Digital Commons Network^™

A Mathematical Investigation Of The Drivers Of Lyme Disease Ecology At Two Ecologically Contrasting Sites, Malia Joy Carpio

Public Health Theses

INTRODUCTION: Lyme disease is an emerging tick-borne disease of increasing concern in the United States. In order to create and to implement effective public health interventions for Lyme disease, there must be a better understanding of the factors driving pathogen transmission.

OBJECTIVES: The primary objectives of this study were to determine how presence/absence of “super-spreaders” and observed differences between two ecologically contrasting sites influence Borrelia burgdorferi transmission.

METHODS: A next generation matrix R0 model was parameterized with field data from an island site (Block Island, Rhode Island) and a mainland site (Connecticut) in order to generate R0 estimates. A local …

Five-Year Resistance Trends Of Bacterial Isolates In Kigali, Rwanda, Makeda Aminah Carroll

Public Health Theses

Antimicrobial resistance (AMR), the phenomenon of decreased sensitivity to pharmaceutical agents that kill or inhibit the growth of bacterial pathogens, is a serious threat to public health worldwide. Many countries, including Rwanda, lack current information on antibiotic sensitivity profiles that would greatly aide clinicians and policy-makers. The current study aims to describe the time trends of antibiotic sensitivity for the isolates of six different bacterial pathogens from patients at King Faisal Hospital in Kigali, Rwanda and to make inference about future patterns of drug resistance in the study setting, to guide physicians in their prescribing practices and provide baseline data …

Community Systems, Health Knowledge, And The Role Of Promotoras De Salud In Rural Bolivia, Jennifer Grasso

Public Health Theses

Community Health Worker (CHW) programs have had a positive impact on public health across many settings worldwide. However, due to the nature of their vocation and the challenging health infrastructure in which they often work, these individuals commonly face significant barriers that threaten their performance as health promoters, educators, and liaisons. This qualitative research study assessed the perceived challenges for volunteers of a rural Promotoras de Salud program in Bolivia. Data were collected by way of in-person interviews with 20 active Promotoras de Salud of ten communities in the north central region. Results showed that two commonly reported sources of …

Drug Use And Smoking Among Hospitalized Influenza Patients, Connecticut 2011-2014, Georgiana E. Green

Public Health Theses

INTRODUCTION: Globally, influenza is responsible for 3-5 million cases of severe illness annually. In the United States alone, it is estimated that flu-associated infections account for 3.1 million hospitalized days per year. While the overall impact of flu is relatively well-studied, severe influenza is not well-characterized among the substance abuser and smoker populations.

OBJECTIVES: This study characterizes the risks for and complications associated with serious influenza infection among the substance abuser and smoking populations within Connecticut.

METHODS: Data were obtained via retrospective medical chart review. Cases were individuals within New Haven and Middlesex counties hospitalized with a positive influenza test …

Sex Differences Among Adult Influenza Hospitalizations Associated With Age, Race, And Socioeconomic Status In 14 Us Sites, 2010-2012, Kelly Elizabeth Kline

Public Health Theses

BACKGROUND: Previous studies have shown sex differences in influenza hospitalizations, but sex differences across the United States by demographic characteristics have not been well-established. We investigated potential sex differences across 14 FluSurv-NET (FSN) sites that conduct active population-based surveillance for laboratory-confirmed influenza-associated hospitalizations among residents of 76 counties in 2010-2012, stratifying by age, race, and census tract-level poverty.

METHODS: We used 6,292 laboratory-confirmed adult (>18 years) cases collected by the 14 FSN sites during the 2010-11 and 2011-12 influenza seasons linked to 2010 Census data to calculate overall age-adjusted and age-specific incidence and incidence rate ratios (IRRs) for sex …

Task Shifting To Nursing For A Sustainable Staffing Model Of School-Based Health Center In Under-Resourced Areas, Laura Lee Setliff Whittaker

Yale School of Nursing Digital Theses

Background: There is a well-established link between health and education (Bundy and Guyatt 1996). An efficient and cost effective way to increase access to care is through school-based services.

