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Climate Change and Infectious Disease Dynamics in the U.S.: Spatial-Temporal Patterns and Epidemiological Insights
No full textHuman exposure to climate-sensitive infectious diseases presents a growing public health challenge in the United States. As disease outcomes are shaped by the complex interaction between environmental conditions and population susceptibility, these exposure-outcome vary across regions and demographic groups. Enhancing public health preparedness and environmental health literacy through evidence-based risk communication is crucial for mitigating the effects of climate variability on infectious disease dynamics. The use of national public health surveillance systems offers a valuable approach to quantify these risks, though several gaps remain in understanding how climate drivers influence disease outcomes.
This dissertation addresses key gaps in the epidemiology of climate-sensitive infectious diseases by examining the spatial and temporal patterns of disease mortality and prevalence in relation to temperature, temperature anomalies, and drought conditions. Using mortality and prevalence data from national surveillance systems, we applied a longitudinal and ecological framework to assess climate-health associations across three distinct use cases: 1) vector-borne diseases, 2) fungal infections, and 3) thermophilic pathogens.
In the first study, we analyzed mortality patterns of West Nile Virus (WNV) and Lyme disease, the two most prevalent vector-borne diseases (VBDs) in the U.S. and identified geographic and sociodemographic disparities in mortality outcomes. The second study examined the association between climate variability and mortality due to Invasive Fungal Sinusitis (IFS), revealing significant links to temperature anomalies and drought across climate regions and vulnerable populations. The third study explored the patterns of Naegleria fowleri (N. fowleri), a rare but fatal pathogen, and identified environmental thresholds associated with case emergence across diverse geographic regions.
The findings from this dissertation contribute to the growing field of climate-health research by integrating environmental exposures with public health surveillance data. These results are intended to support public health departments, policymakers, and healthcare providers in developing targeted interventions and adaptive strategies. Further studies incorporating individual-level data, refined exposure measurements, and stratified analyses are needed to strengthen the evidence base for climate-sensitive disease prevention and policy development
HPV Vaccination in the U.S. Midwest: Barriers and Facilitators of Initiation and Completion in Adolescents and Young Adults
No full textBackground/Objectives: HPV vaccination uptake among adolescents and young adults in the US remains low, and coverage in the Midwest falls short of the Healthy People 2030 goal of 80%. Methods: A cross-sectional survey of adolescents and young adults was conducted to identify facilitators and barriers to HPV vaccination uptake among adolescents and young adults in the Midwest. Results: Out of 1306 individuals aged 13-26 years, 397 (30.4%) were fully vaccinated (2-3 doses), 124 (9.5%) had received one dose, 324 (24.8%) were unvaccinated, and 461 (35.3%) were unsure of their vaccination status. Awareness of HPV vaccines (OR: 2.4, 95% CI: 1.6, 3.6), beliefs about vaccine effectiveness (OR: 1.8, 95% CI: 1.1, 2.9), family support (OR: 2.3 95% CI: 1.4, 3.8) and knowing someone with cervical cancer (OR: 1.8, 95% CI: 1.2, 2.7) were associated with increased odds of full vaccination. Beliefs in vaccine safety (OR: 2.0, 95%CI: 1.0, 3.9) and having health insurance coverage (OR: 1.9, 95% CI: 1.0, 3.5) were associated with increased odds of initiated vaccination (i.e., receiving at least one dose). Concerns about vaccine side effects (OR: 0.5, 95% CI: 0.3, 0.8) and not receiving recommendations from doctors were significantly associated with decreased odds of full vaccination (OR: 0.5, 95% CI: 0.3, 0.8) or initiated vaccination (OR: 0.5% CI: 0.2, 0.9). Clinician recommendations and awareness also reduced the likelihood of unknown vaccination status. Race-stratified analyses suggested heterogeneity in predictors across racial/ethnic groups. Conclusions: Our findings support the need for multi-level interventions aimed at increasing HPV vaccination initiation and completion in the Midwest
Creating Actionable, Culturally Appropriate Interventions from Survey Data: A Community-Driven Capstone Pilot Project
No full textThe Community-Driven Capstone Track is a pilot program designed as an alternative to the traditional capstone track. With this track, students are able to engage with community partners through an integrative learning experience. The goal is to address real organizational needs in a way that demonstrates the mastery of foundational and concentration competencies.
