2014 Master of Public Health Graduates

Capstone Abstracts & Presentations

2014 graduates

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  Olufemi Adekeye, MD, MPH | Why Do People with Compensable Injuries Have Poorer Outcomes Than Those with Non-Compensable Injuries?

Advisor: Robert Goldberg, MD, FACOEM


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 Unpublished articles and indexed articles that have not been published yet were excluded from the analysis.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 | Timing of Death in Pediatric Sepsis: A Descriptive Study

Advisor: Laura Cassidy, PhD


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 | Firehouse Staffing and its Effect on Response Times to Emergencies

Advisor: E. Brooke Lerner, PhD


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 | Ethanol Fuel Initiative: A Program Plan for Education through Multimedia

Advisor: Julie Willems Van Dijk, PhD, RN


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 | 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

Advisor: Nancy Kreuser, PhD


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 | Systematic Review of the State of HIV/AIDS in Nigeria

Advisor: Alan Wells, PhD, MPH


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 1.7 million. 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 order 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 | DOT Commercial Driver Manual

Advisor: John Meurer, MD, MBA


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 | Milwaukee Public School Body Mass Index Policy

Advisor: David Nelson, PhD


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 | Worksite Wellness Programs on Cardiovascular Risk Reduction: A Review of Services Offered and Possible Recommendations

Advisor: Kenneth Schellhase, MD, MPH


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

Advisor: Andrew Petroll, MD


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

Advisor: Edit Olasz, MD


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

Advisor: Julie Willems Van Dijk, PhD, RN


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 | Public Health Implications of Lymphatic Filariasis

Advisor: Michael Kron, MD


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)

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