MPH Program

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Capstone Project Abstracts and PowerPoint Presentations

 

2014 Graduates

  • Olufemi Adekeye, MD, MPH - Why do People with Compensable Injuries have Poorer Outcomes than those with Non-Compensable Injuries?
  • Gina Bane, MD, MPH - Timing of Death in Pediatric Sepsis: A Descriptive Study
  • Michael Bauman, MPH - Firehouse Staffing and its Effect on Response Times to Emergencies
  • Scott Hallal Negishi, MPH - Ethanol Fuel Initiative: A Program Plan for Education through Multimedia
  • Tara Humfeld, MPH - The Food Safety Modernization Act: A History of Changes in Authority by the Food and Drug Administration on Imported Food and the Effects on Global Public Health
  • Blessing Jerome, MPH - Systematic Review of the State of HIV/AIDS in Nigeria
  • Jamie Kondelis, MD, MPH - DOT Commercial Driver Manual
  • Roohi Kharofa, MD, MPH - Milwaukee Public School Body Mass Index Policy
  • Cavine Opondo, MD, MPH - Worksite Wellness Programs on Cardiovascular Risk Reduction: A Review of Services Offered and Possible Recommendations
  • John O'Horo, MD, MPH - Diagnosis of Blastomyces dermatitidis in the Urban and Rural Environment: A Comparative Study
  • Danessa Sandmann, MPH - A Comprehensive Review of Current Indoor Tanning Facility Usage Policy and Regulation in Wisconsin and Future Recommendations
  • Claire Schuenke, MPH - Best Practices in Workplace Wellness Programs for Stress Management Interventions and Program Planning
  • Sanja Vodanovic Jankovic, MPH - Public Health Implications of Lymphatic Filariasis

2013 Graduates

  • Allison Beilke, MPH - Literature Review to Demonstrate the Relation of Health Effects Due to Obesity and Motor Vehicle Crashes in Truck Drivers
  • Kavita Bhat, MD, MPH - What are the top health concerns in the City of Milwaukee and how do we manage them?  An examination of Key Informant Interviews from Milwaukee's 2013 Community Health Assessment
  • Gayathri Chelvakumar, MD, MPH - LGBT Healthcare Experiences in Milwaukee
  • Paula Cody, MD, MPH - Parental Knowledge and Beliefs Regarding Childhood Immunizations
  • Gerard Coly, MPH - Characteristics of African American Study Participants in Milwaukee
  • Kevin Culbert, MD, MPH - Considerations for Legislation to Raise the Minimum Legal Sales Age for Tobacco in the Commonwealth of Virginia
  • Melissa Enriquez, MPH - A Nutrition Assessment of the Uninsured Hispanic Population Living in Wisconsin and Accultration's Role on Health
  • Lisa Forsch, MPH - The Influence of Social Business on Public Health
  • Nicholas Hevey, MPH - Analysis of the Public Health Fund Provision of the Patient Protection and Affordable Care Act: How We Can Direct the Funds to Maximize Public Health Impact in Wisconsin
  • Kerri Holden, MPH - Effectiveness of Motivational Interviewing on Health Outcomes in Patients with Diabetes: A Review of the Literature
  • Mandy H. W. Kastner, MPH - Review of the Quality of Hypertension Care at the Lake Area Free Clinic in Oconomowoc, Wisconsin
  • Sharon Kolbe, MPH - Chagas Disease: A Systematic Review of Prevention Efforts in Latin America
  • Carrie Madormo, MPH - A Comprehensive Evaluation of the Wisconsin Seal-A-Smile Program
  • Jessica (Arndt) Olbrot, MPH - Barriers and Facilitators for Hmong Seeking Mental Health Counseling: Implications for Community-Based Organizations and Public Health
  • Cathlyn Smith, MPH - First Steps to Mitigate Opioid Abuse in a Local Community
  • Ema Uko-Abasi, MPH - Developing an Expanded Tobacco Use Vital Sign Program Through Research Evidence of Effectiveness
  • Joseph Welter, MD, MPH - The Amish of Central Wisconsin: Preparing for an Outbreak of Vaccine-Preventable Disease

 

2012 Graduates

  • Erica K. Bergstrom, MPH - Sport Related Injuries in Competitive Swimmers: A Review of the Epidemiology of Swimming Related Injuries
  • Laura (Fadrowski) Conklin, MPH - Web 2.0 – Social Media Marketing:  Taking Local Public Health Departments to the Next Level
  • Shereen Elbaz, MD, MPH - Impact of prenatal health care, prenatal smoking and alcohol drinking on infant mortality
  • Jennifer L. Hanke, MPH - Refugees in Colorado:  A Review of Colorado’s Refugee Preventive Health Program and the Health Status of a Community
  • Christy L. Kiekenbush, MPH - The Human Papillomavirus Vaccine:  A Systematic Review Elucidating the Dynamics of Ethical Concerns and Public Health Policies
  • Jennifer L. Leonard, MPH - Identification of the Need for Inclusion of Alcohol / Substance Use into Comprehensive Sexual Education Courses in Public Schools
  • Peigang Li, MPH - Racial and Social-economic Evaluations of Community Health Disparities:  The Association between Health Outcomes and Local Retail Food Environment in the City of Milwaukee
  • Katharine E. Lohse, MPH - How does the rate of cesarean section rates affect rural areas?  A systematic literature review
  • Alexandra M. Ostromecki, MPH - A Program Plan for Childhood Obesity Prevention in a Local Community
  • Esha Pillai, MPH – The Mobile Markets Project:  Nutrition Education with Healthy, Affordable Food at the Neighborhood Level
  • Elma Racquel Racadio, MPH - Barriers to Emergency Contraception Access in Rural Wisconsin Communities:  A Qualitative Analysis of Public Health Officer Interviews
  • Brianne N. Runyan, MPH – The Future of Public Health:  National Public Health Department Accreditation versus the Current Wisconsin DHS 140 Review:  Requirements of Local Health Departments
  • Devyne L. Schmidt, MPH, CHES - The Role that Incentives Plan in the Improvement of Population Health at Worksites:  A Systematic Review
  • Michelle Thate, MPH – Nutrition Education at Mobile Markets:  A Community Needs Assessment to Guide Nutrition Programming Development and Implementation at Mobile Market Sites
  • Sylvia Torres, MPH - The Teen Perception of Unhealthy Sexual Behaviors:  The Development of Items for a Teen Survey

 

2011 Graduates

  • Morgan K. Anderson, MPH - Drinking Water Concerns and Water-borne Illness Prevention Recommendations in Rural Kenya: A Systematic Review
  • Waqar Jabbar Malik, MD, MPH - Effects of Cell Phone Usage (including Talking and Texting) on Driving
  • Sarah A. Muir, MPH - A Mental Health Anti-Stigma Program for the West Allis Health Department
  • Mario Pena, Jr, MD, MPH - Pesticide Exposure in Migrant Workers and their Families: An Evaluation of Pesticide Exposure as Measured by Acute Illness in Migrant Field Workers in Texas Health Region I
  • Heather B. Puente, MPH - Teen Pregnancy in Milwaukee: An Analysis of Effective Prevention Methods and Factors
  • H. James Sleavin, MD, MPH, FAAP, COL (Ret.) MC USAR - Traumatic Brain Injury and Posttraumatic Stress Disorder in Returning Soldiers Serving in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) and their Re-integration into the Community
  • Carol M. Smith, MD, MPH - An Overview and Survey of the Medical Management and Reporting by Medical Providers in Dutchess County, New York
  • Annika Swenson, MPH - A Program Design for Tobacco Education and Cessation in the Youth of Sawyer County
  • Jennifer Peelen Thomas, MD, MPH - Use of E-mail by Physician Breastfeeding Experts For Support of the Breastfeeding Mother
  • Ronald Thomas, MD, MPH, FACEP - Impact of Emergency Department Crowding on Public Health and Patient Safety
  • Rebecca VanAmburg, MPH, ATC - An Analysis of Four Types of Single Payer Health Insurance Systems: Canada, Sweden, Taiwan and the United Kingdom – How do they compare to the United States?

 

2010 Graduates

  • R. Lee Barnes, MD, MPH - Identifying Obstructive Sleep Apnea in the Commercial Truck Driver: Literature Review with Proposed Revisions to the Department of Transportation Medical Examination Form
  • Steven Bratman, MD, MPH - The Current Status of Observational Studies as Scientific Evidence: A Critical Appraisal
  • Casey J. Brown, MPH - The Homeless Population: A Literature Review of Health Care Access with a Case-study of Autumn West and the Homeless Outreach Nursing Center Programs in Milwaukee, WI
  • Erwin Cabacungan, MD, MPH - Racial and Ethnic Disparities in Maternal Morbidities and Preexisting Medical Conditions during Labor and Delivery Hospitalizations in Wisconsin
  • Thomas Frye, DDS, MPH - Access to Dental Care for Rural and Underserved Areas: Applying Evidence to the Practice Setting
  • Jessica Gathirimu, MPH - A Mother's Perspective: An Analysis of Fetal Infant Mortality Review (FIMR) Maternal Interviews
  • John Hall, MD, MPH - Hepatitis B Prevention Awareness in San Francisco Dental Offices
  • Elizabeth Kailath, MD, MPH - Emerging Infectious Diseases with an Emphasis on the Novel H1N1 Influenza Strain and its Impact on Public Health
  • James Laurino, MD, MPH - The Bioterrorism Research Handbook for Category A Biological Agents: Natural History of Disease, Pre-Research Testing, Post Exposure Testing, and Disease Treatments
  • Amir Nicknam, MD, MPH - Strategies and intervention methodologies to achieve the elimination of childhood lead poisoning disparities in Southern Nevada
  • Amanda Ruth Phillips-Savoy, MD, MPH - How to Select a Mass Notification System: A 12-Step Program
  • Michael Rosenberg, MD, MPH - HIV/AIDS Issues Facing America: Understanding the Current Demographic Trends of the Epidemic and Addressing the Public Health Needs of High-Risk African American Women
  • Michael Schmalz, MPH - Analysis of Novel H1N1 Pandemic Plan for Wauwatosa’s Health Department: Communication and Mass Clinic Implementation
  • Graciela Villadoniga, MD, MPH - Applying the Chronic Care Model to Diabetes Mellitus: Does its application improve Diabetes Mellitus outcome? A literature review.
  • Ghousia Wajida, MD, MPH - Salt and High Blood Pressure: A Community Experience

 

2009 Graduates

  • Steven A. Harris, MD, MPH - Health Effects of an Efficient, Vented Stove in the Highlands of Guatemala
  • Ernest E. Sullivent, III, MD, MPH - Helicopter EMS transport is associated with reduced mortality in injured adults
  • Jennifer Verre, MPH - Prevention of Diabetes Mellitus in African Americans: Interventions and Recommendations for a Federally Qualified Health Center in the City of Milwaukee

 

2014 Graduates

Olufemi Adekeye, MD, MPH

Email: fadekeye@gmail.com

Advisor: Robert Goldberg, MD, FACOEM

Why Do People With Compensable Injuries Have Poorer Outcomes Than Those With Non-Compensable Injuries?

Abstract:

Background: Many people with compensable injuries have worse outcomes than those with non-compensable injuries.   Studies have failed to reach a consensus on why individuals with compensable injuries have poorer health outcomes than those with non-compensable injuries, and a complex interplay of psychosocial factors has been suggested to contribute to poor health outcomes in compensable injuries.

Methods: A literature review examined why people with compensable injuries have worse outcomes than those with non-compensable injuries.  PubMed search and secondary data sources formed the basis of this review.  Unpublished articles and indexed articles that have not been published yet were excluded from the analysis.

Results: Data indicate that most people with compensable injuries return to work and their regular activities, however, a large proportion of these people have worse outcomes than those with similar injuries that are non-compensable.  The reasons for this are not very clear but factors such as the psychological environment of the injured at the time of injury, the handling of case management by insurers and the management of the initial treatment have been identified as contributing to worse outcomes. 

Conclusion: Research into why patients with compensable injuries have poorer outcomes than those with similar but non-compensable is inconclusive at best.   A complex interaction of factors could be responsible for this finding but not enough is known of the different compensation schemes or case management methods.  A multidisciplinary and early intervention approach to case management will help identify psychosocial factors that are important in long-term disability and help reduce long-term disability.  Collaboration and cooperation between professionals of all fields involved in the case management will help in reducing long-term disability.  

PowerPoint Presentation (PDF)

 

Gina Bane, MD, MPH

Email: ginabane@gmail.com

Advisor: Laura Cassidy, PhD

Timing of Death in Pediatric Sepsis: A Descriptive Study

Abstract

Background: Sepsis remains one of the most common causes of death in children worldwide. The epidemiologic data describing pediatric sepsis is limited and primarily based on hospital data prior to the year 2000. Substantial changes in diagnosis and management have subsequently occurred; thus, it is possible that the current patient population may be dissimilar to that already described.

Objective: The primary objective was to describe the differences in the population of children who die early (defined as within 48 hours of admission) compared to those who die late (defined as after 7 days following admission) from pediatric sepsis after admission to the Pediatric Intensive Care Unit.  The study groups were compared with respect to age, gender, risk of mortality using the Pediatric Index of Mortality score (PIM2) and comorbidities.

Design/Methods: A retrospective descriptive study was performed involving data queried from the Virtual PICU Systems, LLC database, a national clinical database that collects data from over 100 Pediatric ICUs. All pediatric patients admitted with a primary diagnosis of sepsis during the time period of January 1, 2009 to March 30, 2013 were included. The Mann-Whitney test was used for skewed data to compare means and the chi-square test was used to compare proportions using SPSS Statistics Version 21.

Results: A total of 657 patients were identified that died from sepsis, 290 who died early and 199 who died late. There was no significant difference in the median age of patients who died early versus late (5.4 vs 5.7 years) or gender (51% male vs 54% male). PIM2 scores were significantly different between the groups with the early death group having a higher risk of mortality (median risk of 0.14 vs 0.05, p<0.001). The late death group had significantly more cardiovascular, oncologic and immunologic comorbidities.

Conclusions: A large number of patients die later following admission for pediatric sepsis. Patients with cardiovascular, oncologic and immunologic comorbidities may be at increased risk for mortality later on in their hospital course.

PowerPoint Presentation (PDF)

 

Michael Bauman, MPH

Advisor: E. Brooke Lerner, PhD

Firehouse Staffing and Its Effect on Response Times to Emergencies

Abstract:

Background:  The purpose of this paper is to review publicly available data and media articles on firehouse response times and firehouse staffing to determine whether staffing has an impact on response times to emergency situations.  Budget cuts by municipalities in recent years have caused many fire departments to operate at staffing levels below minimum standards and close firehouses, resulting in increased response times.  The response time standards for fire and EMS personnel is NFPA 1710 Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments.  The standard states four minutes or less travel for the first arriving engine company or first responder and/or eight minutes or less for the deployment of a full first alarm assignment or advanced life support unit.  

Methods:  A literature review was conducted to identify firehouse response time trends and firehouse staffing trends throughout the nation.  Popular media and publicly available reports were reviewed as well as reports from the U.S. Fire Administration, National Fire Protection Association and Federal Emergency Management Administration.

Results:  Response times have steadily increased since the beginning of response time reporting in 1986.  The National Fire Incident Reporting System indicates that fire departments only met the eight minute full response standard 58% of the time in 2003 as opposed to meeting the standard 75% of the time in 1986.  The volume of calls fire departments are responding to has doubled over the last two decades with most of the increase due to the fact that departments are providing emergency medical services to the communities they serve.

Conclusion:  Overall as staff and firehouses decrease, response times have increased.  Departments must realize that lower budgets are a reality and the staff must be able to cope with lower staffing levels.  Creative ways to provide the same levels of services is becoming common practice.  As lower staffing levels become the norm, the firefighter/EMT will adapt as they have throughout the evolution of the fire and emergency medical service.

