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Community Health Workers To Strengthen Hiv Care Continuum And Prep Delivery In The Us/Hics: A Scoping Review, Vanessa Abigail Nunez

Public Health Theses

Introduction: With the ongoing global HIV/AIDS burden, community-based service delivery models are increasingly recognized, with community health workers (CHWs) at the forefront. In high-income countries (HICs) like the United States, CHWs have long served marginalized communities, gaining recent legislative attention. Despite this, there's still a need for comprehensive evidence on CHW integration in healthcare delivery.

Methodology: We conducted a scoping review to gather available evidence on community health workers (CHWs) and their impact on HIV outcomes in HICs, and to identify evidence gaps in the use of community-based HIV/PrEP services in HICs. Using the American Public Health Association’s definition of …

Refractory Neurogenic Cough Management: The Non-Inferiority Of Soluble Steroids To Particulate Suspensions For Superior Laryngeal Nerve Blocks, Hisham Abdou

Yale Medicine Thesis Digital Library

Purpose: Superior laryngeal nerve (SLN) block utilizing triamcinolone (TA) or methylprednisolone acetate (MP) has been described as an efficacious treatment for refractory cough (RC). Particulate corticosteroid injection in the neck carries a risk of large-particle embolization and devastating neurologic sequela in the event of inadvertent intravascular injection. Herein, we compare the efficacy of a soluble steroid (dexamethasone, SS) with particulate steroids (PS) in reducing cough severity in RC-patients.Materials and Methods: Patient charts for those receiving SLN blocks by fellowship-trained laryngologists for the sole indication of RC were reviewed. Drug/dose, timing/laterality, and adjuvant treatments were compared using chi-squared test. A paired …

Medicaid Coverage For Undocumented Children In Connecticut: A Political History, Chinye Ijeli

Yale Medicine Thesis Digital Library

In the US, undocumented immigrants are barred from receiving coverage from the federal government for healthcare other than emergency services. States can offer government-funded health insurance to undocumented immigrants, but as of 2021, only six had. Forces standing in the way of other states implementing such coverage include nativism, racism, and fears about immigrants taking scarce jobs during economic downturns.In 2021, Connecticut passed S.B. 956, a bill extending Medicaid coverage to all low-income children up to the age of eight—regardless of immigration status—starting in 2023. This policy was the culmination of a twelve-year-old grassroots movement started by Connecticut Students for …

The Hardships Of Healthcare Among People With Lived Experiences Of Homelessness In New Haven, Ct, Brandon James Hudik

Yale Medicine Thesis Digital Library

Objectives: People with lived experiences of homelessness encounter barriers to accessing and maintaining appropriate healthcare. This project aims to: 1) identify how these barriers manifest in New Haven, CT; 2) examine the negative health and healthcare impacts such barriers may incur, including when people adapt to or try to overcome them; 3) examine the characteristics of positive experiences in accessing healthcare in order to inform future approaches to healthcare for this vulnerable population.

Methods: This study is a subanalysis of the Justice, Health, and Housing Study (JustHouHS) and draws on longitudinal, qualitative interviews with low-income New Haven residents who experienced …

Prevalence Of Metabolic Comorbidities And Viral Infections In Monoclonal Gammopathy, Mansen Yu

Yale Medicine Thesis Digital Library

Monoclonal gammopathy (MG) encompasses a spectrum of related diseases, with monoclonal gammopathy of undetermined significance (MGUS) being the most prevalent, serving as a precursor of smoldering and clinical multiple myeloma. While the association between gammopathies, metabolic conditions and antigenic stimulation has long been recognized, the precise mechanism remains unclear. Prior research has shown that a subset of MGUS and MM is driven by chronic antigenic stimulation of B cells by endogenous lipids and exogenous microbial antigens. The aim of this study is to assess the prevalence of metabolic comorbidities and viral infections in a large population with monoclonal gammopathy, providing …

A Needs Assessment For Rural Health Education In United States Medical Schools, Kailey Carlson

Yale Medicine Thesis Digital Library

This study is a needs assessment for rural health education at United States medical schools. Health disparities between rural and urban populations are significant and worsening. Rural areas are home to 20% of Americans but just 11% of physicians, contributing to health inequity. Medical schools must produce more future rural physicians to meet the needs of the population. To understand the need for rural health education in medical schools, medical students were surveyed on attitudes toward living and working in rural areas and comfort with clinical competencies important in rural areas. The hypothesis was that medical students at schools focusing …

H.R. 133: Consolidated Appropriations Act, 2021, United States: Congress: House Of Representatives

Documents

No abstract provided.

