Digital Commons Network^™

Evaluating The Impact Of Preventative Health Services On Improving General Well-Being, Mallory Lucille Madden

Public Health Theses

Individuals in the United States suffer from an unnecessarily high rate of preventable chronic disease. One reason for this may be the nation's focus on tertiary care rather than preventive care. Health is multi-dimensional and should therefore be approached in an integrative manner. The current study proposes an integrative and preventative approach to health care services that utilizes Rath and Harter's (2010) five dimensions of well-being. We measured the impact of preventative health services in addition to tertiary care services on the general well-being of individuals over a two-month period of time. We found that those receiving preventative care in …

Unanticipated: Healthcare Experiences Of Gender Nonbinary Patients And Suggestions For Inclusive Care, Hannah Mogul-Adlin

Public Health Theses

Transgender populations face substantial barriers to healthcare access, exacerbated by a lack of inclusive research. The health needs of those who are gender nonbinary or genderqueer, identifying outside the binary of man and woman, are especially poorly understood. Using a primarily qualitative online survey, data on gender identity, health access, and healthcare experiences were collected from 81 gender nonbinary participants, and analyzed using a mixture of quantitative and qualitative methodologies. A number of interesting findings emerged, including that 90% of participants across age groups began identifying as gender nonbinary within the last 6 years, 77% reported interest in some aspect …

Impact Of Maternal Demographics On Infant Feeding Habits In American Samoa, Renu Nadkarni

Public Health Theses

Obesity and overweight prevalence in American Samoan adults are among the highest in the world, and levels are also high and increasing in children and infants. Obesity levels are believed to be due ultimately to the dramatic changes in lifestyle and diet over the past half century. A shift away from breastfeeding and to early introduction of formula and solid foods feeding is a dietary habit effected in this change, and can potentially influence a child's future body size and other health outcomes. As decisions about infant feeding are associated with certain maternal demographics in other populations, this study specifically …

The Effect Of Masculine Ideology On Sexual Communication And Sexual Self-Efficacy Among Expectant Adolescent Couples, Melanie K. Norton

Public Health Theses

This study examined the relationship between traditional masculine role norms (status, toughness, anti-femininity) and psychosocial mechanisms of sexual risk (sexual communication, sexual self-efficacy) among young, low-income, and minority parenting couples. Between 2007-2011, 296 pregnant adolescent females and their male partners were recruited from urban obstetrics clinics in Connecticut. Data regarding participants’ beliefs in traditional masculine role norms, frequency of general sex communication and sexual risk communication, and sexual self-efficacy were collected via computer-assisted self-interviews. Generalized estimating equation (GEE) models were used to test for actor effects (whether a person’s predictor influences the person’s own outcome) and partner effects (whether a …

Contribution Of Income To Self-Management And Health Outcomes In Pediatric Type 1 Diabetes, Kaitlyn Rechenberg

Public Health Theses

Low income has been established as a risk factor for poorer outcomes in

youth with type 1 diabetes; however, the effect of moderate income has not

been studied. The purpose of this secondary analysis of baseline data from a multi-site study was to compare glycemic control, self-management, and

psychosocial outcomes [depression, stress, and quality of life (QOL)] at

different income levels in adolescents with type 1 diabetes. Youth (n=320,

mean age=12.3+1.1, 55% female, 64% white, mean A1C=8.3±1.4)

completed established self-management and psychosocial measures. A1C

levels were collected from medical records. Caregivers reported annual family income, categorized as high (>$80K), …

The Epidemiology Of Drug Use And Hiv-Related Risk Behaviors In Mwanza, Tanzania, Xulin Tan

Public Health Theses

Heroin trafficking and consumption has increased steadily over the past decade in Tanzania, but limited information regarding HIV and drug abuse exists for the city of Mwanza. Our study investigates the epidemiology of drug use, and HIV risk behaviors among drug users in the northwestern city of Mwanza. Using a combination of targeted sampling and participant referral, we recruited 480 participants in Mwanza between June and August 2014. The sample was 92% male. Seventy-nine (16.4%) of participants reported injecting heroin, while 434 (90.4%) reported smoking heroin. Housing and cohabitation status were the only socioeconomic characteristics significantly associated with heroin injection. …

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 …

Cigarette Smoking And Thyroid Cancer Risk: A Population-Based Case-Control Study, Qian Wang

Public Health Theses

Abstract

Objective: Thyroid cancer incidence has increased substantially in the United States. Previous studies of the relationship between cigarette smoking and thyroid cancer have yielded conflicting results.

