Digital Commons Network^™

The Hiv Care Continuum And Barriers To Viral Suppression Among Men Who Have Sex With Men In Greater Kuala Lumpur, Malaysia., Lauren Haerin Kim

Public Health Theses

Background: Men who have sex with men (MSM) now account for nearly half of all new HIV cases in Malaysia. There has been little research, however, characterizing the HIV care continuum among MSM living with HIV in Malaysia. This study describes the HIV care continuum and examines factors associated with HIV viral non-suppression among newly diagnosed MSM living with HIV in Kuala Lumpur, Malaysia.

Methods: We enrolled 163 MSM living with HIV who were in care at a major university hospital in Kuala Lumpur, Malaysia. Participants completed a self-administered questionnaire. Electronic medical chart review also provided data on engagement in …

Investigating The Community-Level Variation In Hookworm Prevalence In The Kpandai District, Ghana: A Mixed-Methods Study, Harry Hyunteh Hyunteh Kim

Public Health Theses

Soil-transmitted helminths are a major cause of disability and morbidity in resource-poor settings: over 1.5 billion are estimated to be at risk of infection. Human behaviors and household socioeconomic conditions that facilitate contact with contaminated soil may increase exposure to parasites. The primary objective of the study was to investigate the community-level variation in hookworm prevalence in the Kpandai district of Ghana.

We used a mixed-methods approach to investigate behavioral, societal and environmental risk factors to hookworm exposure. 264 individuals from three neighboring villages (Jagbigbingdo [JG], Takumdo [TK], Wiae Chabor [WC]) were recruited using a convenience sampling strategy. Household questionnaires …

Prevalence, Awareness And Control Of Hypertension And Diabetes Among Hiv Positive And Negative Patients At The Military Hospital Of Douala, Cameroon, Duane Killian Madziva

Public Health Theses

Background: With anti-retroviral therapy (ART) prolonging the survival of people of living with HIV/ AIDS, other chronic co-morbidities such as hypertension, and diabetes are becoming an increasing problem. Studies on hypertension and diabetes in Sub-Saharan Africa are still limited, even with the growing concern of Africa’s dual burden of chronic and infectious diseases. As such, we aimed to determine the prevalence, awareness and control of hypertension and diabetes among people living with and without HIV/ AIDS in Cameroon. Methods: This was a hospital-based cross-sectional study conducted at the Military Hospital of Douala, Cameroon. Participants aged 21 – 65 years were …

Assessing The Functional Impact Of Pfrh5 Genetic Diversity On Erythrocyte Invasion Pathway Utilization In Plasmodium Falciparum, Adam Joseph Moore

Public Health Theses

Malaria is still responsible for over 405,000 deaths and 228 million cases of disease globally each year, with the large majority of these cases being caused by the Plasmodium falciparum parasite subspecies1. The RTS,S P. falciparum malaria vaccine, the only malaria vaccine ever licensed, is currently being rolled out in three African countries as part of a pilot implementation program and targets a major circumsporozoite protein (PfCSP). After three doses and a seven-year follow up, the vaccine showed a 7% efficacy on average with a -56.8% efficacy for patients in regions with above average exposure to P. falciparum2. While the …

Drug Use And Severe Outcomes Among Patients Hospitalized With Influenza Over Three Seasons, Christina Elizabeth Parisi

Public Health Theses

Influenza is a significant public health problem in the United States and around the world, causing considerable morbidity and mortality annually. Drug use is also a significant issue that is associated with numerous health complications and conditions. However, the relationship between severe influenza outcomes and drug use is not well understood. The objectives of this investigation are to compare the prevalence of demographic and behavioral factors associated with severe influenza outcomes between persons who use drugs (PWUDs) and non-PWUDs hospitalized with influenza and, by controlling for those factors we find are significant, determine if there is an association between severe …

Geospatial Analysis Of Drug-Resistant Tuberculosis In Santiago De Cali, Colombia, Oscar Norberto Perales

