Epidemiology Commons^™

Beyond The Bruise: Understanding Injury Risk Factors Among Livestock Workers In Cattle Feedyards And Animal Handling Farms And Ranches, Rishad Ahmed

Theses & Dissertations

Cattle feeding and livestock production are central to U.S. agriculture and represent some of the most hazardous occupational environments. Workers in feedyards and on cattle farms and ranches face elevated risks of injury due to physically demanding labor, frequent animal handling, and exposure to environmental and ergonomic hazards. Many feedyard workers are Hispanic/Latino immigrants who may experience additional barriers related to language, healthcare access, and job security. Similarly, injury risks among cattle producers are compounded by seasonal workload fluctuations, limited rest opportunities, and psychosocial stressors. Beyond individual impacts, agricultural injuries also pose a substantial economic burden. Recent estimates indicate that …

Symptom Clusters And Their Association With Health-Related Quality Of Life In Pediatric Cancer Survivors After Treatment Completion, Krishtee Napit

Theses & Dissertations

A critical area of cancer research, symptom management, has evolved from focusing on individual symptoms to recognizing the complexity of co-occurring symptoms, commonly referred to as symptom clusters. However, most studies on pediatric cancer symptom clusters have focused primarily on the treatment phase or long-term survivorship, overlooking the early post-treatment period. This dissertation examines the prevalence of multiple symptoms and symptom clusters in pediatric cancer survivors post-treatment; factors associated with the total number of symptoms and symptom clusters; and the association of the total number of symptoms and symptom clusters with health-related quality of life (HRQoL). We developed and tested …

From Vector To Consequence: Integrating Vector Surveillance, Environmental Drivers, And Public Health Impact Into Lyme Disease Risk Management, Kathleen E. Angell

Theses & Dissertations

Lyme disease is the most common vector-borne disease in North America. This dissertation examines (1) how crowd-sourced compares to active vector surveillance and whether they are associated with Lyme disease, (2) how ecological factors relate to tick abundance and whether they can predict high disease years, and (3) estimated health and economic burden of Lyme disease and savings when interventions are applied. Tick abundance data from active and passive surveillance were compared and tested for association with Lyme disease in the first aim. We found differences in tick life-stage, species, and seasonality. Tick observations were positively correlated with Lyme disease. …

Schistosoma Haematobium Infection In Ethiopian Children: Evaluating Praziquantel Efficacy, Nutritional Effects, And Diagnosis Using Flukecatcher, Louis Fok

Theses & Dissertations

Urogenital schistosomiasis continues to impact the wellbeing of hundreds of millions of people worldwide and remains a significant public health challenge across Ethiopia. Despite existing knowledge on the disease, there remain significant unanswered questions with regard to its treatment and diagnosis. This dissertation evaluated the efficacy of praziquantel at treating urogenital schistosomiasis, improving nutritional parameters among children and the performance of FlukeCatcher at detecting and determining the intensity of infection. In effecting this, a total of 977 children aged 5 through 15 from the Afar and Gambella regions of Ethiopia were screened for S. haematobium infection using urine filtration microscopy …

A Comprehensive Usability And Economic Analysis Of Heat-Related Wearable Technologies: Applications To Occupational Health, Ryan T. Cannady

Theses & Dissertations

The purpose of this research was to analyze the usability and economic considerations of real-time wearable technologies that are implemented in occupational settings to assess risk of heat stress and heat strain. The study population included current agriculture workers and Department of Energy (DOE), Environmental Management (EM) contractors. We employed a mixed-methods approach to comprehensively analyze the usability and economic considerations of heat-related technologies. Specifically, our approach assessed three distinct aspects the applications of these technologies in occupational settings to comprehensively address our research objective: (1) worker perceptions of heat-related wearable technologies, (2) field-based assessment of these heat-related wearable technologies, …

Association Between Agrichemical Mixtures And Pediatric Health Outcomes: Evidence From A Nebraska Population-Based Surveillance, Jabeen Taiba

Theses & Dissertations

Human exposure to environmental contaminants is associated with various pediatric health outcomes. Agrichemicals are a significant environmental risk factor for childhood cancers and congenital anomalies, and reduced exposure could improve pediatric health outcomes. Previous studies in Nebraska have explored the association between single pollutants and pediatric cancers and birth defects. However, it is important to estimate the overall effect of the agrichemical mixture on these pediatric health outcomes. In addition to environmental risk factors, several social vulnerability factors also contribute to increased agrichemical exposure and show disparities in pediatric cancers and birth defects. The objectives of this dissertation are to …

