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Primary Care Characteristics And Medication Management Among Patients Receiving Office Based Opioid Treatment With Buprenorphine, Xinxin Du

Yale Medicine Thesis Digital Library

AbstractBackground: Office-based opioid treatment (OBOT) is an evidence-based treatment model for opioid use disorder (OUD) offered by both addiction and general primary care providers (PCPs). Calls exist for more PCPs to offer OBOT. Few studies have been conducted on the primary care characteristics of OBOT patients. Objective: To characterize medical conditions, medications, and treatment outcomes among patients receiving office-based opioid treatment (OBOT) with buprenorphine for OUD, and to describe differences among patients by age and by time in care. Methods: This study is a retrospective review of medical records on or before 4/29/2019 at an outpatient primary care clinic within …

Pet Imaging Reveals Reduced Synaptic Density In People With Well-Controlled Hiv Infection, Julian Joseph Weiss

Yale Medicine Thesis Digital Library

Background: Synaptic injury is a pathological hallmark of neurological impairment in people living with HIV (PLWH), a common complication despite viral suppression with antiretroviral therapy (ART). However, there are no biomarkers sensitive to neurocognitive impairment in PLWH. Measurement of synaptic density in living humans may allow better understanding of HIV neuropathogenesis and provide a dynamic biomarker for therapeutic studies. We applied novel synaptic vesical protein 2A (SV2A) positron emission tomographic (PET) imaging to investigate synaptic density in the frontostriatalthalamic region in PLWH and HIV-uninfected (HIV-) participants.

Methods: In this cross-sectional pilot study,13 older male PLWH on ART underwent neurocognitive assessments, …

This Place Is A Message: A Case Study Examining The Role Of Emotion, Storytelling, And Interactive Performance Art In Climate Change Communication, Maryanne Rebstock Cosgrove

Public Health Theses

Objectives. This Place Is A Message is a populist performing arts piece created by Faultline Ensembles to explore the relationship between the individual emotional experience and the collective trauma of the climate change crisis. Through personal narratives and emotional appeals, this production seeks to build community solidarity through community-led storytelling and harness participatory theater for climate change communication to be used to find climate solutions in a joint manner. Methods. Data was collected and analyzed using a mixed-methods approach utilizing self-reported surveys, including audience pre-show (N=75) and post-show (N=48) assessments and a survey of cast and crew members (N=14). Additionally, …

Using Community-Based Screening To Quantify The Relationship Between Hiv And Hypertension In A Rural South African Community, Jessica Ainooson

Public Health Theses

Background: Over the past three decades, the prevalence of hypertension has increased in sub-Saharan Africa, paralleling the HIV/AIDS epidemic. The aim of this study is to assess the relationship between HIV status and elevated blood pressure in a rural South African community. Methods: A secondary analysis was conducted from a community-based screening program providing TB/HIV/blood pressure/glucose screening in the rural sub-district of Msinga, KwaZulu-Natal, South Africa from 2011 - 2017. Descriptive analyses were used to characterize the frequency of measured and self-reported hypertension, HIV status, and sociodemographic variables. Multivariable logistic regressions were used to estimate the relationship between HIV status …

Descriptive Characteristics Of Injury Recidivism Among Adults In The Us: Population-Based Study, Mahna Alyami

Public Health Theses

Abstract

Introduction: In the United States (US), injury-related morbidity and mortality is a public health burden in terms of lives lost, healthcare costs, and lost productivity. In 2020, according to the Centers for Disease Control and Prevention (CDC), unintentional injuries were the fourth leading cause of death (200,955) behind heart disease, cancer, and COVID-19. Many of the studies of injury recidivism were limited to demographic data and often focus on a specific type of injury, such as motor vehicle crashes, interpersonal violence, or falls. The aim of this study is to present the descriptive characteristics of injury recidivism among adults …

Identification And Correction Of Normalized Deviance In Healthcare Systems To Prevent Healthcare-Associated Infections And Improve Patient Outcomes, Elliana Sophia Barbell

Public Health Theses

Introduction: In healthcare, normalized deviance is characterized by the steady transition away from standard practice toward variations in practice behaviors. This deviation presents minorly at first and is accepted to save time and increase efficiency. However, initial evaluations of innocuity do not represent actual safety. While the deviant practice may not cause immediate patient harm, its alignment with additional system weak points has the potential to lead to poor patient outcomes, including the development of healthcare-associated infections (HAI). One behavior that may influence HAI development and patient outcomes is hair removal during preoperative skin preparation.Methods: An observational study of hair …

