Digital Commons Network^™

Implementation And Evaluation Of Perinatal Educational Video Series – Postpartum Hemorrhage, Daileann Lamara Hemmings

Yale School of Nursing Digital Theses

Abstract

Implementation and Evaluation of Perinatal Educational Video Series –Postpartum Hemorrhage Per the Centers for Disease Control and Prevention (2021), 700 women die each year due to pregnancy related complications in the United States. Black women (Erickson, 2020) have a 26.6% higher risk for morbidity resulting from postpartum hemorrhage (PPH) and a five times higher risk of mortality. Education can serve as a tool to increase knowledge, promote a mother’s ability to identify the onset of a risk and report signs and symptoms of PPH that could otherwise lead to complications or death. ​ This DNP pilot project developed and …

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, …

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 …

Bmi's Early Echo: Deciphering Adolescent Body Mass Indicator On Adulthood Breast Cancer, Tianyu Feng

Public Health Theses

This study aimed to explore the association between body mass index (BMI) during adolescence and the risk of breast cancer in adulthood among a Chinese female population. We conducted a nested case-control study within a prospective cohort comprising 62,487 Chinese women aged 25-55 years. Adolescent BMI was retrospectively collected via interviewer-administered questionnaires and analyzed as the primary exposure variable. Breast cancer incidence served as the primary outcome. Propensity Score Matching (PSM) was employed to adjust for confounding variables, such as socioeconomic status, lifestyle factors, and adult BMI.Of the 9,163 participants eligible for analysis, 57 breast cancer cases were identified during …

Wearable Passive Air Sampling And Crohn's Disease In Pregnancy, Hazel Ann Fajardo

Public Health Theses

Inflammatory Bowel Disease (IBD) is an immune dysregulation in the gut caused by genetic predisposition and environmental triggers. IBD represents two chronic intestinal inflammatory disorders: ulcerative colitis and Crohn’s Disease (CD), both presenting with multiple gastrointestinal symptoms and complications that affect a patient’s quality of life. Throughout the years, patterns of IBD and CD across the globe vary with trends for IBD prevalence increasing since the 1950s, in North America, Europe, and Australia. Rising incidences in developing regions are seen in Asia and Latin America, and newly industrialized countries in Asia, Africa, and South America, in the 21st century. Several …

Exploring The Associations Between Stereotypes Of Aging And Dementia And Self-Reported Health In Parent-Adult Child Dyads, Yunke Gu

Public Health Theses

Stereotypes and stigma about Alzheimer’s Disease continue to emerge, as the number of populations affected by the disease in society is escalating. The sociocultural context sets the stage for the significant impact that Alzheimer’s has on family dynamics, especially for the adult children who provide over half of informal caregiving. Our study aims to adopt a dyadic approach, examining the interrelated experiences of adult child caregivers and their parents with ADRD. 126 dyads were included in this secondary data analysis. Measures included depressive symptoms and self-reported physical and mental health, stereotypes of aging and of person with memory loss. Results …

Polypharmacy Is Associated With Biomarkers Of Cognitive Frailty In Older People With Hiv, Priya Kosana

Public Health Theses

Background: Little is known on the impact of taking multiple medications in older people with HIV (PWH), who have higher rates of medical comorbidities than HIV uninfected individuals. We assessed the prevalence and clinical impact of polypharmacy among a large, mixed gender cohort of PWH, and assessed for the relationship between polypharmacy and clinical and laboratory-based biomarkers of cognitive frailty.Methods: We used data from the AIDS Clinical Trials Group (ACTG) A5322 (HAILO) cohort of PWH aged 40 or older with plasma HIV RNA levels below 200 copies/µL from 2013 to 2014 study visits. We assessed the relationship between polypharmacy ( …

Light At Night And Cancer Incidence: A Gis-Based Study In The Us, Linshuoshuo Lyu

Public Health Theses

Aims: Light at night (LAN) can cause circadian disruption and was found to be a potential risk factor for several cancers. This study aims to confirm the adverse effect of LAN on hormone-related cancers and explore the association between LAN and the prevalence of various cancer types under an ecological study design. Methods: County-level age-adjusted cancer incidence data was obtained from the CDC Cancer Statistics (2016 to 2020), while LAN data (1996 to 2000) was obtained from the satellite imagery of Version 4 Defense Meteorological Satellite Program. Linear mixed effect regression models (LMMs) were performed to assess the relationship of …

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 …

Effect Of A Weight-Loss Intervention On Oxidative Stress Biomarkers Among Breast Cancer Survivors In The Lifestyle, Exercise, And Nutrition (Lean) Study, Yiyi Li

