Issaka Kabore: Nebraska Department of Health and Human Services

“Background: The Department of Health and Human Services team contributes to the lives and health of Nebraskans every day. Our mission, “Helping people live better lives,” provides the motivation to make a difference said Courtney N. Phillips the CEO of DHHS. The DHHS-NE covers 93 counties but the two principal counties are Douglas and Lancaster. The Division of Public Health is responsible for prevention, community health programs and services. They are also responsible for the regulation and licensure of health-related professions and occupations, as well as the regulation and licensure of health care facilities and services. Our internship is going to be at the Public health division and specifically at Infectious Diseases Prevention Unit. Our Mentor is Dennis Leschinsky, epidemiologist coordinator at the DHHS.

Activities: total 36 hours
➢ 5/24/2018 from 0900 to 1700.
Day 1 working on HIV/AIDS Annual Report: First step is to analyze the data from an excel
data sheet for people newly diagnosed and living with HIV/AIDS in Nebraska, 2016 and
2017. Interpret the output from SAS (Preceptor assisted with SAS process), organize the
result on Excel sheet, and finish by writing a formal HIV/AIDS reports in Nebraska for 2016 and 2017. Many steps before getting to the final report.

➢ 5/25/2018 from 0900 to 1700
Day 2 working on HIV/AIDS Annual Report: First step is to analyze the data from an excel
data sheet for people newly diagnosed and living with HIV/AIDS in Nebraska, 2016 and
2017. Interpret the output from SAS (Preceptor assisted with SAS process), organize the
result on Excel sheet, and finish by writing a formal HIV/AIDS reports in Nebraska for 2016 and 2017.
➢ 5/29/2018 from 0900 to 1700
Day 3 working on HIV/AIDS Annual Report: First step is to analyze the data from an excel
data sheet for people newly diagnosed and living with HIV/AIDS in Nebraska, 2016 and
2017. Interpret the output from SAS (Preceptor assisted with SAS process), organize the
result on Excel sheet, and finish by writing a formal HIV/AIDS reports in Nebraska for 2016 and 2017. Many steps before getting to the final report.
NEDSS_Investigation- updating, which is the diseases surveillance sheet, on an excel data
sheet, all the communicable diseases are updated by county for 2006 and 2017.

➢ 5/30/2018, from 0900 to 1700.
Day 4 working on HIV/AIDS Annual Report: First step is to analyze the data from an excel
data sheet for people newly diagnosed and living with HIV/AIDS in Nebraska, 2016 and
2017. Interpret the output from SAS (Preceptor assisted with SAS process), organize the
result on Excel sheet, and finish by writing a formal HIV/AIDS reports in Nebraska for 2016 and 2017. Many steps before getting to the final report.

➢ Some examples of graphs instead of photos, we generate during this long process of HIV annual reports 2016 and 2017.

In conclusion: This third period was so far rich in practical experiences. I had more hands toward concentration Competencies. As, a future epidemiologist and with the expectation one day to work at local or state health department, I learned data entry process, and how to clean data using excel. In real world data are very messy with a lot of missing information, it is important to be able to clean it properly. Moreover, the data analysis step is very important and I have learned and applied it in many occasions. EPI Info is not well known at academic setting but some health department still using this software to run their dataset and I got the opportunity to learn some fundamentals of the free Software (Most used in developing countries and by WHO). Finally, the report step is the most useful because the way to present the result and make it understandable to all is one of the goals of public health. In sum, I have learned a lot and I was useful to  helping my unit to update the HIV/AIDS reports for 2015 and 2016.” – Issaka

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Shelby Webb: SHE Project

“I have finished all the activities I needed to complete my original research project for my capstone with SHE! It feels fantastic, but now the hard part comes: communicating my research to a wider audience. For the capstone alone, this means creating a capstone report and defending it to an audience. Additionally, the SHE team encourages everyone to publish. So after I have completed my capstone report I will be turning it into a manuscript for publish.

