Digital Commons Network^™

A Retrospective Cohort Study: Association Of Sex And Race Differences On 30-Day Retention In Addiction Treatment For Substance Use Disorders After Discharge, Bingning Wang

Public Health Theses

Objective: Little is known about the association of sex and racial differences in accessing SUD treatment. little is known whether these disparities continue despite hospitalization. The main objective was to determine the association of race and sex differences on 30-day retention in addiction treatment for all substance use disorders after discharge. Design: A Retrospective Cohort Study using the Yale Addiction Medicine Consult Service databaseSubjects: Patients with SUD who were hospitalized at Yale New Haven Hospital from Oct 26th, 2018 to Jun 30th, 2021 are eligible, which has 2557 observations. Methods: Mixed effect multivariable logistic regression for sex and racial differences …

Recommendations For Climate Adaptation To Preserve Connecticut Drinking Water Quality And Quantity, Matthew Salvatore Di Vitto

Public Health Theses

Climate change impacts drinking water both directly and indirectly. Increases in temperature, drought frequency, and precipitation are among the climate impacts which currently and are projected to affect water quality and quantity in the continental United States. These impacts limit access to clean and abundant water sources by damaging habitat, spreading toxic substances via runoff and favoring the growth of harmful algal blooms. States can learn from one another to adopt best practices and policies to increase water resilience around the country. This paper explores how Connecticut can employ strategies from the States of New York, New Jersey, Massachusetts, Minnesota, …

Redox Changes In The Livers Of Mice Exposed To Environmentally Relevant Doses Of 1,4-Dioxane In Drinking Water, Caroline Erickson

Public Health Theses

1,4-dioxane (DX) is designated as a probable human carcinogen (Group 2B) based on demonstrated liver carcinogenicity in animal models. DX was a widely-used stabilizer for organic solvents throughout the late 20th century. Today, DX is found in many public water supply systems as well as personal care products. A lack of data on the mechanisms of action (MOAs) of its toxicity has contributed to the absence of adequate regulation. As a result, no federal Maximum Contaminant Law (MCL) exists leaving states responsible for designing exposure guidance amidst the regulatory melee. This thesis seeks to investigate redox changes associated with DX …

“You Are Just Trying To Make It Work”: A Qualitative Exploration Of Healthcare Provider Implementation Considerations For Integrating Mental Health And Hiv Care In Central Uganda, Divya Gumudavelly

Public Health Theses

There is a growing push to integrate mental health services within HIV care in urban Uganda. Amidst HIV clinics becoming comprehensive healthcare centers, there is a critical need to understand how providers can better adopt and implement mental health specific protocols in HIV practice. Semi-structured interviews were conducted with 16 healthcare providers at two different HIV care centers to understand current practices, routines, barriers, and facilitators to implementing mental health care services within HIV care. Abductive thematic analysis, drawing from Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF) frameworks, was used in conjunction with constructivist grounded theory …

Cleft Lip And Depression In Adults: A Multi-Ancestry Mendelian Randomization Study, Anne Lyon Havlik

Public Health Theses

Background: Clefting of the lip with or without cleft palate (CLP) is the most common congenital craniofacial abnormality globally, affecting one in 700 live births. Traditional observational studies suggest an increased risk of adult depression among subjects with CLP, but these studies are subject to residual confounding.Objective: We aimed to address residual confounding by evaluating the association between the genetically-predicted risk of CLP on the risk of adult depression in a Mendelian randomization framework. Methods: We used single-nucleotide polymorphisms strongly associated with CLP as genetic instruments. Genetic associations with adult depression were extracted from separate studies. Three ancestry groups were …

Do Longitudinal Trends In Caloric Intake Vary By Income, Education, Or Race?, Daniel Davila

Public Health Theses

Background: The prevalence of obesity in the United States has increased over the last few decades. Reasons for the increases are abundant, but one factor consistently stands out, caloric intake. Cross-sectional data on differences in caloric intake by race/ethnicity and socioeconomic status are common; however, few studies have evaluated the long-term trends in calorie intake by these factors. Methods: We evaluated trends in average calories consumed by adults in the United States by income decile, educational attainment level, and race/ethnicity from 1971 to 2018 using data from the National Health and Nutrition Examination Survey (NHANES), which purposely assessed and recorded …

Automated Cancer Prognostic Modeling With Pathological Imaging Features, Kehan Yan

