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Cost-Effective Analysis Of Rotavirus Vaccination In Dhaka, Bangladesh Using A Dynamic Model Of Rotavirus Transmission, Anher Pinky

Public Health Theses

Background: Despite the global introduction of rotavirus vaccinations across countries, Rotavirus infections continue to be a

leading cause of severe, dehydrating gastroenteritis in children under the age of 5 (Crawford et al., 2017). Bangladesh

experiences an extremely high burden where rotavirus infections contribute to 6,000–14,000 deaths each year in children <5

years of age (Rahman et al., 2007). A cost-effective analysis can aid decision-makers in determining the pros and cons of

introducing a rotavirus vaccination program in limited-resource countries.

Objective: A cost-effectiveness analysis was developed to evaluate the potential benefits of introducing rotavirus vaccination.

The analysis performed aims to inform key …

“I Was Reaching Out For Help And They Did Not Help Me”: Mental Healthcare In The Carceral State, Anna Grace Preston

Public Health Theses

Background: Despite the limitations the carceral environment may impose on mental wellness, mental healthcare is increasingly becoming a carceral endeavor. Over the course of the last several decades, prisons and jails have become the de facto mental healthcare provider for thousands of incarcerated individuals. Furthermore, practices like mandated mental healthcare for supervised individuals further broaden the population experiencing mental healthcare within the criminal legal system at large. This study examines the perspectives of nine individuals who experienced mental healthcare within the carceral state, whether in prison or on parole or probation, with a special focus on how attributes of the …

The Undercurrents Of Disease In Armed Conflict: An Analysis Of Aggregate National Dstb And Mdr/Xdr Tb Screening & Diagnosis Trends During The 2022 War In Ukraine, Sakina Erika Reames

Public Health Theses

​​Tuberculosis (TB) is the second leading cause of death by an infectious disease worldwide after COVID-19. Extensive efforts have been made for decades to tackle this disease through bolstering healthcare systems especially in countries experiencing a disproportionate burden of TB. Ukraine is considered by the WHO to be one of the 30 high burden countries in the world with a notably high burden of MDR TB. In addition, Ukraine has the second largest HIV epidemic in Eastern Europe and Central Asia as well as the fifth largest number of extensive drug resistant cases in the world. Ukraine has made extensive …

Developing And Using Cholera Models In Northwest Syria, Emily Rose Tobik

Public Health Theses

Researchers have utilized transmission dynamic modeling to determine interactions between hosts and pathogens in many humanitarian settings. However, modeling for the cholera outbreak in Northwest Syria (NWS) has yet to be completed. This thesis presents a path towards cholera model building in NWS by investigating the current cholera outbreak, outlining how to create a compartmental model in this region given its complexities, and determining ways potential cholera models could be utilized in NWS. Intricacies involving the region's ongoing civil war, significant internally displaced persons (IDP) population, and the February 2023 earthquake add complexities to modeling in this region. For the …

Almajiri Health; A Scoping Review On Disease, Health Literacy And Space For Participatory Research, Muzzammil Imran Muhammad

Yale Medicine Thesis Digital Library

Introduction

Almajirai are male children who leave the care of their parents to learn the Qur’an and study Islam under the tutelage of a Mallam or Imam at a Tsangaya. Almajiranci refers to the system of education based on this relationship between almajiri and mallam, and which was the dominant mode of education in precolonial Hausaland – Northern Nigeria and Southern Niger. This system remains widespread and popular in both countries. In recent years, discourse around almajirai has featured prominently in media from and about this region, and has associated almajiranci with non-participation in formal education, abuse, poverty, and underdevelopment. …

“I Was Reaching Out For Help And They Did Not Help Me”: Mental Healthcare In The Carceral State, Anna Grace Preston

