Digital Commons Network^™

Neighborhood-Level Socioeconomic Status And County Fairs And The Risk Of Shiga Toxin-Producing Escherichia Coli Incidence In Connecticut, 2012 To 2014, Gili Hrusa

Public Health Theses

Abstract

Background: Shiga toxin-producing E. coli (STEC) is a reportable illness. It is associated with a spectrum of clinical manifestations that range from watery and/or bloody diarrhea to hemolytic uremic syndrome (HUS), a life threatening condition which causes acute renal failure in both children and adults. A study in Connecticut (CT) by Whitney et al. (2015) found a strong association between higher socioeconomic status (SES) and Shiga toxin-producing E. coli incidence. In the same study, there was a weaker association demonstrated between rurality and STEC incidence as well. The primary aim of this study is to investigate the relationship between …

Factors Influencing Care-Seeking Behavior Among Patients In Ethiopian Primary Health Care Units, Orit Abrahim

Public Health Theses

Abstract

Background

The utilization of primary health care in many countries in sub-Saharan Africa has been limited. The objective of this study was to evaluate the factors that influenced why patients sought care at health centers versus primary hospitals in the primary health care unit (PHCU) in three regions in Ethiopia. The study also examined whether these factors varied based on a patient’s clinical or demographic characteristics and by whether they had sought prior care.

Methods and Findings

We conducted a cross-sectional study using face-to-face interviews in the local language with 796 people (99% response rate) seeking outpatient care in …

Probiotic Therapy For The Prevention Of Recurrent Spontaneous Preterm Birth, Kali O’Dell

Yale School of Medicine Physician Associate Program Theses

Preterm birth is the national leading cause of neonatal morbidity and mortality. Nearly 500,000 infants are born prematurely each year in the United States and the annual cost of prematurity averages over $26 billion dollars. Despite multiple interventions to reduce infection related prematurity many spontaneous preterm births remain attributed infection and inflammation. We hypothesize that prevention of infection and inflammation related spontaneous preterm birth is possible through enrichment, stabilization, and normalization of the vaginal microbiome. To test this hypothesis we will perform a randomized, double blind, placebo-controlled trial of intravaginal Lactobacillus probiotic in women at high-risk for spontaneous preterm birth. …

The Girl With The Peanut Necklace: Experiences Of Infertility And In Vitro Fertilization In China, Ruoxi Yu

Student Work

A 2014-2015 William Prize for best essay in East Asian Studies was awarded to Ruoxi Yu (Berkeley College '15) for her essay submitted to the Department of Anthropology, “The Girl with the Peanut Necklace: Experiences of Infertility and in vitro Fertilization in China.” (Marcia Inhorn, William K. Lanman Jr. Professor of Anthropology, advisor; Susan Brownell, Professor of Anthropology at USML, secondary reader.)

Ruoxi Yu’s essay, “The Girl with the Peanut Necklace: Experiences of Infertility and in vitro Fertilization in China,” situates original research within the history of the one-child birth control policy and the tension between the …

Yale Medicine : Alumni Bulletin Of The School Of Medicine, Spring 2015, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the Spring 2015 issue of Yale Medicine: alumni bulletin of the School of Medicine, v. 49, 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).

Reporting Of Results In Clinicaltrials.Gov And High-Impact Journals: A Cross-Sectional Study, Jessica Elizabeth Becker

Yale Medicine Thesis Digital Library

In 2007, the FDA Amendments Act expanded requirements for ClinicalTrials.gov, a public clinical trial registry maintained by the U.S. National Library of Medicine, mandating results reporting within 12 months of trial completion for all FDA regulated drugs. We compared clinical trial results reported on ClinicalTrials.gov with corresponding published articles. We conducted a cross-sectional analysis of clinical trials published from July 1, 2010 through June 30, 2011 in high impact journals (impact factor 10 or higher) that were registered and reported results on ClinicalTrials.gov. We compared trial results reported on ClinicalTrials.gov and within published articles for the following: cohort characteristics, trial …

Telepsychiatry And Mental Health Care For Syrian Refugees In Turkey, Moustafa Moustafa

Yale Medicine Thesis Digital Library

The Syrian conflict is now in its fourth year and has produced one of the largest humanitarian disasters since the Cold War. Violent fighting and aerial bombings in many of the country’s major cities have resulted in massive numbers of internally and externally displaced Syrians, many psychologically traumatized and in need of expert mental health attention. The influx of refugees into Syria’s neighboring countries of Lebanon, Jordan and Turkey has stressed already strained health systems. The ability to deliver mental health care is inextricably linked to the existing health care infrastructure—a dynamic and often unstable institution as refugees migrate from …

Medicine@Yale June 2015 Volume 11, Issue 1, Yale School Of Medicine Office Of Communications

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.