Methods: The purpose of this study is to develop a sustainable staffing model of a school-based health center in a country with limited health care resources. Two specific steps towards developing such a model are: (1) to critically review and analyze the evidence in the literature supporting an expanded nursing care practice model for the school-based health center, and (2) to merge the literature review findings with participatory field notes taken …

Medication Persistence In The Treatment Of Hiv Infection: A New Construct For Hiv Research And Clinical Care, Jason Bae

Yale Medicine Thesis Digital Library

Adherence to therapy has dominated clinical and investigational conversation on how HIV patients take medications. Adherence, although a critical concept in medication-taking behavior, is becoming increasingly limited in its relevance to patient outcomes as treatment regimens and our understanding of antiretroviral resistance development evolve over time. In this thesis, a new construct of HIV medication-taking behavior called `persistence' is introduced and defined, in order to provide researchers and practitioners with a more comprehensive understanding of patient behavior and achieve better health outcomes. Literature review of adherence, persistence, viral suppression, development of antiretroviral resistance is performed here to reveal patient, medication, …

Reducing Respiratory Virus Testing In Hospitalized Children With Machine Learning And Text Mining, Mark Mai

Yale Medicine Thesis Digital Library

Despite pressure from the federal government for US hospitals to adopt electronic medical records systems (EMR), the benefits of adopting such systems have not been fully realized. One proposed advantage of EMRs involves secondary use, in which personal health information is used for purposes other than direct health care delivery, particularly quality improvement. We sought to determine whether information recorded in the EMR could improve diagnostic pathways used to diagnose respiratory viruses in children, the most common etiology of diagnoses in the pediatric population. These tests potentially represent a source of unnecessary testing. We performed a retrospective observational study analyzing …

Medicine@Yale December 2014 Volume 10, Issue 3, 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.

Alcohol Use Disorders And Antiretroviral Therapy Among Prisoners With Hiv/Aids In Argentina, Michael Drake Alpert

Yale Medicine Thesis Digital Library

While Argentina has significantly improved access to HIV care and antiretroviral therapy (ART) for both the general population and prisoners, the prevalence of alcohol use disorders (AUDs) among HIV-infected prisoners and their relationship to accessing ART in Argentina is currently unknown. This study aims to characterize the substance abuse patterns of HIV-infected prisoners in Argentina and to assess the independent correlates of receipt of pre-incarceration ART.

An anonymous, cross-sectional survey of 100 HIV-infected federal prisoners was conducted in the Buenos Aires municipality from July-December 2010. AUDs were assessed using the AUDIT scale.

A majority (63 per cent) of participants met …

Longitudinal Characteristics Of Depression And Mood States Beginning In Primary Hiv Infection, Jessica Ashley Gold

Yale Medicine Thesis Digital Library

LONGITUDINAL CHARACTERIZATION OF DEPRESSION AND MOOD STATES BEGINNING IN PRIMARY HIV INFECTION. Jessica A. Gold, Marie Grill, Julia Peterson, Christopher Pilcher, Evelyn Lee, Frederick M. Hecht, Dietmar Fuchs, Constantin T. Yiannoutsos, Richard W. Price, Kevin Robertson, and Serena Spudich. Department of Neurology, Yale University, School of Medicine, New Haven, CT.

Though depression is known to frequently afflict those with chronic HIV, mood during the early course of HIV is not well characterized. In a prospective study we assessed mood during primary HIV infection (PHI, <1 year duration), its association with neuropsychological performance and markers of neurological disease, and its longitudinal course including effects of highly active antiretroviral therapy (HAART). The Beck Depression Inventory (BDI) and Profile of Mood States (POMS) subscales were longitudinally administered prior to and after HAART in PHI subjects. This evaluation of mood was done concurrently with blood, cerebrospinal fluid (CSF) and neuropsychological (total z and global deficit score, GDS) evaluation at each visit. Analysis employed Spearman's rho, logistic regression, and linear mixed models. 47.7% of the 65 men recruited at a median 3.5 months HIV duration met BDI criteria for clinical depression at baseline, classified as `mild' (n=11), `moderate' (n=11), or `severe' (n=9). Drug, alcohol, and depression history did not associate with BDI score. Proportional somatic-performance scores were worse than cognitive-affective scores (p=. 0045). Vigor subscore of POMS was reduced compared to norms and correlated with total z (r=0.33, p=0.013) and GDS (r=-0.32, p=0.016). BDI and POMS correlated with one another (r=0.85, p< .0001), but not with CSF or plasma HIV RNA, white blood cell (WBC) count, albumin ratio or neopterin. Improvement was not observed in BDI and POMS over 330 total follow-up visits, even after initiation of HAART. Depression was prevalent during PHI in our subjects, associated with abnormal somatic-performance and vigor scores. Neither neuropsychological performance nor disease biomarkers correlated with depressed mood. Mood indices did not improve over time in the presence of HAART.