Yale Medicine Thesis Digital Library

Background: Despite the limitations the carceral environment may impose on mental wellness, mental healthcare is increasingly becoming a carceral endeavor. Over the course of the last several decades, prisons and jails have become the de facto mental healthcare provider for thousands of incarcerated individuals. Furthermore, practices like mandated mental healthcare for supervised individuals further broaden the population experiencing mental healthcare within the criminal legal system at large. This study examines the perspectives of nine individuals who experienced mental healthcare within the carceral state, whether in prison or on parole or probation, with a special focus on how attributes of the …

The Synergy Between Physiologic Dendritic Cells And Mrna-Loaded Lipid Nanoparticles And Its Potential As A Cellular Immunotherapy, Brian Myles Wei

Yale Medicine Thesis Digital Library

Transimmunization (TI) is a dendritic cell (DC)-based immunotherapy derived from extracorporeal photochemotherapy (ECP), a widely used immunotherapy for cutaneous T cell lymphoma. TI builds upon the mechanistic understanding that ECP inducts large-scale monocyte-to-dendritic cell differentiation through physiologic platelet-monocyte interactions that occur during the passage of cells over a plastic plate. While TI and ECP have used apoptotic tumor cells treated with 8-methoxypsoralen (8-MOP) and ultraviolet-A (UVA) irradiation as the source of antigens by which to target its immunotherapeutic effects, there is investigational interest in alternative antigen sources, including mRNA-containing lipid nanoparticles (LNP). In this work, we developed a modified version …

A Deeper Dive Into Food Insecurity Among Women Involved In The Criminal Justice System, Jessica Robles

Public Health Theses

Background: The U.S. has the highest incarceration rate globally and a recent study found that 91% of formerly incarcerated individuals report being food insecure. Given that, women have become the fastest-growing segment in the incarceration system. Women who are involved in the criminal justice system (WICJ) are more at risk for experiencing food insecurity and chronic diseases. Therefore, this study aims to contribute to existing knowledge on the overall health of WICJ by assessing the prevalence of food insecurity and the social determinants of health (SDOH) that may contribute to food insecurity.Objective: To provide information on the overall health of …

Chagas Disease Screening: Awareness, Practices And Perceived Barriers Among Health Care Providers In Connecticut, Erica J. Rayack

Public Health Theses

Background: An estimated 288,000 people in the United States are infected with Chagas disease. Despite published recommendations for health care providers, the neglected nature of this disease persists, in part due to gaps in knowledge and low levels of Chagas disease awareness among health care providers. A survey was emailed to health care providers to assess knowledge, screening practices and provider-perceived barriers to screening for Chagas disease.

Methods: The survey link was emailed to healthcare providers and department heads. Providers answered a series of questions categorized either as knowledge (K), practice (P), or perceived barriers (B), which were then scored …

Towards A Saliva-Based Pcr Test For The Detection Of Mpox, Russell J. Thomas

Public Health Theses

Current recommendations for the diagnosis of mpox (monkeypox) rely on lesion-swabs as the gold-standard specimen type even though many patients experience symptoms prior to lesion-onset. Earlier detection could bolster the mpox response by mitigating transmission and facilitating access to antiviral treatments. In this study, we validated five PCR assays and compared their detection of mpox virus DNA extracted from 30 saliva specimens collected into Spectrum SDNA-1000 tubes. We found the Logix Smart™ Mpox (2-Gene) RUO assay (Co-Diagnostics, Inc., Salt Lake City, UT) performed statistically significantly better than the other assays. Next, we tested five raw (unsupplemented) known-positive saliva samples in …

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 …

Hiv Treatment Patterns Across A Us Data Network: 2012-2021, Raechel Elizabeth Davis

Public Health Theses

IntroductionOnce-daily combination antiretroviral therapy is recognized as the standard treatment for people living with Human Immunodeficiency Virus (HIV) in the United States.1,2 Treatment strategies for HIV have changed substantially over the years, influenced by individual and clinical factors, new medication options, and changing clinical guidelines.1–3 Observational data sources provide a unique opportunity to characterize populations and provide insight into medication usage under real-world conditions that differ systematically from controlled trial scenarios.3,4 Methods We evaluated the treatment patterns and characteristics of 12288 individuals diagnosed with HIV and continuously treated with antiretroviral medications across four, US-based observational databases using the Observational Health …