Widespread Dissemination Of Diarrhea Due To Rotavirus Serotype G9p8 In The Solomon Islands After A Focal Flood-Related Outbreak, Forrest Kirby Jones

Public Health Theses

Background

Extreme weather events can precipitate epidemic transmission of diarrhea. We describe a large nationwide epidemic in the Solomon Islands following a focal flash flood disaster on April 3-5, 2015 in the capital city of Honiara.

Methods

The Early Warning Alert and Response Network surveillance system (EWARN) detected an outbreak of diarrhea in Honiara. We identified cases from EWARN and retrospective review of outpatient registries in Honiara prior to and during the outbreak. We reviewed data from the public adverse event system to identify diarrhea-related deaths. Rapid diagnostic testing for rotavirus was performed on stool samples from cases. RT-PCR analysis …

Medicare And Medicaid Enrollment And Utilization Among Hiv-Infected And Uninfected Veterans In Va Care, Harry Chang

Yale Medicine Thesis Digital Library

Many veterans engaged in care with the Veterans Administration (VA) health system are also enrolled in Medicare and/or Medicaid and may receive care both inside and outside of the VA. Use of dual health systems has been associated with worse outcomes. Veterans with human immunodeficiency virus (HIV) may have different rates of Medicare and Medicaid enrollment, and may be at greater risk of poor outcomes related to non-VA use. This study compares the frequency of Medicare and/or Medicaid enrollment and factors associated non-VA use in an HIV-infected and uninfected population of veterans.

We used data from the VA and Center …

Racial/Ethnic Differences In The Presentation And Management Of Severe Bronchiolitis, Jonathan Santiago

Yale Medicine Thesis Digital Library

We examined if racial/ethnic differences exist in the presentation and management of severe bronchiolitis using a 16-center, prospective cohort study from 2007-2010. Children <2 years hospitalized with a diagnosis of bronchiolitis were included. A structured interview, chart review, and 1-week phone follow-up were completed. Multivariable logistic regression was used to examine the independent association between race/ethnicity and diagnostic imaging, treatment, management, discharge on inhaled corticosteroids, and bronchiolitis relapse. Among 2,130 patients, 818 (38%) were non-Hispanic white (NHW), 511 (24%) were non-Hispanic black (NHB), and 801 (38%) were Hispanic. Compared with all groups, NHB children were most likely to receive albuterol before admission (OR 1.58; 95%CI, 1.20-2.07) and least likely to receive chest x-rays during hospitalization (OR 0.66; 95%CI, 0.49-0.90); Hispanic children were most likely to be discharged on inhaled corticosteroids (OR 1.92; 95%CI, 1.19-3.10). We observed differences between NHW and minority children regarding pre-admission albuterol use, inpatient diagnostic imaging, and prescription of inhaled corticosteroids at discharge; practices that deviate from the American Academy of Pediatrics guidelines. The causes of these differences require further study but they support implementation of clinical care pathways for severe bronchiolitis.

Development, Implementation, And Evaluation Of An End Of Life Care Online Module For Pre-Clinical Students, Chung Sang Tse

Yale Medicine Thesis Digital Library

Basic palliative and end-of-life care skills are necessary for all physicians regardless of their field of specialty. Education should begin during the early stages of medical training, as early as medical school, to ensure that all physicians acquire a basic understanding of these aspects of medical care. At the Yale School of Medicine, the End-of-Life and Palliative Care Curriculum was formalized in 2008 to address this need and was expanded in 2012 to include an original educational online module. This new module was designed specifically for second-year medical students, who had the opportunity to visit hospice patients but do not …

The Hepatitis C Care Continuum Among Hiv-Infected Patients In A Large Urban Outpatient Clinic: Identifying Barriers To Achieving Optimal Outcomes, Austin Weiss

Yale Medicine Thesis Digital Library

BACKGROUND: Despite the availability of effective therapies for the treatment of chronic hepatitis C virus (HCV) infection, therapeutic benefits have yet to be experienced by patients affected by the disease, including human immunodeficiency virus (HIV) infected individuals. The aims of this study were to describe the continuum of hepatitis C care among HIV/HCV coinfected patients and identify barriers to achieving optimal management outcomes.