The Dissemination And Implementation Of N95 Fit Testing Capacities For Nebraska Long-Term Care Facilities: A Mixed-Methods Analysis Using The Re-Aim Framework, Anthony Blake

Theses & Dissertations

Background: Ensuring the proper fit of N95 respirators used by healthcare workers in long-term care facilities (LTCF) is essential for their safety. The Nebraska Department of Health and Human Services launched a LTCF strike team project (STP) in the summer of 2022, focused on increasing the number of staff trained in infection control and building internal capacity for LTCFs to fit test their employees. This study describes the N95 fit-testing initiative for Nebraska LTCFs.

Methods: Staff from all 19 local health departments (LHD) received “train-the-trainer” training to prepare LTCF staff to perform qualitative fit testing. LTCF administrators were requested to …

Bridging The Information Divide: Leveraging The Learning Health System To Understand Rural-Urban Health Disparities In The Covid-19 Era, Alfred J. Anzalone

Theses & Dissertations

The examination of healthcare disparities, which the COVID-19 pandemic exacerbated, revealed a pronounced divide between rural and urban settings. This divide particularly underscored the challenges of integrating rural healthcare into the Learning Health System (LHS) and utilizing real-world data (RWD) in response to a public health emergency. Our investigation expanded the growing body of literature on the rural mortality penalty, encompassing the period following the COVID-19 pandemic. By employing an LHS-enabled centralized platform of RWD, we assessed the impact of rurality on adverse COVID-19 outcomes (Aim 1), focusing on inpatient adverse events and the effectiveness of treatments and vaccinations across …

Gender Differences In Breast Cancer Treatment Decisions And Related Survival: A Study Using The National Cancer Database, Shamim Shahi

Theses & Dissertations

Despite increasing incidence, male breast cancer (MBC) remains understudied in almost all aspects of disease management. MBC patients are more likely to be diagnosed with larger tumors, at an advanced stage, and to experience poorer survival than female patients. There is a need to identify modifiable factors that can improve MBC patients’ survival.

This dissertation aimed to investigate whether there was a difference in the refusal of recommended treatments and related survival, by gender, in breast cancer patients enrolled in the National Cancer Database. Specifically, we conducted separate analyses for four treatments: hormone therapy, chemotherapy, radiation therapy, and surgery. Then, …

Assessing The Methodology, Prevalence, And Associated Factors For Adverse Childhood Experiences (Aces) Among Children And Adolescents In The United States, Kiara L. Lyons

Theses & Dissertations

To comprehensively capture the risk and protective factors of ACE exposure and ACE-related outcomes, we propose to consider a social-ecological model framework. The concept of the Social-Ecological Model was originally introduced in the 1970s by psychologist Urie Bronfenbrenner and designed to theoretically capture the multifaceted influence different personal, social, and environmental factors have on health behaviors and outcomes. Additionally, this would help to determine what prevention and intervention methods would be more appropriate to implement. This conceptual framework had five system levels: microsystem (individual), mesosystem (interpersonal), exosystem (community context), macrosystem (societal and cultural influences), and chronosystem (internal and external elements …

Environmental Exposures And Human Health Challenges: Evidence-Based Insights From Health Surveillance Systems, Jagadeesh Puvvula

Theses & Dissertations

Human exposure to environmental hazards is associated with a variety of preventable adverse health outcomes. As the environmental health risks result from the complex interaction between hazard, exposure, and susceptibility, these exposure-outcome associations are heterogeneous across the population. Improving environmental health literacy by advocating evidence-based environmental risk communication could play a role in reinforcing protective behavior against environmental hazards. The use of public health surveillance systems to assess the exposure-response associations is one of the effective ways to quantify the environmental health risks. However, there are several gaps in effectively quantifying environmental health risks. This dissertation aims to address a …

Evaluation Of Awareness, Knowledge, And Preventive Intervention Of Nonalcoholic Fatty Liver Disease Among Chinese Young Adults, Yi Du

Theses & Dissertations

The prevalence of nonalcoholic fatty liver disease (NAFLD) among Chinese young adults (CYA) aged 18-25 years ranges from 4.7% to 15.1% and has kept increasing in recent years. Previous studies reported limited awareness and knowledge of NALFD among middle-aged and older Chinese populations, however, they have not investigated awareness in CYA, for which there is no well-validated questionnaire. There is currently no efficacious educational intervention on NAFLD for CYA.

