Digital Commons Network^™

Forced Migration & Health: A Course Proposal, Lauren Ashle Gaston-Hawkins

Public Health Theses

Forced migration is poised to be one of the leading public health issues of our time. The Syrian refugee crisis in particular has placed issues of forced migration firmly in the consciousness of everyday people in developed nations in a way that has not occurred arguably since the genocide in Rwanda. Thus it is important to capitalize on this moment of awareness to prepare future leaders and public health advocates to effectively address the host of issues that accompany the forced migration of populations. As the number of forced migrants increase and represents a larger proportion of the world’s population, …

Self-Medication And "Personal Medicine" As Alternatives To Pharmaceuticals Among Young Adults With Mental Health Conditions, Jessica Hahne

Public Health Theses

Background:

Many studies have documented high rates of non-adherence to prescribed psychiatric medications among individuals receiving mental health services. Few studies have sought to understand how young adults with mental health conditions who are not consistently connected to mental health services view psychiatric medications, or what types of self-directed symptom management strategies they might prefer to psychiatric medications.

Methods and Results:

This secondary analysis on 11 pairs of semi-structured interviews with young adults (aged 24-28) used a grounded theory approach to elucidate common themes in self-management of mental health symptoms. Many participants described alcohol or marijuana use as preferred strategies …

Transitioning Of Hiv-Infected Children From Pediatric To Adult Care: A Jamaican Case Study, Flavia De Souza

Yale Medicine Thesis Digital Library

Successful public access to antiretroviral therapy in resource-limited settings (RLS) has resulted in survival of HIV perinatally infected children into adulthood. There are few studies on transition of care in RLS, where 90% of HIV-infected children reside. We aimed to characterize the current landscape of the transfer process of HIV-infected adolescents in one such RLS, Jamaica. We conducted in-depth interviews of 18 HIV-infected adolescents in pediatric care and 21 health care providers. We analyzed the data using the grounded theory approach. Five themes emerged: 1. Pediatric clinics were like families who provided care-taking and developmental support in addition to HIV …

Upper Cervical Spine Fracture At Yale: Factors Associated With Management And Outcomes, Erica M. Giles

Yale Medicine Thesis Digital Library

Traumatic fractures of the upper cervical spine are a diverse group of injuries with high morbidity and mortality. Guidelines for treatment of these injuries have been based off limited medical literature; the factors associated with the management decisions and the outcomes associated with those decisions have not been well described. In particular, recent literature supports the idea that nonclinical factors such as race and insurance may affect treatment decisions for all spine fractures.

The electronic medical record was queried for trauma patients admitted to Yale New Haven Hospital diagnosed with an upper cervical spine fracture using relevant ICD-9 codes. Information …

Viral Causes Of Gastroenteritis In The Era Of Widespread Rotavirus Vaccination, Dame Idossa

Yale Medicine Thesis Digital Library

Background: It is unknown if widespread use of Rotavirus (RV) vaccine will impact the primary causative agent of viral gastroenteritis (VGE).

Objective: To identify changes in epidemiology of VGE affected by vaccination, determine factors associated with higher severity of illness, and assess agreeability between two clinical severity-grading scales; Clark and Vesikari.

Methods: We analyzed fecal samples of children, 6 months-5 years of age, evaluated at YNHH for VGE. Fecal samples were tested using a real-time PCR assay. Primer and probe sequences targeted conserved regions of the genome for RV, Norovirus GI/GII, Adenovirus, Astrovirus, and Sapovirus. Data were analyzed using SPSS. …

“For The Safety Of Our Health”: A Qualitative Analysis Of Pre-Exposure Prophylaxis (Prep) Acceptability Among Female Sex Workers In Malaysia, Shaylen Susalla Foley

Public Health Theses

Female sex workers (FSW) in Malaysia are at substantially increased risk of acquiring HIV compared to the general female population. Daily oral pre-exposure prophylaxis (PrEP) offers a novel way to prevent HIV transmission in this population. This research aims to inform culturally relevant implementation of PrEP through a qualitative exploration of the factors that determine FSW willingness to use PrEP. In-depth, semi-structured interviews (n=30) were conducted with FSW in English, Malay, or Tamil. Transcribed and translated interviews were analyzed using a grounded theory approach. FSW expressed positive interest in PrEP but preferred it as a supplement to condoms, not a …

Community Mental Health Workers And Capacity Building: A Qualitative Evaluation From Ghana, Jurema Gobena

Public Health Theses

Background: Ghana is among countries facing human resource shortages for mental healthcare. Since 2011, the country has shifted to a community-based model of mental healthcare and has used task-shifting to fill the mental health professional gap.