Prevalence Of Tuberculosis Symptoms And Latent Tuberculosis Infection Among Prisoners In Northeastern Malaysia, Benjamin Margolis

Yale Medicine Thesis Digital Library

Background: Tuberculosis (TB) is a known public health threat to prison systems due to poor hygiene, crowded living conditions, poor health of inmates, and poor prison healthcare systems. The large population of HIV-infected people living in prisons is especially susceptible to increased TB transmission and higher mortality. In Northeastern Malaysia, there is no screening for active or latent TB infection (LTBI) in the prison system.

Aims and Hypothesis: This study serves to measure the prevalence and correlates of LTBI and active TB symptoms in HIV-infected and non-HIV-infected prisoners in Northeastern Malaysia. Given the host of factors that contribute to TB …

Assessment Of The Capacity Of Ugandan Health Facilities, Personnel, And Resources To Prevent And Control Noncommunicable Diseases, Hilary Eileen Rogers

Public Health Theses

Due to the rapid rise of noncommunicable diseases (NCDs), the Uganda Ministry of Health (MoH) has prioritized NCD prevention, early diagnosis, and management. In partnership with the World Diabetic Foundation, MoH has embarked on a countrywide program to build capacity of the health facilities to address NCDs. A needs assessment was developed and conducted in 13 regional referral hospitals, 27 general hospitals, and 14 health center IVs in Uganda to: (1) assess the capacity of health units to detect and manage noncommunicable diseases; (2) describe provider knowledge, attitudes, resources, and practices, and (3) identify areas of improvement and areas in …

Evidence For Selection Acting On Immune-Related Iron Transport Genes In Wild Rodents, Dylan Adam Duchen

Public Health Theses

Every organism requires certain resources that they cannot endogenously produce; one such dietary component, iron, is essential for many basic cellular functions and the host-immune response. By studying patterns of genetic diversity within the genes involved in immune-related iron transport we can achieve a greater understanding of the evolutionary mechanisms which drive these processes, including those underlying host-pathogen interactions.

This thesis describes further evidence of patterns indicative of positive selection within apical regions of the transferrin receptor complex (Tfr1), sites known to be involved in an evolutionary arms race with pathogens, within two rodent species endemic to Europe and Asia, …

The Epidemiology Of Primary Varicella And Herpes Zoster Hospitalizations In The Post-Varicella Vaccine Era: Connecticut, 1996-2012, Elizabeth Humes

Public Health Theses

Background: A vaccine for primary varicella (VZV) was licensed and recommended for use in children as a single dose in 1996, and as two doses in 2006. A vaccine for herpes zoster (HZ) was licensed and recommended for use in adults ≥60 years in 2006. Both vaccines have the potential to modify the epidemiology of VZV and HZ. Rates of hospitalization due to VZV and HZ were examined in the post-vaccine era to characterize the epidemiology of severe disease and to assess the possible impact of vaccination on the incidence of hospitalization.

Methods: Statewide hospital discharge data in Connecticut were …

Improving Human Health By Increasing Access To Natural Areas: Opportunities And Risks, Bradford S. Gentry, David Krause, Karen A. Tuddenham, Sarah Barbo, Benjamin D. Rothfuss, Christopher Rooks

Yale School of the Environment Publications Series

Report of the 2013 Berkley Workshop

Held at the Pocantico Center of the Rockefeller Brothers Fund, Tarrytown, NY - July 2013

Novel Interdisciplinary Approaches To Understanding Kidney Transplantation Outcomes, Neel Butala

Yale Medicine Thesis Digital Library

This thesis details 2 studies using novel approaches to understand kidney transplant outcomes: instrumental variables and social network analysis. Together, these studies demonstrate the value of interdisciplinary approaches to advance the field of kidney transplantation.