PowerPoint Presentation (PDF)

 

Scott Hallal-Negishi, MPH

 

Email: scott.hallal@gmail.com

Advisor: Julie Willems Van Dijk, PhD, RN

Ethanol Fuel Initiative: A Program Plan for Education through Multimedia

Abstract:

Background: The United States government has implemented the Renewable Fuel Standard as part of the Energy Independence and Security Act (EISA) of 2007, which addresses the need to improve the vehicle fuel economy while improving air pollution and greenhouse gas emissions (US Department of Energy [US DOE], 2013).  There is a well-documented relationship between vehicle emissions and air pollution, including fine particulate matter, and health, including decreased lung function, chronic bronchitis, and asthma (County Health Rankings and Roadmaps, 2013).  Through a multimedia tool called serious games, the general public will be educated and made more aware of the Renewable Fuel Standard and the production and consumption infrastructure of the specific renewable fuel ethanol.

Methods: Raising awareness of ethanol fuel production and consumption, in line with the government’s initiative to increase the supply of renewable alternative fuel sources, requires a multi-faceted approach to achieve the ultimate goals of increased use of alternative fuels and subsequent improvements in air quality.  This paper will present a program plan for one specific strategy to accomplish these goals, a multimedia resource called serious games; however, to be successful, the serious games approach must occur within the framework of a broader national approach.  This approach is based on the premises that gasoline is not a good long-term option for U.S. automobile fuel and that ethanol is a better alternative.  The broader U.S. approach to the implementation of ethanol as an alternative fuel will be discussed.  The serious game strategy that will be described in further detail in the Results section of this paper provides specificity on what is required for one strategy within this national program to be deployed.

Results: As a long-term outcome, this program plan will lead to decreased air pollution and improved health in the United States.  To achieve this outcome, the intervention strategy will educate the general public and increase awareness on the ethanol fuel cycle through serious games.  Based on the intervention strategy, this program plan will address the key processes, outcomes and evaluation strategy for the program.

Conclusion: After the implementation of a government program, an actual effect on the health of the target population should occur (Issel, 2009).  To determine the effects of the program, an evaluation will be conducted on the quality of the program assessed through a discussion on the methods, design, and practicality of success.  Recommendations on further action will also be discussed.

PowerPoint Presentation (PDF)

 

Tara Humfeld, MPH

Email: taraaikens@sbcglobal.net

Advisor: Nancy Kreuser, PhD

The Food Safety Modernization Act: A History of Changes in Authority by the Food and Drug Administration on Imported Food and the Effects on Global Public Health

Abstract:

The United States (US) food supply has expanded over the years to include an increased amount of foreign imports. In an effort to address public health and safety, regulations were implemented as check points with enforcement authority to assure the same quality food standards for both US and foreign suppliers. Although regulations are written with the best intent, there is room for interpretation due to vague language, allowing the opportunity for loopholes in the laws.

 

The Food and Drug Administration (FDA) has long been the authority over imported food products as well as other regulated products within the Food, Drug, and Cosmetic Act (FDCA, 1938).  From the first act in 1897 to the present, many acts, amendments, and regulations have been created for such a changing global food system.  The Food Safety Modernization Act (FSMA) was the first major legislative update to the  FDA in over 70 years.1  President Barack Obama signed FSMA into law on January 4, 2011 and it continues to be amended and updated.  The change in regulation came at a time when food borne illness outbreaks were high and changes were desperately needed.

PowerPoint Presentation (PDF)

 

Blessing Jerome, MPH

Email: bjay5us@yahoo.com

Advisor: Alan Wells, PhD, MPH

Systematic Review of the State of HIV/AIDS in Nigeria

Abstract:

Introduction: The HIV/ AIDS epidemic is one of the major public health problems in Nigeria. The prevalence of HIV in Nigeria is thought to be the third highest in the world (only behind) India and South Africa. The high prevalence may be attributed to various factors including; significant human rights issues, dilapidating health care infrastructure and inadequate financial and human resources to healthcare, illiteracy and lack of awareness of HIV/AIDS, poverty, religious, ethnic and gender-related violence, customs and cultural practices.

Methods: A number of scholarly articles, journals, government official websites were used to source for literature on HIV/AIDS in Nigeria.

Results: The World Health Organization (WHO) states that the population of Nigeria is about 168 million. Another international organization the World Bank estimates the Gross National Income per capital as $2,290. Furthermore, the prevalence of HIV in Male adults 15-49 in Nigeria on the average is about 3.4million. The HIV prevalence of adult females 15-49 is about 3million and that of Children 0-14 is about 1.7million. The deaths due to HIV are about 430,000 annually. UNAIDS states 3.4million people are living with HIV in Nigeria, with a female gender preference in the age group of 20-24 having the highest rate of infection. Subsequently, the Federal Government of Nigeria in response to the rising HIV epidemic formulated multiple assessment committees like the National AIDS Advisory committee, the National Expert Advisory committee on AIDS among others to implement policies and proffer solution to the increasing prevalence of HIV in Nigeria.
In other to check the spread of HIV in Nigeria, resources should be channeled to improving health care services and facilities. Confidential testing and counseling should be highlighted in drawn out health programs to minimize the stigmatization of people living with HIV/AIDS. Emphasis should be placed on education of the girl child. In addition, Poverty alleviation programs should be set up to eradicate early marriages and prostitution. Prevention practices should also be implemented.

Conclusion: HIV/AIDS is one of the leading causes of morbidity and mortality in developing countries like Nigeria which requires prevention and treatment efforts on the part of government, cooperate organizations as well as nongovernmental organizations in a transparent synergized manner. A failure to properly address the issue could have ripple effect such as significant depletion of the working population, loss of revenue, decrease in national gross domestic product etc.

PowerPoint Presentation (PDF)

 

Jamie Kondelis, MD, MPH

Email: jkondelis@gmail.com

Advisor: John Meurer, MD, MBA

DOT Commerical Driver Manual

Abstract:

In most states, to obtain or maintain a Commercial Driver’s License, commercial drivers are required to pass the Department of Labor (DOL) physical examination, a fitness for duty medical assessment. The proof that the driver has passed the Department of Transportation (DOT) exam is the DOT medical card, which is valid for up to 24 months.  The medical examiner may issue a certificate for less than 24 months depending on the medical conditions the driver may have.  Periodic medical examinations help ensure the safety of both the CDL holder and other drivers on the road.  The DOT medical exam looks for certain pre-existing medical conditions that might impair a driver’s ability to safely operate a commercial motor vehicle.  The requirements for passing the exam are detailed in the provider DOT Handbook, which is tailored to the medical provider.  But there is no commercial driver’s guide to the DOT physical examination.  A basic recipe manual for what the driver can and would do to prepare for the upcoming examination would obviate the all-too- common scenario where the driver presents on or just before the day of expiration/recertification without adequate documentation of his/her preexisting condition(s), causing last minute stress for the driver and the provider and potential disqualification.  My capstone project will be the development of this driver’s manual that an employer can provide each employee at the time of hire.  This could have a significant impact on overall employee compliance, driver satisfaction, and employer satisfaction, lost days from work, reduction of administrative time, provider stress reduction and potential road safety for all persons.

PowerPoint Presentation (PDF)

 Roohi Kharofa, MD, MPH

Email: roohiabdulla@gmail.com

Advisor: David Nelson, PhD

The Creation of a Body Mass Index Policy for Milwaukee Public Schools

Abstract: 

It is well known that childhood obesity rates are high, with more than one third of children and adolescents currently falling into the overweight or obese categories. Numerous programs have been put into effect to address this epidemic, with school interventions thought to be ideal given the access to children 5 to 18 years of age. One such initiative involves the measurement of height and weight and calculation of BMI in schools. Results are used for education to teach students about health related fitness, for surveillance to monitor district programming directed at improving nutrition and physical activity, and for screening to inform parents about their child’s weight category. No concrete data has been published to date verifying the success of this approach in addressing the childhood obesity long-term. However, no negative impacts have resulted either. Research has found no increase in children/adolescents taking diet pills, exercising excessively, or starting unhealthy diets. Given the potential for positive outcomes and the magnitude of the obesity epidemic, Milwaukee Public Schools believes that this effort would add to their current programming targeted at improving the health of their students. As a result a district wide BMI policy based on best practices and local preferences of physical education teachers and parents was sought out. In order to gather the necessary data, an extensive literature search was paired with focus groups. The results of these strategies lead to the creation of a BMI policy that reflected lessons learned by other schools throughout the United States as well as the assets and barriers present within Milwaukee Public Schools.    

PowerPoint Presentation (PDF)

 

Cavine Opondo, MD, MPH

Email: gcavin2001@yahoo.com

Advisor: Kenneth Schellhase, MD, MPH

Worksite Wellness Programs on Cardiovascular Risk Reduction; A review of services offered and possible recommendations

Abstract: 

Background: Worksite wellness programs for cardiovascular risk reduction constitute an important strategy in the reduction of mortality from heart disease and stroke. Cost implications might hinder the reach of many preventive health programs. The worksite provides a readily available target group with potential for large scale recruitment.  The convenience to the employee and enhanced compliance through strategies like peer motivation further underscores the importance of such an approach in promotion of cardiovascular wellness. 

Methods: A literature search was conducted through Medline, Pubmed, and Cochrane in a bid to determine what services are offered and the overall cost implications. Based on the findings, there are various recommendations to enhance the success of such programs.

Results: There is an upward trend in wellness programs in general, and these include those that target cardiovascular risk reduction. Such programs incorporate Health Risk Assessment (HRA) questionnaires and appraisals, health screening for cholesterol and blood sugar levels, health education, counseling, quit-smoking programs, and some medical referral system.

Conclusions: Worksite wellness programs for cardiovascular risk reduction remain an important strategy in preventive health care. More still needs to be done to increase the reach and enhance patient participation and compliance.

PowerPoint Presentation (PDF)

 

John O'Horo, MD, MPH

Email: jcohoro@gmail.com

Advisor: Andrew Petroll, MD

Diagnosis of Blastomyces Dermatiditis in the Urban and Rural Environment: A Comparative Study

Abstract: 

Context: Blastomycosis is a systemic fungal infection endemic to northern and Eastern Wisconsin. Disease typically starts as a pneumonia, but may disseminate. Diagnosis is labor intensive and time consuming, requiring either culture or histology. Recently, a urine antigen test has been developed to allow for rapid, if not definitive, diagnosis of blastomycosis.

Objective: To compare the diagnostic practices of clinicians in Urban/Suburban Eastern Wisconsin to those from rural Vilas County.

Design: A retrospective review of health department mandatory reports and records from a large Eastern Wisconsin health system compared symptoms and diagnostic practices from Vilas County and Urban/Suburban Eastern Wisconsin cases.

Results: Pulmonary blastomycosis was more common in rural cases than the Urban/Suburban group (89.0% vs. 58.4%, P<0.001). Hemoptysis as a presenting symptom was more common among Urban/Suburban cases (43% vs. 13%, p=0.00). Histologic diagnosis was more common in rural cases (P<0.00), while microscopic diagnosis and serology were each more common with Urban/Suburban patients. Urine antigen testing was not used extensively at either site (10.2% in Urban/Suburban vs. 1.8% in rural)

Conclusion: Milder cases of pulmonary blastomycosis may be more readily diagnosed in rural, highly endemic settings. More frequent use of urine antigen testing may improve the diagnosis of blastomycosis.

PowerPoint Presentation (PDF)

 

Danessa Sandmann, MPH

Email: dssandmann@gmail.com

Advisor: Edit Olasz, MD

A Comprehensive Review of Current Indoor Tanning Facility Usage Policy and Regulation in Wisconsin and Future Recommendations

Abstract

Background: Despite current regulation of indoor tanning beds, the incidence of melanoma, the most fatal type of skin cancer, is on the rise in Wisconsin. The use of tanning beds before the age of 35 has been linked to a dramatic increase in melanoma prevalence. The goal of this paper is to explore the rationale for increasing minimum age for tanning bed use to 18 in Wisconsin and critically analyze connections between prohibiting minor use of indoor tanning facilities and the associated health effects.

Method: A literature review regarding minor tanning behavior, current tanning regulation, and policy compliance and effectiveness was conducted.

Result: Tanning bed use parallels tobacco use in many aspects. The carcinogenic nature of tanning beds warrants similar approaches to those taken in tobacco control and prevention, such as age restriction. In order to strengthen protections for youth and decrease the incidence of melanoma, policies banning the use of sunbeds by minors should be enacted in Wisconsin following suit of many states and several countries.

PowerPoint Presentation (PDF)

Claire Schuenke, MPH

Email: claireschuenke@gmail.com

Advisor: Julie Willems Van Dijk, PhD, RN

Best Practices in Workplace Wellness Programs for Stress Management Interventions and Program Planning 

Abstract

Objective: At least 50% of workplaces have a wellness program in place to help not only improve the health of employees, but also reduce insurance costs for employers. Stress management programs are a major component of effective workplace wellness programs. The objective of this review was to identify evidence based stress management interventions within the workplace and incorporate those interventions into a workplace wellness program.

Method: A literature review was conducted to gather current recommendations regarding workplace wellness programs. From there a search was used in Pubmed and EBSCO to identify studies on primary, secondary, and tertiary forms of prevention on stress management in the workplace. Results: Primary interventions for stress include prevention efforts that stop stress before it starts. This would include offering flexible scheduling within the workplace, creating cohesive work teams, having a supportive working environment, and encouraging regular communication among employees. Secondary interventions for stress are prevention efforts that help individuals better manage their response to stress and improve their coping skills. To effectively do this, employers can offer trainings on mindfulness, therapeutic yoga, coping strategies, and other stress management techniques. In person, self-study, or web based stress management programs have proved to positively influence an individual’s ability to cope with stress. Lastly, tertiary prevention for stress helps undo the damage that causes stress. Employee assistance programs and other counseling services have shown to improve stress, but are often underutilized in workplaces, especially by those who need it the most.

Conclusion: For a workplace wellness program to see results in their stress management related programming it is imperative that they implement a stress intervention in the three areas of prevention (primary, secondary, and tertiary).

PowerPoint Presentation (PDF)

Sanja Vodanovic Jankovic, MPH

Email:mjankovic@wi.rr.com

Advisor: Michael Kron, MD

Public Health Implications of Lymphatic Filariasis

Abstract:

Lymphatic filariasis is a chronic, contagious disease caused by any one of primarily three species of parasitic worms: Wuchereria bancrofti, Brugia malayi and Brugia timori, whose larvae are transmitted by a mosquito bite.55 Worldwide, 120 million people are infected and 1.4 billion people are at risk because they live in the areas with active mosquito transmission.106 Although the World Health Organization (WHO) prioritized the eradication of lymphatic filariasis by the year 2000, the disease is still reported in 73 countries, including Haiti, the Philippines and Brazil, which are frequented by American tourists, as well as India, China, Egypt and Middle Eastern countries where American immigrants come from.50 The WHO provides an expert advice for elimination efforts in numerous countries.  Comprehensive interventions are needed to improve the outcome of the lymphatic filariasis elimination efforts.64 The following obstacles should be addressed.