Unlike the traditional capstone track, the CDC offers flexibility in both project type and deliverables. Rather than one formal written report, students might produce a series of products or tools. Deliverables are decided collaboratively between the student, community partners, and the faculty committee to ensure they are appropriate and useful.
This intervention brief is one of four deliverables completed for this capstone project. The foundation for the project comes from the citywide survey conducted in 2024 and 2025 by the New Americans Task Force, in partnership with the Asian Community and Cultural Center. Together, they surveyed over 500 immigrants and refugees living in Lincoln, Nebraska, with the intent of gaining a deeper understanding of their experiences regarding language access, community connectedness, health, housing, civic engagement, employment, and more.
The findings highlight both the strengths of the community and barriers that remain. This was the second survey of its kind, with the first being completed in 2019. This project utilized those survey results, along with community partner input from the Asian Community and Cultural Center and the Lincoln-Lancaster County Health Department, to identify how community needs align with organizational priorities and capacities
A Literature Review: Back Injuries Affecting Certified Nursing Assistants in Nursing Facilities
No full textCertified nursing assistants (CNAs) are at a higher risk of back injuries in healthcare, particularly in long-term care settings. This literature review assessed the primary causes of these injuries and the efficacy of current interventions, particularly Safe Patient Handling and Mobility (SPHM) programs. A total of 26 peer-reviewed articles were published between 2014 and 2025, including experimental simulations, cross-sectional and longitudinal studies, quasi-experimental training interventions, and evaluations of SPHM programs. Across the literature, the primary contributors to back injuries included high physical workload, inadequate ergonomic design, limited access to assistive devices, and staff shortage.
Experimental and biomechanical studies have demonstrated that assistive device technologies, such as slide sheets, air-assisted devices, and motorless mechanical aids, reduce spinal load and ground reaction forces during patient transfers. Cross-sectional research identified a relationship between low back pain prevalence and limited access to equipment and poor work organization. At the same time, quasi-experimental studies showed that ergonomics training and follow-up reinforcement can reduce the risk of musculoskeletal injuries. Longitudinal evaluations of SPHM programs reported reductions in injuries and disability duration; however, effectiveness declined without ongoing training, leadership engagement, and consistent equipment availability.
Significant obstacles to safe patient handling included time pressures, inconsistent access to devices, patient resistance, and inadequate organizational support. The evidence suggests that the success of an injury prevention intervention depends not only on equipment, but also on ergonomic training, a supportive safety culture, adequate staffing, and consistent reinforcement. Strengthening these factors is essential to reducing back injuries among CNAs and improving long-term workforce safety in nursing facilities
Association Between Rurality and Race/Ethnicity and Pediatric Cancer Early Mortality: A Population-Based Cohort Study Using SEER Data from 2000 to 2021
Full text linkBACKGROUND: Pediatric cancer mortality rates have steadily declined since 2009, but over a thousand deaths still occur annually. While existing research highlights the effects of race/ethnicity and rurality on overall survival, few studies have specifically analyzed these factors in relation to early mortality, defined as death within 12 months of diagnosis.
PROCEDURE: This study utilized SEER Research Plus Limited-Field Data (2000-2021) to examine the association between race/ethnicity, rurality, and early mortality in pediatric cancer patients. A cohort of 138,648 individuals was analyzed using Cox proportional hazards regression models to calculate hazard ratios and 95% confidence intervals (CIs).
RESULTS: The results demonstrated that both race/ethnicity and rurality were significantly associated with early mortality. Non-Hispanic Black patients were 70% (95% CI: 1.60-1.82) more likely to die within the first year of diagnosis compared to non-Hispanic Whites, and other racial/ethnic groups also saw significant associations. The adjusted hazard ratio for early mortality compared to urban counties greater than 1 million was significant (p \u3c 0.05) for all degrees of rurality. Pediatric cancer patients in rural counties not adjacent to urban counties had the highest risk of early mortality, 27% (95% CI: 1.13-1.42), within 1 year of diagnosis. A subanalysis of adolescent patients also showed similar patterns.