Methods: In order further clarify the association between cigarette smoking and risk of thyroid cancer, we analyzed data from a population-based case-control study in Connecticut in 2010-2011 including 462 histologically confirmed incident thyroid cancer cases and 498 population-based controls. Multivariate unconditional logistic regression models were used to estimate the associations between cigarette smoking and risk of thyroid cancer adjusting for potential confounders.

Results: Our data showed a decreased risk of well-differentiated thyroid carcinoma …

The Microbiome And Pneumonia Disease Severity In Asthmatic Children, Sarah Rae Wannier

Public Health Theses

Background: Pnuemonia is a leading cause of morbidity and mortality worldwide and children diagnosed with asthma have been shown to be at greatly increased risk of recurrent Community-Acquired Pneumonia (CAP). CAP in asthmatic children can incur nearly double the healthcare costs and lead to poorer outcomes during the course of the pneumonia infection.

Objective: This study seeks to determine if sputum (SP) samples may be used in the pediatric population to better understand the microbiome environment during severe pneumonia in place or in conjunction with the more commonly used nasopharyngeal (NP) samples. Additionally, this study seeks to identify features of …

The Effect Of Exercise Versus Usual Care On Depression In Breast Cancer Survivors: The Hormones And Exercise (Hope) Study, Bridget Ann Winterhalter

Public Health Theses

Purpose: Despite effective therapies and treatments, breast cancer survivors often suffer from distressing side effects which may increase depressive symptomatology. Aromatase inhibitors (AI) are widely used as adjuvant treatment in breast cancer patients, but are associated with side effects such as joint pain that may impact quality of life. We conducted, in 121 breast cancer survivors receiving an AI, a yearlong randomized trial of exercise versus usual care on depressive symptomology.

Methods: Eligibility criteria included taking an AI for at least 6 months, reporting < 90 minutes per week of exercise and no strength training, and reporting > 3 on a scale of 10 for worst joint pain on the Brief Pain Inventory (BPI). …

Acculturation And Likelihood Of Exclusive Breastfeeding Among Liberian Refugees And Ghanaians Living In Buduburam Camp In Ghana: A Cross-Sectional Study, Meley T. Woldeghebriel

Public Health Theses

Poor breastfeeding practices can put children at increased risk of morbidity and mortality particularly due to diarrheal and respiratory diseases and impaired physical and mental development. It is therefore important to understand the determinants of exclusive breastfeeding, particularly among residents in refugee settlements who may not have access to key resources and health education. The purpose of this study was to explore if acculturation influenced exclusive breastfeeding practices among Liberian refugees living in the Buduburam refugee settlement. A cross-sectional survey was administered between July - August 2008 to Ghanaian and Liberian women, with at least one biological child between 6 …

Development And Validation Of A Nomogram To Predict Pathological Complete Response To Neoadjuvant Chemotherapy For Breast Cancer, Qi Yang

Public Health Theses

Purpose The purpose of this study was to combine clinical pathologic variables that are associated with pathological complete response (pCR) following neoadjuvant chemotherapy into a prediction nomogram.

Methods A total of 15,553 women who underwent neoadjuvant chemotherapy for invasive breast cancer in 2010 and 2011 were identified from National Cancer Database (NCDB). Univariate analysis and multivariate logistic regression analysis were used to examine the association of patient age, race, tumor histology, tumor grade, molecular type, and clinical stage with pCR. A nomogram was then developed to predict individual patient probability of pCR to neoadjuvant chemotherapy. Internal validation was performed in …

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 …

Extended Conventional Therapy In Adult Xlh Patients, Jessica Ann Connor

Public Health Theses

Context: Treatment of X-linked hypophosphatemia (XLH) with active vitamin D metabolites and phosphate can partially correct skeletal deformities. It is unclear if therapy influences the occurrence of two major long-term morbidities in XLH: enthesopathy and dental disease.

Objective: To investigate the relationship between treatment and enthesopathy and dental disease in adult XLH patients.

Design: Observational and cross-sectional.

Setting: Academic medical center’s hospital research unit.

Participants: 52 XLH patients aged >= 18 at time of study.

Interventions: None

Main outcome measures: Number of enthesopathy sites identified by radiographic skeletal survey and dental disease severity (>5 or <=5 dental abscesses), identified historically.

