Public Health Commons^™

Effects Of Immunosuppressive Treatment On Patient Outcomes After Immune Checkpoint Inhibitor-Related Gastrointestinal Toxicity, Malek Shatila, Weijie Ma, Yantong Cui, Sidra Naz, Anusha S Thomas, Enrico N De Toni, Helga-Paula Török, Najib Ben Khaled, Mehmet Altan, Bryan Schneider, Yinghong Wang

Faculty, Staff and Student Publications

Purpose: Immune checkpoint inhibitors (ICIs) are increasingly used in the treatment of certain cancers but cause immune-related adverse events (irAEs). Gastrointestinal irAEs may necessitate extended periods of steroid use and the initiation of selective immunosuppressive therapy (SIT) which could theoretically counteract the effect of ICIs. In this study, we aim to explore the impact of immunosuppression use and duration on cancer progression and progression-free survival (PFS).

Methods: This is a single-center retrospective review exploring cancer outcomes in patients taking ICIs who developed gastrointestinal irAEs within 1 year of ICI initiation. Cancer outcome and progression free survival (PFS) were measured and …

Ancestral Diversity In Lipoprotein(A) Studies Helps Address Evidence Gaps, Moa P Lee, Sofia F Dimos, Laura M Raffield, Zhe Wang, Anna F Ballou, Carolina G Downie, Christopher H Arehart, Adolfo Correa, Paul S De Vries, Zhaohui Du, Christopher R Gignoux, Penny Gordon-Larsen, Xiuqing Guo, Jeffrey Haessler, Annie Green Howard, Yao Hu, Helina Kassahun, Shia T Kent, J Antonio G Lopez, Keri L Monda, Kari E North, Ulrike Peters, Michael H Preuss, Stephen S Rich, Shannon L Rhodes, Jie Yao, Rina Yarosh, Michael Y Tsai, Jerome I Rotter, Charles L Kooperberg, Ruth J F Loos, Christie Ballantyne, Christy L Avery, Mariaelisa Graff

Faculty, Staff and Student Publications

INTRODUCTION: The independent and causal cardiovascular disease risk factor lipoprotein(a) (Lp(a)) is elevated in >1.5 billion individuals worldwide, but studies have prioritised European populations.

METHODS: Here, we examined how ancestrally diverse studies could clarify Lp(a)'s genetic architecture, inform efforts examining application of Lp(a) polygenic risk scores (PRS), enable causal inference and identify unexpected Lp(a) phenotypic effects using data from African (n=25 208), East Asian (n=2895), European (n=362 558), South Asian (n=8192) and Hispanic/Latino (n=8946) populations.

RESULTS: Fourteen genome-wide significant loci with numerous population specific signals of large effect were identified that enabled construction of Lp(a) PRS of moderate (R

CONCLUSIONS: …

Variability In Anesthesia And Its Implications For Improving Patient Safety, Joshua Michael Biro

All Dissertations

Improving patient safety in anesthesia has proven to be an arduous and challenging task. Despite the many strategies and interventions to improve patient safety that have been employed, patient harm in anesthesia remains a problem. The struggle to reduce patient harm in anesthesia is both attributable to and representative of the complexity of the anesthesia system. In navigating this complex system, anesthesia providers have different approaches to how they accomplish their work, which results in variability in anesthesia practice. This variability provides an immense challenge to designing and implementing efforts to improve patient safety, as rigid interventions are often met …

Assessing The Role Of Distance To Level I Trauma Units On Atv Rollovers, Tractor Rollovers, And Machinery Entanglement Outcomes, Andrew K. Schissel

Capstone Experience: Master of Public Health

All-Terrain Vehicle (ATV) rollovers, tractor rollovers, and machinery entanglements cause traumatic injuries to agricultural workers. Response time of first responders combined with travel to trauma units can take a significant amount of time in rural areas, potentially leading to an increased risk of fatal outcomes for those involved in these incidents. The aim of this study is to determine if distance to a level I trauma unit is a factor in the outcomes of these incidents. ATV rollovers, tractor rollovers, and machinery entanglement injuries and fatalities, collected from a 7-state Midwestern region were entered into a GIS system along with …

