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2017 Master of Public Health Graduates

2017 Masters of Public Health Graduates

2017 Abstracts and Presentations

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Bhavna Asthana

Racial and Ethnic Disparities in HIV/AIDS in the United States
vbhavna92@gmail.com
Advisor: Eric Gass, PhD

Abstract
Background
According to the Centers for Disease Control and Prevention (CDC) surveillance data, 1.2 million people are living with the human immunodeficiency virus (HIV) in the United States, with one fifth unaware of their status. In 2010, 47,500 new cases of HIV were diagnosed and 71 percent of these cases were among adults and adolescents of different racial and ethnic minority groups. In recent years, use of antiretroviral therapy has slowed the progression of HIV in many infected individuals; however, a similar decline is not observed in ethnic and minority populations. The paper analyzes various articles and highlights the reasons for such disparities.

Methods
An online search of databases including PubMed, NIH and Medscape was conducted to look for published studies. Only full text articles were retrieved for reviewing and extracting information. The following search terms were used: HIV/AIDS, racial/ethnic disparities, high risk sexual behavior, HIV stigma and access/barriers to healthcare. Articles selected provided HIV/AIDS related information, HIV/AIDS surveillance and analytical data, socio-economic determinants, HIV related risk behaviors, access and barriers to care and treatment about ethnic and racial population groups in United States. A total of 30 articles were chosen for review.

Results
The study found that racial/ethnic population groups in the United States continue to bear the disproportionate burden of HIV/AIDS. African Americans account for 12% of the U.S. population, but represent 45% of the HIV diagnoses. Hispanics/Latinos represent 18% of the U.S. population, but account for 24% of the HIV diagnoses. Such disparities stem from a lack of health insurance, poor access to quality health care, lack of education, poverty, and societal stigmatization. Future HIV prevention programs and strategies should focus more on addressing behavioral and sociocultural causes and optimize healthcare delivery in such communities.

PowerPoint Presentation (PDF)

Amy Brudnicki

Climate Change, Climate Action, and Public Health: The Relationship Between Green Infrastructure and Health
ames010827@gmail.com
Advisor: Kirsten Beyer, PhD

Abstract
Background
Anthropogenic driven climate change has been characterized as the defining challenge of our time. Environmental alterations induced by excessive greenhouse gas emissions threaten essential ecosystems and ecosystem services, economic development, global security, human development, and ultimately population health and well-being. As a result of these significant challenges, addressing climate change through climate action has become a leading global priority. Among emerging mitigation and adaption strategies is the use of green infrastructure (GI) as a common component of climate action. GI has the ability to not only mitigate and adapt to climate change, but also to protect and promote health and well-being.

Objective
To document the potential pathways through which GI can impact health and well-being.

Methods
A literature review of peer-reviewed journals and grey literature was conducted to document the evidence-based pathways through which GI can impact health and well-being.

Results
GI has the ability to impact health through three primary pathways: (1) provisional ecosystem services; (2) regulatory ecosystem services; and (3) cultural ecosystem services. Through the provision of services such as food, freshwater, carbon sequestration, air quality regulation, climate regulation, runoff regulation, water purification, recreation, aesthetic values, and the stimulation of social relations, GI provides life-supporting and health promoting services.

Conclusion
Emerging evidence suggests that GI provides multiple beneficial services that can assist in addressing climate change and its impacts, and ensuring health and well-being. While additional research is necessary, current research supports the place-based incorporation of GI into climate action, public health, and land use plans. The collective challenges of climate change require a multidisciplinary, multifaceted, and multiphase response. GI has the opportunity to be an effective component of climate and public health action.