I was able to interview 16 participants and validate self-reports with medical records for 23 participants. Over half of my participants did have a validated Pap smear, which doesn’t tell us much about the overall accuracy of self-reports. However, what I did find was that the accuracy of a cervical cancer self-report is more likely to be accurate if a participant is able to recall a Pap smear well (based on semi-structured interviews) and if a participant has high health literacy. This makes it easier to make an estimation of what percentage of self-reported Pap smears are accurate based on a participant’s health literacy.

I have a first draft of my capstone report already and I have some feedback I need to incorporate before it’s finalized. Turning that report into a manuscript will be another challenge though. I have a list of changes I’ll need to make, including: developing a running title, separating my figures and tables from the text, and getting my word count down to 4,000 (I’m currently at 4,700!). Before I knew how to format the manuscript, I first had to decide where to publish. This is a daunting task. I’m grateful for the SHE team, who pushed me in the direction of one journal. Without their help, I was helplessly lost in a sea of impact factors (a measure of how many citations to recent articles a journal has) and author requirements.

Many people in academia have heard the term publish or perish, describing the pressure to publish academic work during one’s career. This is something I often worried about when thinking of whether or not I wanted to pursue a career in academia. Publishing seems intimidating and discouraging. But then I look at the SHE team. Almost everyone has their hands on a paper or two currently with a few (or more!) behind them. They certainly aren’t perishing – rather, they are thriving. Maybe this is something that would get easier the more I work at it. Certainly, the time I have spent with the SHE team completing my research with them and now working on this report/manuscript has made me consider a career in academia more and more.” – Shelby

Shelby-1

“A majority of the SHE team. There are a few members that work with SHE remotely and teleconference with us every Tuesday.”

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Issaka Kabore: Nebraska Department of Health and Human Services

Background: The Department of Health and Human Services team contributes to the lives and health of Nebraskans every day.  Our mission, “Helping people live better lives,” provides the motivation to make a difference said Courtney N. Phillips the CEO of DHHS. The DHHS-NE covers around 93 counties but two principal counties are Douglas and Lancaster. The Division of Public Health is responsible for preventive and community health programs and services. It is also responsible for the regulation and licensure of health-related professions and occupations, as well as the regulation and licensure of health care facilities and services. Our internship is going to be at the Public health division and specifically Epidemiology department.

Activities: total 48 hours

5/16/2018 from 0900 to 1700

EPI info training and application

5/7/2018 from 0900 to 1700

NEDSS Investigation Analyze on EPI Info and Updated communicable diseases rates by county 2016 and 2017 on an Excel data sheet

5/18/2018 from 0900 to 1700

NEDSS_Investigation Analyze on EPI Info and Updated communicable diseases rate by county 2016 and 2017 on an Excel data sheet

5/21/2018 FROM 0900 to 1700

NEDSS_Investigation Analyze on EPI Info and Updated communicable diseases rates by county 2016 and 2017 on an Excel data sheet.

5/22/2018, from 0900 to 1700.

Corrections newly diagnosed Hepatitis C, Nebraska, 2013 to 2017, data cleaned up, analyze on EPI info, Report using an excel format.

5/23/2018, from 0900 to 1700.

Corrections newly diagnosed Hepatitis C, Nebraska, 2013 to 2017, data cleaned up, analyze on EPI info, Report using an excel format

In conclusion: This second period was so far very great, I had the opportunity to be more involved and helped to update the Disease Surveillance Sheet of the state and by county. I calculated the rate by county and by condition, a lot of work but very rewarding because I can see my contribution to the unit. Moreover, under the supervision of my preceptor, we have to do a report of newly diagnosed Hepatitis C among prisoners in Nebraska. That was very exciting due to the different steps we have to go through. It was an occasion for me to understand the difficult to analyze data in real world due to a lot of missing information. Lesson, I have learned it is to be very resilient and go for walk every hour to reach the goal of 10,000 steps per day.” – Issaka

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Ann Essay: Nebraska Association of Local Health Directors

This summer I am working with the Nebraska Association of Local Health Directors (NALHD) in Lincoln, Nebraska. NALHD is a professional association open to local public health directors in Nebraska with the mission of amplifying the impact of local public health departments at the state and local levels. I am currently working on two projects with NALHD, one focused on health literacy and one focused on a community health needs assessment.