PowerPoint Presentation (PDF)

 

 

2013 Graduates


Allison Beilke, MPH

Email: arbeilke@gmail.com

Advisor: E. Brooke Lerner, PhD
Associate Professor and Research Director, Department of Emergency Medicine

Literature Review to Demonstrate the Relation of Health Conditions Due to Obesity and Motor Vehicle Crashes in Truck Drivers

Abstract:

Rates of obesity in the United States have monumentally risen in the past 20 years with recent rates finding over one-third of adults (35.7%) are obese (Ogden et al., 2012). As a major public health issue, obesity supported the modernization of public health efforts, compelling a shift from infectious diseases towards chronic diseases. Obesity raises the risk of numerous chronic diseases and raises the overall risk of mortality by all-causes (National Heart Lung and Blood Institute, 1998). More specifically obesity raises the risk of morbidity from conditions such as hypertension, type 2 diabetes, coronary heart disease, as well as sleep apnea and respiratory problems.  The ability to perform personal and occupational tasks may be hindered by chronic disease and physical disability. Due to the health conditions associated with obesity a person may be less able to perform tasks requiring vigilance, such as driving (Anderson et al., 2012). For example, sleep apnea may cause excessive daytime sleepiness (ESD) as well as fatigue, which can lead to dangerously reduced driving abilities. This presents a public safety concern. Due to the associated monetary, social, and physical costs, the obesity epidemic, as it has been deemed, not only affects people who are obese, but the entire country.

PowerPoint Presentation (PDF)



Kavita Bhat, MD, MPH

Email: kavita26s@yahoo.com

Advisor:  Eric Gass, PhD 
Assistant Professor, Institute for Health and Society

What are the top health concerns in the City of Milwaukee and how do we manage them?  An examination of Key Information Interviews from Milwaukee's 2013 Community Health Assessment

Abstract:

Background and Objective: The city of Milwaukee is currently one of the least healthy cities in Wisconsin. It has an overwhelming amount of health issues and concerns. These health issues are currently being addressed by the city of Milwaukee Health Department through a community health assessment. The purpose of this paper is to gain perspective on the top health concerns for the city of Milwaukee and examine the methods to take on these issues through a qualitative analysis of key informant interviews.

Methods: Fifteen key informant interviews were conducted and the data regarding “top health concerns” was thoroughly analyzed using a coding process.

Results: The top health issues and concerns stated by the key informants in order of priority were: Mental Health, Access to Health Care, Overweight/Obesity, and Nutrition. The informants expanded on each of these issues stating: existing strategies, barriers, additional strategies, and potential partners.

Discussion: The benefits of the key informant interviews were that they provided rich, insightful information and awareness regarding the health issues of the community and how to manage them. The limitations of the interviews were that they did not represent the entire community’s views and there may have been inadvertent biases. Expanding further on the results of the key informant interviews provides a deeper understanding of what is currently being done about the health issues of concern.

Conclusion: Key informant interviews provide important information and help to build the foundation of the community health assessment, but are only a small piece of the overall picture of the community. Next steps in the process are: completing the four assessments, strategies and goal formation, and finally the action cycle. Hopefully upon completion, the assessment will lead to a healthier Milwaukee.


Gayathri Chelvakumar, MD, MPH

Email: gayacmail@gmail.com

Advisor:  Andrew Petroll, MD, MS
Assistant Professor of Infectious Diseases, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine

LGBT Healthcare Experiences in Milwaukee

Abstract:

Background:  LGBT individuals are disproportionately at risk for many medical and mental illnesses. Bias and discrimination from health care professionals and perception of such bias have been identified as one of the barriers to care that contributes to these disparities.
Objectives: Gather information on Milwaukee LGBT individuals’ healthcare experiences, identify characteristics of non-judgmental, LGBT friendly care, and identify patient expectations at healthcare visits.


Methods: A mixed method study design utilizing a quantitative written survey and qualitative structured interview was used to gather information on healthcare experiences.


Results: The majority of study participants (5/7) reported that their sexual orientation or gender identity had negatively affected the quality of healthcare they received. Qualities that were repeatedly identified as characteristics of LGBT friendly care were respect, provider knowledge of LGBT specific issues, provider comfort in caring for LGBT patients, efficient care, and a safe clinic environment.
Conclusions: The majority of individuals recruited reported that discrimination based on sexual orientation or gender identity had at some point affected the quality healthcare they received. Participants reported that a safe, respectful and welcoming environment in a clinic that provided timely, efficient, LGBT sensitive care were aspects of an LGBT friendly clinic. 

PowerPoint Presentation (PDF)


Paula Cody, MD, MPH

Email: paula_cody@hotmail.com 

Advisor:  Paul Hunter, MD
Volunteer Clinical Professor, Department of Family and Community Medicine

Parental Knowledge and Beliefs Regarding Childhood Immunizations

Abstract:

Objective: To determine barriers to vaccination of children, including parental knowledge, beliefs, and perceived vaccination status of the child.

Design: A survey was administered asking questions about knowledge and beliefs about vaccines and vaccine-preventable diseases, preferred sources of health information, and perceived vaccination status of the participant’s children.  This perceived vaccination status was compared to vaccination status of the children as documented in the Wisconsin Immunization Registry (WIR).

Setting: Women, Infants, and Children (WIC) clinics in urban Milwaukee.

Participants: Parents/guardians of children 19-35 months of age.
Main Outcome Measures: Parents’ perceived vaccination status of the child (up to date, not up to date, on time, not on time) compared to recorded vaccination status.

Results: 36 parents/guardians completed the survey representing 76 children whose vaccines were recorded in WIR.  95% believed their children were up to date (UTD), while only 66% were UTD in WIR. 84% of the parents believed their children got all their vaccinations on time, however only 32% of the children received their vaccinations in accordance with the Advisory Committee on Immunization Practices (ACIP) schedule.  The majority of parents were familiar with WIR, but only 19% have ever used WIR to look up their child’s immunizations.  All the parents stated that immunizations were important to the health of their children and 92% thought that vaccinations were safe The parent’s preferred source of health information was a health care provider.

Conclusions: One-third of the children whose parents/guardians report as up to date with their vaccinations when they are not up to date in WIR.  This misperception might result in missed opportunities to vaccinate when parents/guardians do not ask for vaccinations to be updated during clinical visits.  Educating and motivating parents/guardians to access WIR and encouraging parents to keep track of their child’s immunizations may reduce the misperceptions of vaccination status and thereby reduce missed opportunities.

PowerPoint Presentation (PDF)


Gerard Coly, MPH

Email: gcoly@wi.rr.com

Advisor: Theodore A. Kotchen, MD
Professor, Department of Medicine - Endocrinology

Characteristics of African American Study Participants in Milwaukee

Abstract:

 Background: Researchers continue to voice concerns about the relatively low African American participation in medical research studies which prevents them from generalizing their findings and reducing health disparities.

Objectives: To examine characteristics of African Americans study participants and to determine to what extent the awareness of Tuskegee Syphilis Study, the financial incentives, the consenting process, and the trust of the researchers affect their willingness to participate in medical research.

Methods: Ninety African Americans enrolled in the Insulin Resistance and Gender Differences Study were invited to participate in a survey. The survey was either mailed to all participants who already completed the above mentioned research study or administered to other participants who came to Froedtert Hospital for the screening visit.

Results: All 38 respondents were non-smoking, healthy African Americans between the ages of 18 and 45; 50% were females, 79% had graduated or attended college, and 50% of the respondents had never been involved in medical research.  Ninety two percent reported their trust level will not change based on the race of the researcher or staff. Nearly 52% of the respondents knew about the Tuskegee Syphilis Study and among those who were aware of the TSS, 63% felt that this historical event did not play a role in their decision to take part in the study.

Eighty- nine percent reported the consent form length was correct and 71% of the study participants read the consent form all the time. Nearly 41% would not participate in the research study if they did not receive a financial incentive.

Conclusions: Although Tuskegee syphilis study awareness is high among this young African American sample with college educational level, this historic event has less influence in their trust and decision to participate in medical research. However, the financial incentive aspect deserves our full attention to appropriately set the payment s and avoid coercive actions toward minorities involved in research.

PowerPoint Presentation (PDF)


Kevin Culbert, MD, MPH

Email: jkculbert@verizon.net

Advisor:  Nancy Kreuser, PhD, MSN
Assistant Professor, Institute for Health and Society

Considerations for Legislation to Raise the Minimum Legal Sales Age for Tobacco in the Commonwealth of Virginia

Abstract:

Background: Tobacco use and cigarette smoking in particular among youth provide the basis for a lifelong addiction. Another 3,800 Americans under 18 years of age start smoking each day.  Policymakers have advanced both demand reduction and youth access strategies to prevent tobacco use among adolescents and young adults. Unsuccessful legislative efforts have sought to increase the age limit to 19 in two states and to 21 in twelve states. The purpose of this paper is to evaluate the effectiveness of access limits in reducing youth tobacco use.

Methods: A literature search was conducted using CINAHL, MEDLINE, PsycINFO, and the Cochrane Database for studies and reviews published in English between 1987 and 2012 that report outcomes from interventions intended to reduce youth tobacco access and use.

Results:  The evidence obtained from the review indicates that tobacco minimum age of sales restrictions have yielded mixed results when retailer compliance has been marginal. Local interventions with strong enforcement and community support, as well as nationwide access limits have resulted in reductions in youth smoking prevalence.

PowerPoint Presentation (PDF)

 

Melissa Enriquez, MPH

Email: melissa.enriquez@aurora.org

Advisor: Zeno Franco, PhD
Assistant Professor, Department of Family Medicine

A Nutrition Assessment of an Uninsured Hispanic Population Living in Wisconsin and Acculturation's Role on Health

Abstract:

The goal of this study was to determine the nutritional status of an uninsured, Spanish-speaking, Hispanic population and to determine if acculturation decreases healthy nutrition practices compared to a native Hispanic population.  Nutrition questionnaires were used to determine the consumption frequency of food and drink items.  Additional questions were asked concerning length of time living in the United States, country of origin, and self-reported disease status.  98 questionnaires were completed by adult participants and analyzed to determine the nutritional status of the population of interest.  Multiple variables were also analyzed in order to establish a correlation between acculturation, measured as length of time living in the United States, and a decrease in healthy nutrition habits or food frequencies.  Four predictors of variance were identified that accounted for 19.8% of the variance including: aguas frescas, soda, cream, and salsa.  A limitation to the study is the relatively small sample size.  One of the most unique native traditions of the Hispanic diet is the consumption of corn tortillas instead of flour tortillas.  This behavior was reflected across all subsets, regardless of years of immigration.  The consumption frequency was higher across all groups, ranging from nearly 47% to over 94%.  In conclusion, a similar result was found in this study as in other studies regarding Hispanic participants not meeting dietary recommendations.  Extraneous factors such as being uninsured and not speaking the native language prove to be barriers to achieving good health and nutrition, but future interventions and research still need to be done to identify the most effective way to improve the nutrition status of the population under study. 

PowerPoint Presentation (PDF)


Lisa Forsch, MPH

Email: lisamarie0516@gmail.com

Advisor: David Nelson, PhD
Assistant Professor, Department of Family Medicine

The Influence of Social Business on Public Health

Abstract: 

A variety of evidence-based solutions exist to improve the burden of global malnutrition, yet the statistics still impair both developing and developed nations.  New, emerging and innovative practices are evolving, but need further research and support in order to make vast improvements in malnutrition rates and break the poor health cycle. The relationship between social business and public health is an example of a not commonly investigated solution option; though the relationship provides promising creative and reasonable insight into the development of multidimensional public health solutions.  The premise of this relationship builds upon the idea that a social business, created by social entrepreneurs, is an organization that utilizes the strategies, technologies and processes to maximize a social impact through a profitable business model while engaging all the individuals of its ecosystem. The profitable social activism idea demonstrates that social entrepreneurship and social business alike have the opportunity to actively build creative ways to solve pressing social issues. Due to the nature of the malnutrition, this social business-public health relationship presents a valid resolution proposition.

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Nicholas Hevey, MPH

Email: njhevey@gmail.com

Advisor: C. Oren Renick, JD, MPH, FACHE
Associate Adjunct Professor, Institute for Health and Society

Analysis of the Public Health Fund Provision of the Patient Protection and Affordable Care Act: How We Can Direct the Funds to Maximize Public Health Impact in Wisconsin

Abstract:

Objective. To analyze the usage of funds directed from the Patient Protection and Affordable Care Act by means of the Public Health Fund Provision of the law in the State of Wisconsin.  Also, provide insight and analysis on how the funds can be best used within the State in the future and explain how the State would need to effectively do so.  Methods. The author searched public health governmental and non-governmental organizations’ websites to determine how the public health funds were being used in the State of Wisconsin and conducted an internet search to determine how obesity prevention can best maximize public health goals for the State of Wisconsin by usage of funds from the Public Health Fund.  The author conducted personal interviews via telephone with important public health department leaders and personnel to learn more about the status and usage of the public health fund as well.  Results. The author identified that the Public Health Fund has made $18.3mil available to the State of Wisconsin, but only $683,000 of these funds have been mandated for anti-obesity campaigns.   Obesity has been linked to 75% of the nation’s overall health care expenditures each year because obesity is linked to higher rates of chronic diseases. 

Conclusion: The majority of the investment of the Public Health Fund in Wisconsin should be directed solely towards anti-obesity campaigns.  Obesity is the largest looming epidemic in the State of Wisconsin today and can be reduced through public health anti-obesity campaigns, school anti-obesity initiatives and increasing the access to affordable and fresh produce in underserved areas of Wisconsin.  The political climate towards the public health fund from both sides of the political aisle makes the availability of these Public Health Funds from year-to-year tenuous.  The State of Wisconsin and local municipalities should act quickly to create a plan to use the Public Health Fund to combat obesity in Wisconsin. 

PowerPoint Presentation (PDF)


Kerri Holden, MPH

Email: kerri1614@hotmail.com

Advisor:  Julie Willems Van Dijk, PhD, RN
Assistant Professor, Institute for Health and Society

Effectiveness of Motivational Interviewing on Health Outcomes in Patients with Diabetes: A Review of the Literature

Abstract: 

The global prevalence of diabetes has increased rapidly during the last two decades, becoming one of the most common non-communicable diseases of the 21st century. Prevention of diabetes related complications is essential for reducing the morbidity and mortality associated with the disease. However, individuals with diabetes may be ambivalent about making these necessary lifestyle changes. Motivational interviewing (MI) is a patient centered counseling technique, which focuses on allowing patients to explore their ambivalence to lifestyle changes. This systematic review evaluates the effectiveness of MI as a basis for improving health outcomes among patients with diabetes. A search of the literature restricted to randomized controlled trials (RCTs) identified 10 applicable studies. Six studies demonstrated significant differences in behavior, psychosocial, or clinical outcomes between treatment and control groups. Since diabetes management involves daily engagement in self-care behaviors, it is imperative that healthcare providers understand the patient's individual needs and work collaboratively to overcome barriers unique to their everyday situations. Part of this care could involve motivational interventions, as the present review offers some preliminary evidence that MI may improve perceived competence in several diabetes management behaviors.

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Mandy H. W. Kastner, MPH

Email: mandykastner@hotmail.com

Advisor:  James Sanders, MD, MPH
Associate Professor, Department of Family and Community Medicine

Review of the Quality of Hypertension Care at the Lake Area Free Clinic in Oconomowoc, Wisconsin

Abstract:

Background:  Hypertension is a causal factor in cardiovascular disease and death and is present in about one-third of the US population.   Like many chronic conditions, it is more prevalent among patients accessing safety net clinics.  Improving the quality of hypertension care at the Lake Area Free Clinic has the potential to improve health outcomes and decrease health care costs.  The first step to making improvements in care is to measure aspects of that care.

Methods:  A ten-step performance measurement process was followed to establish how to measure the performance of hypertension care at LAFC.  First, treatment guidelines, health plans and quality reports were reviewed to select appropriate quality indicators.  Those included blood pressure control, annual lipid and creatinine monitoring and body mass index. The indicators and sample population were clearly defined.  Data were extracted and analyzed to illustrate baseline performance. Based on the results, recommendations were made for short term and long term process improvements at LAFC.