PowerPoint Presentation (PDF)

Tobi Cawthra

Hospital-Community Analysis and Plan to Reduce Neonatal Intensive Care Utilization and Cost
tcawthra@hotmail.com
Advisor: Kim Gearin, MS, PhD

Abstract
Background
Hospitals are encountering changing reimbursement structures including through the Patient Protection and Affordable Care 30-day readmission penalties, Medicare and Medicaid capitated systems, and others. As part of an analysis of de-identified data of births in 2014 and 2015 at Unity Point Health- Meriter (Meriter), I identified several social factors which may be influencing neonatal intensive care unit (NICU) use. By identifying high-risk patients early in pregnancy, hospitals can provide programs and services to address identified social factors, ultimately reducing NICU utilization and reducing hospital costs.

Methods
A literature review of interventions to address NICU use for infants born to women who smoked, live with a smoker, experience prenatal depression and use illicit drugs provided the framework for potential program development. Discussions with internal hospital leaders and external community-based non-profit organizations formed the basis for a high-level cost-benefit analysis for programs that may address social factors influencing NICU utilization.

Results
Prenatal yoga has been shown to reduce preterm births in pregnant women as well as in women with depression. Using data from Meriter’s birthing center, an analysis of projected savings was conducted. A program plan, performance management plan, and budget plan was proposed for a drop-in yoga program for pregnant women with depression. The program would provide simple yoga instruction for women on a drop-in basis, to accommodate complex schedules, and would offer child-care services and transportation support to address anticipated barriers to participation. The total cost for a full-time yoga instructor, two part-time child care staff, space for yoga and childcare, and supplies is less than the projected savings resulting from reduced NICU utilization, resulting in a positive return on investment for Meriter.

Conclusion
Prenatal yoga offered for depressed women may result in cost savings for a health system able to identify high-risk patients during their pregnancy. Programs such as prenatal yoga can help address social factors affecting birth outcomes. This project used a narrow parameter for determining a financial benefit to a health system. By taking a wider view and considering factor than influence a child’s health beyond the NICU, there are many other programs which can help reduce unnecessary medical costs. As health systems experience pressures on reimbursement and other financial measures, it will be worthwhile to investigate potential savings through programs that address factors outside of the hospital which influence health.

PowerPoint Presentation (PDF)

Mary Dorn

Staff Time Allocations in Local Health Departments: Implementation of a Time and Cost Allocation System in a Local Health Department
mary.dorn@outagamie.org
Advisor: Nancy Kreuser, MSN, PhD

Abstract
Background
The evolution of services provided by local health departments (LHD) has vacillated between clinical and population services over time. The variation of services and structure in LHDs contributes to the challenge of determining the cost to provide basic public health services in a community. To determine a return on investment for the services provided to the community, public health leaders need the ability to perform financial management and analysis (Honore & Costich, 2009).

Methods
A comprehensive review of the literature on public health staffing in LHDs was completed with a focus on systems or methods utilized to monitor the time that staff spend on various areas of their work and determining the investment made from a staffing perspective to provide public health services at the local level.

Results
The grey literature supports the need for consistent concurrent methodologies to be implemented in LHDs. A staff time allocation framework was developed for implementation in LHDs that allows public health leaders the ability to monitor, track, and evaluate the time that staff members from various job classifications dedicate to services and program areas.

Conclusion
Limited research is available to assist local public health leaders in workforce management. Implementation of methodologies established by national public health organization’s research, further research as the implementation occurs, and publication of the research, will assist in providing rationale and support for funding of public health services at the local level. In addition, research will assist public health leaders in determining the current and future workforce needs.

PowerPoint Presentation (PDF)

Douglas Durley, Jr.

Increasing Condom Availability Around Selected High Schools in High Impact Areas of Miami-Dade County, Florida
ddurleyjr@gmail.com
Advisor: Alan Wells, PhD, MPH

Abstract
Objective(s)
To explore lo

  1. To explore local factors and reasons related to sexual behaviors contributing to increasing STI rates.
  2. To increase condom availability to high school students by recruiting businesses in nearby high schools in high impact areas.