DESIGN AND METHODS: We conducted a retrospective analysis of HIV/HCV coinfected patients under care at an urban HIV referral clinic, comprising patients identified with HCV infection from 2002-2014. Electronic medical records of eligible patients were reviewed, capturing …

Prevalence Of Malaria And Glucose-6-Phosphate Dehydrogenase Deficiency In Malaria-Endemic Southwestern Uganda: Implications For Primaquine Use, Michelle Roh

Public Health Theses

Abstract

Introduction: Malaria transmission in Uganda is remarkably heterogeneous, and declines in prevalence have not been uniform. Previous surveys in southwestern Uganda have shown declines in parasite prevalence from 2004 to 2010. As malaria transmission continues to decline in southwestern Uganda, aggressive strategies, such as the addition of primaquine (PQ) to artemisinin-combination therapies (ACTs), are being considered in low transmission settings. Despite the potential benefit of PQ in reducing transmission, concerns over its safety and efficacy have hampered its deployment. In particular, those with glucose-6-phosphate dehydrogenase (G6PD) deficiency are at a higher risk of hemolytic toxicity.

Methods: To better assess …

Spatial Distribution And Sociodemographic Composition Of High Grade Cervical Lesion Clusters In Connecticut 2008-2013, Aref Senno

Public Health Theses

Introduction: HPV is necessary for the development of invasive cervical cancer. There were 530,000 cases and 275,000 deaths attributable to cervical cancer in 2008. Since the introduction of HPV vaccines in 2006, the incidence of high grade cervical lesions (HGCL)—precancerous lesions which may develop into cervical cancer—has decreased significantly. Some changing sociodemographic trends in disease burden have been previously reported since 2008.

Objectives: The objectives of this analysis were to identify regions of Connecticut with high rates of HGCLs and to describe how trends of disease changed over time in the post-vaccine era.

Methods: This is a descriptive analysis of …

The Impact Of Hurricane Sandy On Healthcare Workers In Nyc, Grace Barlet

Public Health Theses

There is a gap in the literature regarding whether training in emergency preparedness and response makes a difference in the overall health outcomes of healthcare workers who are responding to and working during a natural disaster. The objective of this study was to investigate whether emergency preparedness training lowers the risk of poor health outcomes as reported by healthcare workers in New York City responding to Hurricane Sandy. A survey created by 1199 SEIU United Healthcare Workers East was conducted between July and August 2014 to capture the health and safety experience of workers during and after Hurricane Sandy. The …

Medicine@Yale October/November 2015 Volume 11, Issue 2, Yale School Of Medicine Office Of Communications

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.

Describing The Health Care Needs Of School-Age Children In Sub-Saharan Africa In Order To Develop A Model Of A Nurse-Run School-Based Health Clinic, Bonnie Tong

Yale School of Nursing Digital Theses

Objective: Rural Kenya is affected by health disparities and poor health outcomes among school-age children. This paper identifies gaps in health care among school-aged children in rural Kenya, in order to identify a health care model to meet those gaps.

Design: The results of a systematic review on the health care needs were triangulated with field notes from interviews of stakeholders in a rural Kenyan village. Needs were then compared with currently available health care resources to identify gaps.

Sample: Multiple databases were searched to identify relevant articles published between the years 2000- 2014. Interviews were conducted with health workers, …

Counting Uncounted Gunshot Injuries: A Capture‐Recapture Study Of People Minding Their Own Business, Zev Balsen

Yale Medicine Thesis Digital Library

Objectives. To apply a novel statistical method to create a comprehensive estimate of incidence of firearm related injuries.

Methods. A database of firearms injuries in New Haven, Connecticut, during a five- month period was created with records from law enforcement, emergency departments, emergency medical services (EMS), news media, and the medical examiner. The overlap of these various sources was operationalized in a capture-recapture model to generate an estimate of uncounted firearms injuries, and log linear modeling was used to control for positive and negative dependencies.