Methods: Associations between proportion …

A Case-Control Study To Assess Risk Factors For Community-Associated Clostridium Difficile Infection, Samantha Greissman

Public Health Theses

INTRODUCTION: Clostridium difficile infection (CDI), initially thought to be acquired in the hospital, has occurred often in persons not recently hospitalized. Community-associated CDI (CA-CDI) may affect healthy individuals who lack the traditional risk factors for health care-associated CDI (HA-CDI). Risk factors for CA-CDI have yet to be fully identified.

OBJECTIVES: The objective of this study was to assess the risk factors for CA-CDI in the small Connecticut sample of a larger multi-state case-control study being conducted by the Emerging Infections Programs, and to help inform analysis of the larger study.

METHODS: A matched case-control study was conducted of consenting individuals. …

Maternal Passive Smoking And Risk Of Small For Gestational Age Among Non-Smoking Chinese Women, Huang Huang

Public Health Theses

Maternal active smoking is an established risk factor for small for gestational age (SGA). The role of maternal passive smoking in SGA, however, is unclear. The present study analyzed data from a birth cohort study conducted in Lanzhou, China between 2010 and 2012 including 8,638 non-smoking women who delivered singleton live births. Among those, 775 were SGA and 7,863 were appropriate for gestational age (AGA). Multivariate logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs). Potential confounding variables included in the final models were maternal age, education, employment status during pregnancy, parity, maternal …

Effect Of Exercise Vs. Attention-Control On Depression Symptomatology In Ovarian Cancer Survivors: The Women’S Activity And Lifestyle Study In Connecticut (Walc), Meghan B. Hughes

Public Health Theses

Background: With no effective screening tool, ovarian cancer survivors often suffer from unpleasant treatment-related side effects that influence quality of life. Increased physical activity has been associated with lower depression scores in ovarian cancer survivors. However, to date, no randomized controlled trial assessing the effect of exercise on depression has been conducted in this population. The Women’s Activity and Lifestyle Study in Connecticut (WALC) was a randomized trial examining the impact of exercise vs. attention-control on quality of life, body composition, and cancer biomarkers in ovarian cancer survivors. This analysis examined the effect of exercise on depression scores.

Methods: We …

It Takes Two?: Exploring The Supportive Role Of Fathers During Pregnancy And Its Effect On Birth Outcomes Among Young Couples, Grace Kim

Public Health Theses

Few studies have evaluated the relationship between prenatal paternal support and adverse birth outcomes among young couples. Traditionally, paternal support has been measured based on pregnancy wantedness and the presence of the father’s name on the child’s birth certificate. However, these indices may not capture key components of paternal support. The current study developed a paternal support index that expands the traditional view of parental support by incorporating other forms of support, including financial support, accompanying the mother to prenatal care visits, labor/birth classes, ultrasound appointments, and the father’s presence at the child’s birth. We examined its association with various …

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 …

Reconstructing Neuronal Connectivity From Calcium Imaging Data Using Generalized Transfer Entropy, Jina Li

Public Health Theses

The reconstruction of neuronal connectivity is a very interesting and important topic in neuroscience as it helps with understanding neuronal circuit and function. With the advancement of calcium fluorescence imaging technique, we can now observe the dynamical activity of hundreds of neurons in vivo in one setting, which provides a foundation for inferring connectivity within a community or network. Poor signal-to-noise ratio and low frame rate with respect to neurons’ actual firing rate are challenges that come with calcium imaging data. Here we review several methods that can be applied to calcium imaging data, without the direct need for converting …

Yale Medicine : Alumni Bulletin Of The School Of Medicine, Autumn 2014, Yale University. School Of Medicine

Yale Medicine Magazine - alumni bulletin and magazine

This is the Autumn 2014 issue of Yale Medicine: alumni bulletin of the School of Medicine, v. 48, no. 3. 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).

Applying Novel Tree-Based Frameworks To Big Data For Classification Of Heart Failure Patients And Prediction Of Clinical Responses, Yan Zhang, Nicholas Downing, Emily Bucholz, Suganthi Balasubramanian, Shu-Xia Li, Tara Liptak, Harlan Krumholz, Mark Gerstein

Yale Day of Data

Over 5 million Americans suffer from heart failure, a condition with a 5-year survival that eclipses all cancers apart from that of lung cancer. Conventional understanding of heart failure is simplistic: it is viewed as a single syndrome, despite real heterogeneity. In addition, models predicting outcomes focus on dichotomous results, like 30-day readmission. A novel approach to classification of heart failure may improve our ability to target interventions, improve patient experiences, and predict outcomes.