Yale Medicine Magazine Autumn 2024, Issue 173, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the Autumn 2024 issue of Yale Medicine Magazine, issue 173. Prepared in cooperation with the alumni and development offices at the School of Medicine. Earlier volumes include 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).

The Struggle For Eudaemonia: The Eugenics Movement In Psychology And Community Resistance In Connecticut, Eve Galanis

Academic Articles

Throughout the twentieth century, the eugenics movement dominated medical discourses in the state of Connecticut. From deportations, coerced institutionalizations and sterilizations, to proposed executions of people with mental illness, eugenic policies were deployed in an attempt to control and direct populations. The state collaborated with academic institutions like Yale University, and agencies like The Eugenics Record Office at Cold Spring Harbor, to endorse pseudo-scientific techniques of surveilling and administering bodies across intersecting lines of race, ability, gender, sexuality, class, and citizenship status. This research examines the biopolitics of eugenics and the contest for economic, geographic, social, and ideological space. Using …

Investigating Tuberculosis Dynamics Using Surveillance Data And Statistical Modeling: Studies In Three High Burden Settings, Melanie Hunter Chitwood

Yale Graduate School of Arts and Sciences Dissertations

Tuberculosis (TB) is a leading cause of death from infectious disease globally, despite the availability of effective antibiotic treatment. Control efforts focus on the rapid diagnosis and treatment of individuals with TB, which reduces both disease-related morbidity and mortality and onward transmission. In addition to passive case finding, the World Health Organization recommends active case finding for high-risk individuals and their contacts. Expanding these activities to populations in which there is evidence of recent transmission may be a suitable strategy to reduce TB burden, but identifying these populations is a persistent challenge. Statistical analyses, informed by high quality surveillance data, …

Improving Outpatient Medication Reconciliation And Reducing Adverse Drug Events: Development Of A New Process, Marisa Kristine Blake-Raut

Yale School of Nursing Digital Theses

AbstractImportance: Prescribed medications can pose risks to patient safety. In the United States, persons aged over 65 account for nearly 450,000 annual emergency department (ED) visits, and they are seven times more likely to require hospital admission than younger persons (Centers for Disease Control and Prevention, 2022). Medication reconciliation (MR) errors are more likely to affect those older than 65, but can be prevented by using standardized MR criteria that identify medications with higher risks for adverse drug events (ADEs) (O’Mahoney, 2020). Objective: The DNP project goal was to create and implement a risk stratified medication reconciliation (RSMR) intervention process …

The California Bridge Model For Emergency Department-Initiated Medication-Assisted Treatment For Opioid Use Disorder: Adaptations For Perinatal Hospital Services, Devin C. Thomas

Yale School of Nursing Digital Theses

Background: Poor access to gender-specific, pregnancy-focused medication-assisted treatment for perinatal opioid use disorder greatly contributes to adverse outcomes for pregnant patients, infants, and society, at large. It is well established that Emergency Department-initiated pharmacotherapy for opioid use disorder is safe, effective, and can be rapidly adopted by hospital systems to improve access to care for people who misuse opioids. Like the Emergency Department, perinatal hospital services are well positioned to serve as critical access points in the treatment of perinatal opioid use disorder. However, concerns such as lack of training, workflow inefficiencies, and bias act as barriers to co-located, integrated …

Unveiling Chagas Disease: An In-Depth Analysis Of Epidemiological Patterns In High Burden Latin American Nations, Nicole Del Castillo

Public Health Theses

Background: Chagas Disease, endemic to 21 countries in Latin America, is transmitted by triatominae insects infected with parasites known as Trypanosoma cruzi.1–3 It is the most prevalent tropical disease in Latin America, affecting about 6 million individuals across the Americas.1 This literature review aims to summarize unique epidemiological patterns over a 9-year time period from 2010 to 2019 across three nations in South America that experienced the highest Chagas Disease burden in 2019: Bolivia, Venezuela, and Argentina.4