The objectives were 1) to develop and validate a questionnaire which can be used to assess the awareness and knowledge of NAFLD among CYA; 2) to assess the awareness and knowledge …

Investigation Of Cumulative Genetic Risk And Cc16 In Adult Asthma And Copd Populations, Kelli C. Gribben

Theses & Dissertations

INVESTIGATION OF CUMULATIVE GENETIC RISK AND CC16 IN ADULT ASTHMA AND COPD POPULATIONS

Kelli C. Gribben, Ph.D.

University of Nebraska Medical Center, 2022

Supervisors: Paraskevi A. Farazi and Tricia D. LeVan, Ph.D.

Asthma and Chronic Obstructive Pulmonary Disease (COPD) have complex etiologies and lack biological predictors that can be used for primary prevention, early detection, progression, or monitoring. Genetic risk scores (GRS) aggregate genetic effects from GWAS-identified susceptibility variants associated with a trait. GRS may provide opportunities to improve disease prediction to inform public health and clinical interventions. Asthma GRS studies utilizing multi-ethnic populations are scarce and there is a …

1-Check Unmc Mobile App Usage: A Quantitative Analysis Of The Data, Molly Pofahl

Theses & Dissertations

As COVID-19 cases continued to rise in Nebraska, universities and colleges were faced with unique challenges in the effort to continue providing quality education for students. The University of Nebraska Medical Center (UNMC) took on especially difficult challenges due to its status as an academic medical center. By the Fall of 2021, students, faculty, and staff were beginning to return to campus. The 1-Check UNMC app was created to help keep sick people from coming to campus. The UNMC community was expected to screen themselves for COVID-19 using this app each day before coming to campus. This thesis is an …

Clinical Consequences And Determinants Of False Positive Blood Cultures In Adult Hospitalized Patients, Sidra Liaquat

Theses & Dissertations

Blood cultures are the gold standard for detecting blood stream infections. However, in the US, 0.6-6% of all blood cultures get contaminated leading to adverse clinical outcomes such as unnecessarily prolonged hospital stay and antibiotic therapy. Using electronic medical records, we explored the clinical outcomes and patient-specific risk factors of contaminated blood cultures in an era where rapid blood culture testing was being utilized to provide blood culture results within hours. Rapid blood culture test results can help clinicians in early and more effective management of patients with contaminated blood cultures, thus improving clinical outcomes. We also studied the impact …

Neurocognitive Impairment In People Living With Human Immunodeficiency Virus (Hiv): Risk Factors And Mortality, Zaeema Naveed

Theses & Dissertations

Despite the widespread use of combination antiretroviral therapy (cART), HIV-associated neurocognitive impairment (NCI) persists in people living with HIV (PLWH) with clinical and public health implications. Studies have generated inconsistent results regarding etiological factors for NCI in PLWH and a brief user-friendly predictive tool is desirable in clinical practice to assess the probability of having NCI in PLWH. Furthermore, factors associated with clinically meaningful decline in neurocognitive status and survival disadvantage for patients with NCI are understudied in the post-cART era. The goal of this dissertation was to investigate factors associated with baseline NCI and neurocognitive decline and the association …

Fire Service Covid-19 Infection Prevention And Control Policy Comparison, Saaddedine Dichari

Theses & Dissertations

To date, there have been over 2.7 million deaths and more than 126 million cases attributed to the COVID-19 pandemic (JHU, 2021). This pandemic has affected nearly every aspect of daily life. Among those impacted are U.S. firefighters, as they provide many services beyond simply extinguishing structure fires and are frequently dual certified as emergency medical technicians. Many of the victims of this pandemic have relied on first responders to provide them with emergency medical care and hospital transport. When caring for these infected patients, firefighters have an increased risk of exposure and must be provided with adequate …

Reducing Adverse Outcomes In Hepatocellular Carcinoma Patients Undergoing Hepatectomies, Yongyue Qi