Results:  The results of the chart review revealed that 74% of patients with hypertension had their blood pressure controlled at last measurement.  Seventy-five percent had creatinine measured during the measurement period, while 68% of patients had lipids drawn.  Eleven percent of patients had a healthy BMI, with 31% being overweight and nearly 58% obese. 

Conclusion:  Though there are limitations to the review, it illustrates the capacity for a free clinic to provide high quality hypertension care.  Several recommendations have been made to build the foundation of tracking hypertension quality indicators at LAFC.  Once the foundation for performance measurement of the quality of hypertension care has been laid, changes can be implemented to improve upon that care.  Being able to track and improve performance will better position LAFC to be competitive in funding requests and will also illustrate to donors that their contributions have made an impact.

PowerPoint Presentation (PDF)


Sharon Kolbe, MPH

Email: sharonmarie81@gmail.com

Advisor: Alan Wells, PhD, MPH
Assistant Professor, Institute for Health and Society

Chagas Disease: A Systematic Review of Prevention Efforts in Latin America

Abstract:

Chagas disease is a potentially deadly, infectious vector-borne parasitic disease. Identified as “the most serious parasite disease in Latin America” by PAHO and WHO, it is the fourth leading cause of disability and death in at-risk populations.  With over 55,000 new infections occurring each year in the region, prevention is the key to halting this devastating disease. This paper provides in-depth background of Chagas disease, and includes a systematic review of the effectiveness of primary prevention strategies employed to prevent transmission. Successful strategies employ multiple prevention methods simultaneously; take into consideration the contextual political, cultural, and socioeconomic factors; and call on entire communities, including individuals at risk, to take action.

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Carrie Madormo, MPH

Email: cmadormo@chw.org

Advisor: John Meurer, MD, MBA
Director and Professor, Institute for Health and Society

A Comprehensive Evaluation of the Wisconsin Seal-A-Smile Program

Abstract:

The purpose of this paper is to evaluate the effectiveness of school-based dental sealant programs using existing literature and local data from Children’s Health Alliance of Wisconsin (Alliance) Seal-A-Smile (SAS) program.  Oral health is a concern for children across the country.  Nationally, dental decay is the most common pediatric chronic illness.  It is four times more common than asthma in children2.  By age 17, 80% of young people have had a cavity.  According to 2010 National Oral Health Surveillance System (NOHSS) data, 33% of Head Start children and 55% of third-grade children have experienced dental caries.  In Wisconsin, 25% of Head Start children and 20% of third-grade children had untreated decay.

PowerPoint Presentation (PDF)


Jessica (Arndt) Olbrot, MPH

Email: redfish414@sbcglobal.net

Advisor: David Nelson, PhD
Assistant Professor, Department of Family Medicine

Barriers and Facilitators for Hmong Seeking Mental Health Counseling: Implications for Community-Based Organizations and Public Health

Abstract:

The purpose of this paper is three-fold:  to (1) describe how cultural brokers are utilized within the context of mental health, (2) describe the facilitators and barrier to seeking mental health services impacting the Hmong community, and (3) describe the public health implications.
The Academic Search Premier search for “Hmong Cultural Broker” resulted in 1 full text article. Searches for full text articles using the search term “cultural broker refugees” resulted in 6 articles, and the search term “Asian cultural broker” resulted in 14 articles. The search term “cultural broker” resulted in 423 full text articles. The 423 articles were further narrowed down by filtering only peer reviewed articles, and revising the term to “cultural broker mental health”. This narrowed the results to 23 articles. Only 13 of these articles from the Academic Search Premier were pertinent to the subject matter. Ten articles were not used because there subject matter did not relate to the topic of this paper.  The topics of these articles included measuring masculinity in men of color, caregiving for cancer patients, and dementia and aging in India . The PsycINFO search found no articles and a search in PubMed resulted in three additional articles. This paper is a review of those sixteen articles. Conclusion: Reaching culturally diverse groups of people like the Hmong, is a difficult task for healthcare providers, yet one that is viewed as a top public health priority to eliminate health disparities and increase access to care. A community-driven program is needed in the Milwaukee area to reach out to the Hmong community and increase their awareness of mental health issues and services. Although there is no current program using cultural brokers within the Hmong community, many existing groups could n partner and provide cultural brokers. Resources also exist at the State and Federal level to guide community driven programs aimed at reducing health disparities among minority populations like the Hmong.

PowerPoint Presentation (PDF) 


Cathlyn Smith, MPH

Email: csmith@chw.org

Advisor: Mark Kostic, MD
Associate Professor, Pediatrics and Emergency Medicine

First Steps to Mitigate Opioid Abuse in a Local Community

Abstract:

In recent years, there have been numerous journal articles, white papers and editorials written regarding the growing problem of prescription drug abuse.  According to the Centers for Disease Control, this abuse is the fastest growing drug challenge in the US.  In 2007, an average of one person died every 19 minutes involving unintentional drug overdoses. Data from the National Center for Health Statistics for 2007 states unintentional poisoning was the leading cause of unintentional injury death involving adults 35-54 years of age and the second leading cause of injury death for adults aged 25-34 and 55-62.

Further, in 2009, 16 million Americans ages 12 and older took prescription pain relievers, tranquilizers, stimulants, or sedatives for strictly nonmedical purposes at least once in the previous year.  The National Institute on Drug Abuse (NIDA)-funded 2010 Monitoring the Future Study showed that 2.7% of 8th graders, 7.7% of 10th graders, and 8.0% of 12th graders had abused the opioid pain medication Vicodin and 2.1% of 8th graders, 4.6% of 10th graders, and 5.1% of 12th graders had abused the opioid OxyContin, for nonmedical purposes at least once in the previous year.  The focus of this report is to examine the prescription drug abuse epidemic:  its contributing factors, increasing frequency, and impact on society. 

PowerPoint Presentation (PDF)


Ema Uko-Abasi, MPH

Email: ukoabasi@hotmail.com

Advisor: John Meurer, MD, MBA
Director and Professor, Institute for Health and Society

Developing an Expanded Tobacco Use Vital Sign Program Through Research Evidence of Effectiveness

Abstract:

Background: The battle against tobacco use has been a long one over the years, particularly following the first Surgeon General's report on its health hazards. Happily, the yield of this enduring effort is the declining level of tobacco use in the United States. Various public health strategies have resulted in this positive outcome, including the recommendation of the United States Surgeon General to include tobacco use status with the traditional clinical vital signs to increase the identification and consequent management of tobacco use during every clinic visit. Following the inception of this intervention in 1991, it is important to determine how effective the tool is at a clinical level. This project aimed to search for evidence of its effectiveness and use this evidence to design a program that could further promote its use and effectiveness in primary care settings.

Methods: I performed a review of evidence of the effectiveness of the tobacco vital sign in published research work. Evidence in the form of study results and author recommendations provided the basis for the design of an expanded Tobacco Vital Sign using a guiding logic model.

Results: Evidence demonstrated that the Tobacco Vital Sign is effective in increasing identification and documentation of tobacco use status, but besides facilitating moderate increase in simple quit advice, it is largely ineffective in moving the tobacco user towards long-term abstinence and cessation as a single intervention. 

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Joseph Welter, MD, MPH

Email: welterj@gmail.com

Advisor: Nancy Kreuser, PhD, MSN
Assistant Professor, Institute for Health and Society

The Amish of Central Wisconsin: Preparing for an Outbreak of Vaccine-Preventable Disease

Abstract:

Numerous outbreaks of vaccine-preventable disease have occurred within Amish communities.  Wisconsin has the fourth highest state Amish population in the U.S., and central Wisconsin is home to approximately 17% of the state’s Amish population; yet, this population has not been well-defined and its immunization level has not be well-determined.  This study describes Amish history in practical terms, and through the use of Amish sources, better defines the Amish population of central Wisconsin.  Through studying state-mandated school immunization records, less than 12% of Amish schoolchildren were found to have received any vaccinations, placing this and surrounding populations at significant risk for vaccine-preventable disease.  Recommendations are made for accessing this local, and often reclusive, Amish population for the purpose of increasing the vaccination rate and, ultimately, lowering the area risk of vaccine-preventable disease.

PowerPoint Presentation (PDF)

 

2012 Graduates


Erica K. Bergstrom, MPH

Email:  bergstro.eric@gmail.com

Advisor:  E. Brooke Lerner, PhD
Associate Professor and Research Director, Department of Emergency Medicine

Sport Related Injuries in Competitive Swimmers: A Review of the Epidemiology of Swimming Related Injuries

Abstract:

Competitive swimming is a popular physical activity in the United States with over 300,000 swimmers registered with USA-Swimming in 2011. This report examined the epidemiology of swimming injury and the current status of sports injury surveillance systems active in the United States through a comprehensive English language literature review of swimming injury related publications.  Articles were identified using Google Scholar, Pub Med, and multiple swimming specific resources. Injuries were found to occur in roughly 70% of swimmers, with shoulder injury occurring the most commonly at an estimated rate of up to 91%.  Spine, and hip and knee injuries occurred at maximum estimates of 68% and 28% respectively.  Three injury surveillance systems were examined including USA-Swimming, High School RIO, and NCAA Injury Surveillance System.  The report concluded that competitive swimming - related injury, despite its apparently high incidence, is not adequately captured by current sports surveillance systems, and a sport specific injury surveillance system will be needed if the true incidence and mechanisms of swimming injury are to be understood.  USA-Swimming is suggested as a prime organization with already established resources to collect injury data and conduct this much needed research.

PowerPoint Presentation (PDF)


Laura (Fadrowski) Conklin, MPH

Email:  lfadrows@hotmail.com

Advisor:  Julie Willems Van Dijk, PhD, RN
Assistant Professor, Institute for Health and Society

Web 2.0 – Social Media Marketing:  Taking Local Public Health Departments to the Next Level

Abstract:

Social media has quickly become one of the most effective ways to communicate with the general public about a wide variety of issues, including public health matters.   The need for public health officials to understand and become proficient in the use of social media to advance their objectives is evidenced by the sheer number of individuals who subscribe to social media sites.  The number of people looking to social media as their sole source of information grows every day.  How does a local health department (LHD) effectively utilize Facebook, Twitter, and other social media tools to market public health ideas, programs and initiatives?  What are some examples of how social media has aided public health initiatives?  What are some barriers reported by LHD’s in utilizing social media?  How can these be addressed to move forward with social media marketing?   This paper addressed these questions through a comprehensive literature review, as well as interviews conducted with local and national public health officials.  The results of this research show it is now more important than ever for public health departments to join the social media revolution.

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Shereen Elbaz, MD, MPH

Email:  shereen_elbaz8@hotmail.com

Advisor:  Jason Jarzembowski, MD, PhD
Assistant Professor, Department of Pathology

Impact of prenatal health care, prenatal smoking and alcohol drinking on infant mortality

Abstract:

Introduction:  Infant mortality is one of the important indicators of a nation’s health. It is greatly affected by maternal health and behavior during pregnancy. Our focus in this study was prenatal smoking and alcohol drinking as determinants of infant mortality. We also addressed the prevalence of these behaviors in Wisconsin to help enable policy makers to set preventive programs to improve health outcomes over the long term.

Background:  The infant mortality rate has not declined significantly in the US since 2000. A literature review supports a strong correlation between each of smoking and alcohol consumption during pregnancy and infant mortality. The prevalence of smoking during pregnancy in the U.S. was 40% in 1967 and has gradually declined to 13% in 2006. The prevalence of alcohol use during pregnancy was 20% in 2001. It has also declined to 15% for moderate drinking and 4% for frequent drinking in 2005.

Methods:  We conducted a retrospective study based on data collected from the Infant Death Center of Wisconsin (IDCW) survey from 1991 to 2000. It was offered to the family of every infant who died in Wisconsin during that time period excluding in-hospital deaths. A subset of the survey questions addressed smoking and alcohol drinking during pregnancy and prenatal health care. A descriptive analysis was used in this study showing the prevalence of each behavior within this cohort. We compared these results with the national averages to explore the magnitude of the problem and examine if infant mortality in our study was attributable to these negative behaviors.

Results:  The proportion of women who smoked during pregnancy in the IDCW study is significantly higher than in the overall population (50% vs. 20%, p < 0.05). However, the proportion of women who drank during pregnancy in our study is no different than that in the population (20% vs. 20%, p > 0.05).

Conclusion:  We concluded from literature and our study data that there is a relationship between smoking and alcohol use during pregnancy and infant mortality. We recommend establishing more well-constructed preventive services that focus on modifying negative health behaviors during pregnancy. 

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Jennifer L. Hanke, MPH

Email:  jlhanke@comcast.net

Advisor:  James Sanders, MD, MPH
Associate Professor, Department of Family and Community Medicine

Refugees in Colorado:  A Review of Colorado’s Refugee Preventive Health Program and the Health Status of a Community

Abstract:

Objective:  Refugees resettled in new countries often arrive with abnormal health conditions.  While various studies have provided information regarding the scope and rates of common ailments, an in-depth review of the health services provided to this population has not been undertaken.   This review serves to detail the duties and purposes of Colorado’s Refugee Health Services Program, and determine the health status of Colorado’s refugee population.

Methods:  A literature review was conducted regarding refugee health on both a national and global scale.  William Stauffer and Michelle Weinberg’s article “Emerging Clinical Issues in Refugees,” published in Current Opinion in Infectious Disease in 2009 provides the basis for this study.  Personal interviews were conducted with administrators of Colorado’s Refugee Resettlement Program and Colorado Refugee Health Services Program, along with employees of a non-profit agency serving Colorado’s refugee population.

Results:  Refugees enter the state with a variety of health concerns, which include a high rate of communicable illnesses (e.g. Hepatitis B, parasitic infections, tuberculosis).  As many refugees find employment in “high-risk” areas such as food service industries and child care centers, risk for transmission becomes a concern.

Conclusion:  While many refugees are found to have abnormal health conditions at their domestic health screening, the resulting treatment, and follow up care has proven effective, as there have been no known outbreaks of communicable illness associated with the refugee population in Colorado.

PowerPoint Presentation (PDF)


Christy L. Kiekenbush, MPH

Email:  ckiekenbush@gmail.com

Advisor:  Thomas May, PhD
Associate Professor of Bioethics and Medical Humanities, Institute for Health and Society

The Human Papillomavirus Vaccine:  A Systematic Review Elucidating the Dynamics of Ethical Concerns and Public Health Policies

Abstract:

This report employs a systematic literature review to explore factors impacting HPV vaccination acceptance and compliance with recommended vaccination guidelines, as well as strategies which may guide future approaches to increase attainment of vaccination goals.  A systematic search for articles published from 2004 to April 2012 related to the HPV vaccine was performed.  Extracted articles provided quantitative and qualitative information on the HPV epidemic and factors influencing vaccination compliance.  Several factors were identified, including related public health policies, ethical considerations, and expressed public opinions concerning HPV vaccination.

The results of the research reveal that moral and ethical beliefs, social influences, public health policies, interaction with the health care system, and cost are associated with parental and young adult perceptions of the HPV vaccine and intent to vaccinate.  This systematic review also elucidates potential strategies to increase HPV vaccination rates.  The information supplied by this systematic review may have implications for future novel vaccines, in particular, those for sexually-transmitted infections, which may encounter similar barriers to vaccination as those experienced by the HPV vaccine.

PowerPoint Presentation (PDF)


Jennifer L. Leonard, MPH

Email:  jen-leonard@hotmail.com

Advisor:  Andrew Petroll, MD, MS
Assistant Professor of Infectious Diseases, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine

Identification of the Need for Inclusion of Alcohol / Substance Use into Comprehensive Sexual Education Courses in Public Schools

Abstract:

Academic and public health researchers have examined the sexual behaviors as well as alcohol and substance use among teens, but rarely the complex relationship between the two.  To further explore these topics and their relationship, I conducted a review of published data pertaining to (a) teen sexual activity and risk of sexually transmitted infections, (b) alcohol and substance use among teenagers, (c) current sexual education curricula, and (d) examples of change to sexual education curricula. Two programs were effective at reaching their target population and reducing the rate of HIV when incorporating alcohol and substance use with sexual education curricula. This paper outlines this data and highlights the need to incorporate alcohol and substance use into comprehensive sexual education.

