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  Parents Perspective In Early Childhood Communicative and Learning Intelligence in Nebraska School Environment

  Oluwaseun Famojuro, Na-Omi Hassane Dan Karami, Krishtee Napit, Rashmi Lamsal, and Onoriode Kesiena

  Introduction: Center for Disease and Prevention Control had reported a rising in the prevalence of social communication and learning disabilities, including autism in the United States. The role of parents as primary agents in childhood language and behavioral development has also been established. Parents have been linked to child communicative and learning intelligence. However, there have been few research studies in Nebraska about parental perspectives in an early child's intelligence development at preschool and school levels. Objectives:1. To explore the parents' attitude towards their children's (0 – 5 years) communicative and learning intelligence in the school environment. 2. To assess the relationship between sociodemographic factors and parent perspectives of a child's intelligence in the early stage. Method: Self-reported data from the National Survey of Children's Health was used for the study. Explanatory variables include the age of the child, family structure type, primary language spoken in the home, poverty level or status, gender of the child, and race of the parent. Outcome variables are levels of concern towards learning and communication style of the child in preschool and school environment. Potential confounders and modifiers were controlled. Descriptive and logistic regression analyses were done to assess the association between the variables. Data analysis was done using SASv9.4. Results: Parents who speak other languages apart from English are 11.016 more likely to show zero concerns toward their child's intelligence development in school. Furthermore, parent perspectives in showing motivation in a child's learning skills at school are low for parents with children ages below 12 months compared to above 12 months. Minority race is associated with poor parental beliefs in a child's communicative intelligence. Conclusion: Parents' primary language, age of the child, and parent's race significantly affect the parents' attitude towards the child's intellectual development. However, further longitudinal studies could be helpful to explained gaps in our findings.

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  Assessment of Trends in Population-Based Health Indicators in the Great Plain States

  Jessica Pahwa and Shinobu Watanabe-Galloway

  Purpose/Objective: The objective of this study is to analyze the geographic trends and to highlight the importance of social and geographic based health disparities using population health indicators and Health determinants among the great plains states (Nebraska, North Dakota and South Dakota).

  Methods/efforts: Online databases (CDC, BRFSS, America’s Health Rankings, SAMHSA, County health rankings etc) were accessed to collect data population-based data for the great plains states. The incident rates of 10 health indicators and health determinants were chosen and studied. After tabulating the data in excel, the analysis was made through plotting graphs in SAS. Line graphs depicting the increase/decrease in the incidence rates were obtained describing the changes in trends with respect to each of the health indicators over the past decade.

  Results/findings: Among the 10 health indicators/determinants studied, the incidences of death due to alcohol-impaired driving and Chlamydia were significantly higher than the national average. The use of cigarettes among youths between the age range of 12-17 has shown a steep decline over the years. Application to the field/research: Health indicators are important tools used in the assessment of the overall health of the population. It could help in prioritizing the area of focus for improvement. It can depict the impact and disease burden, of the condition in the area. Influence new policy-making. Indicate the need for evaluations of the existing policies and interventions. Population trends give a representation of the success or failure of the health policies and interventions and gives an idea of the progress of the current healthcare programs and allocation of resources. The data also provides a source of comparison between the three states and draws attention towards improving the health outcomes
  

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  Cervical Cancer Screening among Patients Receiving ARVs in a Resource-Limited Environment

  Moses New-Aaron, Jane L. Meza, Martha Goedert, Stephen Kibusi, Samwel Sumba, Caroline Damien, Siraj Shabani, and James Charles

  Significance

  Cervical cancer is the most common cancer worldwide with increased risk among women living with HIV in a resource limited environment. Hence the need to determine factors affecting awareness, prior uptake of cervical cancer screening and willingness to screen among patients receiving Antiretroviral (ARV) drugs.

  Data analysis

  The data was collected by administered questionnaires to patients presenting for monthly ARV refills in a HIV clinic in Dodoma, Tanzania. A total of 421 women in the clinic with an average monthly income of 39 (USD) were interviewed. A total of 306 (73%) were aware of cervical cancer. Among those who were aware, 84 % (257) did not recall been screened for cervical cancer. A total of 231 (90%) expressed willingness to be screened among patients who have never screened for cervical cancer. The average years since HIV infection for the subjects was 5.4 years; average age was 44. A logistic regression model was used to examine factors associated with awareness of cervical cancer, prior uptake of screening and willingness to be screened. Urban dwellers were found to have higher odds of awareness than rural dwellers (OR: 3.68 95% CI: 2.12-6.38). Prior uptake of screening was found higher among urban vs. rural dwellers, OR: 3.43, 95% CI: 1.02-11.51. The willingness to be screened decreased with age (OR: 0.93, 95% CI: 0.88-0.97).

