Digital Commons Network^™

Effectiveness Of An Integrated Multilevel Early Child Development Intervention On Caregiver Knowledge And Behavior: A Quasi-Experimental Evaluation Of The Malezi Program In Tanzania, Gretchen Antelman, Josephine Ferla, Michelle M. Gill, Heather J. Hoffman, Teopista Komba, Amina Abubakar, Pieter Remes, Ola Jahanpour, Martha Mariki, Mary A. Mang’Enya, Roland Van De Ven

Institute for Human Development, East Africa

Background The quality of caregiving and the parent-child relationship is critical for early child development (ECD) and has been shown to be modifiable. This study evaluated an ECD project in Tanzania, assessing the effectiveness of radio messaging (RM) alone and a combined radio messaging/video job aids/ECD (RMV-ECD) intervention.

Methods This two-arm pre-post evaluation study enrolled a cohort of caregivers of children 0–24 months in four districts of Tabora region, following them for 9 months. ECD radio messages were broadcast on popular stations at least 10 times/day reaching all study districts. In two districts, community health workers (CHW), trained in UNICEF’s …

Perceptions Of Adults With Type 1 Diabetes About Diabetes Management And Exercise, Meera Swaminath

Public Health Theses

This study was conducted to understand participants’ experiences with diabetes management and relationships with exercise for a sample of adults (27-65 years old) with Type 1 diabetes living in the United States and identify potential technological features for a digital health tool supporting physical exercise and diabetes management. The sample consisted of 12 participants living across the nation. Participants were recruited online, through social media and healthcare system platforms. Participant data was collected in the form of surveys and interviews and analyzed using a constructivist framework and thematic analysis. Findings were collapsed into four major themes: 1) making exercise decisions …

Associations Between Involvement In Shared Activities With Plwd, Relationship Closeness, And Loneliness Of Friends And Family, Marielle W. Quinn

Public Health Theses

Objectives. To examine the association between self-reported relationship closeness, loneliness, and engagement in shared activities with a person living with dementia (PLWD) in a community sample of family members and friends of PLWD. Methods. Using data from a Qualtrics-administered online survey, we examined involvement in shared activities of 51 respondents who have or had a family, friend, or intimate relationship with a PLWD. Outcome variables included relationship closeness, measured with the Inclusion of Other (IOS) scale, and loneliness, measured using a revised three-item questionnaire from the UCLA loneliness scale. Results. The main findings of the study were as follows: 1. …

Evaluating The Direct Medication Costs Associated With Advanced Non-Small Cell Lung Cancer (Nsclc) Treatment By Biomarkers In The United States: A Coarsened Exact Matching Retrospective Cohort Study, Juanyi Tan

Public Health Theses

IMPORTANCE Most NSCLC patients are diagnosed at an advanced stage. Given recent advancements in immunotherapy and targeted therapies, identifying the biomarker status—such as targetable gene alterations and immune checkpoints—of patients becomes critical in selecting the appropriate treatment. Despite the substantial economic burden of lung cancer, little is known about the medication costs associated with advanced NSCLC treatment by different biomarkers.OBJECTIVE To investigate the association between biomarker status and first-year direct medication costs associated with advanced NSCLC treatment. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted using the Flatiron Health electronic health record (EHR)-derived de-identified database. The study population …

A Robust Bayesian Model Averaging Method For Basket Trials With Different Endpoints, Xueting Wang

Public Health Theses

Oncology drug research in the last few decades has been driven by the development of targeted agents. In the era of targeted therapies, basket trials are often used to test the antitumor activity of a novel treatment in multiple indications sharing the same genomic alteration. As patient population are further fragmented into biomarker-defined subgroups in basket trials, novel statistical methods are needed to facilitate cross-indication learning to improve the statistical power in basket trial design. Here we propose a robust Bayesian model averaging (rBMA) technique for the design and analysis of phase II basket trials. We consider the posterior distribution …

Cleft Lip And Depression In Adults: A Multi-Ancestry Mendelian Randomization Study, Anne Lyon Havlik

Public Health Theses

Background: Clefting of the lip with or without cleft palate (CLP) is the most common congenital craniofacial abnormality globally, affecting one in 700 live births. Traditional observational studies suggest an increased risk of adult depression among subjects with CLP, but these studies are subject to residual confounding.Objective: We aimed to address residual confounding by evaluating the association between the genetically-predicted risk of CLP on the risk of adult depression in a Mendelian randomization framework. Methods: We used single-nucleotide polymorphisms strongly associated with CLP as genetic instruments. Genetic associations with adult depression were extracted from separate studies. Three ancestry groups were …