Trends In Antimicrobial Resistant Non-Typhoidal Salmonella Before And After The Food And Drug Administration’S Guidance For Industry #213, United States 2013-2020, Lily Valentina Carruthers

Public Health Theses

Background: Previous research has shown a potential link between antibiotic use among food-producing animals and antimicrobial resistant enteric pathogens. In late 2016, the Food and Drug Administration completed the implementation of its Guidance for Industry #213, through which growth promotion was removed as an indication for use of medically-important antimicrobials among food-producing animals. This study aimed to describe trends in antimicrobial resistance among human Salmonella isolates from 2013-2020 in the United States before and after the implementation of this regulation.Methods: All non-Typhoidal Salmonella isolates sent to the National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS) from 2013-2020 were included …

Exploring Climate Policy And Health Perspectives In Samoa: A Mixed Methods Study, Erika-Ann Fumiko Kim

Public Health Theses

Background: Greenhouse gas emissions have driven human-induced climate change, bringing several impacts to small island nations in the Pacific. Samoa, a small island developing state located in the south Pacific Ocean, is at disproportionate risk from impacts of climate change such as rising surface temperatures, rising sea levels, increases in frequency and degree of heavy precipitation events, and increases in the frequency of droughts. Simultaneously, Samoan populations possess a high prevalence of non-communicable diseases such as diabetes, heart disease, and hypertension. For multiple decades, the Government of Samoa has framed climate change as a key issue that threatens the lives, …

Modeling The Effects Of Climate Factors On The Incidence Of Future Campylobacter Infections In Connecticut, Hannah Lemanske

Public Health Theses

Background & Introduction: Campylobacter is one of the most common foodborne bacteria in the United States, accounting for 48 million infections each year. Campylobacter infections can arise from consuming contaminated food, especially poultry, water, or contact with infected animals. Due to its strong seasonality, cases peaking in the summer and declining in the winter, potential relationships between climate and campylobacter have been analyzed.Methods: Weekly campylobacter surveillance data was obtained from the Connecticut Department of Public Health for 2000 through 2018. Historical and projected temperature and precipitation data were also gathered from the National Oceanic and Atmospheric Administration. A statistical analysis …

Evaluating The Cost-Effectiveness Of Varied Vaccination Strategies For Ebola Virus Disease In The Democratic Republic Of The Congo, Rachel Amanda Lobe-Costonis

Public Health Theses

Introduction: The 2018 outbreak of Ebola virus in the Democratic Republic of Congo was the first to occur in the context of an ongoing complex humanitarian emergency. Despite optimism for an effective response given the efficacious one-dose Merck vaccine (ERVEBO), the immense challenges to public health efforts caused by the ongoing armed conflict posed unprecedented complications to the recommended ring vaccination strategy. In the end, contract tracing efforts for ring vaccination reached only 82% of individuals at best estimate, and the outbreak lasted 89 weeks with a total cost of $734 million. In comparison, transmission dynamic modeling has shown the …

Epidemiology Of Covid-19 Hospitalizations In New Haven And Middlesex Counties, Connecticut, July - September 2021, Caroline Mary Mcwilliams

Public Health Theses

Abstract:Background. This thesis explores the epidemiology of COVID-19 hospitalization among residents of New Haven County and Middlesex County, Connecticut from July - September 2021 with an emphasis on quantifying racial/ethnic and SES disparities. Two previous studies, the first conducted from March - May 2020 and the second conducted from July - December 2020, used COVID-NET Surveillance data from New Haven and Middlesex counties to explore the same questions. This thesis will compare findings with these previous studies to better understand how the epidemiology of COVID-19 hospitalization and racial/ethnic and SES disparities have changed in New Haven and Middlesex counties. Methods. …

Factors Associated With Failure To Complete Multi-Dose Vaccine Series Among U.S. Children Ages 19–35 Months, National Immunization Survey-Child, 2019, Sarah Yukari Michels

Public Health Theses

Background: Most early childhood immunizations require 3-4 doses to achieve optimal disease protection. Failure to complete multi-dose vaccine series is an important driver of undervaccination. Our objective was to evaluate factors associated with starting but not completing all multi-dose series in the combined 7-vaccine series.