  Conclusion

  This study have indicated the problem of access among rural dwellers to cervical cancer screening. Willingness to screen among younger patients could be due to increased awareness of the disease among younger patients than older patients. However, the older and rural patients are at higher risk of cervical cancer and should be targeted for primary prevention.

  Category

  Advocacy and Health Policy

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  Birth outcomes and water: A multidisciplinary study

  Moses New-Aaron, Jane L. Meza, Patrick J. Shea, and Martha Rhoades

  Evidence that agrichemicals are associated with the incidence of birth defects is inconsistent. We examined whether nitrate and nitrosatable agrichemicals present in well water are associated with birth defect rates in Nebraska counties. Birth defect data from the Nebraska Department of Health and Human Services, 2005-2014, were merged with well data obtained from the Quality-Assessed Agrichemical Contaminant Database for Nebraska Ground Water (1977-2014). Nebraska counties with higher rates of birth defects had a greater prevalence of agrichemicals in well water. Of the 33 contaminants sampled from different well types, nitrate and atrazine were of interest. Birth defect rates were negatively correlated with nitrate-positive wells and directly correlated with atrazine positive wells. After stratification by well types (domestic and public wells) we found the highest correlation between nitrate+atrazine positive wells as compared to wells contaminated with either nitrate or atrazine. This study suggests stronger association between birth defects and maternal exposure to nitrate+atrazine when compared to maternal exposure to only nitrate or atrazine in drinking water. This association does not imply causation but provides direction for further investigation.

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  Effect of Nitrosamine (NNAT) on Embryogenesis: Evidence from a Study Using Avian Embryos Exposed to NNAT

  Moses New-Aaron, Martha Rhoades, Jane L. Meza, and Jeffrey Wallman

  Background

  Birth defects are a known cause of infant death in the United States with higher rates in the Midwest perhaps due to higher use of agrichemicals for farm activities. Nitrate and atrazine are two of the most prevalent agrichemicals contaminating drinking water supplies. When ingested together, in the acidic environment of the human stomach, they can react to form a nitrosamine, NNAT. Many nitrosamines are known to be mutagenic, carcinogenic and teratogenic.

  Significance

  Preliminary studies have suggested that NNAT is a teratogen and mutagen. Several other agrichemical compounds have been detected in Nebraska groundwater wells that have the potential to nitrosate and studies are underway to evaluate the risk of adverse birth outcomes associated with exposure to these compounds. In this study, we evaluated growth in chick embryos after exposure to NNAT.

  Hypothesis

  We hypothesize that the embryo exposed to NNAT would have delayed development compared to unexposed embryos.

  Experimental design

  Three groups of eggs were observed in the study: the treatment group was treated with different doses of NNAT dissolved in Dimethyl sulfoxide (DMSO), the vehicle control group were treated with only DMSO and the untreated group (control). The air sac of the treatment groups was injected with varying concentrations of NNAT at one time to stimulate an acute response and at different times for a chronic response.

  Result/Data:

  All analysis was done on SAS 9.4. The effect of treatments on the weight and survival of the embryos were determined using analysis of covariance (ANCOVA) and multiple logistic regression respectively. The effect of treatment was found to be significant on the embryo treated with NNAT after adjusting for the effect of the positions of the eggs during incubation (p<0.0001). Embryos that were untreated (controls) had the highest weight (weight=0.34g), and as the dose of NNAT was increased during treatment the weight of the embryo decreased significantly after incubation for 5 days : 0.245 µmol/l of NNAT (weight=0.15g, p=0.0009), 1.11 µmol/l of NNAT (weight=0.13g, p=0.004), 2.22 µmol/l of NNAT (weight=0.11g, p=0.01) and 3.33 µmol/l of NNAT (weight=0.12g, p=0.01). Also, it was found that the odds of survival among the embryo decreased linearly with increased dose when treated with NNAT as compared to the untreated embryos: 1.11 µmol/l of NNAT vs untreated (OR=0.250 95% C.I. 0.078-0.799), 2.22 µmol/l of NNAT vs. untreated (OR=0.120 95% C.I. 0.042-0.347) and 3.33 µmol/l of NNAT vs untreated (OR=0.106 95% C.I. 0.036-0.311)

  Conclusion:

  This study has revealed that weight and odds of survival of embryo exposed to NNAT decreased after 5 days of incubation. Dose-effect of the treatment was also observed during the development of embryos exposed to NNAT. Additional studies, however, is needed to evaluate the toxic effects of DMSO on the chick’s embryo before a conclusion can be reached.