Public Health Theses

Introduction: As the number of breast cancer survivors increases, ensuring quality of life during the survivorship period is important. Obesity may induce oxidative stress, which may be relevant mechanistically for adverse health outcomes among breast cancer survivors. Diet, exercise, and weight loss may mitigate oxidative stress, yet few lifestyle trials have investigated if these interventions have impacted oxidative stress. Therefore, we conducted a secondary analysis in a 6-month weight loss randomized controlled trial, the Lifestyle, Exercise, and Nutrition (LEAN) study, among breast cancer survivors with a body mass index (BMI) ≥ 25 kg/m2 to evaluate the effect of the intervention …

Exploring The Use Of Mobile Health Application To Promote Self-Managment Of Cardiovascular Disease: A Study Of Age-Related Differences And Technology Adoption Among Chinese Patients, Yunan Mei

Public Health Theses

Background: Cardiovascular diseases (CVD) are the leading cause of mortality globally, particularly in China's aging population. Mobile health (mHealth) technologies offer a promising avenue to address healthcare disparities and enhance CVD management among the elderly. This study aims to explore the acceptance of mHealth in improving self-management of CVD among older adults in China, focusing on its potential to mitigate accessibility and treatment challenges.

Methods: This cross-sectional study was conducted at the Xinhua Hospital of Shanghai Jiao Tong University. Data were collected using an online Qualtrics questionnaire from 225 participants who met inclusion criteria including being Chinese speakers, diagnosed with …

Racial Disparities In Metastatic Non-Small Cell Lung Cancer In The Post-Immunotherapy Era, Victoria Mcclare

Public Health Theses

Importance: The approval of immune checkpoint inhibitors (ICI) has improved survival amongthose with metastatic non-small cell lung cancer (mNSCLC). However, it is unclear to what extent existing racial and ethnic disparities in survival outcomes for those with mNSCLC are widening under the new ICI treatment era. Objective: Examine changes in racial and ethnic disparities in mNSCLC survival rates before and after the U.S Food and Drug Administration (FDA) approval of ICI in the United States. Design, Setting, and Participants: This study is a population-based retrospective cohort of patients with NSCLC from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020), …

Analysis Of Mercury Exposures In The United States Reported To The National Response Center (2018-2022), Abigail E. Mcdonald

Public Health Theses

Introduction

The frequency and extent of environmental elemental mercury exposures in the U.S. are unknown. Due to its marked toxicity, elemental mercury has been phased out of many newer commercial products. However, mercury-containing products are still available, and a variety of religious, cultural, decorative, cosmetic, and illicit uses have been reported in the community. Small quantities of mercury can be highly toxic, and mercury toxicity can present nonspecifically and multi-systemically with the potential to be easily missed. Therefore, it is important to characterize the settings where mercury exposures occur and the extent of such exposures. The overall aim of this …

Biomarker Profiles And Treatment Patterns In Patients With Advanced Non-Small Cell Lung Cancer: A Real-World Database Analysis, Zijian Niu

Public Health Theses

Background: With the rapidly evolving treatment options for patients with advance-staged Non-Small Cell Lung Cancer (NSCLC), the National Comprehensive Cancer Network (NCCN) offers systematic guidelines on treatment choices based on biomarker profiles and adjunctive information as the reference. This study aim to understand how patient’s biomarker profiles influence the receipt of Guideline-Concordant Treatments (GCTs) and exploring potential prognostic factors that exert such positive impacts on receiving these guideline-concordant therapies.Methods: This retrospective study focused on using the Flatiron Health NSCLC deidentified database, targeting at advanced NSCLC patients with 5 main confirmed actionable biomarker (ALK+, EGFR+, PD-L1 <1%, PD-L1 1%-49%, PD-L1 ≥50%). Patients with five main biomarkers were further described by whether they have undergone first lines of treatment (LOT) GCTs post-confirmation of biomarker status exclusively. Descriptive analysis was used to examine of the frequency distribution of GCTs across out cohort, while the multi-variate logistic regression model was used to identify potential prognostic factors influencing the receipt of NCCN GCTs. Results: 15,221 individuals were aligned with GCTs, underscoring a substantial compliance within the cohort with pre-treatment confirmed biomarker profiles. Descriptive analyses revealed a statistically significant correlation with receiving GCTs across gender, ECOG status, biomarker profiles, histology and smoking history. Strikingly, patients with PD-L1 expression and ECOG status of 2-4 had the highest rates of GCTs than other ECOG subgroups. By adjusting ORs, Asian and patients with PD-L1 expression were more predisposed to receive GCTs. Conclusion: By confirming the importance of biomarker profiles and ECOG status in the receipt of GCTs, results highlighted the necessity of addressing disparities in healthcare accessibility and treatment equity for patients from varied biological and social backgrounds, ensuring that advancements in precision medicine benefit all individuals equally.