Pre-Admission Depression And 6-Month Post-Discharge Sleep Disorders In Elderly Covid-19 Survivors, Yixiao Zhang

Public Health Theses

ABSTRACTObjective: This study aims to evaluate the association between depression at baseline and presence of three sleep disorder symptoms (fatigue, daytime sleepiness, and insomnia) following 6-month hospital discharge in elderly COVID-19 survivors. It also aims to identify which other baseline patients’ characteristics or post-discharge factors may be associated with these sleep disorder symptoms. Methods: The participant datasets were obtained from VALIANT, a prospective longitudinal study of community-living adults aged ≥ 60 years who were admitted with COVID-19 to hospitals within the Yale New Haven Health System (YNHHS) from June 2020 - June 2021. Multiple logistic regression models were performed to …

Copd And Asthma: Genome-Wide Associations And Genetic Pleiotropy, Yixuan Yang

Public Health Theses

This study aimed to describe the overlap between genetic variants that are independently associated with COPD and asthma, then dissect the cross-phenotype associations to characterize patterns of pleiotropic effects. The COPD and asthma datasets were separately extracted from an aging population consisting of white European subjects from the UK Biobank database. Genome-wide association tests were performed separately with the COPD and asthma data to first investigate significant genetic variants independently associated with each of the two phenotypes. With the GWAS summary statistics, several significant genetic loci that exhibit potential pleiotropic effects on COPD and asthma on a genome-wide significant level …

Interrupted Time Series Analysis To Evaluate Regional Greenhouse Gas Initiative Health Impacts, Julia Sweatman

Public Health Theses

Abstract

Background & Aims: Fossil fuel combustion emits a spectrum of ambient air pollutants, with the most harmful health effects seen from particulate matter 2.5 μm or less in diameter (PM2.5). Pricing carbon can reduce PM2.5 emissions and yield co-benefits for public health. The Regional Greenhouse Gas Initiative (RGGI) is a cooperative carbon pricing initiative among twelve states aiming to curb carbon dioxide emissions from the power sector. This preliminary analysis explores methodological approaches to quantify the health benefits associated with PM2.5 changes after RGGI was first implemented in 2009.

Methods: An interrupted time series analysis was performed to compare …

Analyzing Pediatric Department Documentation Of Patient Social Needs With Icd-10 Z-Codes, 2019-2020, Oluwatofunmi Jummie Akinwunmi

Public Health Theses

The 10th revision of the International Classification of Diseases (ICD-10) allows healthcare professionals to document social needs with ICD-10 Z-codes. Data derived from documentation of ICD-10 Z-codes can be leveraged to identify at-risk populations for targeted intervention. However, there remains concern for underutilization of these codes particularly in the pediatric population. We sought to examine the documentation of ICD-10 Z-codes in the pediatric outpatient setting of the largest Connecticut hospital network by specialty type and age group. We examined deidentified electronic health records of pediatric outpatient patients from 2019-2020. We used descriptive statistics to measure the proportion of patients with …

Exploring The Perceptions Of Genetics, Genetics Testing, And Science In People Of African Descent, Maame-Owusua Boateng

Public Health Theses

Background: Historical injustices towards Black populations in the United States have impacted how communities interact with medicine and public health such as medical experimentations, scientific racism, medical racism, and eugenics. Black communities are underrepresented in human genomics projects compared to those that identify as white or of European ancestry. Prior research has demonstrated that Black people are less likely to know about the availability of genetic testing for diseases and have less confidence in the benefits of genetic testing. These disparities make it imperative to understand the perspectives of people of African descent. Methods: The Black Genome Project is an …

A Dna-Extraction-Free Method For The Molecular Detection Of Streptococcus Pneumoniae Carriage In Saliva, Tzu-Yi Lin

Public Health Theses

Pneumococcal carriage is a prerequisite for pneumococcal disease and surveillance of carriage is crucial for evaluating and informing vaccination strategies. In recent years, molecular methods have improved the sensitivity of pneumococcal carriage detection as compared to the gold standard culture-based method. However, nucleic acid extraction from samples collected is resource-intensive, limiting scalability for extensive surveillance, particularly in low-resource settings. We previously developed a saliva-based PCR test for SARS-CoV-2, having identified that nucleic acid extraction can be omitted and replaced with a simple enzymatic lysis or heat treatment step without compromising the accuracy and efficiency of testing. Here, we compared pneumococcus …