PowerPoint Presentation (PDF)


Peigang Li, MPH

Advisor:  Alan Wells, PhD, MPH
Assistant Professor, Institute for Health and Society

Racial and Social-economic Evaluations of Community Health Disparities:  The Association between Health Outcomes and Local Retail Food Environment in the City of Milwaukee

Abstract:

Background:  Studies have shown that increased access to healthy foods is linked to positive health outcomes in children and adults. The project aims to study associations between local retail food environments and health outcomes, specifically the relationship between density of food stores and infant birth outcomes such as morbidity, low birth weight (LBW), and mortality.

Methods:  A multilevel and ecological approach was taken to explore the associations and to help inform public health policies that aim to eliminate  health disparities. Both a modified retail food environment index (RFEI) and a local disparity value (LDV) were derived as risk factors from the multiple data sources. Geographical Information System (GIS) software was used to overlay health outcome and risk factors by zip codes in the Greater Milwaukee area.

Results:  Individual-level health determinants were associated with birth outcomes confirmed in other epidemiological investigations.  The area-level (neighborhood) risk factors were marginally associated with birth outcomes, determined by the variation at the area-level factors (types and density of food stores in zip code area).

Conclusion:  The current study demonstrates the utility of both multilevel analysis and applied GIS in examining the link between local retail food environments and birth outcomes. The main outcome of this project is the relationship between area-level factors (food stores in zip code areas) and birth outcomes. Variation in the area-level data suggests that birth outcomes are associated with RFEI and zip code.

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Katharine E. Lohse, MPH

Email:  lohs0021@gmail.com

Advisor:  Kirsten Beyer, PhD, MPH
Assistant Professor, Institute for Health and Society

How does the rate of cesarean section rates affect rural areas?  A systematic literature review

Abstract:

The purpose of this paper is to examine how the rise of cesarean section rates in the United States affects rural areas. The way in which this increase in cesarean section rates affects rural women in the United States is not well understood. It is likely that unique health and medical challenges face pregnant women living in rural areas of the United States, as it is known that rural populations face particular health related challenges associated with rural environments. While there is information available on different aspects of the topic, we know of no published review of cesarean section rates and their effects in rural settings.  To address this gap in knowledge, we performed a systematic review of the published literature to understand how the rise in cesarean section rates affects rural areas. In total, 226 articles were identified and seven were included in the final review. We focus on the following domains that emerged while conducting the review: cesarean section rates in rural versus urban areas; access to healthcare in rural areas; socioeconomic status, healthcare payments and insurance; and cesarean sections as linked to other birth and health outcomes. We found that a small amount of research has been conducted comparing cesarean section rates in rural and urban areas, showing a slightly higher rate in rural areas versus urban.  Given the rise of cesarean section rates, more research is needed to determine whether rural-urban differences in cesarean sections rates occur across the United States and what factors influence these differences. To truly understand and correct any disadvantages facing rural pregnant women, more studies should include primary data collection from rural women making birth choices and seeking pregnancy related services.

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Alexandra M. Ostromecki, MPH

Email:  alexandra.ostromecki@gmail.com

Advisor:  James Wallace, MD, PhD
Professor, Department of Surgery

A Program Plan for Childhood Obesity Prevention in a Local Community

Abstract:

Childhood obesity is a rapidly progressing issue in the United States that continues to grow. It is a salient public health, medical, economic, and social issue, and federal policy related to childhood obesity as it currently exists does not adequately reach the grassroots level in many local communities. This paper describes a community health program plan designed to implement national childhood obesity-related policies at the local level, as executed by a local public health department. The program is targeted at childhood obesity prevention in school-age children, with beneficial secondary effects for family and the surrounding community members and stakeholders. Prevention components include, but are not limited to, increased physical activity, proper nutrition and healthy lifestyle education, school compliance with federal policies, and stakeholder involvement and support. The program utilizes various state and federal programs aimed at combating obesity, including the Farm to School Program and Let’s Move! Campaign championed by First Lady Michelle Obama, and this paper illustrates what a $70,000 budget can achieve for a local community in terms of childhood obesity prevention in a one-year time period. Overall, it is a promising program that is designed to be easily modified for almost any local organization to implement, be it public or private, and it moves this country one step closer towards subduing the childhood obesity epidemic, one community at a time.

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Esha Pillai, MPH

Email:  esha.pillai@gmail.com

Advisor:  Paul Hunter, MD
Volunteer Clinical Professor, Department of Family and Community Medicine

The Mobile Markets Project:  Nutrition Education with Healthy, Affordable Food at the Neighborhood Level

Abstract:

An obesity epidemic is sweeping the nation, and the most vulnerable individuals are those living in “food deserts,” or locations where the existing food environment has multiple barriers to healthy food access (Cannuscio, Weiss, & Asch, 2010, p. 388). Health interventions have been conducted in urban disadvantaged neighborhoods all over the country to address this issue. One such intervention is the evidence-based, community-informed Mobile Market (MM) Nutrition Education Project.

The MM Project was created through collaboration between various community and academic groups to provide a nutrition education adjunct to the existing Mobile Markets provided by SHARE Wisconsin at five culturally diverse sites. The nutrition education project presented a different nutrition topic at each session, accompanied by interactive components such as games and food demonstrations. The sessions were specifically tailored based on the cultural backgrounds of the populations at each site. Surveys presented at each session provided a means to measure the success of and interest in the programming. This paper serves to provide the process evaluation for the project.

Participants at all five of the sites enjoyed the sessions overall, especially the interactive components and incentives; however, attendance was not optimal. Possible reasons for absences included lack of transportation, sick children, or school holiday. The relationship of the target population to the site was a key factor in the likelihood of sustained attendance. Future implementation of similar programming could follow the session framework presented here, but further studies should consider/identify additional recruitment strategies to increase attendance.

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Elma Racquel Racadio, MPH

Email:  eracadio@hotmail.com

Advisor:  Alan Wells, PhD, MPH
Assistant Professor, Institute for Health and Society

Barriers to Emergency Contraception Access in Rural Wisconsin Communities:  A Qualitative Analysis of Public Health Officer Interviews

Abstract:

Coming Soon

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Brianne N. Runyan, MPH

Email:  briannerunyan@gmail.com

Advisor:  Nancy Kreuser, PhD, MSN
Assistant Professor, Institute for Health and Society

The Future of Public Health:  National Public Health Department Accreditation versus the Current Wisconsin DHS 140 Review:  Requirements of Local Health Departments

Abstract:

Background:  The purpose of this paper is to examine the new national accreditation process and the influence it may have on the Wisconsin Department of Health Services 140: Required Services of Local Health Departments Review (DHS 140 Review).  This paper will aim to understand why some local health departments (LHD) are motivated to pursue accreditation while others are not. Since the accreditation program is relatively new to the world of public health, and to many it may seem daunting, this report will be significant in that it will help others to better understand accreditation and how it relates to the current practice. Accreditation is currently voluntary; however, there is a chance that it may be mandatory in the future. The big question is, “What does this mean for the DHS 140 Review?”

Methods:  A literature search was conducted to determine if accreditation is appropriate in public health. Accreditation programs have been developed for a variety of other settings, including healthcare, and reports on the lessons learned from these other settings will be reviewed and discussed. A survey was also designed and conducted among Wisconsin public health officers about their knowledge and opinion of the voluntary, national public health department accreditation process and the current DHS 140 review. With this information, the paper intends to evaluate different factors related to local health departments, such as level, size, resources, etc. and how that might affect their decision to apply for accreditation. Lastly, an interview was conducted with a former Health Commissioner for the City of West Allis/West Milwaukee. Information from all sources is used throughout the paper to illustrate the key findings.

Results:  When examining the public health workforce demographics of Wisconsin and the entire nation, the 2011 Wisconsin Local Health Department Accreditation Survey and the 2010 National Profile Local Public Health Departments provided information on the size of populations served, the types of jurisdictions, the annual expenditures, the number of full-time equivalents(FTEs), the overall distribution of the LHD workforce, if departments participated in any quality improvement activities and how all of these characteristics relate to an agency’s familiarity with the national accreditation program and their intentions on applying. After extensive research regarding information on local public health agencies, there is a correlation with the size of the jurisdiction served by departments and these departments’ eagerness to apply for accreditation. Even though the responses to questions about intent to seek voluntary national accreditation suggest a high level of interest among LHDs in the national accreditation program, the literature indicates some departments in Wisconsin and across the US are not going to have the resources to apply for the program. This may have to do with the fact that accreditation readiness relies on numerous factors which can be very limited in many health departments. These factors include financial resources, dedicated staff available to work on accreditation activities, etc. In addition, health departments also need to have the three pre-requisites in place before they can consider applying for accreditation.

Conclusion:  There is much to be learned from accreditation programs in other service industries as well as from current public health quality improvement efforts. While results from key studies related to accreditation program may not be entirely applicable to public health, it has been argued that if these programs have been successful in strengthening the delivery systems for other health and social services, a similar program may hold promise for the field of public health. It would behoove every LHD, whether they are the early adopters, the majority who will wait a few years to seek accreditation, or the late followers, to work together towards the same vision that every LHD in America will someday be accredited and every individual in this nation can receive the same care regardless of where they live and which department serves them.

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Devyne L. Schmidt, MPH

Email:  strand.devy@gmail.com

Advisor:  Robert Goldberg, MD
Assistant Professor, Institute for Health and Society

The Role that Incentives Plan in the Improvement of Population Health at Worksites:  A Systematic Review

Abstract:

Introduction/Purpose:  As the presence of chronic diseases related to modifiable risk factors continues to cause an increase in health care costs, employers have taken a recent interest in improving their employees’ health.  One way to accomplish this goal is by offering worksite health programs (WHPs) and encouraging employees to participate through different means, including offering incentives.  The purpose of this paper is to determine the role that incentives have in the improvement of population health at worksites.

Methods:  A two-part systematic review was conducted on studies of efficacy of WHPs where 28 articles met the inclusion criteria and participation rates in WHPs where 23 articles met the inclusion criteria.

Results:  25 of the 28 studies proved effective where the participants had better outcomes than the control group.  Participation rates varied from 3.5% to 90% depending on the type of incentive offered.

Discussion:  WHPs which were determined effective had variations in program length, topic, and modality of delivery, making it difficult to draw concrete conclusions.  Readiness to change was identified as a variable to consider, along with effectiveness.  In addition, gender was identified as a confounding variable when exploring participation rates.  The variation in participation rates is an important factor, but the limited number of mutually exclusive incentives produced inconclusive results.  A more relevant study to address the impact of incentives would be to review participation rates for programs already deemed effective, to allow for more control of the variables also impacting participation rates.

Conclusion: Offering an incentive is just one of the many variables employers need to consider while aiming to improve the health of their employee population.  Additional variables to consider include the type of incentive and intervention, communications, and worksite culture.  Addressing each of these variables is likely to provide a recipe for success for WHPs.

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Michelle Thate, MPH

Email:  michellethate@gmail.com

Advisor:  Paul Hunter, MD
Volunteer Clinical Professor, Department of Family and Community Medicine

Nutrition Education at Mobile Markets:  A Community Needs Assessment to Guide Nutrition Programming Development and Implementation at Mobile Market Sites

Abstract:

Many residents of low-income neighborhoods live in ‘food deserts’ – areas that have limited access to affordable and nutritious foods. Current research suggests that these residents have higher rates of obesity and chronic diseases, possibly due to their socioeconomic status and environment (Whitacre et al., 2009). The evidence-base is growing to show that increasing healthy food access paired with nutrition education is a promising intervention combination to improve both the health of these residents and communities.

One current program is SHARE Wisconsin’s Mobile Markets (MM), which bring healthy, affordable foods into Milwaukee’s low-income neighborhoods. In addition to increased access to good nutritional options, community and academic groups have partnered to develop and provide nutritional education programs to be held at the MM sites. The current project seeks to develop nutrition education to promote consumption of nutritious food and increase knowledge of healthy food preparation methods and food selection. A consumer survey was administered to 261 consumers to identify interests in nutrition education and determine population specific pre-education attitudes, beliefs, and self-reported fruit and vegetable consumption. After frequency and percent analysis, this needs assessment report utilizes the survey data to provide recommendations for the project team to utilize in developing nutrition education programming.

The typical MM customer is approximately 50 years old, generally healthy, and a recipient of federal food assistance. Healthy food access does not appear to be an issue, but cost is. The majority understand that fruits and vegetables are important for good health and are confident in meeting USDA recommendations. Yet, most also think it is necessary to eat more fruits and vegetables than they currently do, and interest in nutrition education is high. Thus, results may have been subjected to self-reporting bias. This report is strengthened by the survey development process.

Further studies should explore community-specific food desert dynamics prior to program planning, and develop surveys with more knowledge specific questions to thoroughly measure change in comprehension and behaviors. Nevertheless, providing education and nutritious food resources will aid food desert residents in making healthy life choices.

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Sylvia Torres, MPH

Email:  sylvia_torres2000@yahoo.com

Advisor:  Eric Gass, PhD 
Assistant Professor, Institute for Health and Society

The Teen Perception of Unhealthy Sexual Behaviors:  The Development of Items for a Teen Survey

Abstract:

Objective: The purpose of this project is to determine the types of questions that will be used in a survey that will capture the understanding behind the engagement of unhealthy sexual behaviors by teens.

Methods: A list of 83 developed items regarding sexual health and education were given to teens from the University of Wisconsin-Milwaukee Upward Bound Program. These teens were instructed not to answer any of the items and only cross out the item the teen did not feel was a good question to ask other teens for a future survey. A factor analysis was conducted to find correlations among the items the teens did not discard.

Results: A total of 21 teens ages 15-18 reviewed the list of items. Out of the 83 list of items, 5 items were kept by all of the teens that participated. The list was further reduced to 55 items after the analysis was performed.

Conclusion: Allowing teens the opportunity to judge a list of items that will be used in a future survey is important to gain the teen perception on the importance of the item. This process allows us to gather appropriate items that today’s teen is currently experiencing. By developing these items with a teen’s perception, it allows us to ask the questions that are pertinent and that will give us an insight into the mind of their peers. Once this type of tool is developed, it can be incorporated into model programs that contribute to reducing teen pregnancy rates, increasing high school graduation rates and post-secondary education.

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2011 Graduates


Morgan K. Anderson, MPH

Email:  morgan.k.anderson@gmail.com

Co-Advisor:  Emmanuel Ngui, DrPH
Assistant Professor, Department of Pediatrics

Co-Advisor:  Alan Wells, PhD, MPH
Assistant Professor, Department of Family and Community Medicine

Drinking Water Concerns and Water-borne Illness Prevention Recommendations in Rural Kenya:  A Systematic Review

Abstract:

Aim: The purpose of this systematic review was to gather published literature to evaluate methods in rural Kenya of obtaining safe drinking water through 1) point-of-use disinfection, 2) safe water storage, 3) sanitation/hygienic methods, and 4) behavioral change.

Methods: The systematic review was limited to finding full-text literature through online database searches and utilizing inclusion criteria along with the four main components of safe drinking water initiatives (point-of-use disinfection, safe water storage, sanitation/hygienic methods, and behavioral change). After eliminating non-relevant text, a total of 18 relevant articles based on intervention, prevention, and experimental purposes were utilized.