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  Effect of N-nitrosoatrazine on Embryogenesis in Avian Embryos

  Nur Firyal Roslan, Moses New-Aaron, Martha Rhoades, and Kent Eskridge

  Preliminary studies suggest that the nitrosamine N-nitrosoatrazine (NNAT) is teratogenic and mutagenic. We hypothesized that the embryos exposed to NNAT would have higher mortality and lower growth rate compared to unexposed embryos. In this study, we evaluated growth and mortality in chick embryos after exposure to NNAT dissolved in dimethyl sulfoxide (DMSO). The study was divided into three experiments depending treatment design. First, the effect of DMSO on embryo growth and survival was tested. Second, we compared growth and survival between embryos treated with DMSO, 50:50 DMSO:water and NNAT at 0.245 µmol/l. Finally, we compared growth and survival between embryos treated with DMSO and varying doses of NNAT (1.11 µmol/l, 2.22 µmol/l, 3.33 µmol/l) dissolved in DMSO. Based on this, we determine the LD50 (lethal dose for 50% of a test population) for NNAT. In terms of mortality, the first experiment shows that there is no effect of DMSO compared to water and blank, but the third experiment shows that there is a linear relationship between NNAT doses where high NNAT dose level will reduce the survival rate of the embryos. From this relationship, we determine that LD50 to be 2. 85µmol/l. We continue the analysis on the survive embryos and reveals that DMSO and NNAT had no effect on the growth of embryos in all three experiments.

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  A systematic review of universal, teacher-led interventions targeting anxiety in U.S. schools

  Sonja F. Tutsch, Patrick Fowler, Gaurav Kumar, Adam Weaver, Brian McKevitt, Denise Britigan, Christian I.J. Minter, and Lorena Baccaglini

  Implications of anxiety symptomatology experienced among children and adolescents in the US constitute a major public health crisis, calling for promising universal mental health interventions in K-12 schools. Schools represent an ideal setting for the implementation of population based, public health interventions, as children and adolescents spend a significant proportion of time in school. Discussions within the scientific community document several advantages to utilization of universal, Tier1 interventions. However, the efficacy of universal, school-based anxiety interventions in the US are not consistently documented. The purpose of this study is to systematically review the literature to identify the efficacy of universal teacher-led school-based anxiety interventions in the US. A comprehensive literature search was conducted employing PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, PsycINFO, Education Resources Information Center (ERIC), and Google Scholar databases up to December 2016. Each of the articles was independently reviewed for relevance and inclusionary criteria, with five studies meeting these criteria. Overall, the quality of the included studies was moderate. All reviewed studies found that universal teacher-led anxiety interventions in school-based programs had a positive impact on the anxiety outcomes of students when compared to control groups. However, several methodological and design concerns were identified across studies. While our findings suggest that universal teacher-led anxiety interventions have the potential to reduce anxiety symptomatology among school-aged children in the US, further research is needed.

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  2016 Refugee Health Needs Assessment in Omaha, Nebraska

  Kandy Do, Drissa Toure, Naw Latt Nlam, and Dejun Su

  Refugees resettling to Nebraska undeniably have different health needs compared to native Nebraska residents. Capturing those differences is the start to catering local health care to refugees. A health needs assessment of refugees in Omaha, Nebraska seek to assess their perceived needs, barriers, and preferences regarding health care, in order to address them justly. The refugee population in Omaha, Nebraska has exponentially increased over the past decade and will continue to increase, bringing global health matters to our backyard. The data and results from surveying over 290 refugees will guide health care organizations and services to appropriately serve refugees and their specific needs.

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  Determinants of Risky Sexual Behaviors Among Patients Living with HIV in a Low-Income Environment

  Moses New-Aaron, Jane L. Meza, Martha Goedert, Stephen Kibusi, James Charles, Caroline Damien, Samwel Sumba, and Siraji Shabani

  Background:

  High risk sexual practices among people living with HIV is a crucial public health issue due to increasing HIV incidence. This study describes factors that could be attributed to risky sexual behaviors among people living with HIV

  Methods:

  Self-reported patient characteristics were collected using a mobile-based data collection method from the HIV clinic in Dodoma, Tanzania. Risky sexual behavior was defined by the patient's use of condoms during sexual intercourse. SAS 9.4 was used for all statistical analysis. Test of association was conducted between the use of condom and the patient's characteristics using a univariate analysis. Significant associations were determined at p<0.05. Multivariate analysis was further conducted to determine the factors that impacted risky sexual behavior among the study population.