“You Are Just Trying To Make It Work”: A Qualitative Exploration Of Healthcare Provider Implementation Considerations For Integrating Mental Health And Hiv Care In Central Uganda, Divya Gumudavelly

Public Health Theses

There is a growing push to integrate mental health services within HIV care in urban Uganda. Amidst HIV clinics becoming comprehensive healthcare centers, there is a critical need to understand how providers can better adopt and implement mental health specific protocols in HIV practice. Semi-structured interviews were conducted with 16 healthcare providers at two different HIV care centers to understand current practices, routines, barriers, and facilitators to implementing mental health care services within HIV care. Abductive thematic analysis, drawing from Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF) frameworks, was used in conjunction with constructivist grounded theory …

Optimization Of An Elisa-Based Leptospirosis Diagnostic, Kevin Yuhang Zhao

Public Health Theses

Leptospirosis is an infectious zoonotic disease responsible for about 1 million cases annually. Issues in early diagnosis is a major contributor towards poor health outcomes. Current tests for diagnosis, such as whole-cell ELISA-based diagnostics or the microscopic agglutination test (MAT), importantly lack sensitivity during acute-phase disease. Therefore, creating an ELISA-based diagnostic, which is generally cheaper and easier to perform than the MAT, using highly-conserved targets, that has high sensitivity towards acute-phase disease, would be desirable. This study first attempted to optimize protocols for diagnosis, and next applied the optimized protocol against epitopes derived from hamsters vaccinated with a multi-recombinant protein …

Effect Of Digital Public Health Campaigns By The World Health Organization On Self-Reported Behavior, Recall/Knowledge, And Attitude Toward Interventions Related To Covid-19: A Meta-Analysis, Zili Zhou

Public Health Theses

The COVID-19 pandemic highlighted the need for effective scientific communication. The success of public health interventions are largely dependent on public knowledge and behavior. With the global rise of social media usage, as well as the increased prevalence of social media advertisement campaigns, the platforms present a tool with the potential to be utilized by public health authorities to deliver information and influence broad populations within a short period of time. From 2020 to 2022, the World Health Organization conducted 58 social media campaigns, totaling 176 brand-lift studies, in partnership with Meta on the subject of COVID-19. The campaigns conveyed …

The Undercurrents Of Disease In Armed Conflict: An Analysis Of Aggregate National Dstb And Mdr/Xdr Tb Screening & Diagnosis Trends During The 2022 War In Ukraine, Sakina Erika Reames

Public Health Theses

​​Tuberculosis (TB) is the second leading cause of death by an infectious disease worldwide after COVID-19. Extensive efforts have been made for decades to tackle this disease through bolstering healthcare systems especially in countries experiencing a disproportionate burden of TB. Ukraine is considered by the WHO to be one of the 30 high burden countries in the world with a notably high burden of MDR TB. In addition, Ukraine has the second largest HIV epidemic in Eastern Europe and Central Asia as well as the fifth largest number of extensive drug resistant cases in the world. Ukraine has made extensive …

Vector Status Of Aedes Albopictus In Connecticut: Analyses Of Invasion Pattern, Geographic Distribution, And Disease Risk, Meredith Bagger

Public Health Theses

Introduction: Aedes albopictus is a highly successful invasive mosquito. Its presence and expansion into Connecticut have implications for human and animal health. The factors limiting Ae. albopictus spread and risk by the pathogens it carries have not been previously examined. Methods: This study leveraged data from the Connecticut Mosquito and Arbovirus Surveillance Program during 2006-2022 and a project designed to characterize mosquito-borne filarial parasite species in Connecticut from 2020-2021. We examined correlations between mosquito abundance and winter temperature as well as land use. We described the arboviruses detected in Ae. albopictus collections and calculated the risk of Ae. albopictus transmitting …

Primary Liver Cancer In China From 2000-2020: Evolution Of Epidemiology, Clinical Disease, And Therapy, Wanqing Chi