Methods
Data was collected at the Healthy Teen Expos through generated surveys. Healthy Teens Expos provide students with the opportunity to receive free, confidential HIV and STI testing as well as health care information, counseling, and education to promote health awareness. Teen friendly businesses were recruited within a one to three mile radius of five priority high schools. Evaluations were used to document the number of condoms distributed at recruited businesses approximately four weeks from the initial condom distribution date. In addition, evaluations were used to gather feedback from businesses such as potential increases in customers, age range of customers, inquiries regarding additional condoms pickup locations or STI/HIV materials.

Results
A total of 99 surveys were collected from the Healthy Teens Expos. Survey data collected from Healthy Teens Expo revealed that many students were unaware of a location where they can pick up free condoms, and some students were opposed to picking up condoms due to social stigmas. A total of 13 businesses were recruited and 3,250 condoms were distributed. A total of 68%, or 2,222 of the condoms provided to the businesses were distributed to the public after a four-week period.

Conclusion
Although project aims were met, future outreach efforts are crucial to reducing STI’s in high priority Miami-Dade County high schools. Future recommendations include: tailoring prevention programs towards STI/HIV education as well as collaborating with additional local businesses to provide condoms for high school students.

PowerPoint Presentation (PDF)

Fuad Aziz Khoury II

Mental Health's Impact on the Greendale Community: A Review of Hospital Admissions Data
fuadkhoury@gmail.com
Advisor: Kaija Zusevics, PhD. MPH, CHES

Abstract
Background
The Village of Greendale Health Department (GHD) is continually tasked in performing a Community Health Assessment (CHA) as prescribed by the Public Health Accreditation Board (PHAB) in order to maintain accreditation. The GHD will use hospital admissions data to determine mental health’s impact on the community as well as compare rates with Milwaukee County. There is also a special focus on dementia-related diagnoses among the admissions.

Methods
The GHD has obtained hospital admissions data for residents from 2010 – 2014 in order to gain insight on community health using admission diagnoses. Diagnoses used are classified by the International Classification of Disease (ICD). The data was compiled by the Wisconsin Department of Health Services Office of Health Informatics in a Microsoft Excel workbook. Filtering for mental health and dementia-related diagnoses was done using Excel functions. Calculation of rates was done using population estimates from the U.S. Census Bureau.

Results
There were 9,521 total hospital admissions of Greendale residents between 2010 – 2014 and 422 or 4.4% had a principal diagnosis classified under ICD’s mental illness. Data indicates that mental health’s impact on the Greendale community, using hospital admissions, disproportionately affects the population aged 65 and older. This demographic is the only group within Greendale that had rates higher than those of Milwaukee County. Dementia’s effect on the community is demonstrated by 298 individuals aged 65 and over admitted with a dementia diagnosis, accounting for 9.3% of the over 65 population.

Conclusion
The Greendale Health Department can utilize the results of this project in order to prioritize resources for community mental health initiatives. The GHD has already implemented some dementia-friendly community initiatives to help create better experiences for those suffering from dementia within the community. The findings of this project will be presented to the Village of Greendale Board of Health to potentially influence the Board to advocate for community mental health initiatives.


Marta Koelling

Managing the Public Health Workforce: An Examination of Employee Performance Review Processes in Local Public Health Departments
martalenore@gmail.com
Advisor: Seth Foldy MD, MPH, FAAFP

Abstract
Purpose
This investigation identified best practices for employee performance evaluations through a literature review. Next, it determined prevalent employee performance evaluation practices in Public Health Accreditation Board (PHAB) accredited local health departments through the use of a survey. Lastly, based on the identified list of best practices and prevalent practices, the investigation provides recommendations on employee performance evaluations and the supporting process for local health departments.

Literature Review
The literature search demonstrated that previous research on the specific topic of employee performance evaluations in public health is very limited. Literature was identified, however, that focused on the evidence base supporting the use of employee performance evaluations in public health, the assurance of an accurate tool and rating system, competencies and skills to be assessed, the use of motivational tools and incentives, and evaluating supervisors or using a 360 degree review process.