Methods and Results: A qualitative study was conducted using in-depth interviews with 17 community mental health workers (16 psychology college graduates and 1 community psychiatric nurse) employed through the publically funded health system to explore their experiences in mental health promotion and service delivery on the ground. Several findings characterize the CMHWs experiences: limited mental health literacy, overwhelming stigma, performing duties outside of their …

Livestock Prevalence Of Brucellosis And Q Fever In Thailand, Soledad Colombe

Public Health Theses

Background

Brucellosis and Q fever may impart high morbidity in humans and economic losses among livestock. Yet, a systematic investigation has not been performed in Thailand, where a significant proportion of the rural population may be vulnerable to these zoonotic diseases.

Objectives

We surveyed the seroprevalence of brucellosis and Q fever in livestock from Thai communities at the border with Cambodia, evaluated risk factors for seropositivity, and performed a risk assessment for potential transmission to farmers.

Methods

We selected herds of beef and dairy cattle and small ruminants (sheep and goats) for Sa Kaeo province in 2015 using a two-stage …

Time-To-Detection Of M. Tuberculosis As A Predictor Of Infectivity, Lea Elizabeth Ghee Hamner

Public Health Theses

INTRODUCTION: Tuberculosis (TB) transmission continues to be problematic in the United States. Contact investigations are essential for identifying new infections and must prioritize limited resources by pursuing more infectious cases. Current infectivity measures like sputum smear grade, chest x-rays, and nucleic acid amplification tests (NAAT) are sub-optimal. Time-to-detection (TTD) of Mycobacterium tuberculosis in liquid culture has shown promising results.

OBJECTIVES: Our objective is to examine the relationship between TTD and TB transmission.

METHODS: This study examined a retrospective cohort of pulmonary TB cases with TTD data from 2009-2014 from the King County Laboratory, Seattle, WA. The primary outcome was transmission …

Comorbidities Of Skin Disease In The Homeless And Medical Students Perspectives, Matthew David Coffman

Yale Medicine Thesis Digital Library

The homeless population is at increased risk for skin disease. Exposure to the elements and lack of access to medical care contribute to the problem. To date there have been few studies analyzing the medical comorbidities that put homeless patients at increased risk for skin disease. The aim of this study is to discover what medical conditions are associated with skin disease to allow physicians to better screen their homeless patients for skin disease. The secondary aim of this study is to determine whether medical students are being adequately trained to recognize medical conditions associated with skin disease. Data from …

The Role Of Oxytocin In Modulating Neural Oscillations In Nulliparous Women, Xiaoyue Mona Guo

Yale Medicine Thesis Digital Library

The hormone oxytocin (OT) has been implicated in social cognition and behavior as well as in modulating important affiliative relationships such as parenting; meanwhile, intranasal OT administration is gaining popularity as a means to modulate neural activity in brain regions during experimental tasks. However, the neural mechanisms underscoring the changes associated with OT administration have yet to be fully elucidated. Using electroencephalography (EEG), this thesis project aims to further our understanding of how OT affects brain activity and response to infant cues. In a double-blind placebo controlled design, OT’s effect on resting-state neural oscillations and event-related potentials (ERPs) to face …

Association Of Tuberculosis And Macrophage Migration Inhibitory Factor In A South African Population, Duncan Reid Reid

Yale Medicine Thesis Digital Library

Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine that plays an important role in the pathogenesis of autoimmune inflammatory diseases. Functional promoter variants in the MIF gene influence host susceptibility to different infectious diseases, including tuberculosis (TB). However, the effect of functional MIF promoter variants in subjects with co-infection with human immunodeficiency virus (HIV) and TB, who comprise over 12 percent of new TB cases globally and 60 percent of new TB cases in South Africa, has been examined only in one prior study. Here, an association study was carried out in a clinically well-defined rural population in KwaZulu-Natal, …