A Literature Review Of The Psychosocial Impacts On Livestock Producers And Veterinary Responders Involved With Depopulation During And After An Animal Health Emergency, Beth Galles

Capstone Experience: Master of Public Health

A vital aspect of an animal health emergency in the United States is removing and disposing of diseased and healthy animals through depopulation. It is frequently required to prevent the spread of diseases that affect human health or economic stability. Production animals are eventually slaughtered, but this does not negate the human-animal bond felt between these animals and their caretakers. There is increasing recognition that participation in depopulation may be a traumatic event requiring care for the individuals involved, including livestock producers and veterinarians. Despite this, limited resources are available for these individuals when an animal health emergency occurs. This …

Occupational Exposures Associated With Thyroid Cancer In The Thyroid Tumor And Cancer Collaborative Registry In The Integrated Cancer Center Repository For Cancer Research, James Buckley

Capstone Experience: Master of Public Health

Thyroid cancer is one of the fastest growing cancers in the United States, with the rate of new cases increasing from 5.2 per 100,000 in 1985 to 13.8 per 100,000 in 2019, with a peak of 14.5 per 100,000 in 2015. Increased thyroid cancer incidence is associated with certain occupations, including healthcare and agriculture. Most existing literature on occupational exposures and thyroid cancer evaluate their association in terms of occupation type and thyroid cancer, rather than specific occupational exposures and thyroid cancer. This study sought to utilize the wide range of occupational exposure data in the Integrated Cancer Center Repository …

Evaluating Nebraska’S State Health Assessment (Sha) And State Health Improvement Plan (Ship) Methodology To Inform The Redesign Evaluation Plan, Austin J. Osborn

Capstone Experience: Master of Public Health

The Division of Public Health (DPH) within the Nebraska Department of Health and Human Services (DHHS) is redesigning its State Health Assessment (SHA) and State Health Improvement Plan (SHIP) procedures. This study aimed to support the Nebraska DPH SHA/SHIP redesign evaluation plan by determining the local health department (LHD) health priority determination processes, Tribal and LHDs’ (T/LHD) CHA/CHIP methodology, and if any differences exist between rural & urban and small, medium, and large jurisdictional size health departments in Nebraska. The results show that most health departments utilize the MAPP process to conduct their CHA/CHIP, one tribal entity utilizes a different …

Influence Of Sexual Orientation On Sexual Risk Behaviors Among High School Students – United States, 2023, Carley J. Cortez

Capstone Experience: Master of Public Health

The Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Intersex, Asexual, and other (LGBTQIA+) community participate in higher sexual health risk behaviors that lead to outcomes such as sexually transmitted infections and unwanted pregnancies than their heterosexual peers. Youth and adolescent LGBTQIA+ populations also experience this increased sexual health risk which will increase the risk for negative health outcomes as adults. The 2019 Youth Behavioral Risk Survey dataset was used to assess the association between sexual orientation on specific sexual health risk behaviors such as total number of sexual partners, history of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) testing, and …

Rural-Urban Differences In The Age-Adjusted Pediatric Cancer Mortality In The United States (2000-2020), Reitumetse A. Setai

Capstone Experience: Master of Public Health

In the United States (U.S.), 5-year survival for pediatric cancers improved from 58% in 1975 to 85% in 2017. However, pediatric cancer remains the second leading cause of death in children between 0 – 14 years. Despite the growing body of pediatric cancer research, there is limited knowledge of the urban and rural disparities of pediatric cancer mortality. This study examined: 1) the differences in the U.S. pediatric cancer mortality rates between rural and urban residents during 2016-2020 by demographic characteristics (age group, sex, race/ethnicity, and income) and cancer types and 2) the trend of pediatric cancer mortality in the …

The Impact Of Doulas On Breastfeeding In Black Women: A Literature Review, Delaney C. Holland