While some studies have found an association between delayed graft function (DGF) after kidney transplantation and worse long-term outcomes, a causal relationship remains controversial. In our first study, we investigate this relationship using an instrumental variables model (IVM), a quasi-randomization technique for drawing causal inferences. We identified 73,714 adult, deceased-donor, kidney-only transplant recipients from the Scientific Registry of Transplant Recipients (SRTR) between 1997 and 2010. …

Household Food Insecurity And Obesity Risk In An Urban Slum In Brazil, Krysta Peterson

Public Health Theses

Background: The prevalence of obesity is growing among the poor. Household food insecurity (HFI) may partly explain this trend as individuals experiencing it may cope by consuming low-cost high calorie meals with little nutritive value. This study aimed to estimate the prevalence of HFI, identify its risk factors, and assess the relationship with obesity among adults in an urban slum community in Salvador, Brazil.

Design: This cross-sectional study interviewed participants at home to assess socioeconomic status, demographics, HFI (measured by the Brazilian Food Insecurity Scale (EBIA)), and health. Anthropometric measurements (height, weight, waist circumference) of each respondent were taken to …

Leptospirosis Pulmonary Hemorrhage Syndrome In Salvador, Brazil From 2003 - 2012, Annie J. Tsay

Public Health Theses

ABSTRACT

Objective: Leptospirosis pulmonary hemorrhage syndrome (LPHS) is a severe form of leptospirosis, with a case fatality rate exceeding 50%. Recently, LPHS has become the principal cause of mortality in leptospirosis patients in Salvador, Brazil. This study aims to describe the epidemiology of LPHS since 2003, characterize its clinical presentation, and identify risk factors.

Methods:

Patients admitted between January 1, 2003 and December 31, 2012 in the active hospital-based surveillance who met the clinical case definition for leptospirosis were included in the study. A standardized questionnaire was used to collect data from patient charts and in-person interviews. Unadjusted logistic regression …

The Impact Of Architecture And Natural Ventilation On The Risk Of Tuberculosis Transmission In Brazilian Prisons, Juliana Urrego

Public Health Theses

Tuberculosis (TB) incidence in Brazilian penitentiaries is extremely high as prisons provide ideal conditions for airborne contagion by congregating infectious and susceptible individuals for extended periods of time. We aimed to determine the effects of architectural, environmental, and ventilation factors that impact TB transmission probabilities across prison cells in three penitentiaries of Mato Grosso do Sul, Brazil. We collected descriptive data on cell architectural characteristics and estimated ventilation rates using steady-state exhaled carbon dioxide levels. A hierarchical linear, multivariable model was used to examine cell level architectural and environmental factors affecting absolute ventilation. We then estimated the probability of TB …

Modeling The Zoonotic Transmission Dynamics Of Nipah Virus: Implications For Outbreak Control And Model-Guided Fieldwork, Natasha Wenzel

Public Health Theses

Introduction: Nipah virus is considered a biosafety level-4 pathogen that is endemic to bats of the genus Pteropus. Infection in humans presents clinically as febrile encephalitis with an extremely high case-fatality rate (78.2%). Outbreaks of Nipah virus infection have occurred in Bangladesh and India almost annually since 2001, most recently in January 2013.

Methods: To elucidate Nipah virus persistence at the endemic host and human population level we developed a Susceptible-Exposed-Infectious-Recovered dynamic model and parameterized it from published epidemiological case data and serological bats surveys on the Nipah Virus-Bangladesh variant. We conducted a Markov Chain Monte Carlo simulation to estimate …

Conflict And Vaccine-Preventable Disease In Children Under Five In The Eastern Mediterranean Region: A Systematic Review, Alexandra Marion Adams

Public Health Theses

Background: Conflict is one of the main reasons for our failure to reach worldwide immunization targets. An objective of 90% immunization coverage is included in the fourth Millennium Development Goal to reduce under-five mortality by two thirds, which is still far from achieved in the conflict-ridden Eastern Mediterranean Region (EMR). Despite global progress, vaccine-preventable deaths still account for 20% of childhood mortality under five years of age in the EMR, and communicable disease a third of all mortality. Conflict remains a critical root cause of low vaccination coverage in the EMR, resulting in high levels of vaccine-preventable disease, disability, and …