Medicine@Yale September/October 2016 Volume 12, Issue 2, Yale School Of Medicine Department Of Surgery

Medicine@Yale - development newsletter

Medicine@Yale : advancing biomedical science, education and health care was a print and online newsletter which published news about academics, research and philanthropy for alumni, donors, faculty, students and the general public. It was initially published 6 times a year and then changed to a quarterly schedule. The first issue came out June/Jul. 2005. The final issue was published in May/June 2022, vol. 17, issue 1. Published by Yale School of Medicine, Office of Communications.

Treading The Path Of Least Resistance: Fda's Regulation Of The Subtherapeutic Use Of Antibiotics In Animal Agriculture, 1970-2015, Colleen Flynn

Harvey M. Applebaum ’59 Award

No abstract provided.

Broadly Neutralizing Human Antibodies Inhibit Dengue Virus Infection In Aedes Mosquitoes, Colette Jolynn Matysiak

Public Health Theses

Introduction

Dengue virus is the leading cause of morbidity and mortality among mosquito-borne viruses globally. There are four Dengue serotypes; immunity to one serotype provides protective immunity to that serotype but increases the risk of severe disease upon infection with a second serotype. Dengue virus, like all Flaviviruses, utilizes class II fusion proteins to gain entry into the host cytoplasm. The fusion loop, which is responsible for viral-host fusion, lies within the envelope (E) glycoprotein and has nearly 100% amino acid identity among all Flaviviruses. Two anti-Dengue virus human monoclonal antibodies (hMAbs), 1.6D and D11C, were isolated from Dengue infected …

Spatial And Temporal Dynamics Of Glossina Pallidipes In Nguruman National Park (Kenya)., Michael Frederic Mengual

Public Health Theses

Abstract:

Background: Glossina pallidipes is a significant vector of trypanosomiasis for humans and livestock across Sub-Saharan Africa. Nguruman national park in Kenya is regarded as a potential location for targeted vector control activity. We screened flies from three locations in Nguruman in 2003, 2009, and 2015 using 13 microsatellite loci to assess population structures of G. pallidipes.

Methods: We acquired Tsetse samples from three sites across Nguruman in Kenya at three time points. We then performed genetic analyses on 267 flies using 13 microsatellite loci and evaluated genetic structure of Tsetses across a geographic distance of about 22 km and …

Sociodemographic Differences In Human Papillomavirus Vaccine Impact: A Systematic Review, Alexandra Nichole Montano

Public Health Theses

IMPORTANCE: The majority of literature related to disparities in human papillomavirus (HPV) vaccination has been focused on sociodemographic differences in vaccine uptake. Now nearly ten years after the introduction of the vaccine, and with a better understanding of disparities in uptake, a small but growing body of evidence is beginning to examine the impacts of the vaccination campaign. Monitoring disparities in the impact of the vaccine is crucial in order to better understand the full implications of the vaccine and to properly guide future programs and recommendations.

OBJECTIVE: To systematically review the literature on the impact of the human papillomavirus …

Knowledge And Attitudes Towards Non-Communicable Diseases (Ncd) Amongst Village Health Teams (Vht) In Iganga And Mayuge Districts, Uganda., Temitope Ojo

Public Health Theses

Background: Community health workers (CHW) have successfully contributed to prevention, management and care for NCD interventions in several low and middle income countries (LMIC). In Uganda, the CHW, known as Village Health Teams (VHT) are the initial point of care in their communities. Though their present roles only attend to infectious diseases, maternal and child health issues, their skills could potentially be utilized in national efforts to promote NCD prevention in communities.

Aim: To assess baseline knowledge of and attitudes toward NCD and NCD care among VHT in Uganda as a step towards identifying a potential role for VHT in …

Respiratory Syncytial Virus In Connecticut: Predictors Of Seasonal Epidemic Timing, Douglas Brian Noveroske

Public Health Theses

Introduction: Respiratory syncytial virus (RSV) is a primary cause of hospitalizations in children worldwide. Prophylaxis (Palivizumab) can be given to infants who are at high-risk of a severe RSV infection, but the timing of seasonal RSV epidemics need to be known in order to administer prophylaxis at the appropriate time.