Capstone Experience: Master of Public Health

This literature review was conducted to explore the impacts doulas have on breastfeeding initiation and continuation in the Black population. Black women’s breastfeeding and continuation is exceptionally low compared to white women and other races and ethnicities. Six journal articles were used to examine the relationships that doulas have on breastfeeding initiation and continuation in black communities. There was an array of study designs found throughout the articles to help support the doula and breastfeeding relationship in Black women. The results of this literature review were preliminarily positive, but more evidence is required to firmly establish the positive impact of …

Understanding Gendered Risks For Severe Covid-19 Through Surveying The Gender Diverse Community, Arden Tyree

Capstone Experience: Master of Public Health

Early on in the pandemic, the medical community began noticing that men were more likely to be hospitalized, require admission to the ICU, and die of COVID-19 than women but few studies of COVID-19 make mention of gender diverse people, an often-overlooked population who may have vastly different experiences than non-gender diverse men or women. Their variations in gender and sex characteristics may also help provide further insight into which traits are protective or risk factors for this disease. This project used Poisson regression in order to analyze self-reported survey data. The major associations of interest will be between disease …

The Risk Factors Associated With Personal Protective Equipment Usage Rates In The Central States By Generalized Multilevel Models, Carter E. Vogel

Capstone Experience: Master of Public Health

Background: Agriculture producers in the United States face some of the highest rates of fatal and non-fatal injuries among all occupations. This includes a high risk of respiratory damage when working in dusty environments, chemical and health hazards when working with pesticides or other dangerous chemicals, and hearing damage when working in noisy environments. These risks can be reduced using personal protective equipment (PPE). While some workplaces are required by the Occupational Safety and Health Administration (OSHA) to provide necessary PPE and monitoring according to the risks of a job, many small farms are not required by OSHA to provide …

Early Childhood Nutrition Education Implementation Evaluation And Planning: Learn, Grow, Eat & Go!, Alyssa L. Wessling

Capstone Experience: Master of Public Health

The obesity rate among American children aged two to five years old is 12.7% (Centers for Disease Control, 2022), indicating a need for health interventions at this critical life stage. Nebraska Extension’s Nutrition Education Program has identified a need for direct education materials to reach Nebraskans in early childhood. Learn, Grow, Eat & Go! Early Childhood was identified as an appropriate curriculum to be tested in an early childhood intervention pilot. Learn, Grow, Eat & Go! Early Childhood is a newly developed program built upon the foundation of teaching children about healthful foods and physical activity through gardening. An early …

A Qualitative Analysis Of Candida Auris Laboratory Surveillance In Nebraska, Lissa M. Young

Capstone Experience: Master of Public Health

Objectives: Candida auris is an emerging pathogenic yeast that was first identified in Japan in 2009 and detected in the United States in 2015. As of 2020, C. auris has been reported in cases throughout 41 countries, including the United States. The ability of this species of yeast to spread rapidly and survive for long periods of time on surfaces, the high mortality rate of those infected, and its multidrug resistant phenotype, have rendered it a urgent public health threat (the highest threat level) by the United States Centers for Disease Control and Prevention beginning in 2019 (CDC, 2019). Since …

Evaluating The Impact Of Culturally Informed Interventions On Nebraska's Refugees: A Pilot Study With Healthcare Workers, Falah Nayif Rashoka

Capstone Experience: Master of Public Health

Background: Refugees in the US are at increased risk of poor health outcomes, spanning mental health and general well-being, compared with American-born individuals. With the rapid growth of the refugee population in Nebraska, the need to train healthcare providers to provide culturally competent care has never been greater. A common point of access to healthcare for the refugee population after resettlement is via local health departments and the primary healthcare network. Recent estimates show close to five thousand Yazidi refugees living in Nebraska, most of whom moved after 2009 based on federal legislation admitting those who served in the …

Operation Wasatch: Scenario Based Planning To Assess The Cold Weather Preparedness Of The National Disaster Medical System, Alison Matthews

Capstone Experience: Master of Public Health

Background: The National Disaster Medical System has little experience with sustained mission operations under anything other than temperate environmental conditions. Extreme weather events increase the complexity of disaster response by presenting significant logistic, operational, and safety challenges. Identifying gaps and vulnerabilities in response capabilities can promote improved Disaster Medical Assistance Team preparedness.