Epidemiology, Risk Factors, And Effectiveness Of Treatment Of Crimean Congo Hemorrhagic Fever In Turkey, 2007-2012, Eda Akyar

Public Health Theses

Objective: Crimean Congo Hemorrhagic Fever (CCHF) is caused by a Nairovirus of the Bunyaviridae family. It was first reported in Turkey in 2002. Infections commonly result from bites from ticks of Hyalomma marginatum marginatum or Rhipicephalus bursa species. Nosocomial infections also occur. CCHF infection occurs in over 30 countries in Europe, Asia and Africa. No vaccine exists and the effectiveness of ribavirin treatment remains controversial. This study's objective was to identify significant epidemiological, environmental, and clinical risk factors associated with disease and death caused by CCHF in Turkey. This study also evaluated the effectiveness of ribavirin as treatment for patients …

Area-Based Poverty And Community Associated Clostridium Difficile Infection In New Haven County, 2011-2013, Ranjit Dhaliwal

Public Health Theses

BACKGROUND: The relationship between socioeconomic status and CA-CDI incidence has not been examined. I hypothesize that there will be higher incidence rates of CA-CDI in areas of higher socioeconomic status, where individuals are more likely to have health insurance, better access to care and are more educated.

METHODS: Community onset (CO) cases from Emerging Infections program surveillance were defined as those with a CDI positive specimen sample less than four days after admission to a health care facility. Community associated CO cases were defined as those that did not have a healthcare exposure in the prior three months. Unadjusted CA-CDI …

Dengue Epidemiology In An Urban Slum Community In Salvador, Brazil, Kristine Gauthier

Public Health Theses

Brazil has experienced a major increase in the incidence of dengue fever and severe dengue since the mid-1990s. Due to incomplete vector-control and transmission prevention efforts, all four serotypes of the dengue virus now circulate in Brazil. Communities such as Pau da Lima, an urban slum in the city of Salvador, Brazil, face a high burden of disease. Beginning in 2009 enhanced surveillance for dengue fever and other acute febrile illnesses has been conducted at the São Marcos Emergency Center (CESM), the only public urgent care health center in Pau da Lima. This sentinel surveillance site serves as a model …

Skilled Birth Attendant Assessment In Haiti: A Pilot Project, Nicole Zickler

Yale School of Nursing Digital Theses

Objective: To evaluate a cohort of graduates from a grassroots skilled birth attendant training program in Haiti to determine if they meet global standards of competency established by the International Confederation of Midwives.

Design and setting: A testing instrument that included both a 50-question, multiple choice knowledge test and two emergency skills tests (postpartum hemorrhage and neonatal resuscitation) was adopted from the USAID Quality Assurance Project. A convenience sample of 30 skilled birth attendants completed the knowledge test and, of this cohort, a random sample of 18 completed the skills test. Data collection took place in Hinche, Haiti in July, …

Problems Of Sample-Selection Bias In The Historical Heights Literature: A Theoretical And Econometric Analysis, Howard Bodenhorn, Timothy Guinnane, Thomas A. Mroz

Discussion Papers

No abstract provided.

A Two-Tiered Demographic System: "Insiders" And "Outsiders" In Three Swabian Communities, 1558-1914, Timothy Guinnane, Sheilagh Ogilvie

Discussion Papers

No abstract provided.

Gerard Van Olphen Leaves Achmea And Becomes Ceo At Sns Reaal, Europawire

Documents

No abstract provided.

Childhood Cancer In The Cinema: How The Celluloid Mirror Reflects Psychosocial Care, Jovana Pavisic

Yale Medicine Thesis Digital Library

Film is a powerful medium for sharing illness narratives, and can exert a significant influence on public medical discourse. The childhood cancer narrative has more recently emerged on the screen, and these images have yet to be analyzed. This study aims to evaluate the childhood cancer experience in commercially produced, readily available films with a character with childhood cancer, with a particular focus on psychosocial care. Twenty-nine films were reviewed, using quantitative and qualitative content analysis to identify the medical and psychosocial characteristics of the cinematic childhood cancer experience. Psychosocial support was rated on a five-point scale (0-4) based on …