Public Health Theses

Objectives. To assess the reproducibility and overlapping of information in the automated pathological imaging features pipeline for lung adenocarcinoma (LUAD), lung squamous cell carcinoma (LUSC) and skin cutaneous melanoma (SKCM); and to construct an integrated prognostic model using these pathological imaging features for LUAD, LUSC and SKCM. Methods. 470 LUAD patients, 477 LUSC patients and 428 SKCM patients are included in the study. Whole-slide histopathology images as well as demographical and clinical data are obtained from the TCGA website. Histopathological images are processed using the Openslide Python library and chopped into twenty small 500*500- or 700*700-pixel subimages. CellProfiler software was …

Optimization Of An Elisa-Based Leptospirosis Diagnostic, Kevin Yuhang Zhao

Public Health Theses

Leptospirosis is an infectious zoonotic disease responsible for about 1 million cases annually. Issues in early diagnosis is a major contributor towards poor health outcomes. Current tests for diagnosis, such as whole-cell ELISA-based diagnostics or the microscopic agglutination test (MAT), importantly lack sensitivity during acute-phase disease. Therefore, creating an ELISA-based diagnostic, which is generally cheaper and easier to perform than the MAT, using highly-conserved targets, that has high sensitivity towards acute-phase disease, would be desirable. This study first attempted to optimize protocols for diagnosis, and next applied the optimized protocol against epitopes derived from hamsters vaccinated with a multi-recombinant protein …

Copd And Asthma: Genome-Wide Associations And Genetic Pleiotropy, Yixuan Yang

Public Health Theses

This study aimed to describe the overlap between genetic variants that are independently associated with COPD and asthma, then dissect the cross-phenotype associations to characterize patterns of pleiotropic effects. The COPD and asthma datasets were separately extracted from an aging population consisting of white European subjects from the UK Biobank database. Genome-wide association tests were performed separately with the COPD and asthma data to first investigate significant genetic variants independently associated with each of the two phenotypes. With the GWAS summary statistics, several significant genetic loci that exhibit potential pleiotropic effects on COPD and asthma on a genome-wide significant level …

Circadian Timing In Cancer Treatment: A Mini Review On Cancer Chronotherapy, Jiawei Yin

Public Health Theses

Organisms exhibit rhythmic fluctuations in their behavior and metabolism every 24 hours, a phenomenon controlled by their circadian clock to anticipate changes in the environment. In the past forty years, substantial progress has been made in our knowledge of the molecular mechanisms underlying the circadian clock and cancer. In this context, researchers have explored the possibility of leveraging the circadian clock to improve cancer treatment. Several randomized controlled trials have investigated the effects of circadian chemotherapy and radiotherapy on drug toxicity and efficacy, with many studies reporting clinically significant outcomes, although some findings remain inconsistent. This mini review aims to …

Uncovering The Relationship Between Opioid Use And Postpartum Depression: Evidence From A Two-Sample Mendelian Randomization Study, Toni-Ann Yapp

Public Health Theses

Background and Objective: Opioid use during pregnancy is a significant public health concern that has been associated with adverse maternal and fetal outcomes. This study aims to investigate the association between the genetic liability for prescription opioid medication and postpartum depression (PPD) using a Two-Sample Mendelian Randomization (MR) approach. By reducing the risk of residual confounding found in traditional observational studies, we can comprehend how MR can further improve our understanding of this issue. Design, setting, and participants: We conducted a 2-sample MR using summary statistics from genome-wide association studies (GWAS) to determine associations of prescription opioid use with PPD. …

Estimating Urinary Nitrate Excretion In Rural Iowans From Dietary And Drinking Water Sources, Timothy Skalaban

Public Health Theses

Nitrate levels are increasing in our environment, and epidemiological studies have found evidence of adverse health risks from this exposure. Therefore, it is important to characterize the magnitude of nitrate exposure from food and drinking water sources. This study assesses the magnitude of nitrate exposure for 47 farmers from the Agricultural Health Study (AHS) in 2018-2019. The participants in our study use private wells as their main drinking water source and live in agricultural area of Iowa (10 counties) where ground water is vulnerable to nitrate contamination. The extent of nitrate exposure is determined by several factors, including the types …

Impact Of Covid-19 On Women Living With Hiv Who Are Survivors Of Intimate Partner Violence, Xinyi Zhang