Methods: This discussion based exercise utilized a scenario involving a 7.0 magnitude earthquake along the Wasatch Fault in winter. This exercise was conducted with members of the Wisconsin-1 Disaster Medical Assistance Team. Team members provided oral and written feedback in response to exercise objectives and prompts. This feedback …

Association Of Socioeconomic Status And Mental Health Characteristics And Participant Attrition In A Cohort Study, Mathews Thampi

Capstone Experience: Master of Public Health

The cohort study is an essential design for investigating associations between a variety of risk factors or exposures and a plethora of health outcomes. However, one of their biggest weaknesses is participant attrition, which can introduce bias and impact validity. Understanding whether this attrition is related to exposure and outcome is a critical aspect of assessing the potential for selection bias. The Women and Their Children's Health (WaTCH) study is a prospective cohort study designed initially to examine the health impacts of exposure to the Deepwater Horizon oil spill. The study has undergone two waves of data collection and is …

Housing Is Safety: An Evaluation Of A Transitional Housing (Th), Rapid-Rehousing (Rrh), And Joint Th/Rrh Program For Survivors Of Interpersonal Violence, Bridget L. Claborn

Capstone Experience: Master of Public Health

In this capstone project, I created a program evaluation plan and conducted preliminary analysis for the Mar􏰀 Parrish Center􏰁s (MPC) transitional housing (TH), rapid-rehousing (RRH), and joint TH/RRH programs for survivors of interpersonal violence and their families. The intent of the project is: (1) to better understand the impact of MPC housing programs; (2) to inform strategies for continuous improvement in client outcomes, access, and satisfaction; (3) to further evaluation capacity for the organization; and (4) to generate practice-based evidence to inform the field at large. As a practitioner in the field of interpersonal violence and former MPC staff member, …

The Relationship Between Congenital Heart Disease And Infant Mortality In Low- And Middle-Income Countries: A Comprehensive Literature Review, Helen Nneoma Odo

Capstone Experience: Master of Public Health

Congenital heart diseases (CHD) are conditions that are present at birth and can affect the structure of an infant’s heart and the way it works. Millions of children are born each year with congenital heart disease yet screening for CHD is not practiced in Low- and Middle-income countries (LMICs). Studies on access to healthcare for infants with congenital heart disease have not kept pace. This literature review centers on the role of congenital heart disease in infant mortality, its burden, incidence and prevalence in LMICs. The databases of PubMed, Google Scholar and Embase were searched and the selected articles for …

Effects Of Hospital Interventions On Maternal Mortality Rates Of African American Women: A Literature Review, Oluwatosin A. Soyege

Capstone Experience: Master of Public Health

Maternal mortality is a serious health concern and harms society’s economic, physical, and psychological well-being. It is tragic for the woman’s family and community when a woman passes away during pregnancy, at delivery, or shortly after delivery. Hospital interventions are needed to mitigate the social impact of maternal mortality. In the U.S., several initiatives have been enacted to reduce maternal mortality. Fighting racism would also help African American women’s rates of maternal mortality as they are subject to stigma in everyday contexts, during pregnancy and obtaining healthcare, and when obtaining resources and services during pregnancy. This paper reviews the literature …

Assessing Meatpacking Worker's Perceptions Of Supervisors' Concern For Safety And Supervisors' Support, Sara Reyes

Capstone Experience: Master of Public Health

Occupational safety is a major public health issue, given that failure to meet safety regulations can lead to incidents and death. Meat processing facilities have some of the highest rates of non-fatal and fatal injuries compared to other industries. A reported 5.9 incidents per 100 full-time occupied within meat processing industries. The majority of workers within meat processing plants are people of color and immigrants, leading to a disproportion in reports of incidents and safety concerns. Immigrant workers frequently occupy positions within the kill floor and fabrication departments. Supervisors are often at the forefront of safety, yet workers often report …

Effectiveness Of Amiodarone, Propafenone And Synchronized Electrical Cardioversion For Conversion Of Atrial Fibrillation Paroxysm To Sinus Rhythm In Rigas Stradins University Hospital Department Of Emergency Medicine., Mihails Tracevskis

Digital Journal of Clinical Medicine

Abstract

Introduction: Atrial fibrillation remains a pervasive global health concern, contributing significantly to the incidence of stroke, heart failure, sudden death, and overall cardiovascular morbidity.