Public Health Theses

Infectious diseases like tuberculosis are undergoing an epidemiological transformation in developing countries such as Colombia and throughout Latin America. Recent economic and social developments may drive heterogeneous burdens of disease in the region, especially in urban settings. Geographic Information Systems (GIS) may allow us to better appreciate the geospatial distributions of TB in these contexts. In this study, we aimed to identify regions in Santiago de Cali facing disproportionate TB burdens and sought to determine whether the distribution of drug resistant TB differed. Additionally, we aimed to identify patient risk factors that could lead to differential drug resistance testing. This …

Evidence-Based Interventions For Antimicrobial Resistance In Conflict-Afflicted Lmics, Noora M. Reffat

Public Health Theses

Introduction: Although control strategies for antimicrobial resistance (AMR) have been described in high-income settings, interventions to curb the emergence and spread of AMR in conflict-afflicted low- and middle-income countries (LMICs) have not been systematically explored.

Objective: The objective of this review was to identify and assess the effectiveness of various control strategies in curbing the emergence and spread of AMR in conflict-afflicted LMICs.

Methods: A systematic scoping review of the literature was conducted using Embase, PubMed, and Scopus to identify primary literature reporting on AMR in Pakistan, Lebanon, Jordan, or Turkey published in the last decade (Jan. 2010 – Jan. …

Are Food Baskets Helpful For Refugees With Chronic Illnesses In Sub-Saharan Africa?, Anthony Russell

Public Health Theses

ABSTRACT

Refugees are among some of the most vulnerable populations in our world today. Food insecurity appears to be a consistent state among many refugee populations regardless of length of refugee status and setting. The primary study aims were to: a) identify factors influencing refugees’ ability to manage their chronic illnesses; b) describe food insecurity and dietary intake among refugees with chronic illnesses; c) understand the role food baskets play for this population.

A cross-sectional mixed methods study was conducted in two phases. Phase 1 consisted of 10 in-depth interviews with older adult refugees to identify factors influencing their management …

Nitrous Oxide: Use In Labor & Delivery And Steps Toward Healthcare Sustainability, Bethany Sanchez

Public Health Theses

Objective: This study explores trends in procurement for 3 hospitals in Connecticut over a four-year period to better understand how much N2O is released. N2O use and frequency of conversion to epidural after N2O, as well as emergency cesarean section after N2O use is also examined. A plan for N2O destruction technology testing is outlined.

Background: Nitrous Oxide (N2O) is a well-documented greenhouse gas (GHG) and ozone-depleting agent. N2O use continues to be unregulated, and concurrently it has also become more widely adopted for use in labor and delivery in the US, though it has been popular in Europe and …

Meteorological Determinants Of Mosquito Populations In Connecticut, Melpomene Vasiliou

Public Health Theses

As climate change continues at an alarming rate, it is important to quantify and characterize its wide-ranging impacts at both the global and more localized scales. This study aims to build on this body of evidence that details the local impacts of climate change that have already begun to and will increasingly harm human health. The study explores time trends in Connecticut’s mosquito abundance, as well as potential meteorological determinants of abundance for one key species. Secondary analysis using computational techniques was performed on mosquito abundance data provided by the Connecticut Agricultural Experiment Station (CAES). Simple linear regression was performed …

Evaluating The Appropriateness Of Oral Antibiotic Therapy Following Discharge For Patients With Urinary Tract Infection, Sera Yoo

Public Health Theses

Introduction: Inappropriate use of antibiotics is common in healthcare settings, with urinary tract infections (UTI) being one of the most common indications for antibiotic prescriptions. This study evaluated the appropriateness of oral antibiotic therapy among adult patients with suspected UTI who were admitted to Yale New Haven Hospital during January 2018. We hypothesized that 60% of antibiotics were inappropriate, and that inappropriate therapy was associated with Clostridioides difficile infection, hospital readmission and/or mortality.

Methods: We conducted a retrospective cohort study of adult patients who were admitted to Yale New Haven Hospital from January 1, 2018 to January 31, 2018. Data …

Hiv Testing During Antenatal Care In Eastern & Southern Africa: How Do Adolescents And Young Women Fare?, Claire Young

Public Health Theses

Background

To validate Elimination of Mother to Child HIV Transmission (eMTCT), pregnant women must receive antenatal care (ANC) HIV testing. Given challenges for adolescent girls in ANC, we hypothesized that adolescents were less likely to receive ANC HIV testing in Eastern and Southern Africa (ESA).