For the health literacy portion of this project, I am reviewing local health department website pages and creating a document of recommendations for improving health literacy. This document consists of my assessment of each page on the health department’s website and recommendations for design and content improvements. We will meet with the health department’s to discuss the health literacy review and next steps. I have completed the review of one department’s website and am beginning review of the next department.

For the community health needs assessment, I am currently creating the assessment for a local health department to implement in their community. The first draft of the assessment has been created and is undergoing review. When necessary revisions are made, this document will be shared at a CHA committee meeting with the health department to determine next steps.” – Ann

 

Essay-1

Essay-2

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Issaka Kabore: Nebraska Department of Health and Human Services

“Background: The Department of Health and Human Services team contributes to the lives and health of Nebraskans every day.  Our mission, “Helping people live better lives,” provides the motivation to make a difference said Courtney N. Phillips the CEO of DHHS. The DHHS-NE covers around 93 counties but two principal counties are Douglas and Lancaster. The Division of Public Health is responsible for preventive and community health programs and services. It is also responsible for the regulation and licensure of health-related professions and occupations, as well as the regulation and licensure of health care facilities and services. Our internship is going to be at the Public health division and specifically Epidemiology department.

Activities: total 45 hours

5/8/2018 from 0900 to 1400

Unit meeting/ quick tour to discover the different units and specially the department of EPI. I had the opportunity to introduce myself to people.

Integrated Data Security and Confidentiality Training

5/9/2018 from 0900 to 1700

Overview of report management system/common communicable diseases with epidemiology coordinator (my preceptor=Mr. Dennis)

Call conference on CROI=Conference on Retrovirus and Opportunistic Infections,

HIPAA&IT user trainings, etc.

5/10/2018 from 0900 to 1700

‘’Data to care program’ ‘overview with Dennis,

Data to Care Program manual reading,

Conference call on Geocoding Data HIV,

Meeting Dr. Safranek Tom the medical department epidemiologist, etc.

5/11/2018 from 0900 to 1700

Tutorial on EPI Info, the software use to care the program “Data to Care”.

               Training and hands-on/survey creation, data analysis process, etc.

5/14/2018, from 0900 to 1700.

Webinar conference call on the burden of Hepatitis C in Nebraska and current efforts to address this public health threat with Dr. Safranek, Tom and Treating Hepatitis C in Primary Care:  The Successes and Challenges of Hepatitis C Treatment at a Community Health Center. Some activities on Data to care program on to report case to the CDC.

5/15/2018, from 0900 to 1700.

Some data shift to analyze on EPI INFO, preceptor absent for training, Skype call on E. coli/romaine lettuce outbreak

In conclusion: At my unit, they are in charge of all communicable diseases surveillance in Nebraska. The local health department such as Douglas County or Lancaster County report to the DHHS. Our focus is on VIH and Hep C. The main program right now is Data to Care which is using the data surveillance to detect VIH+ who are not in treatment and bring them back in care by making calls to the physicians or the patients to understand the different barriers and try to find a solution. The goal is bring them back to care.” – Issaka

 

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Jordyn Gunville: Pregnancy-Related Health among American Indian Women

I passed my defense!!! My committee was very impressed since this was the first data out there that represents American Indian pregnancy and birth outcomes in this region (Midwest).  It was somewhat challenging since there are not a lot of literature out there on American Indians maternal child health.

This was a great experience for me, because I learned how to develop a survey, collect data, and complete the data analysis.  I put this in writing. I am expected to get some of the data published so other students, researchers, and programs can use the data!” – Jordyn

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Jordyn Gunville: Pregnancy-Related Health among American Indian Women

“I completed my final data analysis and wrote my results and conclusion. I turn in my final capstone and the drop of my PowerPoint Presentation for my Defense April 26. I think I used have used more guidance drafting my results. I felt somewhat over whelmed the large some of data, because I wanted to report on everything but had to pick and choice what was most important.” – Jordyn

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Jordyn Gunville: Pregnancy-Related Health among American Indian Women

“My capstone program is moving alone well, I have scheduled my capstone defense for April 26, 2018. I sent my first draft of my chapters 1 & 2 to one of my committee member, and made her suggested edits. I then sent to the draft to my committee chair; I am waiting for feedback.