Methods: For this rapid literature review, one independent reviewer extracted all data for publications reviewed within a 9-year time period: 2010 to 2019. …

The Roads Less Traveled: A Metaresearch Analysis Of Local Histories In Racial Health Equity Research, Devin Trévion Brown

Public Health Theses

While it is important that racial health equity research receive growing attention in theUnited States, doing so must involve a thorough recognition and interrogation of the role that structural racism plays in creating different outcomes for Black communities. History aids in making clear the process through which race can become biology as structural racism is embodied by members of Black communities. Guided by Táíwò’s conceptualization of “resource distribution and accumulation” as well as Carter’s discussion of “racialized local biologies”, this cross-sectional meta-research analysis sought to investigate when and how racial health equity research after 2020 utilized local history to understand …

Examining Factors Associated With Covid-19 Disruptions To Tuberculosis Services, Tejaswini Dharmapuri Vachaspathi

Public Health Theses

Background: The COVID-19 pandemic posed unprecedented challenges to global health systems, significantly impacting the delivery of essential health services, including tuberculosis (TB) care. It is important to analyze the factors associated with the reductions in TB notifications during the pandemic, with a focus on high TB burden countries, to inform strategies for making TB programs more resilient to health system shocks.

Methods: Amongst 98 selected high-burden countries, a GLM analysis was employed to examine the association between ‘missed’ TB case notifications from 2020 to 2021, and various country-level factors including: COVID-19 mortality estimates, lockdown stringency index, GDP per capita, health …

Evaluation Of One Health Education Materials: A Scoping Review And Quality Assessment, Sydney Jones

Public Health Theses

The increasing risk of zoonotic spillover, driven by climate change and evolving human behaviors, requires a systematic shift in pandemic prevention strategies towards a One Health approach. Central to this approach is effective health communication intended to translate knowledge into actionable recommendations for the most vulnerable populations. This thesis aims to systematically evaluate the quantity and quality of existing One Health communication materials through a scoping review and two distinct methods of quality evaluation: the CDC Clear Communication Index and content analysis. Among 82 communication materials identified in the scoping review, the median overall CDC Clear Communication Index score was …

Real-World Rollout Of Injectable Antiretrovirals For Hiv Prevention And Treatment: Understanding Predictors Of Early Adoption, Liza Koshy

Public Health Theses

Background: Data is limited on implementation of long-acting injectable (LAI) HIV treatment (ART) and prevention (PrEP). We sought to characterize “early adopters” of LAI ART and PrEP in terms of social determinants of health, using a health equity lens. Methods: A retrospective cohort included patients prescribed ART or PrEP through a large Northeast urban health system (January 2021-September 2023). Separate analyses used electronic health record data for: 1) prevention (LAI vs. oral PrEP) and 2) treatment (LAI vs. oral ART). Group differences were examined using ANOVA, chi-square tests or Fisher’s exact tests. Bivariate logistic regression modeled associations between LAI ART …

Exploring Health Equity In Global Community Health Worker Compensation With Cfir Analysis, Mansoorah Kermani

Public Health Theses

IntroductionEquitable compensation of community health workers (CHWs) is fundamental to sustaining and maximizing the impact of CHW interventions worldwide. Despite their pivotal role in promoting health equity especially among underserved populations, CHWs often encounter inadequate and inconsistent compensation, undermining the sustainability and effectiveness of their efforts. This review delves into various CHW compensation models and implications that may improve CHW compensation and performance across diverse patient populations.

MethodsEmploying the Consolidated Framework for Implementation Research (CFIR), this review systematically examines empirical literature to examine six different compensation models: alternative payment methods (value-based, capitation, and shared savings), grant-based, public sector or governmental, …

Evaluating Knowledge And Attitudes Towards Dengue Fever And Its Vaccination Among Medical Staff In China: A Questionnaire-Based Study, Ip Man Lam

Public Health Theses

Dengue, a mosquito-borne tropical disease caused by the dengue virus, has seen a significant increase in global incidence in recent decades. China has experienced a rapid rise in dengue cases since 2013, posing a serious threat to population health and increased economic burden. This study aimed to evaluate the knowledge and attitudes towards dengue fever and dengue vaccination among medical staff in China. A cross-sectional study was conducted using an online questionnaire survey targeting medical professionals in Zhejiang, Yunnan, and Hainan provinces, which are known endemic areas for dengue virus infection in China. The questionnaire assessed participants' understanding of dengue …

