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

Describing Independent And Chain Pharmacies Within The Kentucky Medicaid Network, Kimber Woodrum

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

The shift in healthcare towards cost-savings mechanisms is hindering business operations of pharmacies in Kentucky, especially independent pharmacies. Independent pharmacists have reported that the operations of pharmacy benefit managers within Kentucky Medicaid networks have created financial hardships for their pharmacies and there is a threat of closure that could be associated with a potential access barrier to pharmacy services for Medicaid beneficiaries. During legislative meetings, much focus was on this issue and several bills are currently being drafted to correct this issue. It is important to define independent pharmacy and describe, geographically and in terms of utilization, chain and independent …

Retrospective Policy Analysis On The Efficacy Of The Army Hearing Program, Ahmad Brandelle Alexander

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

The present study (1) examined the Army Hearing Program (AHP) and (2) provided a retrospective policy analysis on several of the policies embedded within the AHP, more specifically the hearing readiness policy, to determine their efficacy and impact regarding noise-induced hearing loss (NIHL). The Beaufort Longest Framework was the analytic framework for this project. It was also used to structure the writing and formatting of this report. An extensive literature review of Army Medical Department (AMEDD) journals and Public Health journals were used in addition to several published Army Regulations and Pamphlets for guidance within conducting the Methods section of …

Select Antimicrobial Resistance Trends In Kentucky’S Bovine Population And Antibiogram Development, Jessica Morehouse

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

Introduction: Antimicrobial resistance (AMR) is a complex problem that affects all of society and is driven by many interconnected factors. It is important to monitor AMR trends in veterinary medicine to accurately pursue appropriate antibiotic treatment of ill animals. Antibiogram development is also an important tool in guiding the veterinary practitioner in treating empirically or while a culture and susceptibility is being performed.

Methods: This study compared bacterial susceptibility in voluntary samples submitted to the University of Kentucky Veterinary Diagnostic Laboratory and the Murray State University Breathitt Veterinary Center between 2012 and 2017. Equality of proportions was used to compare …

Overdose Prevention And Naloxone Distribution In Jefferson County, Brittany Coleman

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

The United States in battling an opioid epidemic, and rates of overdose fatality have soared to record highs. Kentucky is among the states with highest rates of opioid overdose fatality, and Jefferson County is responsible for about a quarter of all cases. Overdose Prevention and Naloxone Distribution (OPND) programs have been shown to decrease fatality rates by providing a medication that literally reverses opioid overdose. The programs provide other services such as education and connection to recovery facilities.

Currently, the Kentucky Harm Reduction Coalition provides naloxone kits to the residents of Jefferson County, but they do not have a regular …

Aps’Aalooke Led Diabetes Prevention Program, Lucy Hollingsworth Williamson

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

The primary objective of this proposed program is to decrease the burden of diabetes mellitus type II among the Crow Indian tribe members in Montana by preventing the progression of prediabetes to diabetes. Type II diabetes mellitus (DMII), is a debilitating disease that contributes to increased morbidity and mortality, in addition to billions of healthcare costs annually. In the United States, minority populations carry a higher burden of DMII, however American Indians have the highest prevalence of all. In fact, American Indians are 2.4 times more likely to be diagnosed with diabetes than white people.

In Montana, the Crow Indian …

Consultation Experience In Public Health, Xiangya Meng

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

This capstone project describes the results of a consultative experience in biostatistics.

Evaluation Of A Pharmacist Led Medication Reconciliation Process In Primary Care, Benjamin T. Gatlin

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

Medication safety should be at the forefront of public health initiatives. Medication reconciliations in primary care are key to successful, accurate, and safe medication use. Pharmacists are well positioned and educated to have an impact on medication safety by conducting reconciliations in primary care centers. Guidelines for training pharmacists on how to conduct medication reconciliations would be a useful tool for any health board striving to improve medication safety. This study uses observations from pharmacists currently conducting medication reconciliations in primary care to propose such guidelines in the form of a flow sheet. The resulting flow sheet and observations are …

Predictors Of Pm 2.5 And Radon Concentrations In Residences Of Central Kentucky: A Cross Sectional Study, Kyle T. Hancock

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

Aim: To measure levels of respirable particles (PM 2.5) and radon in homes in Central Kentucky and assess modifiable risk factors that could reduce the morbidity and mortality of cardiovascular and respiratory disease.

Methods: PM 2.5 and radon samples were taken in homes (n=21) in Central Kentucky. An in- home checklist was completed for each home that assessed a variety of potential environmental respiratory exposures.

Results: The geometric mean of PM 2.5 for all 21 homes was 8.4 μg/m³ which was well below the EPA air quality standard of 35 μg/m³. Smoking status, burning candles, and general …

Implementation Of An Evidenced-Based Opioid Treatment Program To Improve Maternal-Child Outcomes In Eastern Kentucky, Jordan Rice

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

The Kentucky River Area District Health Department proposes implementation of CHARM-Kentucky, a treatment program for pregnant women with opioid use disorder (OUD), in eastern Kentucky. Over 115 Americans die each day from an opioid overdose, resulting in approximately 42,000 deaths in 2016. In addition to an overall increase in opioid use in recent years, the use of opioids in pregnancy has also increased from 1.19 per 1,000 hospital births in 2000 to 5.63 in 2009. Opioid use during pregnancy results in poor neonatal outcomes including: low birth weight, preterm delivery, small head circumference, increased child maltreatment, and risk for long-term …