Methods

For 10 ESA countries, we use 2015-2018 Demographic and Health Surveys (DHS) to study 46,056 women attending ANC and giving birth in the last three years. We used age-stratified (15-19, 20-24, and 25-49 years of age at time of delivery) crude and adjusted logistic regressions to assess predictive factors for ANC HIV testing, both …

Bismarck To No Effect: Fertility Decline And The Introduction Of Social Insurance In Prussia, Timothy W. Guinnane, Jochen Streb

Discussion Papers

Economists have long argued that introducing social insurance will reduce fertility. The hypothesis relies on standard models: if children are desirable in part because they provide security in case of disability or old age, then state programs that provide insurance against these events should induce couples to substitute away from children in the allocation of wealth. We test this claim using the introduction of social insurance in Germany in the 1880s and 1890s. Bismarck’s social-insurance system provided health insurance, workplace-accident insurance, and old age pensions to a majority of the working population. The German case appeals because the social insurance …

Greater New Haven Community Index 2019, Mark Abraham, Camille Seaberry

Reports

No abstract provided.

Estimated Costs Of Injuries In College And High School Female Sports, Ray C. Fair, Christopher Champa

Cowles Foundation Discussion Papers

Injury rates in thirteen U.S. women’s college sports and four U.S. girls’ high school sports are examined in this paper. The sports are categorized as high injury (H) or low injury (L) and differences in injury rates between the two are examined. Estimates are presented of the injury savings that would result if the H sports were changed to have injury rates similar to those in the L sports. The estimated college savings are 13,610 fewer injuries per year and 2,020 fewer healthy years lost-to-injury per year. The estimated high school savings are 143,900 fewer injuries per year and 24,300 …

Initiating Buprenorphine In Patients Hospitalized With Intravenous Drug-Use-Related Endocarditis, Naiska Y. Cheung

Yale School of Medicine Physician Associate Program Theses

During the current opioid crisis, hospitalizations for the treatment of intravenous drug use-related infective endocarditis have increased. Despite this, opioid use disorder is inadequately treated resulting in continued drug use, higher surgical intervention, recurrence and mortality rates relative to non-drug use-related endocarditis. Buprenorphine* is a safe and effective medication-assisted addiction treatment in outpatient settings; however, buprenorphine remains underutilized, particularly among patients hospitalized for infective endocarditis. Emergency department-initiated buprenorphine combined with referral to ongoing treatment is associated with improved rates of addiction treatment engagement. Therefore, our objective is to investigate whether hospital-initiated buprenorphine combined with referral in patients with opioid use …

Yale Medicine Magazine, Spring 2019, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the Spring 2019 issue of Yale Medicine Magazine, v. 53, no. 2. Prepared in cooperation with the alumni and development offices at the School of Medicine. Earlier volumes are called Yale School of Medicine alumni bulletins, dating from v.1 (1953) through v.13 (1965) and Yale Medicine: alumni bulletin of the School of Medicine, v.1 (1965) through v. 52, no.1. (Autumn, 2017).

Non-Invasive Analysis Of The Sputum Transcriptome Discriminates Clinical Phenotypes Of Asthma, Xiting Yan

Yale Day of Data

Whole transcriptome wide gene expression profiles in the sputum and circulation from 100 asthma patients were measured using the Affymetrix HuGene 1.0ST arrays. Unsupervised clustering analysis based on pathways from KEGG were used to identify TEA clusters of patients from the sputum gene expression profiles. The identified TEA clusters have significantly different pre-bronchodilator FEV1, bronchodilator responsiveness, exhaled nitric oxide levels, history of hospitalization for asthma and history of intubation. Evaluation of TEA clusters in children from Asthma BRIDGE cohort confirmed the identified differences in intubation and hospitalization. Furthermore, evaluation of the TH2 gene signatures suggested a much lower prevalence of …

Controlling Pregnancy: Fred Lyman Adair And The Influence Of Eugenics On The Development Of Prenatal Care, Florence Hsiao