Public Health Theses

Background: As the COVID-19 pandemic continues to evolve, there is a concern about elevated intimate partner violence (IPV) risk. Women living with HIV (WLWH) faced disproportionately high rates of IPV compared to women without HIV. The intersections of the co-occurring pandemics of COVID-19 and IPV present unique challenges to WLWH in different ways. Currently, we have limited evidence on the impact of COVID-19 on the experience of IPV among WLWH. Methods: This is a cross-sectional analysis of COVID-19 impact using baseline data from an ongoing, prospective, micro-longitudinal cohort study on HIV care engagement among WLWH who have experienced lifetime IPV. …

The Potential Link Between Pfas And Colorectal Cancer: A Narrative Review, Amina Mutalib

Public Health Theses

Background: Currently, there is information on the detrimental impacts of exposure to pollutants such as per- and polyfluoroalkyl substances (PFAS) but there is still limited information on the impact PFAS has on colorectal cancer.Aim: To review and examine the evidence available in the existing published literature showing an association between exposure to PFAS and colorectal cancer. Methods: In this narrative review using searches of PubMed, SCOPUS and Google Scholar, publications between 2003 and 2023 were identified to ensure the inclusion of all recent development in this area of research. Inclusion criteria included a focus on the association between PFAS/PFOS and …

Genome-Wide Association Studies Of Depression And Alzheimer’S: Identifying Pleiotropic Snps, Yara Ahmed Kamel Abdelsalam

Public Health Theses

Background: Alzheimer’s disease (AD) has been rising globally, making it important to understand risk factors. Depression has been identified as a risk factor in epidemiological studies and meta-analysis. The possible mechanism could be pleiotropic. This study sought to identify the pleiotropic SNPs associated with depression and AD so that can understand the relationship between the two diseases more evident.Methods: The sample was from the UK biobank population, using the White European subpopulation. Depression was defined using self-reported depression status and electronic medical records. Proxy AD was defined by biological mother and father’s AD status. Two univariate association analysis was conducted …

Analyzing Pediatric Department Documentation Of Patient Social Needs With Icd-10 Z-Codes, 2019-2020, Oluwatofunmi Jummie Akinwunmi

Public Health Theses

The 10th revision of the International Classification of Diseases (ICD-10) allows healthcare professionals to document social needs with ICD-10 Z-codes. Data derived from documentation of ICD-10 Z-codes can be leveraged to identify at-risk populations for targeted intervention. However, there remains concern for underutilization of these codes particularly in the pediatric population. We sought to examine the documentation of ICD-10 Z-codes in the pediatric outpatient setting of the largest Connecticut hospital network by specialty type and age group. We examined deidentified electronic health records of pediatric outpatient patients from 2019-2020. We used descriptive statistics to measure the proportion of patients with …

The Ticking Clock: Understanding Time Toxicity While Treating Older Patients With Metastatic Breast Cancer, Swarali Atre

Public Health Theses

Aim: We aimed to investigate the association between age at diagnosis and time spent seeking care for Metastatic Breast Cancer (MBC) and to identify the major components of acute and outpatient care contributing towards time lost in seeking cancer treatment i.e., time toxicity. Methods: We conducted a longitudinal retrospective cohort study in MBC patients aged 67 or older who initiated treatment from 2010-2017 using the SEER-Medicare linked database. We calculated the cancer-related encounter days by summing up the patients' healthcare system interactions within one year of initiating cancer treatment for each category. We used a Poisson model with days alive …

Exploring The Perceptions Of Genetics, Genetics Testing, And Science In People Of African Descent, Maame-Owusua Boateng

Public Health Theses

Background: Historical injustices towards Black populations in the United States have impacted how communities interact with medicine and public health such as medical experimentations, scientific racism, medical racism, and eugenics. Black communities are underrepresented in human genomics projects compared to those that identify as white or of European ancestry. Prior research has demonstrated that Black people are less likely to know about the availability of genetic testing for diseases and have less confidence in the benefits of genetic testing. These disparities make it imperative to understand the perspectives of people of African descent. Methods: The Black Genome Project is an …

Honoring The Household: A Multi-Method Examination Of Family Structure, Harmony, And Conflict Among Asian Americans, Monica Jing Chen

Public Health Theses

The Asian American community is the fastest-growing racial group in the U.S. (Budiman and Ruiz, 2022), however, mental health research and practice often fail to accurately capture the scope of mental wellbeing across Asian subgroups. Despite shortcomings in the literature on Asian American mental health, researchers have still found concerning mental health outcomes within the community. Key considerations in supporting and understanding Asian American mental health include family harmony and family conflict; many of these communities greatly value family harmony but also are at risk of intergenerational conflict and other stressors within the household. A primary analysis examined the relationship …