CONCLUSIONS: These findings emphasize the need to address disparities in early mortality for pediatric cancer patients, particularly among racial/ethnic minorities and those in rural communities
Is Diabetes a Predictor of a Diagnosis of Hypertension in the Population of 32- to 70-year-olds in a Cohort Study? A Multivariate Logistic Regression Analysis of a Subset of Data Obtained from the Framingham Study
Full text linkObjective: Assess the independent role of diabetes on hypertension using logistic regression, while adjusting for covariates such as age, sex, BMI
Methods: A subset of data from the Framingham Cohort study, with 5,209 participants and collected across three periods from 1956 to 1968, was analyzed. The dataset includes laboratory, clinic, questionnaire, and event data from 4,434 individuals and was analyzed using SAS software for logistic regression.
Results:In the adjusted model, diabetes was not associated with hypertension (aOR:1.1, 95% CI:0.67-1.81, p=0.7). Females had 26% higher odds of hypertension than males (aOR=1.26, 95%CI:1.09-1.25, p=0.00). Participants aged 51 or older (aOR=2.86, 95%CI:2.37-2.47, p
Conclusions: The adjusted model revealed that BMI, sex, and age are significant predictors of hypertension. Further studies are needed to assess the relationship between hypertension and diabetes. BMI continues to play a pivotal role in influencing hypertension outcomes and contributes significantly to the burden on the U.S. public health system
Biopreparedness in Nebraska: A History and Behind-the-Scenes Look at the Exhibit
No full textDiscover the “Biopreparedness in Nebraska” exhibition through the eyes of exhibit curator, Darby Kurtz. During this McGoogan Sessions Health Sciences History Hour, Darby shared the history of biopreparedness as displayed in the exhibition in the Wigton Heritage Center.
Like the exhibit, Darby’s presentation focused on the period from the 1990s when the Nebraska Public Health Laboratory moved to the Medical Center campus to present day responses and research that mark new milestones on the Nebraska Biopreparedness timeline.
The talk also covered additional information about stories that are part of the exhibit and provided insights into curatorial decisions and processes that led to the current display.
This talk will took place on the 5th anniversary of the Training, Simulation & Quarantine Center (TSQC), part of the Global Center for Health Security at UNMC, opening on the UNMC/Nebraska Medical Center campus. Read Med Center leaders’ reactions to that day in this previous UNMC Today article.https://digitalcommons.unmc.edu/mcgoogan_lectures/1011/thumbnail.jp
A Thermodynamic Bottleneck in the TCA Cycle Contributes to Acetate Overflow in Staphylococcus aureus
Full text linkDuring aerobic growth, S. aureus relies on acetate overflow metabolism, a process where glucose is incompletely oxidized to acetate, for its bioenergetic needs. Acetate is not immediately captured as a carbon source and is excreted as waste by cells. The underlying factors governing acetate overflow in S. aureus have not been identified. Here, we show that acetate overflow is favored due to a thermodynamic bottleneck in the TCA cycle specifically involving the oxidation of succinate to fumarate by succinate dehydrogenase. This bottleneck reduces flux through the TCA cycle, making it more efficient for S. aureus to generate ATP via acetate overflow metabolism. Additionally, the protein allocation cost of maintaining ATP flux through the restricted TCA cycle is greater than that of acetate overflow metabolism. Finally, we show that the TCA cycle bottleneck provides S. aureus the flexibility to redirect carbon toward maintaining redox balance through lactate overflow when oxygen becomes limiting, albeit at the expense of ATP production through acetate overflow. Overall, our findings suggest that overflow metabolism offers S. aureus distinct bioenergetic advantages over a thermodynamically constrained TCA cycle, potentially supporting its commensal-pathogenic lifestyle