Public Health Theses

Background & Aims: China contributed to 49% of all liver cancer deaths worldwide in 2020. We sought to investigate the relationship between clinical characteristics, antiviral therapy (ART), and multiple risk factors that affect the prognosis of primary liver cancer (PLC) patients over time to highlight proper chronic liver disease management.Methods: We identified 1322 PLC patients diagnosed between 2000 to 2020 in a major academic teaching hospital in Shanghai, China. We used descriptive epidemiology to characterize the evolution of liver cancer in China, and Cox proportional hazard models and Kaplan-Meier survival analysis to assess the relationship between evolving ART and survival …

Prevalence And Genetic Determinants Of Vancomycin Resistance Of Clostridioides Difficile Isolates In Connecticut, Zeyu Fu

Public Health Theses

AbstractIntroduction: The emergence of vancomycin-resistant strains of C. difficile has become a growing concern, as it can lead to treatment failure and increased morbidity and mortality. In this study, we aimed to investigate the prevalence and mechanisms of vancomycin resistance in C. difficile isolates in Connecticut from patients with confirmed C. difficile infection at Yale New Haven Hospital. Methods: We collected 89 stool samples from patients with confirmed C. difficile infection, isolated C. difficile, and performed susceptibility testing on the isolates using the E-strip test method. Isolates with an MIC value below 4 μg/ml were classified as susceptible and isolates …

Attribution Of Febrile Illness To Circulating Respiratory Viruses In The United States, July 2016 - March 2023, Lily Kitfield-Vernon

Public Health Theses

Background: SARS-CoV-2, an emerging epidemic respiratory virus, has circulated in the United States since early 2020. The dynamics of Influenza (flu) and Respiratory Syncytial Virus (RSV) have shifted, causing atypical timing and levels of illness across the country and in particular age groups. Fever, recorded on at-home bluetooth-enabled thermometers, is a promising new tool with which to monitor respiratory disease. Quantifying the proportion of fever attributable to these three viruses, at a particular time or within a particular age group, would strengthen the collective understanding of viral circulation in the U.S., and enable the use of fever data in the …

Protection Against Cholera From Killed Whole-Cell Oral Cholera (Kocv) Vaccines: Systematic Review And Meta-Regression Of Randomized Control Trials And Observational Studies, Helena Hojeong Kwon

Public Health Theses

Introduction: Although killed whole-cell oral cholera vaccines (kOCVs) are widely used as a part of cholera control strategy, mixed evidence around the vaccine induced protection remains.Objectives: The primary objective of this systematic review was to update estimates of kOCV protection: vaccine efficacy and effectiveness. A secondary objective was to estimate the waning dynamic of kOCV protection by duration of follow-up. Methods: On August 15th, 2022, we searched for randomized control trials and observational studies that reported kOCV protection in low- and middle-income countries on PubMed, EMBASE, Scopus, ISI Web of Science, and The Cochrane Review Library with a start date …

Drivers Of Global Waterborne Disease Transmission Following Extreme Precipitation Events: A Systematic Review, Claire Latendresse

Public Health Theses

Precipitation events such as hurricanes, typhoons, and heavy rainfall can have devastating impacts on water and sanitation infrastructure around the world and have led to large-scale waterborne outbreaks. As climate change amplifies the frequency and intensity of extreme weather events, it is also triggering an increase in waterborne disease transmission. This master’s thesis consists of a systematic review of academic literature pertaining to extreme precipitation events and the pathways by which they trigger waterborne outbreaks.