Theses & Dissertations

The incidence and mortality of liver cancers are increasing in the United States. In addition to the classic risk factors of hepatic viral infection and high alcohol consumption, non-alcoholic Fatty Liver Disease (NAFLD), has emerged as a risk factor for hepatocellular carcinoma (HCC). The most effective curative treatment for HCC is liver resection (hepatectomy), however, hepatectomy is a major operation with potential risks of mortality, hospital readmission and other adverse outcomes such as postoperative complications and longer hospital stay. The reported 90-day mortality and 30-day readmission rates following a hepatectomy vary widely across studies, most of which have limitations due …

Burden And Risk Of Non-Aids Defining Cancers In Hiv-Infected Persons Receiving Antiretroviral Therapy, Brittney L. Dickey

Theses & Dissertations

The burden of cancers not previously associated with an HIV infection, called non-AIDS defining cancers (NADCs), have increased in the years since highly active anti-retroviral therapy has been introduced. The studies in this dissertation attempted to quantify this burden via incidence and mortality compared to the general population. Further, an assessment of risk factors and creation of a predictive risk model, a nomogram, were utilized to better understand how factors associated with demographics, lifestyle, and immune response affected risk for an NADC diagnosis once therapy was initiated and HIV better controlled. Standardized incidence and mortality ratios showed that burden of …

Examining The Relationships Between School Engagement, Physical Activity, And Attention-Deficit Hyperactivity Disorder In Children Using The Ecological Model, Minh Nguyen

Theses & Dissertations

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with onset usually occurring in childhood and adolescence. During these developmental stages, social interactions and external environments can have significant impact on children’s growth and development. Few studies previously used a theoretical model to examine the effects of social and external environments on ADHD. The goal of this dissertation is to apply an ecological perspective to examine the roles of school and community in the development of childhood ADHD through school engagement and physical activity. Three studies were implemented to carry out this goal. Study 1 examined the associations of neighborhood, school, and …

The Impact Of Rural-Urban Residency On Colorectal Cancer Screening, Stage At Diagnosis And Treatment In The Privately Insured Population, Mesnad Alyabsi

Theses & Dissertations

Colorectal Cancer (CRC) is the third most common and leading cause of cancer death in the United States. Although CRC screening can prevent and detect CRC at an early stage, about 35% of Americans are not screened. Despite the recent increase in screening, people with lower SES and those who live in rural areas have lowest screening. In rural areas, a common obstacle for screening is the long trips for health services which is associated with advanced CRC.

Moreover, surgery is a substantial part of CRC treatment since stages I-III and some metastatic CRC (mCRC) patients are treated with surgery. …

The Survival And Treatment Refusal Of Lung Cancer Patients: Analyses Of National Cancer Registries, Poppy Deviany

Theses & Dissertations

Lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer mortality of both genders in the United States. A recent report suggests that the relative five-year survival rate of lung cancer is only 18%. Studies indicate many factors are associated with the survival of lung cancer patients, including age at diagnosis. It is widely known as a disease of older people, but the literature shows a substantial number of young people have been diagnosed with lung cancer. The literature also indicates that the refusal of recommended treatment contributes to cancer-related death and poorer survival. The …

The Effect Of Treatment Delay, Non-Adherence To Treatment Guidelines, And Never-Smoking Status On The Survival Of Lung Cancer Patients, Trisari Anggondowati

Theses & Dissertations

Despite many significant medical advances, lung cancer continues to cause more deaths than any of the other cancers in the United States (US), and worldwide. Timeliness of care and evidence-based guidelines are among the components of quality of care that are expected to improve patient outcomes. However, evidence on the effect of timeliness of care and adoption of evidence-based guidelines on patient survival remains lacking. In addition, there has been increasing concern on the fact that smokers are not the only group that suffers from lung cancer. Never-smokers comprise at least 10% of lung cancer patients in the US, or …

Relationships Between Complex Pediatric Health Conditions And The Built, Physical And Social Environments, Brittany Corley

Theses & Dissertations

The relationship between human health and the environment is complex and overall poorly understood. The environment has a lasting impact on health, and the processes appear to start at conception. Thus, this dissertation examines the potential relationship between pediatric health and the environment.