“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 …

Child And Adolescent Exposure To Environmental Chemicals And Mental Health Outcomes: A New Haven Study, Yunyue Shi

Public Health Theses

Child and adolescent mental health disorders, including anxiety, depression, and behavioral problems, contribute significantly to the global health burden. Exposure to toxic air contaminants such as semi-volatile organic compounds (SVOCs)—especially polycyclic aromatic hydrocarbons (PAHs) and phthalates—during critical developmental periods can have detrimental impacts on children’s brain development and function. This study aimed to identify potential associations between children and adolescents’ chemical exposure and mental health outcomes. The objectives were: 1) to characterize the distribution of individual environmental chemical exposures among children and adolescents using Fresh Air samplers and 2) to determine the association between chemical exposures, particularly PAHs and phthalates, …

Long-Term Exposure To Ambient Pm2.5 & Intentional Self-Harm, Caroline Elise Sutton

Public Health Theses

A growing body of literature is finding that air pollution exposure may contribute to disease onset of certainbrain disorders, including mental disorders such as depression, through mechanisms of neuroinflammation and oxidative stress1. However, even as there is increasing attention on the impacts of air pollution and mental illnesses, most studies focus on mental illness outcomes that might not represent severe or life-threatening symptoms (such as self-harm)2–7 , while a majority of studies focused on intentional self-harm assess the relationship between short-term air pollution exposure (as opposed to chronic and cumulative exposure) and self-harm outcomes8–13 . Given the barriers to treatment …

Birth Characteristics, Outdoor Artificial Light At Night, Ambient Air Pollution And The Risk Of Hepatoblastoma In Young Children, Peiyi Wang

Public Health Theses

Objective: The etiology of hepatoblastoma, the predominant malignant liver tumor in infancy and early childhood, is unclear. We assessed possible associations between birth characteristics, outdoor artificial light at night (ALAN), ambient air pollution (measured by particulate matter PM2.5), and the risk of hepatoblastoma.

Methods: Leveraging a population-based linkage of statewide birth records and cancer registry data in California, we conducted a case-control study that included 356 hepatoblastoma cases diagnosed at the age of 0-6 years during 1988-2015 and 17,800 controls frequency-matched by birth year. Restricted cubic spline transformation was employed to evaluate non-linear associations. Multivariable logistic regression models were used …

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 …

Assessing The Correlation Between Per- And Polyfluoroalkyl Substances (Pfas) Exposure And Cancer Incidence In The U.S., Xiaoqing Zhang

Public Health Theses

AbstractThe study seeks to understand the relationship between key PFAS contaminants and their potential to cause cancer in the United States. It also aims to find out how different PFAS exposures affect different types of cancer and how food can increase or decrease the risk of getting cancer. The study used secondary data from the government and other reliable sources. The process looked at PFAS exposure, food malnutrition, and cancer rates in the population by using both descriptive and inferential statistics. After looking at socio-economic factors and their health effects on the public, the results showed that PFOS, PFHxS, and …

Randomized Trial Of Exercise Vs. Usual Care On Inflammatory And Metabolic Biomarkers In Women With Breast Cancer Taking Aromatase Inhibitors, Lingxiao Zhang

Public Health Theses

ABSTRACT

Background: The Hormones and Physical Exercise (HOPE) study demonstrated efficacy of exercise in reducing AI-associated arthralgia in breast cancer survivors. Yet, the underlying mechanism for this relationship remains unclear. Prior research among breast cancer survivors highlights improvements in metabolic and inflammatory biomarkers related to exercise. This secondary analysis of HOPE examined the potential role of metabolic and inflammatory biomarkers in mediating the effect of exercise vs. usual care on AI-associated arthralgia.

Methods: Our analysis included 80 participants (42 exercise arm, 38 usual care) enrolled in the HOPE study. The intervention was a year-long exercise program that included both supervised …

Resilience In Self-Perception Of Aging Among Chinese Older Adults Under The One-Child Policy, Minyang Zhang

Public Health Theses

This study examines the resilience of self-perception of aging (SPA) among older Chinese adults affected by the One-Child Policy (OCP), based on data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Implemented in 1979, the OCP reshaped family dynamics. It potentially influences aging perceptions among the elderly. Utilizing the stereotype embodiment theory, this research assesses if deep-rooted cultural attitudes towards aging could mitigate the psychological effects of these demographic changes. Results suggest that despite significant societal shifts, the SPA among Chinese elderly remains stable. That indicates a minimal direct impact of the OCP on aging perceptions. The finding underscores …