Methods
Accredited health departments were identified through the Centers for Disease Control and Prevention State, Tribal, Local & Territorial Public Health Professionals Gateway. Agencies were sent a standard set of questions via email during the week of September 12, 2016. Branching logic was used to ask different questions of agencies currently with and without an employee performance evaluation process in place. Questions focused on key components of an evaluation process, how long the process has been in place, benefits, successes, barriers, and challenges, reasons why a process is not in place, what information is needed to put a process in place, and what barriers may need to be overcome.

Results
Eighteen (95%) of the respondents do have some sort of formal employee performance process in place. Only one respondent reported having a formal evaluation of all supervisors by subordinates in place, two, however, utilized it as an optional process, but it was not implemented universally within the department. Twelve (67%) of the 18 respondents who had a formal employee evaluation process in place reported that the evaluation was somehow tied to a monetary increase. Eleven (61%) respondents reported an evaluation process that included the public health core competencies.

Conclusion
Although the literature supports the use of such processes, little is published about the specific implementation of an evaluation process in local public health departments. Through broad research of public health practices and practices of other types of organizations, and outreach to several PHAB accredited local health departments, several ideas and recommendations have been identified for evaluation process implementation. Recommendations include the use of an assessment tool which utilizes standard ratings, yet allows staff to provide input in the form of a self-assessment and targeted questions; assessment of staff based on specific duties, job descriptions, and needs and goals of the agency; 360 degree reviews of supervisors; and goal setting for all staff. Additional research should be conducted following the implementation of such a process, however, it is expected that implementation of specific employee evaluation recommendations outlined would lead to greater staff motivation, satisfaction, accountability, professional development, facilitate open communication, and ultimately enhance department operations and impact.

PowerPoint Presentation (PDF)

Tracy Lee

Occupational Noise Induced Hearing Loss (NIHL): Resounding Effects throughout the Department of Defense (DoD)
tracylee@mcw.edu
Advisor: Seth Foldy, MD, MPH, FAAFP

Abstract
Noise-induced hearing loss (NIHL) is a major occupational health hazard within the Department of Defense (DoD) negatively affecting personnel in the United States (US) as well as DoD installations around the world. The effects of NIHL are not only an occupational hazard within the DoD but also span various private enterprises. Negative effects of NIHL include not only personnel health and well-being comprised of both physical and mental health but also workforce longevity and productivity, significant economic costs, and ultimately the national security of the US.

Hearing conservation is a top DoD health priority especially considering the higher risk of occupational noise exposures of DoD personnel working in unique environments. However, NIHL continues to occur with persistent increases in veteran disability claims attributable to NIHL. NIHL is completely preventable if proper precautions are taken. The current DoD hearing conservation program (HCP) sets forth guidelines for multimodal approaches to prevent NIHL involving multiple professionals, such as audiologists, safety officers, industrial hygienists, and occupational health professionals. Improving upon the DoD HCP by incorporating evidence-based methods is imperative in order to improve NIHL prevention. Thus, recommendations for developing a local HCP are proposed for commands onboard Naval Air Station North Island (NASNI), which, if successful, may serve as a model for future DoD HCP policy worldwide.

PowerPoint Presentation (PDF)

Timothy Lenz

Home Hospice Discharge Prevention - A New Approach to Reducing Hospice Discharge
tilenz@mcw.edu
Advisor: Riccardo Collella DO, MPH, FACEP

Abstract
Background
Community paramedics play a unique role in extending primary care into the patient’s home and prehospital community setting. By targeting at-risk populations and those who inappropriately utilize emergency services, community paramedics offer a unique solution to fill the void in lack of primary care providers and other healthcare services, while improving access to primary care and reducing health care costs. The overall goal of Mobile Integrated Healthcare (MIH) is the integration of emergency medical services (EMS) and community paramedics into the current and future healthcare system. Community paramedicine is a model of community-based health in which paramedics function outside of their typical role of emergency response and transport, and enhance access to care for underserved populations and those who inappropriately use the emergency response system. Community paramedics may provide services to those with limited access to primary care, have recently been discharged from the hospital, have multiple comorbid conditions, and over-utilize the emergency system due to non-compliance with medication regimens or lack of education about their particular disease. One vulnerable population is hospice patients, who may be discharged from hospice care if they seek care related to their terminal illness in the emergency department. Unfortunately, transport to an emergency department is not always best for the patient and does not achieve the overall goals of hospice. Community paramedics could play a pivotal role in preventing unnecessary transport and subsequent discharge of hospice patients.