Exploring The Connections Between The Arts And Mental Health In The Face Of Climate Change, Marla Joy Minkoff

Public Health Theses

Objective: This study aims to explore how engagement with art may shape emotions related to the climate crisis and expand the conception of art as a mechanism of public health practice.Background: Climate change impacts human health not only physically but also psychologically, manifesting in symptoms of climate emotions (e.g., ecological grief, eco-anxiety, eco-paralysis) that arise as a result of changes to the earth and our relationship to the natural world. These symptoms are among the pressing mental health effects of climate change. Methods: A qualitative approach utilizing the Rapid Assessment Process (RAP) was employed to conduct semi-structured interviews (N=10) with …

“Their Body, Their Choice. Your Body, Your Choice. Your Baby, Your Choice.”: A Reflexive Thematic Analysis Of Vaccine Access And Acceptance Among U.S. Pregnant People On Reddit, Sydney Marie Perlotto

Public Health Theses

Compared to the general population, pregnant people and newborns are at a higher risk of contracting infectious diseases and experiencing worse adverse outcomes. Vaccines delivered during pregnancy, known as prenatal vaccines, represent a critical yet underused form of preventive care for these populations in the United States. Increasing successful prenatal vaccination uptake requires a focus on both access and acceptance, which pregnant people may experience differently than non-pregnant people due to their unique physiological and social state. Given the evolution of vaccine hesitancy following the COVID-19 pandemic, coupled with the recent expansion of the U.S. prenatal immunization schedule, this study …

Determining Optimal Media For Carbapenem-Resistant Enterobacteriaceae Recovery From Hospital Sink Drains: A Prospective Environmental Microbial Study, Eryn Larissa Pawluk

Public Health Theses

Abstract Background: Environmental healthcare-associated pathogens are of particular public health concern, not only as potential contributors to the escalating rates of hospital-acquired infections1 noted during the SARS CoV-2 pandemic, but also as valuable indicators for multidrug resistance2. Their significance extends to infection prevention and control, emphasizing the pivotal role of shaping specific interventions within healthcare settings.

Rationale: The study investigates R2A agar’s efficacy in recovering environmental pathogens, specifically carbapenem-resistant Enterobacteriaceae (CRE), crucial for enhancing infection prevention and control in healthcare settings.

Objectives: In this prospective study conducted within hospital environments, our objective is to identify superior culture methods for recovering …

A Climate Change Calamity: Assessing The Impact Of Flooding On Waterborne Disease Burden In Pakistan, Haleigh Schultz

Public Health Theses

Background: Pakistan ranks among the countries most vulnerable to climate change. In 2022, extreme flooding ravaged the country as a result of unprecedented monsoon rains, resulting in widespread environmental and health devastation. As flooding events damage water, sanitation and health (WASH) infrastructure, contribute to disaster conditions, and strain healthcare systems, heavy rains can impact waterborne disease transmission and outbreak events. Extreme flooding events are expected to increase in prevalence, severity, and scope as the climate continues to change in the future. This study aims to assess the impact of monsoon seasons and flooding events on waterborne disease burden in Pakistan …

Examining The Relationship Between Pcv13, Respiratory Viruses, And Invasive Pneumococcal Disease In Massachusetts Children, Kaitlin Soden

Public Health Theses

The landscape of the burden of invasive pneumococcal disease (IPD) in Massachusetts children has been shaped by both the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in 2010 as well as the relationship with respiratory viruses, like influenza and COVID-19. The implementation of non-pharmaceutical interventions (NPIs) and dramatic decline in non-COVID circulating respiratory viruses during the initial waves of the COVID-19 pandemic provided a unique opportunity to evaluate the relationship between respiratory viruses and IPD in Massachusetts children. Using weekly surveillance data for IPD, influenza, and COVID-19 in Massachusetts children 5 years of age and younger from the Massachusetts …

Assessment Of Suicide Risk In Emergency Department Settings For Adults In Nepal: Validation Of The Nepali Ask Suicide-Screening Questions, Pei Wang