Childhood Parental Bonding, Perceived Caregiver Burden, And Relationship Quality Among Adult Child Caregivers Of A Parent With Early-Stage Dementia, Denise Chow

Public Health Theses

Objectives – The objective of this paper was to investigate the associations between childhood parental bonding with current perceived caregiving burden and levels of perceived support from the parent among adult children of a parent living with early-stage dementia.Methods – One hundred and forty-four adult children completed self-report questionnaires that included the following measures: the Parental Bonding Inventory (PBI), Zarit Burden Interview (ZBI), and Perceived Partner Responsiveness Scale (PPRS). Multiple linear regression models were conducted to investigate the relationships between the parental bonding subscales (care, overprotection, and optimal parenting), caregiving burden, and relationship quality scores. Results – Adult children who …

Longitudinal Associations And Trajectories Of Cognitive Decline By Blood Pressure Categories, Namuunaa Juramt

Public Health Theses

Objectives: This study aimed to examine the cross-sectional, longitudinal associations and trajectories between cognitive decline and blood pressure (BP) categories defined by the 2017 American College of Cardiology/American Heart Association guideline and to explore sex differences in cognitive decline trajectories in each BP category.Design, setting, and participants: The Atherosclerosis Risk in Communities study is a longitudinal cohort study (1987-2018). 10,456 of 15,792 participants (female 55.5%) were included in the analysis with a median follow-up time of 22.2 years. Exposures: Blood pressure (BP) was measured at 6 of the study visits and was categorized as normal BP (Systolic BP [SBP] < 120 and Diastolic BP [DBP] < 80 mmHg; n = 930), elevated BP (SBP 120-129 and DBP < 80mmHg; n = 853), hypertension stage 1 (SBP 130-139 mmHg, or DBP 80-89 mmHg; n = 1,142), and hypertension stage 2 (SBP >=140 …

Prevalence And Genetic Determinants Of Vancomycin Resistance Of Clostridioides Difficile Isolates In Connecticut, Zeyu Fu

Public Health Theses

AbstractIntroduction: The emergence of vancomycin-resistant strains of C. difficile has become a growing concern, as it can lead to treatment failure and increased morbidity and mortality. In this study, we aimed to investigate the prevalence and mechanisms of vancomycin resistance in C. difficile isolates in Connecticut from patients with confirmed C. difficile infection at Yale New Haven Hospital. Methods: We collected 89 stool samples from patients with confirmed C. difficile infection, isolated C. difficile, and performed susceptibility testing on the isolates using the E-strip test method. Isolates with an MIC value below 4 μg/ml were classified as susceptible and isolates …

Psychological Resilience In U.S. Military Veterans: Results From The 2019-2020 National Health And Resilience In Veterans Study, Michael Georgescu

Public Health Theses

Psychological resilience is the most common response following exposure to traumatic life events. To date, most research has focused on factors associated with adverse post-trauma mental health outcomes rather than understanding those associated with psychological resilience. In particular, little is known about factors associated with resilience in veterans, despite their high rates of trauma exposure, such as combat and military sexual trauma. To address this gap, we used a discrepancy-based psychiatric resilience (DBPR) analytic approach to operationalize resilience and to identify modifiable health and psychosocial factors associated with resilience in a nationally representative sample of U.S. veterans (N = 4,069). …

The Genetic Generalizability Gap Of Colorectal Cancer: Assessment By Polygenic Risk Score, Lauren R. Lautermilch

Public Health Theses

Colorectal cancer (CRC) is one of the most common incident cancers in developed countries. Though the majority of colorectal cancer cases do not arise in individuals with inherited pathogenic mutations or a family history of CRC, there is a substantial heritable component of colorectal cancer. Thus, there is a critical need to incorporate genetic risk factors into overall CRC risk assessment to ultimately improve the efficacy of current screening strategies and optimize precision medicine approaches.