A systematic review of the literature in PubMed was conducted to identify waterborne disease outbreaks associated with extreme precipitation. The initial search yielded 3,248 results …

The Ethical And Legal Considerations Of Ai-Driven Healthcare In Infectious Diseases, Natalie Makableh

Public Health Theses

Artificial intelligence (AI) has been rapidly growing in the healthcare sector, with the potential to improve patient outcomes, increase efficiency, and reduce costs. However, as with any technological advancement, AI-driven healthcare presents ethical and legal challenges that must be addressed to ensure the responsible and beneficial use of the technology. To the best of our knowledge this is the first study to examine the ethical and legal considerations of using AI technology in healthcare, with a particular focus on infectious diseases. With the growing use of AI in healthcare, it is crucial to evaluate its potential benefits and challenges in …

Knowledge, Attitudes, And Practices (Kap) About Lassa Fever Prevention And Control: A Survey Of Three Rural Communities In Central Liberia-Epidemiology Of Microbial Diseases, Joseph Gibson Jepru Lewis

Public Health Theses

Introduction: Since the discovery of Lassa fever in 1969 in Nigeria, the disease has become endemic in many West African countries. An estimated 500,000 cases of Lassa fever virus occur each year, leading to approximately 5,000 deaths annually. Liberia continues to record outbreaks almost every subsequent year in regions once considered non-endemic. With no effective vaccines, many studies have underscored the importance for residents in Lassa-endemic regions to have good knowledge and good prevention practices in place to prevent Lassa fever.

Methods: A cross-sectional data extracted from a longitudinal, observational, cohort study conducted using voluntary participant self-reported and study visits …

Demographics Of Hospitalized Covid-19 And Influenza Cases In Connecticut During The 2021-2022 Influenza Season: Is There Evidence Of Viral Interference?, Molly Mclaughlin

Public Health Theses

Since the COVID pandemic began in March 2020, the epidemiology of influenza has changeddramatically in the United States. During the 2021-2022 influenza season in Connecticut, only 262 hospitalized influenza cases were recorded in New Haven and Middlesex Counties from October 2021-June 2022, while there are usually well over 1,000 cases in a single season. While the decline in influenza cases could be due to preventive measures adopted early in the pandemic, viral interference could also be to blame. Viral interference is the process by which infection with one virus transiently protects against infection by another virus via a generalized immune …

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 …

Impact Of The Covid-19 Outbreak On Mental Health And Public Practices In Rural Communities In China, Wenxin Liang

Public Health Theses

Coronavirus disease (COVID-19) has significant impact on people’s mental health. However, no nationwide study has investigated the mental health among rural residents during the COVID-19 outbreak in China. This study was aimed to investigate the impact of the COVID-19 outbreak on the mental health and public practices for controlling and preventing the COVID-19 in rural communities in China. An anonymous online survey was sent to participants through WeChat, the most widely used Chinese social-networking app, from March 2 to 11, 2020. We recruited 4607 individuals from 11 representative provinces in mainland China. The analytical sample was 2159 rural residents. The …

Indirect Effects Of Covid-19 Vaccination Against Sars-Cov-2 Omicron: Rapid Review & Meta-Analysis, Brett Anthony Martini

Public Health Theses

Background: First identified in Wuhan, China in late 2019, the infectious viral disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions of lives worldwide and poses the largest public health crisis in the past century. The development and deployment of vaccines have been a key public health measure to mitigate the subsequent harm associated with the viral infection. Despite the mRNA vaccine platform being in development for 15+ years, the mass vaccination campaigns were the first large-scale use of this technology, leaving much to be learned about their effectiveness and longevity. Mass vaccination campaigns influence …

Epidemiology Of Human Hookworm (Necator Americanus) Infection In Rural Ghana: Investigating Host-Parasite Factors That Mediate Infection, Savanna Randi

Public Health Theses

Abstract

Introduction: Hookworms are soil-transmitted helminths (STHs) that cause significant morbidity in high-risk populations, posing a global health concern in locations of rural poverty [1-5]. While there have been ventures by the World Health Organization to eliminate hookworms in Africa by 2030, there is variability in the effectiveness of current chemotherapy regimens. Studies have shown that benzimidazole anthelmintics have reduced effectiveness, and people living in endemic areas are quickly reinfected [6]. Critical gaps remain in understanding parasite-host interactions within communities, further challenging successful disease control. A study initiated in 2022 investigated the epidemiology of human hookworm infection in Beposo, Ghana. …

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 …