Public Health Theses

Objectives: Suicide is a severe public health crisis around the globe. Low-middle-income countries (LMICs) bear 77% of the global suicide burden. Screening is a significant component of suicide prevention, but there is a dearth of suicide screening tools, especially in LMICs. This study focused on validating the Ask Suicide-Screening Questions (ASQ) within an adult Emergency Department (ED) population in Nepal. Although the validation occurred in an ED setting, the Nepali ASQ is designed with the flexibility to be useful in a variety of healthcare contexts, extending its applicability beyond just emergency care.Methods: We systematically translated and adapted the 4-item ASQ, …

Cost-Effectiveness Analysis Of Alternative Infant And Neonatal Rotavirus Vaccination Schedules In Malawi, Catherine Wenger

Public Health Theses

Rotavirus is the leading cause of cases and deaths related to diarrhea-related hospitalizations among children under five worldwide, especially in low- and middle- income countries. Although vaccination is proven to be the best strategy for preventing rotavirus, its impact has been suboptimal in LMICs.

The primary aim of this study was to evaluate the impact of and cost- effectiveness of the current Rotarix rotavirus vaccine, two alternative vaccine delivery schedules, and the next-generation vaccine (RV3-BB) in Malawi.

The cost-effectiveness of rotavirus vaccine strategies in Malawi was evaluated using moderate-to-severe and non-severe rotavirus cases derived from a mathematical model ofrotavirus transmission …

The Impact Of The Covid-19 Pandemic On Cancer Prevention Behaviors In Selected Gen Z Population (Ages 18-25), Lan Zhang

Public Health Theses

Background: The COVID-19 pandemic has resulted in negative changes in health behaviors related to cancer. Recent studies in adults have identified factors leading to harmful/unhealthy lifestyle changes during the pandemic. However, little is known about the factors that predict worse cancer-related health behaviors among young adults.

Methods: The data used for this analysis were from a cross-sectional online survey conducted in Connecticut in 2021 regarding participant’s lifestyle behaviors during the COVID- 19 pandemic. Participants were recruited through social media networks of community partners and organizations within the Yale Cancer Center (YCC) catchment area. Participants included local minority and low socioeconomic …

Do Rental Assistance Programs Relieve Overcrowding In U.S. Children?, Frank Zhu

Public Health Theses

Introduction: Crowded living conditions are associated with many negative health outcomes, with significant implications for children, as they are particularly shaped by their home environment and more likely to live in crowded conditions, given their larger household size. How rental assistance programs may shape and improve household crowding has not been previously explored. Methods: This study leveraged data from NHANES linked with HUD administrative rental assistance records. We examined changes in crowding measures in U.S. children using linear and logistic regression models stratified by different rental assistance program types. Results: There was a statistically significant 40 percentage point reduction in …

Exploring The Role Of Bacteroidales In Human Health: A Comprehensive Literature Review On Their Associations With Selected Diseases, Tingyue Wang

Public Health Theses

Bacteroidales are a vital group of gut bacteria that significantly contribute to human health by maintaining gut balance. However, their abundance is often altered in various diseases, indicating a strong association with disease progression and immune responses. This review categorizes Bacteroidales into clusters based on metabolic phenotypes, suggesting similarities in their metabolic pathways.

To explore the relationship between Bacteroidales species and human health, we conducted a comprehensive literature review. We compiled a list of 16 Bacteroidales species and performed targeted searches in PubMed using keywords related to inflammation and immunity. This process helped us identify relevant diseases, focusing on those …

Environmental Surveillance Of Viral Pathogens For Identifying Infectious Disease Outbreaks, Alessandro Zulli

Yale Graduate School of Arts and Sciences Dissertations

The detection and quantification of viral infectious disease outbreaks is necessary for theeffective implementation of public health interventions that protect human health. Communicable viral diseases are a leading cause of morbidity and mortality worldwide and prior pandemics have had acute economic and social impacts. However, the identification and tracking of community wide outbreaks for most human viruses across the developed and developing world does not occur due to resource constraints. The goal of this dissertation’s research is to develop the science and methodology that underpin the environmental surveillance of viruses, focusing specifically on wastewater monitoring for identifying and tracking viral …