Results: There were 18 studies indentified that met the inclusion criteria. About 77% of the listed literature discussed point-of-use methods; 28% discussed safe water storage; 33% discussed sanitation or hygienic methods; 27% discussed behavioral change such as cultural stigma or education methods, and 33% of the articles utilized 2 or more of the above components within their studies.

Conclusion: The systematic review had a strong indication for the need for collaboration of all four components to achieve quality drinking water standards meeting World Health Organization recommendations. Collaboration with non-governmental organizations, WHO’s Water Safety Plans, and CDC’s Safe Water System to implement culturally appropriate methods to improve drinking water quality standards is achievable.

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Waqar Jabbar Malik, MD, MPH

Email:  drwmalik@hotmail.com

Advisor:  Alan Wells, PhD, MPH
Assistant Professor, Department of Family and Community Medicine

Effects of Cell Phone Usage (including Talking and Texting) on Driving

 

 

Abstract:

Introduction: The use of cell phones has been a growing cause of distracted driving over the last decade. Distracted driving results in motor vehicle accidents and may cause unintentional injuries to the distracted driver and others around him/her. Unintentional injury is a leading public health concern, and this concern is growing with the spread of cell phones.

Methods: I performed a literature search via Ovid/Medline to identify the articles related to cell phone usage while driving. The articles included in this systematic review have explored these effects by studying three main items: self reported behavioral surveys, driving simulations and fatality data from the hospitals involving motor vehicle crashes.

Results: In a retrospective review, the risk of a crash while driving was 4.3 times higher when a cell phone was being used compared to when it was not. Another study showed significantly more dangerous driving behavior during an ‘emotional’ cell phone conversation than that during a ‘mundane’ call, and a 2009 study demonstrated that drivers with the dual task of driving and texting responded more slowly to the onset of braking lights and showed impairments in forward and lateral control, compared to the drivers with the single task of driving only.

Discussion: The studies that compared the conversation with the fellow passenger with the conversation on the cell phone provide insight into how a cell phone conversation may be different than an in-person conversation. Additionally, texting has been demonstrated by many studies to be more dangerous than driving, which may be due to it requiring more attention than talking and because it requires the use of more or different senses (seeing vs. hearing).

Conclusion: More research needs to be done to find out ways to help individuals not only understand the dangers of the texting while driving but also to learn why they do so.

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Sarah A. Muir, MPH

Email:  samuir@hotmail.com

Advisor:  Carol Ping-Tsao, MD, JD
Associate Professor of Psychiatry

A Mental Health Anti-Stigma Program for the West Allis Health Department

 

 

Abstract:

Mental health disorders affect millions of citizens in the United States and worldwide with one in four Americans diagnosed with a mental health disorder (1). Stigma associated with these disorders leads to a number of barriers and challenges, making it difficult for residents to seek out and continue treatment (4). Programs aimed at reducing stigma within communities, families, and the medical community hope to ease the difficulties patients with mental health disorders experience while also educating and promoting awareness in the general population. Significant progress has been made in developing programs that work to educate, increase mental health awareness, and eliminate stigma. With this in mind, the West Allis-West Milwaukee Mental Health Workgroup has begun to formulate and develop an anti-stigma program in accordance with their 2010 Community Health Improvement Plan with implementation set for Mental Health Awareness Month, May 2011. In Conjunction with the workgroup, the West Allis Health Department will develop a general population anti-stigma program in coordination with education and business partners. This paper aims to explain the effects of mental health stigma, the resulting need for an anti-stigma program in the West Allis-West Milwaukee community, and a strategic plan for the West Allis Health Department anti-stigma program.

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Mario Pena, Jr, MD, MPH

Email:  mpena@teamumc.com

Advisor:  Alan Wells, PhD, MPH
Assistant Professor, Department of Family and Community Medicine

Pesticide Exposure in Migrant Workers and their Families:  An Evaluation of Pesticide Exposure as Measured by Acute Illness in Migrant Field Workers in Texas Health Region I

 

Abstract:

The widespread use of pesticides in the agriculture industry is considered to be an important occupational health risk for field workers and their families. The published literature demonstrates the risk and incidence of pesticide toxicity and that is an important cause of illness among migrant field workers. A survey of primary care physicians in Texas Health Region I was conducted to determine if pesticide toxicity posed a health hazard for the area. The results of the survey indicated there were isolated incidents of toxicity. These results may be consistent with that of other studies, which conclude it may be difficult to determine the nature and the extent of agricultural pesticide toxicity. This study focuses on migrant field workers and their families, which is predominately a Mexican population. The history of the migrant movement is described along with its present evolution into the agricultural industry. The study also briefly identifies the four types of pesticides and their potential medical side effects and associated signs and symptoms. The aspect of social justice is addressed with respect to prevention and worker education.

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Heather B. Puente, MPH

Email:  hbpuente@gmail.com

Advisor:  Eric Gass, PhD
Instructor, Institute for Health and Society
Director, Public Health Research and Policy, City of Milwaukee Health Department

Teen Pregnancy in Milwaukee:  An Analysis of Effective Prevention Methods and Factors

 

Abstract:

Objective:  Milwaukee continues to have one of the highest rates of teen pregnancy in the nation especially among Hispanics and African Americans. The purpose of this paper is to create a deeper understanding of the multifaceted issues that influence teen pregnancy, discover if there are evidence-based programs that address these issues, and compare them to Milwaukee’s current teen pregnancy prevention efforts.

Results:  Applying the biopsychosocial model to teen pregnancy, I researched the following areas and their influence on teenage pregnancy: risk perception, stress, education, parent relationships and peer pressure. Researched showed that all of these areas influenced that rates of teen pregnancy and therefore creating effective teen pregnancy programs to combat this issue need to be just as complex and multifaceted. The reality of the situation is that one program will not address all these possible issues; therefore, when implementing teen pregnancy programs, they need to fit with the needs of that particular community.

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H. James Sleavin, MD, MPH, FAAP, COL (Ret.) MC USAR

Email:  harold.james.sleavin@us.army.mil

Advisor:  Alan Wells, PhD, MPH
Assistant Professor, Department of Family and Community Medicine

Traumatic Brain Injury and Posttraumatic Stress Disorder in Returning Soldiers Serving in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) and their Re-integration into the Community

 

Abstract:

Background: A significant portion of soldiers deployed in support of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have been exposed to events associated with traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). TBI and PTSD are now the most common injuries reported in the wars in Afghanistan and Iraq. This has also become a huge health issue in veterans returning from the conflicts and can cause a serious burden in our health care system and society.

Methods: A literature review of various websites and journals was performed. The Department of Veterans Affair, the Defense and Veteran Brain Injury Center (DVBIC), and the US Army Wounded Warrior Program were all searched.

Results: TBI with comorbid PTSD has been the focus of study since the start of the wars in Afghanistan and Iraq, and they have been called signature injuries or invisible wounds. Screening processes are the primary tools to evaluate soldiers who might be suffering from TBI and PTSD, and these processes have been shown to be quite effective. Early intervention programs to lessen the impact of TBI and PTSD on the soldier and his or her family as well as programs designed to reintegrate the soldier back into the community are now becoming standard of care.

Conclusion: Recognition of TBI and PTSD as the most common injuries of the wars in Afghanistan and Iraq has generated much research in diagnosing and treating these overlapping disorders. Advances in screening techniques and early intervention have helped our veterans and their families overcome obstacles that soldiers in previous wars had to endure.

PowerPoint Presentation (PDF)


Carol M. Smith, MD, MPH

Email:  clarksmithonriver@msn.com

Advisor:  E. Brooke Lerner, PhD
Associate Professor, Department of Emergency Medicine

An Overview and Survey of the Medical Management and Reporting by Medical Providers in Dutchess County, New York

 

Abstract:

Background: The following tick-borne diseases have been identified in New York State: Lyme disease; babesiosis; ehrlichiosis, caused by two slightly different organisms (Human Monocytic Ehrlichiosis and Human Granulocytic Anaplasmosis); Powassan encephalitis; and Rocky Mountain Spotted Fever Thousands of cases of tick-borne diseases have been reported to the New York State Department of Health, including over 82,000 cases of Lyme disease, over 1000 cases of ehrlichiosis, and 800 cases of babesiosis, since 1986. There are approximately 50 cases of Rocky Mountain Spotted Fever reported annually in New York State and to date there are two known cases of Powassan encephalitis identified in Dutchess County. The objective of this project was to develop a survey, appropriate for the medical provider community, which queries the diagnostic experience, treatment choices, reporting habits, and continuing medical education needs of the practitioners who encounter these tick- borne diseases in their patients. The aim is to gain better insight into the clinical management of tick-borne illness in Dutchess County.

Methods: There were a total of 15 questions in the survey which were developed to allow for single or multiple answers. Many of the questions were similar (with some modifications) to those used by the Dutchess County Department of Health in prior surveys. The survey was distributed by means of fax and online utilizing “Survey Monkey”, a commercial internet survey development tool.

Results/Conclusions: The respondents consisted of physicians, physician assistants, and nurse practitioners. As expected there was unanimous agreement that tick-borne illness is a major public health problem in Dutchess County. The majority of practitioners routinely provide their patients with information on the prevention of tick-borne illness. Despite the prevalence of Lyme disease in the community, routine testing for Lyme is not done unless symptoms are present. The survey revealed that 57% of practitioners prescribe prophylactic antibiotics for tick bites without associated symptoms. Most of the practitioners prescribe 14 to 21 days of doxycycline for suspected Lyme disease or ehrlichiosis, which is consistent with the Infectious Disease Society of America guidelines. It is unclear if physicians will test for other tick-borne diseases at the time they test for Lyme disease. It would be of value to include this question in future surveys in light of the possibility of the existence of simultaneous infections.

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Annika Swenson, MPH

Email:  annika.swenson@gmail.com

Advisor:  Alan Wells, PhD, MPH
Assistant Professor, Department of Family and Community Medicine

A Program Design for Tobacco Education and Cessation in the Youth of Sawyer County

 

 

Abstract:

With nearly 25% of Sawyer County youth using tobacco, there is a definite need for these rates to drop. As there are currently no tobacco education, cessation or prevention programs in the county, a program needs to be implemented. Research suggests that a model that incorporates cognitive behavioral techniques, peer to peer mentoring, and the Not On Tobacco (N-O-T) program would be the most effective. A program logic model has been designed as the foundation to base the program, as well as measure outcomes. Through continual planning and process evaluation, the long-term outcome of a sustained, reduced rate of youth tobacco use in Sawyer County will be achieved.

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Jennifer Peelen Thomas, MD, MPH

Email:  jenny@drjen4kids.com

Advisor:  Jennifer Griffiths, MD
Assistant Professor, Department of Family and Community Medicine

Use of E-mail by Physician Breastfeeding Experts For Support of the Breastfeeding Mother

 

 

Abstract:

Promoting breastfeeding, with its many known health benefits, is an important public health strategy. Breastfeeding initiation and duration increase because of physician encouragement. However, many physicians have not received any education in breastfeeding, and some may not have a supportive attitude or commitment to breastfeeding. As breastfeeding initiation rates continue to rise, demand for expert help may also be increasing. Patients identify dissatisfaction with their current provider as a motivating factor in seeking health information on the internet. This survey was performed to determine the extent of use of the internet and email in clinical practice by physicians with an interest and expertise in breastfeeding to assess how many are being contacted for breastfeeding information and to examine these physicians’ attitudes to these requests. This type of communication, especially if the patient initiating the communication is not known to the physician, could serve as a marker of maternal frustration with the breastfeeding support they are receiving through traditional means.

An email describing the survey, inviting participation, and containing a link to the questionnaire was posted on the websites of the Academy of Breastfeeding Medicine and American Academy of Pediatrics- Section on Breastfeeding list serves. Information collected included physician training, successes and challenges related to providing email breastfeeding medicine support, and current level of email communication with patients regarding breastfeeding issues. One fourth of physicians in our survey receive email from patients with whom they have no preexisting relationships, and more receive email from known patients, suggesting that breastfeeding mothers seek expert information on the internet. Despite privacy, legal, and time constraints and concerns regarding inappropriate use, over half of the respondents contacted replied to emails individually and without reimbursement. Since many breastfeeding mothers are reaching out to breastfeeding experts, work should be done to increase the number of physicians who can provide expertise in breastfeeding.

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Ronald Thomas, MD, MPH

Email:  rgthomas49@comcast.net

Advisor:  David Nelson, PhD
Assistant Professor, Department of Family and Community Medicine

Impact of Emergency Department Crowding on Public Health and Patient Safety

 

 

Abstract:

Background: Emergency Department (ED) crowding is widespread in US cities, has reached crisis proportions and represents a serious public health problem. In addition to caring for acutely ill or injured patients, EDs help ensure that basic health care is available to anyone, regardless of ability to pay. The juxtaposition of emergency medicine and public health is obvious. Crowded conditions hinder the ability to render timely care to ED patients, let alone to engage in emergency department public health initiatives. Crowded ED conditions increase the risk of medical errors and contribute to adverse outcomes. Crowding in emergency department treatment areas threatens public health by compromising patient safety and possibly jeopardizing the reliability of the entire US emergency care system.

Objective: To describe the magnitude and effects of ED crowding on public health and patient safety.

Methods: A literature search was conducted to define and establish the status of the emergency department as a safety net provider, to review trends and characteristics of US emergency department utilization, to define and establish the magnitude and general effects of emergency department crowding, to review the established and developing emergency medical practice public health programs and initiatives and to demonstrate the effects of emergency department crowding on emergency medicine public health programs and initiatives as well as patient safety.

Results: Emergency Medicine has been established as the nation’s health care safety net. Due to increasing societal pressures, emergency departments throughout the country are more often faced with overcrowding and potentially unsafe conditions. The primary cause of ED crowding is boarding – the practice of holding patients in the ED after they have been admitted to the hospital because no inpatient beds are available. ED crowding is associated with many untoward consequences such as prolonged waiting room times, patient walkouts and worsening of patient pain and suffering. There has been mounting evidence that emergency department overcrowding may negatively affect the quality of care. Several studies have linked ED crowding to clinically significant delays in diagnosis and treatment as well as poor patient outcomes. Benefits are being derived from the emergency department based public health programs. Emergency departments across the country are becoming a place for acute emergency care and for primary health care and public health measures. Crowded conditions in EDs create barriers to executing emergency department based public health programs and the development of emergency department based public health initiatives.

Conclusion: The ED is a vital component of America’s health care safety net. Overcrowding in emergency department treatment areas threatens public health by compromising patient safety and jeopardizing the reliability of the entire US emergency care system. The juxtaposition of emergency medicine and public health has resulted in long standing emergency department based public health programs and initiatives. Emergency department crowding not only jeopardizes execution of existing emergency department based public health programs but also the development and implementation of developing and potential programs. Implementation of preventive and public health care measures is difficult in a crowded emergency department due to the lack of resources and privacy. Although the causes of emergency department overcrowding are complex; the main cause is inadequate inpatient capacity for a patient population with an increasing severity of illness. Potential solutions for ED overcrowding will require multidisciplinary system-wide support. Until emergency department crowding has been addressed and remedied, the emergency department based public health programs will not receive the resources necessary for their success.

PowerPoint Presentation (PDF)


Rebecca VanAmburg, MPH, ATC

Email:  rere76@yahoo.com

Advisor:  Theodore Kotchen, MD
Professor, Department of Medicine - Endocrinology

An Analysis of Four Types of Single Payer Health Insurance Systems: Canada, Sweden, Taiwan and the United Kingdom – How do they compare to the United States?