Results. The combined data sources revealed 49 firearms injuries occurring during the study period within …

Case Finding For Pulmonary Tuberculosis Among People Who Inject Drugs In Dar Es Salaam, Tanzania, Akash Gupta

Yale Medicine Thesis Digital Library

CASE FINDING FOR PULMONARY TUBERCULOSIS AMONG PEOPLE WHO INJECT DRUGS IN DAR ES SALAAM, TANZANIA. Akash Gupta. Jessie Mbwambo. Ibrahim Mteza. Sheela Shenoi. Barrott Lambdin. Cassian Nyandindi. Basra Ismail Doula, Said Mfaume, and Robert Douglas Bruce. Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT.

Active case finding is a World Health Organization (WHO)-endorsed strategy for improving case detection of tuberculosis. Despite WHO recommendations for active case finding among people who inject drugs (PWID), there are few published studies. The historical focus of case finding has been in populations that are HIV-positive, incarcerated, or at higher occupational …

A Descriptive, Comparative Health Assessment Of Unique Older-Adult Populations In Israel, Eliana Marcus Aaron

Yale School of Nursing Digital Theses

Background: Israel is among the nations with the fastest growing older adult population in the world, due to Baby Boomer aging, high immigration rates, and high life expectancies. The country is mandated to provide health coverage to all citizens, but it has historically been poorly equipped to provide geriatric health care. Israel's elders include numerous minorities and special groups, and despite research of many groups over decades, disparities continue to exist. Methods: A descriptive analysis of special geriatric populations and their health issues was performed based on national and international literature, government reports, and statistics. Results: Five research-based unique populations …

Missing Domains Of Lung Transplant Patient Selection, Nancy Picard Blumenthal

Yale School of Nursing Digital Theses

The goal of consistent, predictable, improved outcomes has continued to elude the scientific community in the thirty years since lung transplantation became the procedure of choice for patients with terminal, non-malignant lung disease. Background: Though there is a consensus regarding disease-specific indications for a lung transplant, ambiguity remains regarding how patient-specific attributes should influence lung transplant candidacy. This project had three aims: 1) to establish the missing domains of the interdisciplinary assessment of the lung transplant candidate, 2) to have these domains validated by an international panel of lung transplant experts, and 3) to recommend the next step for inclusion …

Protein Intake And Hookworm Infection Susceptibility In Rural Ghanaian School- Age Children: A Mixed-Methods Study, Luis Enrique Maldonado-Vásquez

Public Health Theses

Background: Because human and animal cross-sectional studies cannot assess temporality, a longitudinal study is needed to assess the association between protein intake and hookworm infection susceptibility. Cultural preferences and belief systems have been noted to affect the intake of food in some African societies but extensive research has not been conducted to characterize them.

Methods: Children (n=274) 7-13 years of age who attended school in the Kintampo North Municipality of Ghana were screened for participation in a longitudinal study assessing the relationship between protein intake and hookworm infection susceptibility. Protein intake was calculated by 24-hour recalls. A qualitative sub-study recruited …

Association Between Pediatric Vaccination Rates And Patterns Of Pneumococcal Disease In Adults In The Pcv7 And Pcv13 Eras, Sundia Cassandra Pingali

Public Health Theses

BACKGROUND: Pneumococcal conjugate vaccine (PCV) is now recommended for use in adults in the United States. Because vaccination of children with PCVs protects adults from the targeted serotypes, local variations in PCV uptake among children could influence the effectiveness of direct immunization of adults. The effect of variations in PCV7 and PCV13 uptake in children will be compared to assess the possible effectiveness of PCV vaccination in adults.