On April 3, 2018 I am going to meet with a graduate student from the biostatics department to get feedback on my SAS programing and run my data. Since my data analysis is very complex I feel like I have been putting in a lot of work reading about SAS coding I did not cover in my master’s program. Once I get my data analysis completed I will draft my results and conclusion.

Next steps:
Draft my results and conclusion
Make final edits
Start creating my power point for my defense” – Jordyn

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Ellen Gackle: Scott County Health Department

“This spring, I started an internship with the Scott County Health Department to assist them in the process of conducting the community health assessment using the MAPP framework. MAPP stands for Mobilizing for Action through Planning and Partnerships and consists of six different phases. Phase one (organizing) started in the fall of 2017 where a “Core” team of representatives from the health department, local hospitals, and other health organizations were assembled. I joined the process in late March by attending Core team meetings every two weeks. Visioning is the next stage where the Core team along with a stakeholder committee of about 25 people discussed what the vision statement should be for this health assessment. At the first stakeholder meeting on May 11th three options for a vision statement were discussed and revised (photos). The Core team plans on reviewing these statements for additional revisions and then sending options back out to stakeholders to decide on a final version. The main portion of this process is conducting the assessments, which is phase three. There are four assessments in the MAPP framework: Community Health Status, Community Themes and Strengths, Forces of Change, and the Local Public Health System. The Community Health Status assessment is being done by a professional research consulting company so this group is responsible for conducting the other three qualitative assessments. At our stakeholder meeting on May 11th stakeholders were divided evenly into the three subcommittees to work on a specific assessment. I will mainly be assisting with the Community Themes and Strengths assessment and our subcommittee plans on preparing a survey as well as conducting focus groups to collect our information. My role so far has been to provide information on the MAPP process, take meeting minutes, and collaborate with my team members on preparing materials for the assessments. All of the assessments will be completed in the months of June and July so that presentation of the results can be done at a stakeholder meeting in late August. Following that, results will be shared with the public in late September.”  – Ellen

 

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Shelby Webb – SHE Project

This spring, I have the privilege of working with the SHE (Sexual Health Empowerment) Project at the University of Kansas Medical Center. I completed a more traditional internship with them last fall and I am now continuing my relationship with them as I complete my capstone for my Master of Public Health. The SHE Project began as a sexual health intervention for incarcerated women in the Kansas City metro area jails. These women are followed up with over three years after the original intervention to assess the long-term affects. The aim of SHE is to empower these women and increase their health literacy to bring about more routine cervical cancer screenings (Pap smears).

My task with SHE is to find a measure of data validation for a sample of the intervention cohort. For women that have self-reported a Pap smear on one of their annual surveys, I have been obtaining their permission to view their medical records, collecting those medical records, and combing them to validate their self-reported Pap smear.

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Figure 1: A stack of medical records faxed to me. There’s got to be a Pap smear in there somewhere

For those that self-reported a Pap smear but then didn’t have a validated Pap in their medical records, I am trying to determine what makes them incorrectly report a Pap. To that end, I’ve been conducting interviews with a sample of these women. In these interviews, I’ve been asking in depth questions about their last Pap smear: What tools did the provider use? What did the provider say they were looking for? Where was it? What were the results? Based on these interviews, I make a determination about whether or not these women are actually describing Pap smears. I combine this data with a measure of health literacy we take on their surveys: a composite score of 15 true/false questions we call the Pap knowledge.

Combining the Pap knowledge score and the interview score should tell us more about the difference between those who accurately self-report a Pap smear and those who do not. I’m learning a lot about gathering qualitative data and my interviewing skills have gotten better. I’ve also learned a significant amount about data management. There have been too many times that I’ve thought If I had just thought a little ahead, I wouldn’t have had to reorganize this data. Mistakes are life’s best lessons though, right?

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