Objectives
The intent of this project is to determine if a fire-based EMS system could be effective in reducing the number of preventable home hospice discharges. Through developing a partnership between Greenfield Fire Department and VITAS Home Hospice, we began shaping the program, creating metrics, and determining efficacy. A two-tiered approach was taken, ascertaining awareness of hospice programs and the comfort level of patients pre- and post-initiation of home hospice and analysis of whether a reduction of unnecessary home hospice discharges occurred in the target population.

Methods
Design: Surveys were developed to be sent to families of deceased hospice patients, home hospice nurses, and EMS personnel involved in the care of the hospice patient in order to establish satisfaction and success of the program. Greenfield Fire Department enrolls those identified at-risk for hospice discharge and enters them into their Computer Aided Dispatch so EMS responders have pre-arrival information about the patient’s hospice status and family contact information. Thirty days following the death of the patient, surveys will be mailed to families so program successes and failures can be assessed. Additionally, home hospice nurses will be surveyed to gain their input on program satisfaction. Finally, EMS personnel will be asked about their interactions with the patient, patient’s family, and hospice nurse, and if they felt as though they and the program were advocates for the patient. Data: Surveys will be entered into a secured database and results analyzed. Descriptive analysis will be utilized to determine significance.

Anticipated Outcome
Positive feedback from EMS and the home hospice nurse is anticipated. We hypothesize a reduction in home hospice discharge due to transport to emergency departments and subsequent hospital admissions. We decided not to survey the patient, as many will likely be too ill to respond or even comprehend the survey. That said, depending on family involvement in care and the hospice discharge prevention program, feedback could be mixed. This is a new concept nationally, so there is no gold standard and little data for comparison.

PowerPoint Presentation (PDF)

Jessica Olson

Retrospective Analysis of Advancing Healthier Wisconsin Endowment-Funded Projects
jeolson@mcw.edu
Advisor: Cheryl Maurana, PhD

Abstract
Background
Since 2004, the Advancing a Healthier Wisconsin (AHW) Endowment has invested approximately $200 million to improve the health of Wisconsin residents through research, education, and community-based initiatives. In that time, no calculation on the collective, transformative value of those investments has been completed.

Methods
A comprehensive literature review was conducted to inform the evaluation strategy. A three-phase protocol of identifying research questions and resources, creating and coding measures of value, and conducting interviews and completing calculations was outlined.

Results
Phases 1 and 2 of this protocol were completed in a format that allows for modifications to be made in response to stakeholder needs. Products produced include a Transformative Value Framework for Coding Analysis, A Framework for Interviewing, A Framework for Calculating Transformative Value, and a Comprehensive Protocol for future use.

Conclusion
Exploring the value of the first ten years of AHW funding will demonstrate the lasting impact of investing in research, education, and community initiatives. It may also result in the creation of calculations to communicate Transformative Value for other grantmaking organizations, and improve future AHW investment practices.

PowerPoint Presentation (PDF)

Jenna Otterholt

Identifying Multidimensional Causes of Obesity and Solutions in the United States
jotterholt218@gmailcom
Advisor: Kaija Zusevics, PhD, MPH, CHES

Abstract
The topic chosen focuses on obesity and the multidimensional causes that are intertwined to produce the epidemic that the United States is facing. Obesity is one of the most common preventable chronic diseases that is costing the United States billions of dollars. The purpose of this paper is to display how obesity is a disease that has multidimensional causes and why prevention should be a priority in the United States. The importance of multivariate causes are summarized through a literature review on related causes of obesity and two interviews completed by front-runners for obesity prevention in Oneida County, Wisconsin. Results indicate that in order to make improvements to current health outcomes, resources must be streamlined and coordinated together to promote prevention and education among all populations and early in life.