METHODS: We obtained ZIP Code-level invasive pneumococcal disease (IPD) data from an active population-based surveillance system in Connecticut (1998-2013) and ZIP Code-level data on immunization with 3+ or 4+ doses of PCV …

Determinants Of Early Feeding Practices Among Hiv+ Mothers In Sub- Saharan Africa: A Realist Review, Camille Adrianne Pottinger

Public Health Theses

INTRODUCTION: Exclusive breastfeeding has been shown to provide many benefits that can be life saving for the infant and mother in low resource settings7. Although the potential effects of breastfeeding appear large, exclusive breastfeeding rates remain low in this area of the world, and are even lower among the HIV population8-10. It is important to understand what influences HIV + mothers to exclusively breastfeed, as well as formula feed and adhere to ARV (antiretroviral) medication while breast feeding in order to make comprehensive policy recommendations that are as culturally sensitive and practical as possible. The objective of this review is …

Assessment Of Foodnet Population Survey Respondents As A Control Group To Determine Stec Risk Factors, Maria Andrea Rincon

Public Health Theses

Introduction: Shiga toxin-producing Escherichia coli (STEC) are important foodborne pathogens, causing approximately 30 deaths a year in the US. Case-control studies to monitor risk factors are challenging; finding representative controls can be labor-intensive. The FoodNet Population Survey (FNPS) is conducted periodically and asks about foodborne disease risk factors.

Objectives: To determine leading risk factors for STEC in Connecticut using the 2006 FNPS participant responses as controls.

Methods: Cases were reported STEC cases in Connecticut 2000-2009 who were interviewed for risk factors following onset. Controls were respondents to the Connecticut portion of the 2006 FNPS. Comparable questions for exposure to dietary, …

Leptospira In The Environmental Reservoir: Quantification And Persistence Of The Pathogen In An Urban Slum Setting Of Endemic Transmission, Andrew Gustav Schneider

Public Health Theses

Introduction

The ecology of Leptospira, the spirochete agent for leptospirosis, in its environmental reservoir is poorly understood. We quantified the presence of pathogenic leptospires in soil and sewage from a high-risk slum community for leptospirosis, and characterized its persistence in this environment.

Methods

We collected soil and sewage samples from three sites within a slum community in the city of Salvador, Brazil, and measured the concentration of leptospires using real-time quantitative PCR targeting lipL32, a gene exclusively present in pathogenic Leptospira. Additionally, we investigated the persistence of L. interrogans serovar Copenhageni, the agent for urban leptospirosis, in soil and sewage …

Intersection Of Religious And Antiretroviral Experiences And Its Implications For Medication Adherence In Hiv Positive Individuals In León, Nicaragua, Kimberly Stephanie Vasquez

Public Health Theses

Worldwide, in 2012, there were about 35.3 million people living with HIV/AIDS (PLWHA).1 Antiretroviral (ARV) significantly improved the livelihood of PLWHA through virological suppression, which has reduced HIV related mortality rates, and decreased the risk of HIV transmission through vaginal and anal sex.2,3 Optimal ARV adherence, around 95%, is required to maintain virological suppression.29 In 2000, a review paper reported that nonadherence rates were around 50-70%.30 Suboptimal adherence can lead to increased mortality, HIV transmission, and ARV resistance.2,3 Global suboptimal illustrates the importance of identifying barriers and facilitators to ARV adherence.7 Research is urgently needed to determine important barriers and …

Namati: Innovations In Legal Disempowerment For Health? A Sierra Leonean Case Study, Ikenna Okezie Achilihu

Public Health Theses

Drawing on eleven weeks of fieldwork for Namati’s Health Accountability and Social Empowerment Program, this case study investigates whether Namati interventions reinforce existing formal and customary structures for the amelioration of grievances between health clinics, their associated staff, and intended beneficiaries. Furthermore, this study questions Namati’s role as an organization that fosters sustainable change at: the level of the grassroots in its ability to influence government health policy, and at the level of the elites in its ability to improve administrative and policy deficiencies in the area of health access. Finally, this study answers critical questions on the equity-enhancing effects …

Who Gets An Iud: The Impact Of Patient Race And Number Of Past Sexual Partners On Clinical Decisions To Prescribe Intrauterine Devices, Tiffany Nicole Bell

Public Health Theses

While disparities by race/ethnicity in reproductive and sexual health outcomes are well documented, the role that healthcare providers play in contributing to these disparities is only beginning to be explored. This investigation sought to examine medical and nursing students' bias surrounding the prescription of intrauterine devices (IUDs, i.e., long-acting reversible contraception) to adolescents based on the patient's race and sexual history. An online survey presented participants with a clinical vignette of an IUD-seeking sexually active adolescent, with the patient's race and number of past sexual partners systematically manipulated. Participants reported predictions about patient risk of getting pregnant with and without …