 

Abstract:

Health insurance is generally delivered by either a single payer or a multiple payer system, with some overlap between the styles. In the examples provided in this paper, single payer refers to the government organizing the funding and delivery of healthcare for all of its citizens. This paper examines four types of single payer health insurance systems in Canada, Sweden, Taiwan and the United Kingdom. The countries are representative of regional/private, regional/public, central/private and central/public single payer healthcare delivery methods. Comparisons are made based on how each country evaluates their healthcare system and between the number of claims and allocation of funding in each country. An example of a multiple payer system is the United States. Here, many organizations are responsible for providing a service of health insurance for the individuals who buy into the system. This paper will also compare those government run health insurance systems to that of the United States to determine if there are any lessons to be learned while we progress through our own healthcare reform.

PowerPoint Presentation (PDF)

 

2010 Graduates


R. Lee Barnes, MD, MPH

Email:  Ronald.Barnes@adm.com

Advisor:  Michael Farrell, MD
Assistant Professor, Department of Medicine - General Internal Medicine

Identifying Obstructive Sleep Apnea in the Commercial Truck Driver: Literature Review with Proposed Revisions to the Department of Transportation Medical Examination Form

 

Abstract:

The goal of this paper is to examine the current literature regarding obstructive sleep apnea and its implications for identification of the commercial motor vehicle operator with sleep apnea. Obstructive sleep apnea is a common condition with significant impact upon the health of the commercial driver as well as public safety. This paper will examine the current recommendations for screening the commercial driver for obstructive sleep apnea as well as make suggestions for modification of the current Department of Transportation Commercial Driver Examination Form. The intent of these suggested modifications are to aid the commercial driver examiner in the identification of those drivers that may have obstructive sleep apnea with the goal of improved driver health and public safety.

PowerPoint Presentation (PDF)


Steven Bratman, MD, MPH

Email:  stevenbratman@googlemail.com

Advisor:  Alan Wells, PhD
Instructor, Department of Population Health & Fellow, Department of Family and Community Medicine

The Current Status of Observational Studies as Scientific Evidence: A Critical Appraisal

 

 

Abstract:

Purely observational studies have long been considered problematic as a source of cause/effect conclusions and, for this reason, have been placed below experimental studies in the hierarchy of evidence. However, in many important areas of medicine and public health, experimental studies (specifically randomized controlled trials) are impractical to perform. In consequence, observational studies are often the primary source of public health recommendations. This practice has recently been called into question by the results of several large randomized controlled trials, which not only failed to confirm predictions based on observational studies but in some cases inverted them, transforming expectation of benefit into a discovery of harm. In this article, we interrogate the use of epidemiologic evidence as a source of “evidence-based” public health advice.

Full Text of Paper (PDF)


Casey J. Brown, MPH

Email:  caseyjobrown@yahoo.com

Advisor:  Alan Wells, PhD
Instructor, Department of Population Health & Fellow, Department of Family and Community Medicine

The Homeless Population: A Literature Review of Health Care Access with a Case-study of Autumn West and the Homeless Outreach Nursing Center Programs in Milwaukee, WI

 

Abstract:

Introduction: Over 3 million individuals in the United States experience homelessness on any given night, yet the homeless population has long been neglected by policy makers and society overall, especially within the realm of health care.

Methods: A literature search of homelessness and health was conducted to determine the cause and effect of limited health care access to homeless persons as well as to seek potential recommendations to alleviate this public health issue. A field study conducted in Milwaukee, Wisconsin, qualitatively examines the homeless condition and programs working to alleviate lacking access in Milwaukee.

Scope & Characteristics of Homelessness: It is believed that the rise in homelessness over the past two decades is largely due to a shortage of affordable housing and simultaneous increase in poverty. The homeless population demonstrates numerous health disparities, suffering in greater proportions than the general population in terms of acute health problems, communicable disease, HIV/AIDS, and mental illness.

Lack of Access: This literature review cites numerous studies to determine the health concerns of the homeless population, the access issues the homeless face when seeking healthcare, nursing outreach and integration efforts, and the need for advocacy by healthcare workers to improve the homeless condition.

Field Study in Milwaukee, Wisconsin: This field study provides an example of a successful nursing outreach model embraced by the Homeless Outreach Nursing Center and Autumn West programs. Background information about the programs and their processes is included as well as de-identified composites of homeless persons that demonstrate stages of progress through the programs.

Conclusion: There needs to be an increase in the number of studies conducted concerning homelessness and healthcare access. These studies must be conducted throughout the nation in many diverse communities. Funding and efforts should focus on nursing outreach, as it appears to be the most viable option to alleviate lacking access given the current economic and political climate of the United States.

PowerPoint Presentation (PDF)


Erwin Cabacungan, MD, MPH

Email:  ecabacun@mcw.edu

Advisor:  Emmanuel Ngui, DrPH, MSc
Assistant Professor, Department of Pediatrics

Racial and Ethnic Disparities in Maternal Morbidities and Preexisting Medical Conditions during Labor and Delivery Hospitalizations in Wisconsin

 

Abstract:

Background: Maternal morbidities (MM) and preexisting medical conditions (PMC) during pregnancy are important measures of maternal health. Although mostly preventable, these conditions are increasing and often lead to adverse perinatal outcomes and increased healthcare costs.

Objective: To compare MM and PMC during labor and delivery among racial/ethnic groups in Wisconsin.

Methods: Retrospective analysis of 206,428 pregnant women aged 13-53 years included in the 2005-2007 Wisconsin Healthcare Cost and Utilization Project State Inpatient Dataset. Logistic regression models were estimated for MM and PMC. Covariates included race/ethnicity, maternal age, socioeconomic factors, and comorbidities.

Results: About 29% of labor and delivery hospitalizations had ≥1 MM and 8% had ≥1 PMC. For MM, adjusted results showed that black women had significantly higher likelihood of infections, preterm labor, antepartum hemorrhage, and hypertension complicating pregnancy compared to white women. Hispanics, Asian/Pacific Islanders and Native Americans had significantly higher likelihood of infections, postpartum hemorrhage, and gestational diabetes than Whites. Major perineal lacerations were significantly higher among Asian/Pacific Islanders. For the MM, cesarean section, Blacks, Hispanics and Asian/Pacific Islanders had significantly lower likelihood of primary and repeat cesarean sections than Whites. For PMC, Blacks had significantly higher likelihood of asthma, diabetes mellitus, chronic hypertension, and obesity than Whites. Diabetes was significantly higher for Hispanics and Native Americans. The likelihood of ≥1 MM was significantly higher for Blacks (OR = 1.27; 1.23 - 1.32), Hispanics (OR = 1.05; 1.01 - 1.09), Asian/Pacific Islanders (OR = 1.07; 1.01 - 1.13) and Native Americans (OR = 1.32; 1.20 - 1.44). Blacks were more likely to have ≥1 PMC (OR = 2.10; 1.99 - 2.21).

Conclusions/Implications: Findings suggest significant racial/ethnic disparities in MM and PMC. Better screening, management and timely referral of these conditions, particularly among racial/ethnic women, should be implemented.

Publication:

Cabacungan, ET., Ngui EM, McGinley EL. Racial/Ethnic Disparities in Maternal Morbidities: A Statewide Study of Labor and Delivery Hospitalizations in Wisconsin.  Maternal and Child Health Journal, 2011 Nov 22. [Epub ahead of print] PMID: 2215738.


Thomas Frye, DDS, MPH

Email:  tfrye@mhtc.net

Advisor:  Alan Wells, PhD
Instructor, Department of Population Health & Fellow, Department of Family and Community Medicine

Access to Dental Care for Rural and Underserved Areas: Applying Evidence to the Practice Setting

 

 

Abstract:

Background: A lack of access to dental health care for rural and underserved populations throughout the country and State of Wisconsin is a critical health care problem. Studies at the state and national levels have failed to reach a consensus on solutions to this problem, and many states are falling below the goals of Healthy People 2010 to ensure adequate access to dental care.

Methods: A literature review of both population and dental provider demographics evaluated the extent of the unmet dental needs. The Surgeon General’s 2000 Report - Oral Health in America, the American Dental Association 2005 – Report on Current and Projected Dental Workforce, and the Wisconsin Dental Association/Delta Dental Report 2010 – Supply and Demand for Dental Services Wisconsin provide the basis for this study.

Results: Data indicate there is no shortage of dental providers nationwide or statewide in Wisconsin, but the problem is one of distribution. Contributing to the lack of access in the rural areas is the Federal Medicaid (MA) program that provides low re-imbursement rates resulting in low provider participation and utilization of services. The establishment of Federally Qualified Health Centers (FQHCs), expanding auxiliary dental provider positions, and the development of market based partnerships have been proposed to eliminate the disparity of dental care delivery.

Conclusions: Efforts in states to increase the reimbursement rates paid to dental providers have been shown to increase utilization. Initiatives to target rural pre-dental students for admission to dental schools and admission of in-state students will increase the retention of dental graduates in the state in all practice locations. The introduction of innovative dental personnel, such as the dental therapist and community dental health coordinator, may also increase access and utilization of services. The development of market-based initiatives that partner dentists and auxiliaries with local state and national programs has been shown to significantly improve the access to dental services for the underserved populations and may provide the solution to the disparity of care existing on the state levels.

PowerPoint Presentation (PDF)


Jessica Gathirimu

Email:  jessicagathirimu@yahoo.com

Advisor:  Emmanuel Ngui, DrPH, MSc
Assistant Professor, Department of Pediatrics

A Mother's Perspective: An Analysis of Fetal Infant Mortality Review (FIMR) Maternal Interviews

 

 

Abstract:

Objective. To use data collected though Fetal and Infant Mortality Review (FIMR) maternal interviews to enhance our understanding of infant and fetal deaths.

Methods. As part of the City of Milwaukee FIMR program, maternal interviews were conducted during the years 2005-2007. We analyzed selected questions from these interviews for this study. Frequencies were calculated on demographics and questions that were dichotomous or multiple choice in response. A qualitative analysis was conducted for open-ended questions to identify important themes.

Results. We identified the following five major themes: 1) unintended pregnancy and inconsistent or lack of birth control use, 2) poor or limited quality of care from prenatal care providers and while at the delivery hospital, 3) communication problems between the patient and medical care providers, 4) increased stress, and 5) unsafe infant sleep practices.

Conclusion. These themes indicate that there is an ongoing need for women to be well informed and involved in their reproductive health decision making, before, during and after pregnancy. It is also clear that stress is still a significant factor in the lives of women and ultimately birth outcomes. Furthermore, programming efforts need to be continued in the area of safe sleep for infants. These results can be used to shape programs and policies in the area of improving birth outcomes.

Publication:

Jessica presented her Capstone Project as a poster at the 2010 Wisconsin Public Health Association annual conference.

Visit our Facebook page to view photos.

PowerPoint Presentation (PDF)


John Hall, MD
, MPH

Email:  jlanehall@me.com

Advisor:  Robert Goldberg, MD
Assistant Clinical Professor, Department of Population Health & Health Sciences Clinical Professor, Division of Occupational and Environmental Medicine, School of Medicine, University of California-San Francisco

Hepatitis B Prevention Awareness in San Francisco Dental Offices

 

Abstract:

Hepatitis B remains a significant public health problem. Although the hepatitis B vaccine has greatly reduced the risk of occupational exposures for dental workers, many remain unnecessarily at risk for this disease. A survey of dentists’ offices in San Francisco was performed to assess existing awareness of measures available to prevent hepatitis B in this population. Outcome was hampered by low response rates to the survey. Most offices responding are aware of the vaccination status of patient care employees but not necessarily their hepatitis B immune status. All offices attempt to provide periodic employee education but acknowledge existing barriers. Some offices seem unsure of current CDC recommendations concerning preventive measures. Potential solutions to improving education and immunity include incentives from the offices’ workers’ compensation carriers, streamlined recommendations from the California Dental Association, and strengthened periodic educational requirements from the state dental board.

PowerPoint Presentation (PDF)


Elizabeth Kailath, MD, MPH

Email:  sierraid@comcast.net

Advisor:  Alan Wells, PhD
Instructor, Department of Population Health & Fellow, Department of Family and Community Medicine

Emerging Infectious Diseases with an Emphasis on the Novel H1N1 Influenza Strain and its Impact on Public Health

 

Abstract:

Background: In the spring of 2009, Mexico City announced that 2500 cases of an influenza-like illness had been identified, of which 150 (6%) resulted in death. It was weeks before this illness was identified as a new H1N1 Influenza A virus. The purpose of this paper is to determine the impact of this disease on the public health’s from a national and international perspective.

Methods: Using Medline, PubMed, Cochrane data base and other search engines, I have collected data on this infectious agent to report international and national trends in incidence and case fatality. Qualitatively, I have drawn upon my clinical setting, where I practice as a physician, to report from an individual community clinician perspective.

Results: The disease was most severe and mortality rates were the highest during the first six months after it emerged. The death rates, however, declined as time went on. The patient population afflicted most seriously with H1N1 Influenza consisted of young children, pregnant women and immune compromised, which is in stark contrast to the seasonal influenza, which typically affects the elderly. Initially, many health professionals feared this Influenza would deplete our medical resources; however, the impact on our medical resources was less than originally feared. To date, the disease has been reported in 207 countries. In the United States alone, there have been approximately 13,000 deaths attributed to this disease.

Conclusion: Pandemics of influenza have been reported around the world for centuries, leaving hundreds of thousands dead in their wake. With advances in overall supportive medical care and effective antiviral therapy, combined with expeditious vaccine development, the needs of vulnerable populations were generally well met during this pandemic, and thus the mortality rate was less than in pandemics years ago. Lastly, it is fortuitous that the elderly were relatively spared in this epidemic since historically they have suffered the greatest mortality risk from respiratory viral infections.

PowerPoint Presentation (PDF)


James Laurino, MD, MPH

Email:  james_laurino@yahoo.com

Advisor:  Robert Goldberg, MD
Assistant Clinical Professor, Department of Population Health & Health Sciences Clinical Professor, Division of Occupational and Environmental Medicine, School of Medicine, University of California-San Francisco

The Bioterrorism Research Handbook for Category A Biological Agents: Natural History of Disease, Pre-Research Testing, Post Exposure Testing, and Disease Treatments

 

Abstract:

This handbook is designed to give the people doing research on bioterrorist agents a quick reference to the properties of the agent, what to do before handling, and what to do after they think they are ill from the agent.

The information is organized into the following sections:

  1. Description of the agent
  2. Pathophysiology or summary of how it infects
  3. Symptoms and signs in the infected organ systems, or how it looks
  4. Pre-experiment baseline tests recommended of the researcher
  5. Post exposure tests to determine if an infective exposure has resulted
  6. Treatments to give after contracting the disease

The handbook covers the following CDC Category A or B Biological Agents:

  • Anthrax
  • Bird Flu
  • Botulism
  • Brucellosis
  • Ebola Virus
  • Lassa Fever
  • Marburg Virus
  • Melioidosis
  • Plage
  • Small Pox
  • Tularemia

The cost of testing is variable, so the handbook gives a ballpark estimate of costs to allow for budgeting when a study is in proposal stages. The individual pages for biological agents will state which tests are recommended to be done on staff, prior to beginning experiments, and also what test to do when an exposed staff member becomes ill.

PowerPoint Presentation (PDF)


Amir Nicknam, MD, MPH

Email:  anicknam1@yahoo.com

Advisor:  Alan Wells, PhD
Instructor, Department of Population Health & Fellow, Department of Family and Community Medicine

Strategies and intervention methodologies to achieve the elimination of childhood lead poisoning disparities in Southern Nevada

 

Abstract:

Objective: This study was conducted in an effort to identify and assess the effectiveness of lead poisoning prevention activities/interventions currently used in Southern Nevada, and to determine which barriers to the provision of these activities/interventions as part of the Southern Nevada Healthy Homes program currently exist.