PowerPoint Presentation (PDF)

Maxwell Roy

Mental Health Treatment Gap Analysis of Washington and Ozaukee Counties
maxwellroy26@gmail.com
Advisor: David Nelson, PhD, MS

Abstract
Mental health is a prioritized issue in the United States (U.S.). A portion of the U.S. adult and child population are impacted by mental illness. Despite being a priority, research shows that many adults and children with mental illness do not receive treatment. The purpose of this paper is to calculate and understand the mental health treatment gap in Washington and Ozaukee Counties in Wisconsin. This paper calculates and identifies themes associated with the mental health treatment gap using mixed methods. A difference was calculated between the any mental illness (AMI) prevalence in both adult and child populations and the unique patient count (received from the Wisconsin Health Information Organization – WHIO) for adults and children who accessed mental health services, which produced an estimate of the mental health treatment gap in both Washington and Ozaukee Counties. Additionally, health and human service professionals were interviewed to provide insight into themes that act as associated factors to the treatment gap. Open coding of the interview notes and recorded conversations highlighted reoccurring themes to help understand the mental health treatment gap in both counties. The mental health treatment gap for children and adults in Washington and Ozaukee were higher than state averages. Lack of providers, long wait times, lack of education, and financial/insurance factors were major themes addressed by interviewees. Further efforts to increase providers, treatment options, educational efforts for adults and youth, and improving transportation systems may help improve the mental health condition and reduce the treatment gap in both counties.

PowerPoint Presentation (PDF)

Greg Stadter

Evaluation Plan for the Enhanced Care Program: Designing a Chronic Disease Medical Home's Health Program Evaluation
gstadter@mcw.edu
Advisor: Julie Mitchell MD, MS

Abstract
Given the increasing expenditures on health care spending and an aging population, the United States health system is currently facing an imperative to improve outcomes while reducing the cost of care. This is especially true for patients with chronic conditions, who currently account for over 85% of the nation’s health care expenditures3. One strategy that has recently been deployed to reduce costs and improve outcomes for patients with chronic conditions is the Medical Home health care delivery model. Medical Homes offer comprehensive, patient-centered care and stress care coordination, accessibility and quality. Through these methods, the Medical Home aims to reduce the cost of patient care for individuals with chronic diseases by encouraging patients to utilize primary care with enhanced services and extended access, rather than emergency department care, while also engaging and empowering these patients to manage their own care. These approaches have been proven to lead to improved health outcomes. This paper will seek to describe and analyze available literature on the Medical Home care model, design a program evaluation for a soon to be established Medical Home at the Medical College of Wisconsin (MCW), and to inform any real evaluation plan that is subsequently developed. The Medical Home model is still a relatively new concept. Therefore, a strong health program evaluation for this newly established program will be essential for the initiative’s success and can inform both internal and external stakeholders moving forward.

PowerPoint Presentation (PDF)

Anne Stanton

Applications of Infrared Spectroscopy in Clinical Medicine and Production Animal Agriculture
aestanton@wisc.edu
David McClure, PhD

Abstract
Introduction
The implementation of infrared (IR) spectroscopy in human medicine and agricultural fields has provided opportunities to sample various tissues and bodily fluid samples for the purpose of diagnosing diseases and conditions through identifying sample composition. Biological specimens are regarded as the ideal sample for this technology, in human medicine as well as in agriculture. Of particular interest is the use of this technology to predict antibiotic residues in milk at both the herd and individual cow level, since the growing concern of antibiotic over-use and antibiotic resistance greatly affects producers, consumers, and has implications in various aspects of public health.