Methods: This study used data from the Connecticut State Inpatient Database to identify RSV hospitalizations based on ICD-9 diagnosis codes. A harmonic regression analysis was used to evaluate RSV epidemic timing at the county level; subsequently, a hierarchical model was fit to assess RSV epidemic timing at the ZIP code …

A Systematic Review Of Sexual Violence And Hiv In The Post-Disaster Context: Latin America And The Caribbean, Jane O'Bryan

Public Health Theses

ABSTRACT

INTRODUCTION: In the last decade, over 800 disasters struck Latin America and the Caribbean, cumulatively affecting an estimated 64 million people. Three quarters of the region’s population lives in disaster risk areas. There is widespread consensus that sexual violence increases in the aftermath of disasters, however historically its prevention has not been prioritized, and in general it remains a vastly understudied phenomenon at the intersection of health and human rights. The linkage between sexual violence and Human Immunodeficiency Virus (HIV) in the post-disaster context is similarly unrepresented in the literature.

OBJECTIVES: This systematic review aims to assess the extent …

Patterns Of Drug Use And Correlates Of Active Amphetamine-Type Substance Use Among Sex Workers In Kuala Lumpur, Malaysia, Courtney Jo Pedersen

Public Health Theses

Objective: To describe the female and transgender sex worker population in Kuala Lumpur, Malaysia, understand their patterns of substance use, and examine the correlates of active amphetamine-type substance (ATS) use.

Methods: We administered a cross-sectional survey and performed biological testing on 492 sex workers to assess lifetime and active substance use history and frequency, criminal justice involvement, alcohol and substance abuse disorders, sexual risk behaviors, experience of childhood and adulthood physical and sexual abuse, depression, and prevalence of HIV, syphilis, chlamydia, and gonorrhea. We performed descriptive statistics to describe demographics and lifetime and active drug use patterns and employed bivariate …

Likelihood Of Achieving Who Leprosy Goals: An Expert Survey, Alex Rittel

Public Health Theses

Much progress has been made in the global fight against leprosy, as evidenced by dramatic declines in prevalence rates in recent years. However, leprosy has proven elusive. New case detection rates have remained fairly stable, particularly in countries with remaining pockets of high endemicity such as India, Brazil, and Indonesia. In 2012, the World Health Organization spearheaded the London Declaration, which in part aimed for the goal of interruption of transmission of global leprosy by 2020. Aggregating the opinions of experts can supplement existing data to help determine the feasibility of reaching the WHO goals. To obtain the opinions of …

Macrophage Migration Inhibitory Factor Polymorphisms And Tuberculosis Disease Susceptibility In Kwazulu-Natal, South Africa, Max Mu Wang

Public Health Theses

Background: TB is a leading cause of mortality, infecting over one-third of the world’s population. Difficulties combating the disease are compounded by the fact that a majority of TB infections remain in an asymptomatic latent state. Macrophage migration inhibitory factor (MIF) is an innate cytokine that is encoded in a functionally polymorphic genetic locus with characterized allelic variants that correlate to TB progression. Understanding the genetic factors that regulate host immune responses to TB will help to identify individuals who are at higher risk of severe infection.

Methods: A case-control study of HIV+ active pulmonary TB cases and HIV+ controls …

Neurocognitive Impairment Impacts Hiv Medication Adherence, Damian Weikum

Public Health Theses

Objective: To examine neurocognitive impairment (NCI) and its association with antiretroviral therapy (ART) medication adherence among HIV-infected men who have sex with men (MSM) and transgender women (TGW) in Lima, Peru.

Methods: A cross-sectional survey assessed 313 HIV-infected Peruvian MSM and TGW prescribed ART using a computer-assisted survey instrument to examine NCI and its association with optimal ART adherence, defined as taking ≥90% of prescribed medications. The survey included demographic characteristics and standardized measures for drug and alcohol use disorders, depression, and other factors associated with non-adherence.