Yale Medicine Thesis Digital Library

This thesis examines the development of prenatal care in the United States in the early 1900s by focusing on the life and career of Fred Lyman Adair who, as an obstetrician and eugenicist, played a significant role in shaping prenatal care into what it is today. Although prenatal care was a product of infant welfare activists and public health officials, obstetricians like Adair who struggled to establish obstetrics as a legitimate specialty, saw an opportunity in prenatal care to pathologize pregnancy and elevate their specialty. Adair, therefore, became one of the foremost champions of prenatal care, and helped to standardize …

A Review On Antibiotic Stewardship In Pediatric Primary Care, Paulina Kaminski

Public Health Theses

Background. Misuse of antibiotics for upper respiratory tract infections (URTIs) in pediatric primary care settings persists despite growing concern over antibiotic resistance. Interventions aimed at improving prescription use, coined Antibiotic Stewardship Programs (ASPs) often target clinicians for improved clinical decision-making. More recently, ASPs have begun educating patients to antibiotic needs, and for pediatric cases, parents who might pressure clinicians into prescribing unneeded antibiotics. While many reviews have targeted adult patients or emergency settings, few evaluate practices for pediatric populations. For this reason, we performed a review of the literature to summarize common strategies used to reduce antibiotic overprescribing for pediatric …

Evaluating Fda Generic Approval After 2017 Agency Initiatives, Kuo Jiao

Public Health Theses

Importance: Generic drugs play an essential role in the US healthcare system, providing less costly alternatives to branded drugs that are equally effective and safe. The US Food and Drug Administration (FDA) regulatory policies influence the standards for generic drug approval. In 2017, the FDA instituted several initiatives to promote generic drug approval, particularly focused on those with limited competition.

Objective: To determine whether the initiatives begun by FDA in 2017 were associated with greater numbers of approvals of generic drugs with limited generic competition and histories of drug shortage.

Study Sample and Design: We conducted a cross-sectional study of …

Understanding How Displacement Affects Hiv Prevalence Among Displaced Populations- A Scoping Review, Ryan Evan Yucha

Public Health Theses

Over the course of the past two decades, the number of people who have been displaced has increased dramatically. With this brings a new set of health challenges for these populations as well as the countries to which these populations are displaced such as HIV/AIDS. There is evidence to show that forced displacement can cause an increase in the HIV prevalence among those displaced. However, there is evidence to suggest the contrary, as well.

The aim of this scoping review study is to determine what the existing literature can and cannot tell us about how forced displacement affects HIV prevalence …

Geospatial Analysis Of High-Grade Cervical Lesions To Address Health Disparities, Savanah M. Russ

Public Health Theses

Introduction: Incidence of high-grade cervical lesions (HGCL) caused by human papillomavirus (HPV) has declined in the U.S following the introduction of the HPV vaccine in 2006. However, disparities in HPV cervical infection and subsequent sequelae by race, ethnicity and income continue to persist. The purpose of this analysis was to identify spatial areas with significantly elevated HGCL burden in Connecticut, and determine socioeconomic characteristics associated with high incidence clusters.

Methods: Data from statewide surveillance in Connecticut for cervical intraepithelial neoplasia grades 2, 2/3, 3 and adenocarcinoma in situ (CIN 2+) from 2008-2016 were used for this analysis. Spatial analyses were …

Predictors Of Incomplete Evaluation Among Pediatric Household Contacts Of Pulmonary Tuberculosis Patients In Kampala, Uganda: A Secondary Analysis, Giyoung Lee

Public Health Theses

Background: Contact investigation is an active approach to identifying new TB cases by screening contacts of known patients for symptoms and risk factors. This is particularly important for child contacts of TB patients because young children are at higher risk of progressing to severe disease compared to adults. Moreover, children are unable or unlikely to travel to clinics for evaluation independently, so their access to TB evaluation may depend on the adults in their household.

Objective: To evaluate the association between individual- and household-level characteristics and completion of TB evaluation for children under 15 years.

Setting: Seven public tuberculosis (TB) …

Evaluating Clostridioides Difficile Infection (Cdi) Risk Factors By Comparing The Use Of Piperacillin/Tazobactam, Cefepime, And Ceftazidime, Shardul Rathod

Public Health Theses

Introduction: Over the past several years, Clostridioides difficile infection (CDI) incidence has been rising. The primary risk factor for CDI is antibiotic use. Many studies indicate that penicillin drugs are among the low-risk antibiotic classes associated with CDI whereas cephalosporin drugs are among the high-risk antibiotic classes. However, there is variation in studies evaluating the healthcare-associated CDI (HA-CDI) risk associated with antibiotics within a class and limited data comparing the use of penicillin versus cephalosporin drugs.