Purpose
The purpose of this literature review is to provide background information on the past and current diagnostic capabilities of IR-spectroscopy and the potential value of this method in detection of antibiotics and antibiotic residues in milk.

Methods
Papers were chosen for this critical review from the biomedical databases PubMed and OVID by searching with the keywords “infrared spectroscopy in veterinary medicine”; “infrared spectroscopy AND milk quality”; “infrared spectroscopy AND mastitis”; “infrared spectroscopy AND clinical medicine”; “infrared spectroscopy AND veterinary”; “infrared spectroscopy AND antibiotic*”. Abstracts were reviewed for relevance, and those remaining were critically reviewed.

Results
Clinical medicine commonly uses IR-spectroscopy to analyze serum, whole blood, and urine. Less commonly assayed bodily fluids include saliva, amniotic, joint and cerebrospinal fluid. Within serum samples, mid-infrared spectroscopy (MIR) and near-infrared spectroscopy (NIR) can determine concentrations of glucose, total protein, albumin, triglycerides, urea and cholesterol. However, while analysis of these metabolites is possible, accuracy has yet to be established for some of these for use in clinical medicine. This is also true for urinalysis, analysis of amniotic fluid, and evaluation of joint fluid. In agriculture, IR-spectroscopy has proven useful for identification of various nutritional components, meat and cheese quality, and milk quality. Within milk quality, components being critically analyzed for use in predictive models may reflect ability to discern aspects of cow health beyond simple monitoring of production components of milk. These may include antibiotic residue detection, identification of organisms causing mastitis, pregnancy status, detection of embryo loss, ketosis, acidosis, methane as an environmental impact, and cow energy balance. In order for these advances in application of IR-spectroscopy to be realized in the agricultural setting, it is recognized that further research is needed for the purpose of standardization of spectrometers; development of a transnational database; building of predictive equations from associations between phenotypes and milk MIR spectra to predict health status, nutritional status, environmental impact of individual cows; and development of web tools to make the service readily available.

Conclusion
The use of IR-spectroscopy as a predictive tool in production animal agriculture has the potential to be invaluable. The technology is non-invasive, rapid, reliable, and cost-effective. However, future research is necessary and should be made a priority as producers, consumers, researchers and public health officials continue to strive towards methods to ensure a safe food supply and reduce the effects of overuse of antibiotics in multiple settings.

PowerPoint Presentation (PDF)

Shelbe Vollmer

Antibiotic Overuse in Agriculture: Implications for Animal and Human Health, A Literature Review
svollmer@mcw.edu
Advisor: Jennifer Peterson, PhD, MA

Abstract
Antibiotic fortified feed and water help contribute to antibiotic resistance in food animals, which has impacted both human and environmental health through excreted veterinary and feed antimicrobials, occupational exposures, and contaminated animal products. The purpose of this literature review is to add new perspectives on the health relationships that exist between animals, humans and the environment with antibiotic resistance stemming from antibiotic overuse in agriculture. This literature review discusses the animal, environmental and human health impacts that result from overuse of antibiotics in agriculture. Peer-reviewed research articles published within the last five years were collected using Google Scholar, PubMed and the National Institutes of Health. Articles were selected based on their relevance to key words such as ‘agriculture’, ‘food animal’, ‘manure runoff’, ‘ecological effect’, ‘transmission’ and ‘antibiotic misuse,’ in combination with antibiotic resistance. Articles were not selected if they were not published within the last five years, were not translated to English, were review articles, the free-full text was not available, or the titles and/or abstracts did not relate to the purpose of this review. This review identified health relationships that exist between animals and people in shared environments through the overuse of antibiotic fortified feed. Antibiotic feed impacted animal health directly through altering the microflora of food animals, impacted both soil and aquatic environments indirectly through excreted antibiotic residues and antibiotic resistance genes, and ultimately impacted community health through occupational hazards and contaminated animal products. The trickle down effects that were identified with overusing fortified feed can drastically impact community health by limiting treatment options for both humans and animals as well as providing additional avenues for people to become infected with antibiotic resistant infections. Furthermore, the health relationships that were identified in this review illustrate an additional argument to investigate policy changes in order to decrease the amount of antibiotics used in agriculture in order to improve overall community health.