Methods:
1) Literature reviews of four separate studies, which report blood level outcomes. Review of these studies were used to determine the efficacy and viability of various intervention strategies for the Southern Nevada Childhood Lead Poisoning Prevention Program and the Southern Nevada Healthy Homes program to employ toward their goals of eliminating childhood lead poisoning in Southern Nevada, and to best advise these programs of preferred methods.
2) Retrospective study of 18 individual cases of children under 72 months of age who were reported as having a blood lead level equal to or greater than 10µg/dL. Interventions used by the Southern Nevada Childhood Lead Poisoning Prevention program were reviewed to determine their overall effect and viability as well as to identify and provide solutions to overcome barriers to the provision of these interventions.

Results: The methods employed in this study found that when implemented alone, educational interventions were not effective in reducing blood lead levels among the target population. Studies researching soil abatement (removal and replacement) were not able to be meta-analyzed due to substantial differences between studies, so no determination was made.
Culturally-sensitive, cost-effective universal screening was recommended for communities with inadequate data on blood lead level prevalence. Comprehensive case management services were also shown to be effective in reducing the blood lead level of a child. In fact, out of the 12 cases which received at least one case management visit and then received follow-up testing, 9 showed a reduction in blood lead level after the primary visit.

Conclusions: Outlined interventions and strategies that can be used in Healthy Homes program goals to eliminate childhood lead poisoning and reduce health disparities in Southern Nevada.

PowerPoint Presentation (PDF)


Amanda Ruth Phillips-Savoy, MD, MPH

Email:  dramanda2001@yahoo.com

Advisor: Kenneth Yen, MD
Associate Professor, Department of Pediatrics - Emergency Medicine

How to Select a Mass Notification System:  A 12-Step Program

 

 

Abstract:

This article was written to develop a logical, systematic process to select a mass notification system for a public health organization. Based on experience and internet research, a 12-step program was developed for use by public health officials. Topics and steps include selection committee considerations, request for proposals, narrowing the field to a final mass notification system, and finally negotiation of a contract. This process is outlined to help public health officials and organizations choose a mass notification system.

PowerPoint Presentation (PDF)


Michael Rosenberg, MD, MPH

Email:  mro845@hotmail.com

Advisor: Robert Dedmon, MD, MPH
Volunteer Clinical Professor, Department of Population Health

HIV/AIDS Issues Facing America: Understanding the Current Demographic Trends of the Epidemic and Addressing the Public Health Needs of High-Risk African American Women

Abstract:

Background: Current statistics reveal that HIV/AIDS remains a major public health problem in America. As the AIDS epidemic in America has matured, there has been a growing public misconception that the issue is under control. Racial and ethnic minorities have been disproportionately affected by HIV/AIDS since the beginning of the epidemic, and they represent the majority of new AIDS cases and people living with HIV/AIDS. Today, women represent a larger share of new HIV infections compared to earlier in the epidemic, and African American women are particularly affected. Many socioeconomic and behavioral factors have been implicated as contributing to the spread of the disease among this demographic.

Objectives: To create recommendations for public health policies and interventions that can be used as guidelines for reducing the number of new HIV/AIDS infections among African American women and to provide better health services for those who are currently infected.

Methods: Comprehensive literature review, which presents the evolution of the HIV/AIDS epidemic in the African American population and establishes the social, behavioral, cultural, and political factors that have contributed to the current prevalence of the disease. Presentation of the epidemiologic findings of HIV/AIDS studies conducted within United States’ populations, and review of interventions that target African American women and their theoretical basis. This information was examined for the health status of minority demographics and possible determinants of illness among African American women.

Results: Significant findings were used to help identify what public health strategies might be most useful in targeting African American women and in what ways current public health policy fails to address their needs. Using this information, public health intervention recommendations were drafted in order to accomplish the stated objectives.

Conclusions: Strategy should focus on prevention. Recommendations for public health include reducing stigma associated with HIV/AIDS, increasing surveillance of the disease in the black population, increasing knowledge among African American females of their HIV status, increasing access to healthcare and reducing barriers to care, and facilitating behavior change among African American women to reduce risk behaviors. These recommendations would be best accomplished through culturally competent community-level and group-level interventions.

PowerPoint Presentation (PDF)


Michael J. Schmalz

Email:  michaeljschmalz@gmail.com

Advisor: Nancy Kreuser, PhD, RN
Assistant Adjunct Professor, Department of Population Health

Analysis of Novel H1N1 Pandemic Plan for Wauwatosa’s Health Department: Communication and Mass Clinic Implementation

 

Abstract:

In April of 2009, the United States diagnosed its first case of novel H1N1 or “swine flu”. On June 11th, the World Health Organization (WHO) declared H1N1 as a pandemic, their first pandemic in over forty years. Since its discovery, federal, state and local health departments (LHDs) have worked tirelessly to inform the public and protect them from infection. Pandemic flu plans exist and constantly evolve to meet the challenges particular to each new strain; however, these plans are formally updated more frequently on the federal and state levels than they are on the local level. Through literature review, data gathered from quality improvement meetings and a review of LHD H1N1 After Action Reports, this paper evaluates the pandemic preparedness planning of the Wauwatosa Health Department (WHD) for the novel H1N1 influenza virus, primarily looking at their mass clinic operations and the efficiency of their communication between the state, community partners and the Wauwatosa community at large. While federal public health agencies develop guidelines and approve vaccines for mass prophylaxis and state health departments coordinate the distribution of those vaccines to LHDs, it is at the local level that the public seeks receives vaccination services. Insufficient vaccine production at the beginning of the nationwide vaccination campaign coupled with unclear communication channels between various health agencies created challenges for the WHD communicating with the public, vaccinating the public and coordinating vaccination efforts with other LHDs. While the complications with vaccine supply were unavoidable, streamlining and practicing communication during mass vaccination campaigns could improve public health service in the future. This evaluation and any recommendations will be used by the WHD for their annual Preparedness Planning grant.

PowerPoint Presentation (PDF)


Graciela Villadoniga

Email:  gracielavs@hotmail.com

Advisor:  Srividya Kidambi, MD
Assistant Professor, Department of Medicine, Division of Endocrinology, Metabolism, and Clinical Nutrition

Applying the Chronic Care Model to Diabetes Mellitus: Does its application improve Diabetes Mellitus outcome? A literature review.

 

Abstract:

The objective of the present paper was to review the literature on the Chronic Care Model (CCM) and how its adoption in primary care clinics affects patients’ outcomes. Specifically we were interested in the adoption of the CCM in clinics that participated in Graduate Medical Education (or resident training clinics) and how the CCM affected patients’ outcomes and allowed teaching of core competencies (as dictated by Accreditation Council for Graduate Medical Education (ACGME)) in this setting. Articles included in this review were identified by searching through the United States National Library of Medicine database (Medline=PubMED database) in the English language. The following Medical Subject Headings (MeSH) and key phrases were used: “Chronic Care Model”, “chronic care”, “patient outcomes”, treatment outcome (MeSH), Diabetes Mellitus (MeSH), Internship and Residency (MeSH), [education, medical, graduate] (MeSH). Only articles in the English language were reviewed. All literature published before January 15, 2010, that was considered relevant was included.

Multiple studies describe the adoption of one or two elements of the CCM, but few describe the implementation of at least four of its six basic elements. Only five studies were found through our search that addressed the CCM in the type of setting we were interested in. From this review, we can conclude that evidence shows clinic processes are improved with the implementation of the CCM. In many studies and reviews, patient outcomes are also improved, nevertheless, this finding is not unanimous. In the very few studies considering patients’ overall quality of life, no significant change was noted with this intervention. In regards to the adoption of the CCM in resident training clinics, the CCM has been used as a tool for teaching core ACGME competencies and the barriers to this implementation are well described.

PowerPoint Presentation (PDF)


Ghousia Wajida, MD, MPH

Email:  gwajida@yahoo.com

Advisor:  Alan Wells, PhD
Instructor, Department of Population Health & Fellow, Department of Family and Community Medicine

Salt and High Blood Pressure: A Community Experience

 

 

Abstract:

We conducted a community based education module consisting of a 20-minute power point presentation regarding salt intake and blood pressure at local community centers in Cleveland, Ohio. Our aims were #1. To raise public awareness about the effects of dietary sodium on blood pressure, heart attack, stroke or kidney disease. #2. To develop an easily accessible curriculum for community members that discusses sodium content, concomitant lifestyle changes and nutritional strategies to reduce stroke risk factors. The power point and poster identifying sodium content in some ready-to-eat food choices, including snack foods and popular restaurants, were made by online searches of fast food restaurants and other websites. We also evaluated clinical studies for the relationship between dietary salt and high blood pressure and the cardiovascular risk reduction on a 2000 mg sodium diet. The participants submitted both pre- and post-talk questionnaires, which took 5-10 minutes to complete. The survey was anonymous and confidential. Results of the questionnaire were analyzed to determine the effect of the educational activity on community members’ understanding of dietary salt and the risks of high blood pressure.

The prevalence of high blood pressure in our study was 33.33%. Our educational activity resulted in statistically significant improvement in participants’ understanding of sodium content in a teaspoon. The pre- and post-educational activity correct responses for this question were n=8 (24.4%) and n=18 (52.94%), respectively, 95% CI = 0.064 - 0.5 and P= 0.016. A majority (73.53%) reported reading food labels compared with 26.47% who do not. A large proportion (81.8%) of participants with high blood pressure wanted to cut back on salt intake compared with 50% in the normal blood pressure group (P= 0.08). Even though this proportion was numerically much higher, it was not statistically significant, possibly due to small sample size. Between both groups, 63.3% wanted to cut back on salt intake. Our study demonstrates that community based educational activities highlighting clinical trials that emphasize healthy diet and lifestyle choices make significant improvement in community members’ understanding with a strong potential to promote healthy behavior and reduce long-term risk of cardiovascular events with substantial cost savings.

PowerPoint Presentation (PDF)

 

2009 Graduates


Steven A. Harris, MD, MPH

Email:  stevenhmd@aol.com

Advisor:  Peter Layde, MD, MSc
Professor, Department of Population Health & Co-Director, Injury Research Center

Health Effects of an Efficient, Vented Stove in the Highlands of Guatemala

 

 

Abstract:

This study is designed to measure the health effects of placement of an improved, vented stove in a village in Guatemala. In Guatemala, as in many places throughout the world, millions of indigenous people cook over non-ventilated, indoor open fires. Indoor air pollution and accidental burns are well known problems of such fires. This study is designed to evaluate the health effects of placement of an improved, efficient, vented stove called the ONIL stove, which were installed in greater than 90% of the homes in Santa Avelina, Quiche, Guatemala between 2002 and 2005. The study consists of a review of medical records from the local health clinic of the village of Santa Avelina before stove placement and after placement of the ONIL stoves. Numbers of cases per year of acute upper and lower respiratory illness, burns, and eye infection and strain were compared for this village. Accurate data was available for upper and lower respiratory illness from 2002 and 2006. Clinic visits for upper and lower respiratory illnesses combined decreased by 26.2%, and for acute lower respiratory by itself, by 45% between 2002 and 2006. This study suggests that placement of an improved, vented stove may be associated with a corresponding decrease in acute respiratory illnesses.

Publication:

Harris, Steven A. , Weeks, James B. , Chen, Juan Perez and Layde, Peter (2011) 'Health effects of an efficient vented stove in the highlands of Guatemala', Global Public Health, 6: 4, 421 — 432, First published on: 18 November 2010 (iFirst)

PowerPoint Presentation (PDF)

 
Ernest E. Sullivent, III, MD, MPH

Email:  esullivent@earthlink.net

Advisor:  E. Brooke Lerner, PhD
Associate Professor, Department of Emergency Medicine

Helicopter EMS transport is associated with reduced mortality in injured adults

Abstract:

Background: Civilian helicopter emergency medical services (HEMS) have played a role in the transport of injured patients since 1967, with increasing numbers of HEMS providers and aircraft committed to this practice ever since. Some studies have shown improved outcomes with HEMS transport, but others have shown no improvement. Increasing concerns regarding cost and safety have prompted a re-evaluation of the widespread use of HEMS. Although studies have examined the relationship between the mode of trauma patient transport and outcomes in local and regional systems, no large national study of this relationship has been published.

Methods: Data for 48,974 injured adults aged ≥18 years transported to 95 U.S. trauma centers by helicopter or ground ambulance were obtained from the 2007 National Trauma Data Bank (NTDB) research data set. In-hospital mortality was calculated for different demographic and injury severity groups. Odds ratios were produced by utilizing a logistic regression model measuring the association of mortality and type of transport, controlling for age, gender, and injury severity (Injury Severity Score [ISS], Revised Trauma Score [RTS]).

Results: In this dataset, the odds of death were 26% higher in those transported by ground compared to helicopter (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.08–1.48) (p<.003). Sixteen percent of all transports were made by helicopter. Males accounted for 72% of helicopter transports and 64% of ground transports, and had a higher odds of death (OR = 1.49, CI = 1.29–1.71). A higher percentage of patients <55 years were transported by helicopter (18%) compared to those ≥55 years (10%). Severely injured (ISS >15) patients were transported by helicopter more frequently than those non-severely injured (29% vs. 12%). Odds of death significantly increased with each year of age (OR = 1.04, CI = 1.04–1.05) and each unit of ISS (OR = 1.09, CI = 1.08–1.09), and decreased with each unit of RTS (OR = 0.45, CI = 0.43–0.46).

Conclusion: The use of HEMS for the transport of trauma patients is associated with reduced mortality. A validated method of selecting those patients who will best benefit from helicopter transport is expected to enhance this reduction in mortality. To further characterize differences, a study comparing other outcome measures (e.g., intensive care unit days, hospital length of stay) for those transported by helicopter and ground ambulance is warranted.

PowerPoint Presentation (PDF)

 
Jennifer M. Verre, MPH

Email:  jennyverre@yahoo.com

Advisor:  Srividya Kidambi, MD
Assistant Professor, Department of Medicine, Division of Endocrinology, Metabolism, and Clinical Nutrition

Prevention of Diabetes Mellitus in African Americans: Interventions and Recommendations for a Federally Qualified Health Center in the City of Milwaukee

 

Abstract:

Background:  Approximately 57 million U.S. adults have pre-diabetes (defined as fasting blood glucose levels between 100-125 mg/dL). Individuals with pre-diabetes and obesity are at a greater risk for developing type 2 diabetes mellitus (DM) and prevention measures have been shown to prevent or delay overt DM. The prevalence of pre-diabetes among Wisconsin’s African American population is large, at approximately 40%, and provides a unique opportunity for public health action through obesity intervention incorporating lifestyle changes in diet and physical activity.

Methods:  The literature review began with a PubMed search for articles pertaining to type 2 DM prevention and article components were then used to evaluate the efficaciousness of interventions in preventing the development of type 2 DM. Literature involving African American cultural perspectives, environmental barriers, and community health centers was reviewed to consider special challenges. Recommendations were assembled to provide the Westside Healthcare Association with a framework for preventing type 2 DM through obesity prevention and physical activity promotion.

Results:  Clinical trials have found a 58% reduction in incidence of DM in individuals undergoing a lifestyle modification intervention and a 31% reduction with pharmacological treatment with metformin compared to a placebo group, representing 39% lower incidence of type 2 DM in the lifestyle intervention group. Women had a higher proportion of obese participants than men and African Americans had a higher proportion of obese participants than Hispanics and whites. Within the lifestyle intervention group, all race-gender groups lost a comparable amount of weight, except for African American females who lost significantly less weight (P< 0.01).

Conclusions:  Westside Healthcare Association (WHA) could administer an intensive lifestyle intervention program to prevent type 2 DM, with length and design components similar to those used in published clinical trials. Performing system-level and provider-level reviews will help prepare WHA for their program. WHA could apply for the REACH U.S. grantee partnership program to acquire the necessary funds for implementation.

PowerPoint Presentation (PDF) & Presenter's Notes (PDF)

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