  Results:

  561 patients were interviewed in the HIV clinic with an average income per month of 126,000tsh (57USD). 56% (315) were sexually active of which 82% (257) used condoms during sexual intercourse. 76% (44) of the patients who do not use condoms earned less than 120,000tsh (54USD) and 83% (48) of the patients who did not use condoms were urban dwellers. 26% (15) of non-condom users reported more than 1 sexual partner and 33% (19) of the non-condom users had their first sexual intercourse at age less than 18 years. In a multiple logistic regression, condom use was 5.5 times more likely in patients who had HIV for 6-9 years when compared to patients who have had HIV for less than 3 years (95% C.I. 1.8-17.0). Homemakers living with HIV were less likely to use condoms when compared to regular workers (OR=0.0065, 95% CI: 0.01-0.6).

  Conclusion:

  The dangers of risky sexual behaviors based on condom use are perceived more in patients who were recently diagnosed. The conditions surrounding the non-use of condoms in HIV positive patients deserves a more global approach, including understanding access to condoms, the availability and cost on set incomes, and the power imbalances that may be at play for women without a regular job beyond access issues and this should be considered for future studies. Also, the early age of first intercourse may be best collected by determining if this was an early childhood sexual abuse with life-long exposure, or later teen onset up to the age of 18 years in order to understand the characteristics of patients who had their first sexual intercourse at age less than 18 years old.

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  The Determinants of Cervical Cancer Screening Among Patients Receiving ARVs in a Resource-Limited Environment

  Moses New-Aaron, Jane L. Meza, Martha Goedert, Stephen Kibusi, James Charles, Caroline Damien, Samwel Sumba, and Siraji Shanbani

  Background:

  Cervical cancer is the most common cancer worldwide with increased risk among women living with HIV in a resource limited environment. This study aimed to describe rates and determinants of cervical cancer screening among patients receiving Antiretroviral (ARV) drugs.

  Methods:

  The data was collected by administered questionnaires to patients presenting for monthly ARV refills in an HIV Clinic in Dodoma, Tanzania.

  Findings:

  A total of 421 women presenting for monthly ARV refills at the Regional Referral HIV Clinic in Dodoma, Tanzania was interviewed, of which 90% (375) had never heard of HPV and only 1% (4) had received the HPV vaccine. The average duration of HIV infection was 5.43years. While 87% (367) of the women had never been screened for cervical cancer, 12.5% (46) were not willing to undergo screening. Uptake of cervical cancer screening and the willingness to screen were modeled in multiple logistic regression models to exam factors impacting screening. Duration of HIV infection was not significant in the model but was linearly associated with the cervical cancer screening (p=0.02) in Mante-Haenszel Chi-Square. Women without any live children were 2.6 (95% C.I 1.2-5.6) times less likely to screen for cervical cancer than women with 1-2 live births and rural dwellers were 3.0 (95% C.I 1.1-8.1) times less likely to screen than urban dwellers. Women age 40-49 years were 5.0(95% C.I. 1.6-15.3) times not willing to screen for cervical cancer than women of age group 18-39 years.

  Interpretation:

  It is recommended that more education on cervical cancer screening should be provided for rural dwellers, older or middle aged women, and women without children. Increasing rates of cervical cancer screening for immune-compromised, along with HPV vaccine campaigns to increase knowledge and vaccination rates are preventive strategies targeting invasive cervical cancer.

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  An Analysis of Correlation Between Agrichemical Contaminated Wells and Birth Defects in Nebraska

  Moses New-Aaron, Martha Rhoades, Jane L. Meza, and Jeff Wallman

  Background:

  Evidences that agrichemicals might be associated with the incidence of birth defects are inconsistent.

  Objectives:

  • Examine whether Triazine, Acetanilide, Carbamothioate, Nitrate, Trifluralin and Uracil present in well-water are associated with birth defect rates in Nebraska Counties
  • Identify the well types contaminated with these pesticides.

  Methods:

  Birth defects data obtained from Nebraska Department of Human and Health Services were merged with data on wells tested for agrichemicals obtained from Quality-Assessed Agrichemical Contaminant Database for Nebraska Ground Water. The 33 contaminants sampled from the wells were sub classified into 6 predictors and expressed as percentages for analysis in a multiple regression model with birth defect rates as the response variable. The pesticides sampled from the wells were also categorized into parent and degradate to examine the nature of pesticide associated with birth defects. Due to multicollinearity, triazine, acetanilide and trifluralin were summed together.