PowerPoint Presentation (PDF)

Meredith Williams

Including and Engaging People with Disabilities: A Guide for Local Health Departments
williamsmer@gmail.com
Advisor: Nancy Kreuser, MSN, PhD

Abstract
Background
When compared with the general population, people with disabilities have traditionally been underserved and experience significant health inequities, receive fewer preventive and primary care services, develop more preventable secondary health conditions, and report poorer health and quality of life. Including people with disabilities in all public health efforts has been widely recommended to address these health inequities. Local health departments (LHDs), however, face multiple barriers to including people with disabilities in their programs and activities, such as resource constraints, competing priorities, and low awareness of and access to disability inclusion strategies.

Methods
A literature search was conducted to identify promising practices and recommendations for disability inclusion from non-profit organizations, government agencies, businesses, and educational institutions. Because much of the work on disability inclusion has been conducted outside the field of public health, making recommendations from other sectors relevant to LHDs was a priority.

Self-assessment and recommendations
This guide provides a self-assessment tool and recommendations that LHDs can use to (1) better understand the needs of people who have disabilities, (2) assess their LHD’s current level of disability inclusion, (3) plan for making practical, sustainable, and low-cost improvements over time. To make the biggest impact for their efforts, LHDs can begin by improving communication accessibility and reaching out to disability organizations.

Conclusion
LHDs are uniquely positioned to improve health outcomes for people with disabilities and promote disability inclusion throughout their communities. Including and engaging people with disabilities can help LHDs improve the health of the general population, meet their goals, fulfill the ten essential public health services and professional competencies, and design policies, programs, and activities that are more effective for everyone. By sharing what they learn while working to increase disability inclusion, LHDs can become leaders in the emerging field of disability and public health.

PowerPoint Presentation (PDF)

Andrew Zane

Efficacy of Home-Based Interventions in Adults with Asthma, A Literature Review and Analysis of a Local Project
azane@mcw.edu

Advisor: Joshua Steinberg, MD

Abstract
Background and purpose
Asthma self-management skills are essential to asthma control. Self-management education can be delivered in inpatient and outpatient clinical settings or individuals’ homes. This paper reviews existing home-based adult asthma interventions and offers suggestions for future research, including the ongoing work of Fight Asthma Milwaukee Allies.

Literature review
Methods
A PubMed literature search identified eight peer-reviewed papers assessing home-based educational or educational and environmental interventions for asthma control in adults.

Results
Research to date has evaluated the impact of home-based interventions on the home environment and health outcomes of adult participants. Limited data showed modest but non-significant decreases in home allergen levels as a result of environmental remediation. With respect to health outcomes, interventions improved asthma control and quality of life. Health care utilization improved in some cases, but home-based interventions had little effect on lung function and asthma management behaviors.

Discussion
Improvements in quality of life measures support the use of home-based asthma management interventions. Future studies should better evaluate the lone vs. combined effects of asthma self-management education vs. environmental interventions on health outcomes and reconsider how lung function measurements are used in evaluating asthma control.

Project analysis
FAM Allies Home Visiting Program

Methods
FAM CARES is a 6-visit home-based asthma education and environmental intervention program led by community health workers.

Results and discussion
Eight adults are currently enrolled in the program. Enrollment and data collection is ongoing. Asthma Control Test scores have improved and quick relief medication use decreased over 4 weeks among participants for whom data is available. Experience continues to inform improved implementation and data collection.

Conclusion
Existing research shows support for continued use of home-based asthma interventions for adults. Programs like FAM CARES will continue to inform the body of evidence supporting the use of community-based health care initiatives. Future research should consider appropriate measures of success for interventions and which activities improve health outcomes the most.

PowerPoint Presentation (PDF)