Methods: Using 2019 National Immunization Survey-Child data, U.S. children ages 19-35 months with provider verified vaccination data were classified in one of three vaccination patterns: (1) completed the combined 7-vaccine series, (2) missing ≥1 vaccine series (i.e., selective vaccination), or (3) all series initiated, but did not complete all multi-dose series (i.e., missing ≥1 dose(s)). …

The Behavioral Immune System: A Public Health Perspective: How Our Partisan Perceptions Of Sickness Influenced Population Health During The Pandemic, Senyte Pierce

Public Health Theses

Researchers propose that people have a disease-avoidance mechanism called thebehavioral immune system, which is intended to identify and prevent possible interactions with harmful infections. This thesis is intended to explain this phenomenon, one well researched in the fields of behavioral and evolutionary psychology, to public health professionals, who can use its hypothesized components to understand better how to support population health and wellbeing. In addition, the COVID-19 pandemic will serve as a case study to understand the limitations of the BIS as it relates to socio-cultural events and personal political identification. The behavioral immune system keeps individuals healthy by monitoring …

Novel Applications Of Music And Digital Media In Global Health Intervention And Education Initiatives During The Covid-19 Pandemic: A Case Study Of Bts And Army, Mariko Fujimoto Rooks

Public Health Theses

The Korean musical group BTS (full name Bangtan Seoyeondan/방탄소년단) is one of the world’s most commercially and artistically successful entertainment acts. BTS is primarily known for their domination of both Western and Korean musical markets, impressive digital media presence, major role in supporting the South Korean economy, and highly mobilized 400,000 member fandom known as ARMY. BTS and their parent company HYBE’s artistic creation and marketing model has long focused on creating “Music and Artists for Healing,” or using music and various forms of primarily digital content to connect with and improve health outcomes for fans. In response, ARMY have …

Prescriptive Faith: Carceral Health Beyond The Prison Walls, Shamar S. Smalls

Public Health Theses

Individuals who are exposed to the carceral system—specifically, solitary confinement are uniquely vulnerable to psychological and physical health conditions. However, the relationship between solitary confinement and physical health conditions are relatively underexamined, compared to mental health disorders. This analysis examines the potential for a risks’ association between solitary confinement and cardiovascular disease risk factors. Additionally, this study examines the relationship between spirituality as a self-efficacious coping measure for health-related outcomes. A cross-sectional analysis of 302 survey participants with a prior history of incarceration in a housing study (New Haven, CT) with a prior history of incarceration from Fall 2017 – …

Using A Dynamic Model To Assess Maintenance Of Deer Tick Virus Via Horizontal Transmission In Ixodes Scapularis Populations, Hannah Jane Sproch

Public Health Theses

IntroductionDeer Tick Virus—a lineage of Powassan Virus—is an emerging tick-borne flavivirus associated with high rates of morbidity and mortality. Although DTV infection is rare, there has been an observed increase in the number of human cases in recent decades, necessitating more public health attention. Ixodes scapularis ticks are known to be the primary vector of DTV. However, the enzootic cycle has yet to be fully characterized and there is evidence that horizontal transmission alone may be insufficient for DTV maintenance; it is hypothesized that vertical and co-feeding transmission are also necessary for sustained transmission.

MethodsA dynamic model was developed to …

Occupational And Socioeconomic Risk Factors Of Noise-Induced Hearing Loss, Rongcan Sun

Public Health Theses

Hazardous noise (>85 dBA) is among the most common occupational exposures and responsible for the majority of noise-induced hearing loss. Noise-induced hearing loss impacts many aspects of a person’s life, including workplace safety, daily routine, economic consequences, and quality of life. However, studies on the relationship between occupational noise exposure and hearing loss were usually done in specific industries rather than the general population. In addition, studies focused on associations between socioeconomic factors and hearing loss rarely take the type of occupation into consideration. In this study, we aim to evaluate both occupational noise exposure and socioeconomic status as …

Nutrition And Hookworm Infection: A Causal Analysis Of The Literature, Mengting Su

Public Health Theses

Hookworm infection is one of the neglected tropical diseases, particularly in low and middle-income countries, but we know relatively little about causal evidence related to malnutrition. This is mainly due to the relatively small research community compared to those investigating the impact of hookworm infection on host nutritional status and disease complications. Causal inference is critical in epidemiology and biomedical research because it can be a powerful tool in enlightening prevention efforts and developing etiology models. The application of causal criteria to address complex epidemiological research questions is indeed helpful in proposing more interventions to improve the health and well-being …