The Healthcare Cost and Utilization Project is a family of administrative claims databases that describes patient demographics, comorbidities, procedures, acute care utilization and outcomes, such as …

Early Life Environment, Fertility And Age Of Menarche: A Test Of Life History Predictions Using A Longitudinal Assessment Of Adversity Perception And Economic Status, Dorsa Amir, Matthew R. Jordan, Richard G. Bribiescas

Yale Day of Data

Perceptions of early life environmental adversity can affect the timing of life history transitions and investment in reproductive effort. These effects are well documented in non-human organisms, but have been challenging to test in humans. Here we present evidence of the effects of variables associated with extrinsic mortality and morbidity on reproductive effort in a contemporary American population. Using a longitudinal database that sampled participants (N ≥ 1,579) at four points during adolescence and early adulthood, variables reflective of perceptions of adversity and risk were significantly associated with age of menarche and early adult fertility. While other factors related to …

Exurban Residents’ Perceptions Of Naturally Returning Predators: Connecticut Case Study, Margaret E. Sackrider, Susan G. Clark, Isaac M. Ortega

Yale Day of Data

As a result of reforestation, growth of exurban areas and wildlife adaptation, it is believed that the public is currently encountering more human-wildlife conflicts than ever before. The key to balancing wildlife conservation and human development is understanding the dynamic relationship between humans and carnivores. Specifically, gaining insight into the complexity of this relationship will aide in the creation of more effective conservation policy and outreach.

Reforestation throughout Connecticut has supported a tremendous population growth of pray species and subsequently the growth of predator populations including coyotes, Canis latrans, and black bears, Ursus americanus. According to some biologists, …

Yale University Faculty Handbook July 1, 2014, Yale University Office Of The Provost

Faculty Handbooks

No abstract provided.

Tender Loving Care And The Woman With A History Of Recurrent Pregnancy Loss, Emily L. Gruetzmacher

Yale School of Medicine Physician Associate Program Theses

Recurrent pregnancy loss affects one to five percent of couples. This complication is traumatic for women and has psychological implications, including anxiety and depression. Increased monitoring and support – tender loving care – from clinicians has been shown to positively impact pregnancy outcomes during subsequent pregnancies in women with recurrent pregnancy loss. The affect of tender loving care on pregnancy outcomes and psychological distress is not entirely clear, however. We propose a randomized controlled trial to determine if these associations are statistically significant. Specifically, we will recruit women with any cause for early recurrent pregnancy loss and compare early pregnancy …

Injection Site Massage To Improve The Pharmacokinetics Of Aspart In Obese Adolescents With Diabetes, Hiwot Ketema Girma

Yale School of Medicine Physician Associate Program Theses

The invention of rapid-acting insulin analogs, such as aspart, was a great step forward in achieving optimal control of blood glucose in patients with type 1 diabetes. Aspart’s action resembles the physiologic endogenous post-meal insulin action; however, the slow rate of absorption through subcutaneous tissue leads to a delay in the time to peak levels and action of pre-meal insulin injection and suboptimal control of postprandial blood glucose excursions. We propose that massaging the site of aspart injection will significantly accelerate insulin action and mitigate postprandial blood glycemic excursions. The study will investigate the effect of injection site massage on …

Measuring "Problems Of Human Behavior": The Eugenic Origins Of Yale's Institute Of Psychology, 1921-1929, John Doyle

Kaplan Senior Essay Prize for Use of Library Special Collections

The Institute of Psychology at Yale was established in 1924 to study what its founders perceived as “problems of human behavior.” The Institute was Yale President James Angell’s first major step towards making the University a pre-eminent center for psychological research in the 1920s and 1930s. Endowed for a five-year term by the Laura Spelman Rockefeller Memorial Fund, the Institute brought three distinguished faculty to Yale: comparative psychologist Robert M. Yerkes, anthropologist Clark D. Wissler, and psychologist Raymond Dodge. While the Institute has been briefly cited in the historical literature as a precursor to the larger Institute of Human Relations …

Yale University Faculty Handbook April 30, 2014, Yale University Office Of The Provost

Faculty Handbooks

No abstract provided.