Results: An exploratory factor analysis was conducted to optimize an NCI self-report scale …

Whole-Genome Sequencing And Phylogenetic Analysis Of Novel Paramyxoviruses Discovered In Bats From Brazil, Heather Louise Wells

Public Health Theses

Wildlife disease surveillance has been increasing in recent years in an effort to identify and characterize novel emerging zoonoses. In particular, bats have been targets of active surveillance because of their recent associations with diseases of global public health importance, such as Ebola virus, SARS-like coronaviruses, and Nipah and Hendra virus. The high species richness, large population sizes, and frequent inter- and intra-species interactions of bats make them ideal reservoirs of infectious diseases. For this molecular epidemiological study, novel paramyxoviruses discovered through surveillance of bats in Brazil were fully sequenced to allow for a range of genetic analyses, including the …

Outbreaks Reveal Deficiencies In Biotech R&D For Emerging Diseases, Rebecca Byler

Public Health Theses

The absence of commercial diagnostics, therapeutics, and vaccines hindered control efforts during the recent Zika and Ebola epidemics. This study evaluates the connectivity and productivity of both viruses’ R&D networks before, during, and after the epidemics to ascertain the ability of current R&D practices to support the development of crucial biotechnologies. Both network maps exhibited low baseline connectivity with emergent collaborative R&D practices during the identified outbreak period that correlated with increased research productivity. It is argued that formally establishing permanent collaborative, open R&D practices prior to epidemics can enhance scientific knowledge and innovation capabilities to more effectively advance commercial …

Care-Seeking Patterns Among Rural Communities In The Republic Of Congo, Haotian Cai

Public Health Theses

In 2014, a mobile pharmacy project was launched to provide accessible and affordable medicines to Yaka hunter-gatherer communities in the Likouala and Sangha regions of the Republic of Congo. This mixed methods study describes the use of available health services by the minority Yaka and the majority Bantu served by the mobile pharmacy and to compare the health-care seeking behavior among these different communities. Overall, 178 households were surveyed about their utilization of available health services and the order in which they seek health services in the event of illness. To provide context to these responses, 18 key informants were …

Predictors Of Nutritional Status Among Young Samoan Children, Courtney C. Choy

Public Health Theses

The nutrition transition is associated with the rising burden of non-communicable diseases in low-and middle-income countries and in Samoa, young children are particularly vulnerable to malnutrition in various forms. In this present study, we documented the current prevalence and co-existence of child nutritional status outcomes within this population and by census region. We then examined the role of selected child, maternal, and household characteristics as potential predictors of child nutritional status. A cross-sectional, community-based design was used to collect data from singleton pairs of a non-pregnant mother and child between 24 to 59 months olds in the Samoan island of …

A Qualitative Analysis Of Multi-Level Barriers To Hiv Testing Among Women In Lebanon, Kirsty Amy Clark

Public Health Theses

The Middle East and North Africa (MENA) is a region of concern in regards to the global HIV epidemic. In 2015, a call to action was released through the American University of Beirut urging an expansion of research and policy regarding women and HIV in the MENA region. Through individual, semi-structured interviews with sexual healthcare providers and NGO staff, we sought to understand barriers to HIV testing among women in Lebanon. Using purposive and snowball sampling strategies, key informants were recruited from neighborhoods in greater Beirut (N=21; 12 physicians, 9 NGO staff). Data were analyzed utilizing a Grounded Theory inductive …

Azithromycin Pharmacodynamics Against Non-Typeable H. Influenzae, James Fisher

Public Health Theses

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States. Significant clinical disease in COPD patients has been tied to non-typeable Haemophilus influenzae (NTHI) infection. However, reasons why some NTHI strains persist despite antimicrobial therapy remain unknown.

Objective

The primary objective was to characterize the pharmacodynamics of azithromycin against a persistent pair of NTHI isolates.

Methods

A persistent pair of NTHI isolates (5P28H1 and 5P54H1) cultured from the sputum of an adult with COPD and determined to be the same strain by multilocus sequence typing was carried for 819 days. The Minimum Inhibitory …