Synergistic Epidemic: A Case Study Of Covid-19 And Substance Use Disorder In New London, Ct, Mary Tate

Public Health Theses

The onset of the COVID-19 pandemic in March 2020, complicated the already ineffectual delivery of health care for historically hard-to-reach populations. Those who face housing insecurity, substance use disorders, unemployment, or uncertain immigration and insurance status were abandoned, as the mainstream U.S healthcare system struggled to cope under the pressure of the novel virus. While parallel public health crises were put on hold to deal with COVID-19, the pandemic collided with and exacerbated the ongoing opioid crisis. Using New London, CT as a case study, this project set out to address a gap in literature on the potential syndemic effect …

Quantitative Real-Time Pcr Assays For The Detection Of Leptospira, Alice Zhao

Public Health Theses

Leptospirosis is an infectious zoonotic disease caused by bacteria of the genus Leptospira. The genus is comprised of 40 pathogenic species divided among P1 (19) and P2 (21). Leptospirosis incurs a disproportionately large burden of disease in urban slum regions of developing countries that lack adequate sewage disposal, water treatment, and sanitation infrastructure. While P1 species have been identified in cases of human infection, it is unclear if all Leptospira species are capable of infecting humans, especially P2 species. Among P1 species, L. interrogans has been described as the most frequent specie to cause disease in both animals and humans, …

Risk Reduction Regarding Stigmatized And Marginalized Communities, Navin Kumar

Yale Graduate School of Arts and Sciences Dissertations

While there are several perspectives on marginalization, there are multiple marginalized individuals, social groups, and communities globally. This process of marginalization produces individuals, groups and communities which are refused complete privileges, rights, and power within the broader political and social framework. Social, cultural, biological, and economic factors can thus be used as yardsticks to marginalize individuals and communities. Marginalization can be based on gender, race and ethnicity, social class, and sexuality, among others. Clearly, marginalized communities face poorer health outcomes and these outcomes are sometimes linked to risky behaviors more prevalent in such demographics. Marginalization is associated with reduced health …

Cost-Effectiveness Analyses Of Typhoid Interventions In Epidemic And Endemic Settings, Maile Thayer Phillips

Yale Graduate School of Arts and Sciences Dissertations

Background: Typhoid fever is a major source of morbidity and mortality in developing countries, accounting for approximately 12-21 million infections, 119,000-269,000 deaths, and 2-23 million disability-adjusted life years (DALYs) annually. Typhoid fever is caused by infection with the bacteria Salmonella enterica serovar Typhi, which is mainly transmitted through fecal contamination of food or water. Due to these modes of transmission, most cases occur in low- and middle-income countries (LMICs) where sanitary conditions are poor and access to clean water and sanitation is not common. However, the scale of disease incidence is uncertain. Studies suggest that facility-based laboratory-confirmed estimates, the numbers …

Biological Mechanisms Linking Stress And Anhedonia, Colin Stanton

Yale Graduate School of Arts and Sciences Dissertations

Evidence from research across species suggests that stress exposure is linked with anhedonia (loss of pleasure and/or decreased motivation). However, the mechanisms through which stress might impact anhedonia remain unclear. Chapters 1 and 2 of this dissertation review putative etiological pathways from stress to anhedonia and discuss stressor characteristics that could inform experimental models of stress-induced anhedonia. Chapter 3 describes an attempt to identify which types of stress are most associated with anhedonia using stress interview data from multiple datasets. Unexpectedly, we found no credible effects on anhedonic symptoms for stressor chronicity, severity, dependence on behavior, or interpersonal focus. Instead, …

Immune Activation By Novel Allobaculum Species Reveals Reciprocal Epistasis Among Human Gut Commensals, Tyler A. Rice

Yale Graduate School of Arts and Sciences Dissertations

Gut commensal microbes that elicit human immune responses are noteworthy for their ability to influence both local mucosal inflammation and, more rarely, systemic antibody responses. Here we isolated and characterized novel strains belonging to genus Allobaculum from inflammatory bowel disease (IBD) stool samples. In defined gnotobiotic mouse models we recapitulated the inflammatory effects of Allobaculum sps. and their notable induction of systemic immune responses at baseline. A microbial ecology screen revealed that this taxon is inversely correlated with Akkermansia muciniphila, and co-colonization experiments uncovered microbe-dependent redirection of immune phenotypes, which we term reciprocal epistasis. These immunostimulatory gut commensal strains exemplify …