Materials and methods: The present study undertook a retrospective analysis involving a meticulous examination of 127 patients, representing a diverse cohort of individuals encompassing 73 men (with a median age of 62 and a range of 37-75) and 54 women (with a median age of 60 and a range of 42-78) duration of atrial fibrillation 48 hours or less.

Results: The results highlighted amiodarone's remarkable efficiency, as it successfully converted 81.2% of cases (56 …

Health Facilities Preparedness To Deliver Maternal And Newborn Health Care In Kilifi And Kisii Counties, Kenya, James Orwa, Marleen Temmerman, Lucy Nyaga, Kennedy Mulama, Stanley Luchters

Population Health, East Africa

Introduction: Health facility preparedness is essential for delivering quality maternal and newborn care, minimizing morbidity and mortality by addressing delays in seeking skilled care, reaching appropriate facilities, and receiving emergency care. A rapid assessment of 23 government health facilities in Kilifi and Kisii counties identified poor maternal and newborn indicators in 16 facilities. The Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) project supported these facilities with training, equipment, and referral linkages. This study focuses on facility preparedness of the 16 facilities to deliver maternal and newborn health services, specifically delays two and three at the end …

Outcomes Of Induction Vs Prelabor Cesarean Delivery At <33 Weeks For Hypertensive Disorders Of Pregnancy, Elisa T Bushman, William A Grobman, Jennifer L Bailit, Uma M Reddy, Ronald J Wapner, Michael W Varner, John M Thorp, Steve N Caritis, Mona Prasad, George R Saade, Yoram Sorokin, Dwight J Rouse, Sean C Blackwell, Jorge E Tolosa

Faculty, Staff and Student Publications

BACKGROUND: Hypertensive disorders of pregnancy are the leading cause of indicated preterm birth; however, the optimal delivery approach for pregnancies complicated by preterm hypertensive disorders of pregnancy remains uncertain.

OBJECTIVE: This study aimed to compare maternal and neonatal morbidity in patients with hypertensive disorders of pregnancy who either went induction of labor or prelabor cesarean delivery at <33 >weeks' gestation. In addition, we aimed to quantify the length of induction of labor and rate of vaginal delivery in those who underwent induction of labor.

STUDY DESIGN: This is a secondary analysis of an observational study which included 115,502 patients in 25 …

Do Vaccinations Influence The Development Of Alzheimer Disease?, Avram S Bukhbinder, Yaobin Ling, Kristofer Harris, Xiaoqian Jiang, Paul E Schulz

Faculty, Staff and Student Publications

A growing literature supports a protective association between vaccines targeting an array of pathogens (e.g., influenza, pneumococcus, herpes zoster) and the risk of Alzheimer disease (AD). This article discusses the potential underlying mechanisms for this apparent protective effect of immunizations against infectious pathogens on the risk of AD; explores the basic and pharmacoepidemiologic evidence for this association, with particular attention paid to important methodological variations among the epidemiologic studies; and reviews the remaining uncertainties regarding the effects of anti-pathogen vaccines on Alzheimer disease and all-cause dementia, with recommendations for future directions to address those uncertainties.

Postoperative Respiratory Complications In Sars-Cov-2 Positive Pediatric Patients Across 20 United States Hospitals: A Cohort Study, Audra J Reiter, Martha-Conley E Ingram, Mehul V Raval, Elisa Garcia, Madelyn Hill, Arturo Aranda, Nicole M Chandler, Raquel Gonzalez, Kristen Born, Shale Mack, Abdulraouf Lamoshi, Aaron M Lipskar, Xiao-Yue Han, Elizabeth Fialkowski, Brianna Spencer, Afif N Kulaylat, Amrene Barde, Ami N Shah, Maeva Adoumie, Erica Gross, Steven C Mehl, Monica E Lopez, Valerie Polcz, Moiz M Mustafa, Jeffrey W Gander, Travis M Sullivan, Jason P Sulkowski, Owais Ghani, Eunice Y Huang, David Rothstein, E Peter Muenks, Shawn D St Peter, Jason C Fisher, Dina Levy-Lambert, Allison Reichl, Romeo C Ignacio, Bethany J Slater, Kuojen Tsao, Loren Berman

Faculty, Staff and Student Publications

INTRODUCTION: Data examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children.