Assessment Of Environmental Injustice: Spatial Analysis Of Pennsylvania Drilling Waste Facilities And Community Demographics, Avery Naperala

Public Health Theses

Background: Unconventional oil and gas drilling practices have led to the production of technologically-enhanced naturally occurring radioactive materials (TENORM) and chemical waste products, with insufficient toxicological data to understand the health impacts of exposures to these waste materials (U.S. Energy Information Administration, n.d.; US EPA, 2015b; ALNabhani et al., 2016; Elliott et al., 2017). Environmental injustices occur when disadvantaged populations experience a disproportionate burden of exposure to environmental disamenities, such as waste facilities (US EPA, 2015a). This study aims to assess whether disparate exposure to drilling waste facilities is occurring in Pennsylvania based on several socioeconomic factors, as well as …

The Impact Of The Covid-19 Pandemic On Non-Typhoidal Salmonella Incidence And Exposures In Connecticut, 2015-2022, Adeline Morris

Public Health Theses

Background: During 2020, Salmonella incidence decreased by 22% in the United States.1 At the same time, many common activities were reduced or restricted, including travel and eating food prepared at restaurants or events, which are known risk factors for Salmonella infection. Methods: A descriptive analysis using Salmonella surveillance data collected in Connecticut between 2015 to 2022 was performed to characterize the changes in travel and outside food exposures. Frequencies of exposures were compared before the pandemic, during the pandemic, and after the vaccine was implemented and restrictions eased. Rate ratios of observed to expected cases were calculated to explore trends …

Antibiotic Prophylaxis For Prevention Of Surgical Site Infections In Orthopedic Surgery, Edwin Ruiz Fuentes

Public Health Theses

Background: In the past decades, there has been an increase in the proportion of orthopedic surgical site infections (SSIs) caused by gram-negative bacilli in various healthcare settings. SSI prevention guidelines suggest that gentamicin can be added to prophylactic antibiotic treatment to target gram-negative bacilli. However, the effectiveness of this strategy remains to be confirmed in orthopedic surgery.

Methods: A retrospective cohort study was conducted to investigate the association between antibiotic prophylaxis with adjunctive gentamicin and SSI rates in orthopedic surgeries. 5,571 patients who underwent hip, knee, spine, and hip fracture surgeries between January 2019 and July 2021 at Yale-New Haven …

Dengue Fever With Normal Platelet Count In A Patient With Β-Thalassemia Trait: A Case Report, Pankaj Kumar Jain, Manoj Seval, Vikas Meena, Rajesh Yadav

Digital Journal of Clinical Medicine

Dengue fever is an arboviral infection typically characterized by thrombocytopenia and hemoconcentration. However, hematological manifestations may differ in patients with underlying hemoglobinopathies. We report a case of 18-year-old female diagnosed with dengue fever (IgM ELISA positive), presented with persistent fever, vomiting, and myalgia. Laboratory evaluation revealed moderate microcytic anemia (Hb 9.7 g/dL, MCV 54.7 fL) with a low Mentzer index (8.7). High-performance liquid chromatography confirmed β-thalassemia trait (HbA2 4.6%). Contrary to the typical presentation of dengue, the patient had elevated platelet counts at admission (584,000/µL), which remained within normal to high range during hospitalization. This case highlights that dengue infection …

Adverse Maternal, Fetal, And Newborn Outcomes Among Pregnant Women With Sars-Cov-2 Infection: An Individual Participant Data Meta-Analysis, Emily R. Smith, Erin Oakley, Gargi Wable Grandner, Kacey Ferguson, Fouzia Farooq, Yalda Afshar, Mia Ahlberg, Homa Ahmadzia, Victor Akelo, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Introduction: Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.

Methods: We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.

Results: We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.

Pregnant women with …

Understanding Maternity Care Providers’ Use Of Data In Southern Tanzania, Regine Unkels, Fadhlun Alwy Al-Beity, Zamoyoni Julius, Elibariki Mkumbo, Andrea B. Pembe, Claudia Hanson, Helle Molsted-Alvesson

Obstetrics and Gynaecology, East Africa

Introduction: Health information management system data is collected for national planning and evaluation but is rarely used for healthcare improvements at subnational or facility-level in low-and-middle-income countries. Research suggests that perceived data quality and lack of feedback are contributing factors. We aimed to understand maternity care providers’ perceptions of data and how they use it, with a view to co-design interventions to improve data quality and use.