The first relationship examined was between the built environment and comorbid Attention Deficient Hyperactivity Disorder and Autism Spectrum Disorder. Many publications have reported the relationship between socioeconomic disadvantage, Attention Deficient Hyperactivity Disorder, and Autism Spectrum Disorder. However, the link between the built environment and Attention Deficient Hyperactivity Disorder and Autism Spectrum Disorder symptom severity is poorly understood. …

Hospital Based Emergency Department Visits With Dental Conditions: Outcomes And Policy Implications In The States Of California, Nebraska And New York, Sankeerth Rampa

Theses & Dissertations

The purpose of this dissertation was to present state-level estimates of hospital-based emergency department (ED) visits with dental conditions across all ages in the states of California, Nebraska, and New York. Also, this dissertation examined the outcomes and impact of changes in Medicaid policies on the utilization of ED with dental problems. State Emergency Department Databases (California, Nebraska, and New York), a component of the Healthcare Cost and Utilization Project (HCUP) was used for this dissertation. Dental conditions were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. High-risk groups visiting EDs with dental conditions were …

Epidemiologic And Clinical Profiles Of Uterine Cancer In The Gharbiah Province Of Egypt, Saad Alshahrani

Theses & Dissertations

Background: Uterine cancer is one of the top-ranking cancers of women with wide international variations in incidence rates. Egypt has a lower incidence of uterine cancer than other countries in the Middle East. In addition to the international incidence variation, there are also wide variations in incidence by rural and urban areas within countries. Therefore, this research project focused on the Gharbiah province, north of Cairo in the Nile Delta, with the aims of investigating demographic and clinical characteristics of uterine cancer, assessing rural/urban variation in incidence rates, and evaluating the possible role of hysterectomy in under-estimating the disease incidence …

Epigenetic Modifications Of Human Placenta Associated With Preterm Birth, Drissa Toure

Theses & Dissertations

Preterm birth is a complex multifactorial process. Despite the well-known role of the placenta in supporting the fetal development and maternal-fetal tolerance, the placental epigenetic modifications and preterm birth (PTB) remains poorly understood and under investigated. Various maternal and environment factors can influence epigenetic programming during fetal development to affect the functioning and structures of organs, including the placenta, which can lead to adverse pregnancy outcomes, including PTB. The understanding of the placental epigenetic alterations and maternal determinants associated with PTB are apparently indispensable for the development of actual diagnosis and methods of prevention and treatment of premature labor. The …

The Effect Of Agricultural Exposures And Genetics On Respiratory Phenotypes, Lisa W. Boyd

Theses & Dissertations

Agricultural workers are at risk for respiratory diseases, such as chronic obstructive pulmonary disease (COPD) and chronic bronchitis, due to exposures and inflammatory agents found in their work environment. While previous studies have been conducted to examine agricultural effects of chronic respiratory diseases more closely, there are still several significant gaps in the existing literature.

This dissertation explores the relationship between agricultural exposures and respiratory diseases. Utilizing two populations, the Keokuk Country Rural Health Study and the AgLung Study, this research: 1) used principal factor analysis (PFA) to distill exposure data into essential variables characterizing long-term agricultural exposures in order …

Surveillance Of Non-Fatal Agricultural Injuries Among Farm Operators In The Central States Region Of The United States, Ketki Patel

Theses & Dissertations

Agriculture is a major industry in the U.S. with high rates of fatal and non-fatal occupational injuries. The dynamic nature of the U.S. agriculture industry, regional variations in farming practices, and the diverse workforce make surveillance of injuries challenging. A recent National Academies (U.S.) evaluation reported that data for non-fatal agricultural injury are scarce, and mainly available through national surveys. Limited data are available for employees in the agriculture sector, especially farm owners and operators. The objectives of this study were to- 1) review and evaluate existing survey-based systems for surveillance of non-fatal agricultural injuries on U.S. farms, and 2) …

Psychological Aspects Of Head And Neck Cancer, Katherine Rieke

Theses & Dissertations

Patients with head and neck cancer may be at increased risk for depression diagnosis when compared to other cancer sites, both before and after their cancer diagnosis. Behavioral risk factors for head and neck cancers, including tobacco and alcohol use, may be indicative of depression before cancer diagnosis. Further, head and neck cancers and their treatments can cause serious morbidity among patients, including physical disfigurement and loss of function. Additionally, these cancers are often accompanied by social stigma, personal shame, and guilt. While there is a significant body of research examining depression in this cancer population, there are still several …