METHODS: This retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020. The primary outcome was frequency of postoperative respiratory complications, including: high-flow nasal cannula/non invasive ventilation, reintubation, pneumonia, Extracorporeal Membrane Oxygenation (ECMO), and 30-day respiratory-related readmissions or emergency department (ED) visits. Univariate analyses were used to evaluate associations between patient and procedure characteristics …

A Previously Healthy Infant With Lemierre Syndrome In The Emergency Department: Case Report, Adeola Adekunbi Kosoko, Omoyeni O Clement

Faculty, Staff and Student Publications

INTRODUCTION: Lemierre syndrome (LS) is a rare condition with a high mortality risk. It is well described in older children and young adults involving bacteremia, thrombophlebitis, and metastatic abscess commonly due to Fusobacterium infections. Young, pre-verbal children are also susceptible to LS; thus, careful attention must be given to their pattern of symptoms and history to identify this condition in the emergency department (ED).

CASE REPORT: A 12-month-old previously healthy boy with a recent diagnosis of acute otitis media and viral illness presented to the ED with a complaint of fever. Additional symptoms developed at the head and neck and …

Who Is At Risk For New Hepatitis B Infections Among People With Hiv?, John M Sladic, Barbara S Taylor, Mae Thamer, Karen J Vigil, Onkar Kshirsagar, Anna Taranova, Andrew Mccracken, Carmen G Sanchez, Mamta K Jain

Faculty, Staff and Student Publications

Hepatitis B virus (HBV) increases morbidity and mortality among people with HIV (PWH). We retrospectively analyzed HBV incidence among 5785 PWH. Fourteen had newly positive hepatitis B s antigen (mean 5.2 person-years of follow-up, 46.4/100 000 infections/year). These data show gaps in HBV vaccination and in the preventative efficacy of HBV-specific antiretroviral therapy.

Individual, Systemic And State Factors Associated With Provider Recommendation Of Hpv Vaccination: Findings From Nis-Teen, 2020, Ikponmwosa Osaghae, Monalisa Chandra, Rajesh Talluri, Sanjay Shete

Faculty, Staff and Student Publications

The most important determinant of HPV vaccination uptake is healthcare provider recommendation, yet not all eligible patients receive HPV vaccination recommendations. We used data from the 2020 National Immunization Survey-Teen to determine individual, systemic, and state factors associated with provider recommendation of HPV vaccination. A total of 18,534 teens were included, with 81.4% receiving provider recommendations for HPV vaccination. HPV vaccination recommendation was higher among females compared to males (AOR: 1.57; 95% CI: 1.27-1.93), teens who received a well-child exam at 11 or 12 years compared to those who did not (AOR: 2.10; 95% CI: 1.61-2.74), and teens whose mothers …

Clinical And Demographic Attributes Of Patients With Diabetes Associated With The Utilization Of Telemedicine In An Urban Medically Underserved Population Area, Lisa Ariellah Ward, Gulzar H. Shah, Kristie C. Waterfield

Health Policy & Community Health: Faculty Publications

Marginalized populations often experience health disparities due to the significant obstacles to care associated with social, economic, and environmental inequities. When compared with advantaged social groups, these populations frequently experience increased risks, poorer health outcomes, and reduced quality of life (QoL). This research examines the clinical and demographic characteristics—age, gender, and race—related to patients with varying stages of type 2 diabetes mellitus (T2DM), comparing the utilization of telemedicine (TM) with traditional healthcare face-to-face (F2F) appointments in an urban medically underserved population area (UMUPA). A logistic regression model, was used to analyze retrospective electronic patient health records (EHRs) from 1 January …