Disorder (PTSD). The goals of the intervention were to reduce the prevalence of anxiety, depression, and PTSD symptoms. Additionally, the project aims to assist veterans to develop and maintain healthy relationships, assimilate with the “civilian” community, and effectively contribute to society.

Methods: Twenty-seven veterans with PTSD attended the twelve-week Dryhootch Outreach program provided by the Winnebago County Veterans Service office and partnering organizations. A pre-post interventional study format was utilized …

Identifying The Newly Insurable Medicaid Coverage Gap Population Under The Affordable Care Act: Who They Are And Where They Live, Samuel L. Woodruff

Capstone Experience: Master of Public Health

The goal of this Capstone Project is to better define and geographically locate the potential distribution of individuals who fall within the current Medicaid Coverage Gap and those populations who would be eligible for Medicaid under the expansion of Medicaid within the state of Nebraska. Using data from multiple United States Census Bureau sources, along with available data from the Health Resources and Services Administration (HRSA), this project looks to also locate populations of these individuals that may live within established Medically Underserved Areas (MUA's) or Health Professional Shortage Areas (HPSA's) within the state. American Community Survey 5-year Public Use …