Methods: We based our research on constructivist grounded theory. We conducted 14 in-depth interviews, two focus group discussions with maternity care providers and 48 hours of observations in maternity wards to understand …

Social Vulnerability And Racial Disparities In Overall Survival Among Endometrial Cancer Patients, Alfonsus Adrian Hadikusumo Harsono

All ETDs from UAB

Introduction. Social vulnerability (SV) refers to potential negative effects on communities caused by external stresses on human health. The CDC/ATSDR Social Vulnerability Index (SVI) scores communities on 15 social indicators in 4 themes: (1) socioeconomic status (SES), (2) household composition and disability, (3) minority status and language, and (4) housing type and transportation. An overall score ranging from 0 (least vulnerable) to 1 (most vulnerable) is calculated to estimate vulnerability. We investigated whether SV as measured by the SVI can explain why black endometrial cancer (EC) patients survive less well than do white EC patients. Methods. We studied the survival …

Identifying The Factors Influencing Hiv Testing And Safe Sex Practices: An Ecological Approach, Shekwonya Evelyn Samuel

All ETDs from UAB

Introduction: HIV (Human Immunodeficiency Virus) is a sexually transmitted infection (STI) that is still a major health issue in the United States and the world. Emerging adults are more likely to engage in risky sexual behaviors such as multiple sexual partners and unprotected sex. HIV testing contributes to ending the HIV epidemic by identifying at-risk individuals and promoting early diagnosis.Methods: Secondary data analyses of the City Health II dataset were conducted to 1) identify the association between HIV testing and risky sexual behaviors among Black/African American emerging adults ages 18-25 years living in Birmingham metro area, 2) use social network …

Association Between Covid-19 Health Knowledge, Self-Efficacy And Preventive Behaviors Among Nursing Students, Josephine Miane Britanico

Walden Dissertations and Doctoral Studies

Abstract Nursing students possess valuable public health knowledge to prevent the spread of COVID-19 infection. They can provide health education to the public with reliable information and adequate resources. To better understand the role nursing students can take in prevention efforts, the purpose of this quantitative correlational study was to examine the association between COVID-19 health knowledge, self-efficacy, and preventive behavior among undergraduate nursing students. The health belief model was the theoretical framework that guided this study. The primary research questions assessed (a) if there was a statistically significant association between COVID-19 health knowledge and preventive behavior among nursing students, …

Navigating Missed Visits In Hiv Primary Care: Exploring Risk Factors Associated With Missed Visits, Jiaying Hao

All ETDs from UAB

The HIV care continuum is a public health model that outlines the steps or stages people with HIV go through from diagnosis to achieving and maintaining viral suppression. Retention in care, a key component of the HIV care continuum, is critical in achieving good health outcomes for people with HIV (PWH) and preventing HIV transmission. Consistent HIV care is essential for the health of PWH as a part of retention in care. De-spite no standard measure for retention in care to PWH, the missed (no-show) vis-its/appointments is one of the most commonly used methods for evaluating retention in HIV care. …

The Genetic Epidemiology Of Complex Lung Diseases, Ava Claire Wilson

All ETDs from UAB

This research utilizes precision medicine techniques to advance our understanding of Chronic Obstructive Pulmonary Disease (COPD) and Idiopathic Pulmonary Fibrosis (IPF) with the overall goal of improving the etiology of and identifying molecular targets and pathways in COPD and IPF to help improve patient outcomes. We aimed to 1) identify novel drug targets and uncover potential mechanisms by which pirfenidone and nintedanib attenuate fibrosis by performing an integrative ‘omics analysis of transcriptomics and proteomic responses to TGFb1-stimulated lung fibroblasts; 2) define a skeletal muscle fiber shift phenotype in both males and females with COPD and begin to disentangle underlying mechanisms …

Help-Seeking Behavior Of African American And Non-African American Victims Of Elderly Abuse, Tesfaye Yigletu Wosene