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 …

Resilience In Self-Perception Of Aging Among Chinese Older Adults Under The One-Child Policy, Minyang Zhang

Public Health Theses

This study examines the resilience of self-perception of aging (SPA) among older Chinese adults affected by the One-Child Policy (OCP), based on data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Implemented in 1979, the OCP reshaped family dynamics. It potentially influences aging perceptions among the elderly. Utilizing the stereotype embodiment theory, this research assesses if deep-rooted cultural attitudes towards aging could mitigate the psychological effects of these demographic changes. Results suggest that despite significant societal shifts, the SPA among Chinese elderly remains stable. That indicates a minimal direct impact of the OCP on aging perceptions. The finding underscores …

King’S Vibrato: Modernism, Blackness, And The Sonic Life Of Martin Luther King, Jr., Joshua Lazard

Yale Journal of Music & Religion

A book review is presented for King's Vibrato: Modernism, Blackness, and the Sonic Life of Martin Luther King, Jr., authored by Maurice O. Wallace, by Joshua Lawrence Lazard.

Use Of Social Media In Public Archives: Perspectives About Ghana’S Readiness And Perceived Challenges., Reuben Saah, Samuel Abban, Esther White

Journal of Contemporary Archival Studies

The study explored the readiness and challenges of social media adoption at the Public Records and Archives Administration Department (PRAAD) in Ghana and was guided by the Iacovou, Charalambos L., Izak Benbasat, and Albert S. Dexter model of Electronic Data Interchange adoption. Using the qualitative approach, 13 participants drawn from the Archives Division were interviewed to explore their perspectives. The results showed that besides the participants high understanding and awareness of the benefits of social media adoption, clients were interested to engage PRAAD on social media. However, PRAAD’s readiness to adopt and effectively use social media was inadequate due to …

Physical Decline Rates: Men Versus Women, Ray C. Fair

Cowles Foundation Discussion Papers

This paper uses world records by age in running, swimming, and rowing to estimate a biological frontier of decline rates for both men and women. Decline rates are assumed to be linear in percent terms up to a certain age and then quadratic after that, where the transition age is estimated. For both men and women decline rates are smallest for rowing, followed by swimming and then running.

Decline rates for women are roughly the same as those for men for the short swimming events. They are slightly larger for the longer swimming events and for the rowing events. They …

Deciphering The Habitability Of The Early Earth: Insights From The Coupled Evolution Of The Crust-Mantle-Atmosphere-Ocean System, Meng Guo

Yale Graduate School of Arts and Sciences Dissertations

Life on Earth traces back to the planet's early geological eons, namely the late Hadean and early Archean. However, direct geological evidence from this period is scarce, necessitating reliance on understanding crust-mantle differentiation and the evolution of atmosphere and oceans to study early Earth habitability. Despite its importance, significant debate surrounds the specific characteristics of Earth's early environment. In this dissertation, we focus on deciphering the chemical and physical evolution of the coupled crust-mantle-atmosphere-ocean system throughout Earth's history, providing insights into continental formation, atmospheric carbon dioxide levels, and ocean pH—essential factors influencing the emergence and development of life on Earth. …

Greener Routes To Biomass Valorization: Lignin Upgrading Using Electrochemical Method, Fang Lin

Yale Graduate School of Arts and Sciences Dissertations

Due to the concerns over the global environmental impact of fossil fuel use, the conversion of renewable biomass to fuels and useful chemicals has attracted increasing attention. Lignin has emerged as a promising candidate due to its unique aromatic backbone structure and its natural abundance coupled with its underutilization as a feedstock. The growing interest in lignin as a renewable feedstock for aromatic platform chemicals has led to increased research efforts into its valorization, particularly through controlled depolymerization into smaller aromatic building blocks. One of the most common bonds in lignin’s complex structure is the C-O bond, and these bonds …

Biopsychosocial Markers Of Social Adversity As Risk Factors For Mental Illness, Meghan Alexandra Collins

Yale Graduate School of Arts and Sciences Dissertations

Stress and adversity are strong predictors of poor mental health outcomes among individuals at clinical high-risk for psychosis (CHR). Furthermore, atypical neurodevelopment during adolescence has been proposed as a biological mechanism that contributes to psychosis onset. Approximately 20% of youth who meet CHR criteria will go on to develop a psychotic disorder within two years. Thus, delineating the mechanisms linking adversity and neurodevelopment with conversion to psychosis is important for enhanced risk identification and early intervention. There is a lack of clarity in the existing literature regarding which types of adversity are most predictive of poor clinical outcomes among CHR, …