  Results

  The percentage for triazine and nitrate in domestic wells were 10.6% and 21.5% respectively. Birth defect rates were discovered to correlate with triazine (r= 0.21 p=0.041). triazine- acetanilide-trifluralin together was found to be linearly associated with birth defect rates in the multiple linear regression model (p=0.012). A stronger correlation was found between the parent contaminants and birth defect rates(r=0.22 p=0.034) than the degradate. (r=0.15 p=0.163).

  Conclusion:

  This study suggests an association between birth defect and percent of wells positive for agrichemical compounds. However, this association does not imply causation but provides direction for future investigation.

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  Comparison of Agricultural Injury and Fatality Characteristics Obtained from Media Monitoring Versus Official Statistics

  Moses New-Aaron, Jessica Semin, Risto Rautiainen, and Murray Madsen

  Objective of project:

  1. Compare the characteristics of fatal injuries reported by CFOI and CS-CASH media monitoring

  2. Analyze the agreement between CFOI reported injuries and CS-CASH media monitoring fatal injuries

  Planning/Research Method:

  Background:

  The Bureau of Labor Statistics, Census of Fatal Occupational Injuries (CFOI) provides statistics on occupational fatalities, but information on individual cases is not reported. The Central States Center for Agricultural Safety and Health (CS-CASH) tracks media reports of agricultural injury and fatality cases to augment CFOI data.

  Methods:

  Data was obtained from variety of sources. The primary data source was "Google Alerts" and other sources includes press clippings and local media reports. The key words used for selecting relevant articles were “farm accident”, “farm incident”, “farm death”, “ranch accident”, “ranch death” and “livestock. All agricultural related incidents occurring in Nebraska, Iowa, Minnesota, South Dakota, North Dakota, Missouri and Kansas between 2012-June 2016 were selected for analysis. Data was obtained from CFOI database for different type of injury events and compared to those obtained from different media sources using 2 independent t test. An association between fatalities or farm injuries and other characteristics was determined in a using a Pearson Chi square and a multivariate analysis using a multiple logistic regression model.

  Results:

  We found significant differences in CS-CASH media monitoring data between fatal and non-fatal injuries. Google alerts included a higher proportion of roadway incidents, …, …, and … compared to data from press clips from print media. CFOI data included a higher proportion of …, …., and … fatalities compared to data from CS-CASH media monitoring.We found significant differences in CS-CASH media monitoring data between fatal and non-fatal injuries (p<0.0001). CFOI data included a higher proportion of injuries from struck, contact and fall when compared to CS-CASH media monitoring data. However, there is no significant difference between the CFOI data and the CS-CASH media monitoring of fatal injury data for “caught” (p=0.094)

  Conclusion:

  This study suggests an agreement between CFOI data and media monitoring data for fatal injury events due to being caught in running equipment.

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  Factors Associated with Fatalities in Production Agriculture

  Moses New-Aaron, Jessica Semin, Risto Rautiainen, and Murray Madsen

  Background: Studying the work environment and demographics of agricultural workers involved in fatal incidents can provide valuable information on the cause of fatalities and lead to better prevention measures.

  Objectives: To determine populations at risk of fatalities and the determinants of fatalities in production agriculture.

  Method: Agricultural injury and fatality data were obtained from Press clippings and Google alerts covering seven Midwest States (SD, ND, MN, IA, NE, KS and MO). Google Alerts were collected based on key words including: “farm accident”, “farm incident”, “farm death”, “ranch accident”, ”ranch incident”, “ranch death”, “ATV farm death”, “ATV ranch death”, “livestock death”, as well as other descriptors. Articles from Google Alerts were screened. Relevant articles were analyzed, and data were then extracted and added to the database. Differences in demographic and characteristics between fatal and non-fatal injuries were compared within the CS-CASH media monitoring database using the chi-square and logistic regression model.

  Results: A total of 1048 agricultural-related injuries including 586(56%) non-fatal cases and 462 (54.16%) fatalities were collected between 2011 to 2017 across the seven Midwest states by CSCASH monitoring database. We found that fatality was significantly associated with; age group (p<0.0001), type of injury event (p<0.0001), source of injury (p=0.01), time of injury (p=0.0018), activities during injury (p=0.0002), place of injury (p<0.0001) and gender (p=0.0004) in a univariate analysis. It was further discovered in a multiple logistic regression that age groups, time and the place of injury were good predictors of fatalities.

  Conclusion: This study suggests that place of injury, time of injury and age of the victims were possible determinants of fatalities and males, elderly and the infants had more fatalities in agricultural production industry.

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  Anaesthesia Error in United States: Reasons for Mismanagement

  Abby Wolfe, Anh Nguyen, Ashleigh Galles, Madison Wolfe, and Ben Lundberg

  A poster from the UNMC Undergraduate Public Health Workshop