Walden Dissertations and Doctoral Studies

Elderly abuse is a pervasive public health problem in the United States. Most abuse and neglect go unreported due to barriers including fear for safety, concerns about the consequences, culture, lack of knowledge about elder abuse, shame, and self-blame. However, there is limited research on how race and ethnicity impact help-seeking behaviors of the elderly. This cross-sectional quantitative study examined the difference in reporting and help-seeking behavior between African American and non-African American victims of elderly abuse. Applying the behavioral model of health services use, this study involved a secondary data analysis using the Nation Elderly Mistreatment Study Wave II …

Health Literacy, Race, And Understanding Health Information Among Women, Adrienne Clark

Walden Dissertations and Doctoral Studies

Health literacy is a topic often referred to by public health professionals to help improve the health of a population. This study used a quantitative approach to understanding health information among women of different races, income levels, household sizes, and education levels within a specific age range. This study used the socio-ecological model for its framework. The overall goal of this study was to improve health disparities and improve health communication one population at a time. Women tend to be the pillar of communities. Having a better understanding of how women understand health information could improve public health outreach. The …

A Community-Based Distribution Intervention For Family Planning Among Women In Northern Nigeria, Joy Matau Garba

Walden Dissertations and Doctoral Studies

In Northern Nigeria, inadequate information on family planning contributes to high mortality and morbidity rates in women of reproductive age due to multiple childbirths yearly. This study aimed to examine the relationship between the community-based distribution (CBD) strategy, religion, and attitudes toward family planning methods. Rosenstock’s health belief model, which can be an instrumental anchor for health promotion programs, was the theoretical framework for the quantitative cross-sectional study design. The data source was survey questionnaires administered by the U.S. Agency for International Development to 809 reproductive-age Nigerian women after implementing a CBD intervention. A multinomial logistics regression analysis showed that …

Improving Student Nurse Clinical Reasoning, Critical Thinking, And Clinical Judgment Through Simulation Debriefing, Deborah Brester

Walden Dissertations and Doctoral Studies

Simulation is an educational strategy in nursing education that incorporates structured activities that depict real-life situations to develop and enhance the knowledge, skills, and attitudes of nursing students by allowing them to analyze and initiate interventions for realistic situations in a simulated environment. Debriefing is a reflective process and is a key component in the simulation education process, but there is a lack of evidence on debriefing methods that enhance learning outcomes in nursing education. This study, which was guided by the National League for Nursing Jeffries simulation theory, was to determine the effect simulation debriefing, as assessed using the …

Self-Efficacy Facilitated Sleep, Physical Activity, Towards Regulating Bmi Of Permanent 12-Hour Shift Registered Nurses, Veronica Brock

Walden Dissertations and Doctoral Studies

Shift workers with obesity-related comorbidities have reduced health and lifespan. Registered nurses (RNs) are ranked fifth among the most obese professionals in the United States, according to recent studies. Researchers have not examined the relationship between self-efficacy, physical activity, sleep, and 12-hour night shift RNs despite demonstrating that self-efficacy inspires confident health habits in the general population. For this quantitative study, the social cognitive theory was applied to study the interrelationships among the independent variables, sleep self-efficacy, self-efficacy for physical activity, and body mass index (BMI), with multiple dependent demographic variables, quality and quantity of sleep, and the level and …

Promoting Healthier Treatment Outcomes In Obese Cancer Patients Taking High Dose Methotrexate, Carly Dell'ova

Walden Dissertations and Doctoral Studies

Cancer and obesity rates continue to rise, creating enormous public heath burdens to the individual and at the national and global levels, reducing quality of life, and increasing spending. Moreover, the relationships between cancer and obesity are not well understood. A commonly used chemotherapy for several types of cancer is high dose methotrexate (HDMTX). Along with chemotherapy, especially at high doses, comes toxicity to specific organs and the entire body. However, limited research has been conducted on obese cancer patients as they are often excluded from clinical studies. Practitioners need to better understand how to dose these patients to provide …

The Experiences Of Middle-Aged Women In An Online Weight-Loss Community, Holly Fields

Walden Dissertations and Doctoral Studies

The obesity epidemic continues to be a public health crisis in the United States. The number of obese middle-aged women has risen dramatically over the past few decades. Despite multiple levels of support available, not all women are receiving the support they need to reduce overweight/obesity, as evidenced by the continuing rise in obesity. Using a qualitative phenomenological approach, this study examined middle-aged women's views on exercising, eating healthily, and social support in online weight-loss communities. For this study, the health belief model (HBM) and social learning theory (SLT) were used as conceptual frameworks to understand a person's behavioral intentions …