Presented here is a polygenic risk score (PRS) utilizing 79 genetic variants for colorectal cancer. The PRS was generated using genome-wide significant single nucleotide polymorphisms …

A First Look Into Cognitive Impairment In The Republic Of Armenia: A Population With A History And Present Reality Of Collective Trauma, Patelle Jivalagian

Public Health Theses

The Republic of Armenia, a largely homogenous population burdened with a history of collective trauma, presents a unique opportunity to explore aging and cognition. The population survived a genocide in 1915 but, continues to face threats to existence today due to geopolitics. Studying the Armenian population can provide insight about the role of mental health in cognitive impairment. This study aimed to examine characteristics associated with cognitive impairment at mobile clinics across 6 provinces in Armenia and provided a first look into the national health profile of the likelihood of dementia progression in Armenia.Participants consisted of 262 subsample of older …

Protection Against Cholera From Killed Whole-Cell Oral Cholera (Kocv) Vaccines: Systematic Review And Meta-Regression Of Randomized Control Trials And Observational Studies, Helena Hojeong Kwon

Public Health Theses

Introduction: Although killed whole-cell oral cholera vaccines (kOCVs) are widely used as a part of cholera control strategy, mixed evidence around the vaccine induced protection remains.Objectives: The primary objective of this systematic review was to update estimates of kOCV protection: vaccine efficacy and effectiveness. A secondary objective was to estimate the waning dynamic of kOCV protection by duration of follow-up. Methods: On August 15th, 2022, we searched for randomized control trials and observational studies that reported kOCV protection in low- and middle-income countries on PubMed, EMBASE, Scopus, ISI Web of Science, and The Cochrane Review Library with a start date …

A Systematic Review Of The Effect Of Maternal Circadian Disruption During Pregnancy On Adverse Fetal Outcomes, Siyu Jiang

Public Health Theses

Exposure to a suboptimal pregnant environment can raise the risk of offspring experiencing a variety of diseases in later life. Circadian rhythms play an important role in endocrine system, physiological and psychological functions. Potentially, interruption of the circadian rhythm in pregnant women might impair fetal growth and lead to adverse effects on the children. In the modern world, millions of women experience circadian disruption during pregnancy due to night shift work, excessive light at night, and jet travel across time zones. However, the impact of maternal chrono-disruption during pregnancy on the health of the second generation remains largely unknown. The …

Elucidating Metformin As A Scavenger Of 4-Hne, An Endogenously Produced Aldehyde Associated With Alzheimer’S Disease Progression, In Hek293t Cells, Miren Lopez Lascurain

Public Health Theses

Metformin, a first-line therapy for Type 2 Diabetes Mellitus (T2DM), has been shown to have numerous health benefits in neurodegenerative disease progressions, including Alzheimer’s disease (AD). Vasiliou et al. have recently proposed that metformin is able to scavenge endogenously produced aldehydes such as 4-hydroxy-2-nonenal (4-HNE), which are thought to contribute to the progression and development of AD. Preliminary in vitro and in silico studies demonstrate that metformin scavenges 4-HNE leading to adduct formation. Therefore, this study sought to determine if metformin adducts 4-HNE in a living system. We hypothesize that metformin can scavenge 4-HNE in HEK 293T cells and will …

Identifying Aberrant Metabolism And Underlying Biology In Colorectal Cancer Tumors Between Early- And Later-Onset Samples, Allison Paige Janak

Public Health Theses

Early-onset colorectal cancer (EO-CRC) occurring in individuals under age 50 is rapidly increasing globally. In comparison, later-onset colorectal cancer (LO-CRC) incidence has decreased or remained stable over recent years. Despite these increases in EO-CRC incidence, the etiology of EO-CRC is largely unknown. This study aimed to compare the metabolomes of EO-CRC (N=53) and LO-CRC (N=314) patients from a cohort of 367 patients using patient matched samples of stages I-IV tumor and healthy colon tissue. Hydrophilic interaction liquid chromatography mass spectrometry (HILIC-MS) and reversed phase liquid chromatography mass spectrometry (RPLC-MS)-based untargeted metabolomics were applied to identify features present in the samples, …

Drivers Of Global Waterborne Disease Transmission Following Extreme Precipitation Events: A Systematic Review, Claire Latendresse

Public Health Theses

Precipitation events such as hurricanes, typhoons, and heavy rainfall can have devastating impacts on water and sanitation infrastructure around the world and have led to large-scale waterborne outbreaks. As climate change amplifies the frequency and intensity of extreme weather events, it is also triggering an increase in waterborne disease transmission. This master’s thesis consists of a systematic review of academic literature pertaining to extreme precipitation events and the pathways by which they trigger waterborne outbreaks.

A systematic review of the literature in PubMed was conducted to identify waterborne disease outbreaks associated with extreme precipitation. The initial search yielded 3,248 results …