Methods: An observational cohort study was performed using patient data from BH and YNHH. Minitab (Version 18) was used to perform survival analysis and …

Single-Cell Transcriptomics In The Protozoan Parasite Trypanosoma Brucei During Acquisition Of Infectivity, Trisha Kaye Ramsdell

Public Health Theses

Single cell RNA-sequencing (scRNA-seq) is a recent innovation that allows sequencing of transcriptomes from a vast number of single cells, thus providing an unbiased view of cell-to-cell variability in gene expression within a population of cells. The Tschudi laboratory has previously established an in vitro differentiation system based on the inducible expression of the RNA-binding protein 6 (RBP6) in cultured non-infective procyclics, which recapitulates Trypanosoma brucei developmental stages that have been previously described in tsetse fly vector. Thus, I aimed to utilize scRNA-seq in this system to describe the potential heterogeneity in transcript abundance of known and suspected T. brucei …

The Care Of The Sexual Assault Patient, Eun Sook Choi

Yale Medicine Thesis Digital Library

Survivors of sexual assault (SA) experience a range of physical and mental health consequences. Despite universal agreement that follow-up care improves outcomes, studies demonstrate only one-third of survivors receive assault related follow-up care. This study aims to describe the patient population presenting after SA, characteristics of their acute care, and rates of follow-up within one-year at two sites of the Yale New Haven Hospital, which includes an urban tertiary care hospital (York Street Campus, YSC), and its satellite community hospital (St Raphael Campus, SRC). A retrospective medical record review was conducted of patients older than 12 years presenting after sexual …

The Reproductive Health Needs Of Women At Risk Of Hiv Infection In Connecticut, Emily Hoff

Yale Medicine Thesis Digital Library

Background: The number of women involved in criminal justice systems (WICJ) and women who use opioids has been dramatically increasing in the United States. An often-overlooked aspect of healthcare for women at risk of HIV infection (either WICJ or women who use drugs) is reproductive health. We aim to provide a framework, informed by a systematic review and primary data, to guide future interventions addressing the sexual and reproductive health (SRH) needs of women at risk of HIV infection.

Methods: We completed a systematic literature review of the pregnancy prevention and planning needs of US WICJ published in English from …

Csf Lymphocyte And Monocyte Activation And Trafficking In Primary Hiv Infection, Aveline Xiang Li

Yale Medicine Thesis Digital Library

Trafficking of immune cells to the central nervous system (CNS) is hypothesized to facilitate HIV entry and immune-induced neuronal injury, and is mediated by cell surface proteins such as chemokine receptors and integrins. We longitudinally assessed immune cell activation and surface marker expression in cerebrospinal fluid (CSF) and blood and their relationship with CSF HIV RNA during primary HIV infection (PHI) before and after combination antiretroviral therapy (ART). Longitudinal paired blood and CSF were obtained in initially ART-naïve PHI (infection) participants; some subjects independently initiated ART during follow up. Multiparameter flow cytometry was used to determine activation (% CD38+HLADR+) and …

The Role Of Traf3 And Cyld Mutationin The Etiology Of Human Papillomavirus Driven Head And Neck Cancers, Tejas Sudarshan Sathe

Yale Medicine Thesis Digital Library

The incidence of HPV-positive head and neck squamous cell carcinoma (HNSCC) con-tinues to rise. Though HPV positivity is correlated with improved survival, up to a quar-ter of these tumors recur or metastasize despite aggressive therapy. Currently, there areno biomarkers that can identify HPV-positive HNSCC patients who would benefit fromreduced doses of radiation–which when given at full dose carries significant morbidity.Through analysis of a limited cohort of The Cancer Genome Atlas (TCGA), we previ-ously showed that two genes, TRAF3 and CYLD, were frequently deleted or mutated inHPV-positive HNSCC. TRAF3 and CYLD are functionally related negative regulatorsof the transcription factor NF-κB. In …