Viral Subjects: Stigma, Civil Society Activism, And The Making Of Hiv/Aids In Lebanon, Elizabeth Berk

Yale Graduate School of Arts and Sciences Dissertations

This dissertation examines HIV/AIDS in Lebanon. It asks how people living with this illness do so in light of civil society activism to overcome social stigma associated with HIV/AIDS and related issues. The first full-length ethnographic study of HIV/AIDS in the Middle East region, research for this project was conducted at various periods throughout 2015-2018 at civil society organizations, among physicians, and among people living with HIV. This dissertation employs the research techniques of semi-structured interviews, participant observation, and media analysis. It argues, overall, that the subjectivities of those living with, treating, and advocating for HIV/AIDS cannot be understood without …

Cross-Kingdom Expression Of Synthetic Genetic Elements Promotes The Discovery Of A New Class Of Nucleotide Analogs From The Human Microbiome, Jaymin Patel

Yale Graduate School of Arts and Sciences Dissertations

The ability to mobilize functional genetic cargo into a versatile array of hosts is a defining challenge, as scientists increasingly reprogram diverse organisms as living therapeutics, for bioremediation, and as foundries for producing materials and molecules. However porting genetic material to diverse recipients is challenged by barriers to robust expression and mobilization. To address these challenges, we have developed an approach that integrates computer aided redesign of genetic sequences that are subsequently mobilized, expressed, and characterized cross-kingdom in diverse microbial hosts, including Gram negative and positive bacteria and yeast. Using the technology developed in this thesis, we were able to …

Onward: An Ethnography Of Latina Migrant Motherhood During The Covid-19 Pandemic, Jessica P. Cerdeña

Yale Graduate School of Arts and Sciences Dissertations

This dissertation evaluates the experience of Latina migrant mothers living in New Haven, Connecticut amid the COVID-19 pandemic. I ask: How do Latin American migrant women accommodate traumatic histories and motherhood amid a global public health and economic crisis? This ethnography demonstrates the powerful ways women cope with histories of trauma and ongoing structural adversity. Using the metaphor of the monarch butterfly, I consider processes of migration from Latin America and adjustment to life in the U.S., motherhood including the sacrifices women make for the betterment of their children, and metamorphosis, or transformations in response to the COVID-19 pandemic and …

Philippine Deposit Insurance Corporation Annual Report 2020, Philippines: Deposit Insurance Corporation (Pdic)

Documents

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The Economics Of The Covid-19 Pandemic In Poor Countries, Edward Miguel, Ahmed Mushfiq Mobarak

Discussion Papers

The COVID-19 pandemic has upended health and living standards around the world. This article provides an interim overview of these effects, with a particular focus on low- and middle-income countries (LMICs). Economists have explained how the pandemic is likely to have differential consequences for LMICs, and demand distinct policy responses, compared to rich countries. We survey the rapidly expanding body of empirical research that documents its many adverse economic and non-economic effects in terms of living standards, education, health, and gender equality, which appear to be unprecedented in depth and scale. We also review research on successful and failed policy …

The Impact Of Community Masking On Covid-19: A Cluster-Randomized Trial In Bangladesh, Jason Abaluck, Laura H. Kwong, Ashley Styczynski, Ashraful Haque, Md. Alamgir Kabir, Ellen Bates-Jeffries, Emily Crawford, Jade Benjamin-Chung, Salim Benhachmi, Shabib Raihan, Shadman Rahman, Neeti Zaman, Peter J. Winch, Md. Maqsud Hossain, Hasan Mahmud Reza, Stephen P. Luby, Ahmed Mushfiq Mobarak, Abdulla All Jaber, Shawkee Gulshan Momen, Faika Laz Bani, Aura Rahman, Tahrima Saiha Huq

Discussion Papers

Background: Mask usage remains low across many parts of the world during the COVID- 19 pandemic, and strategies to increase mask-wearing remain untested. Our objectives were to identify strategies that can persistently increase mask-wearing and assess the impact of increasing mask-wearing on symptomatic SARS-CoV-2 infections.

Methods: We conducted a cluster-randomized trial of community-level mask promotion in rural Bangladesh from November 2020 to April 2021 (N=600 villages, N=342,126 adults). We cross-randomized mask promotion strategies at the village and household level, including cloth vs. surgical masks. All intervention arms received free masks, information on the importance of masking, role modeling by community …