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Counting Uncounted Gunshot Injuries: A Capture‐Recapture Study Of People Minding Their Own Business, Zev Balsen

Yale Medicine Thesis Digital Library

Objectives. To apply a novel statistical method to create a comprehensive estimate of incidence of firearm related injuries.

Methods. A database of firearms injuries in New Haven, Connecticut, during a five- month period was created with records from law enforcement, emergency departments, emergency medical services (EMS), news media, and the medical examiner. The overlap of these various sources was operationalized in a capture-recapture model to generate an estimate of uncounted firearms injuries, and log linear modeling was used to control for positive and negative dependencies.

Results. The combined data sources revealed 49 firearms injuries occurring during the study period within …

Case Finding For Pulmonary Tuberculosis Among People Who Inject Drugs In Dar Es Salaam, Tanzania, Akash Gupta

Yale Medicine Thesis Digital Library

CASE FINDING FOR PULMONARY TUBERCULOSIS AMONG PEOPLE WHO INJECT DRUGS IN DAR ES SALAAM, TANZANIA. Akash Gupta. Jessie Mbwambo. Ibrahim Mteza. Sheela Shenoi. Barrott Lambdin. Cassian Nyandindi. Basra Ismail Doula, Said Mfaume, and Robert Douglas Bruce. Department of Internal Medicine, Yale University, School of Medicine, New Haven, CT.

Active case finding is a World Health Organization (WHO)-endorsed strategy for improving case detection of tuberculosis. Despite WHO recommendations for active case finding among people who inject drugs (PWID), there are few published studies. The historical focus of case finding has been in populations that are HIV-positive, incarcerated, or at higher occupational …

Predictors Of Response In The Multimodal Treatment Of Attention Deficit And Hyperactivity Disorder Trial, Natalie Lastra

Yale Medicine Thesis Digital Library

Baseline clinical characteristics can be used to predict treatment response in children with Attention Deficit and Hyperactivity Disorder (ADHD). This analysis aimed to identify empirically derived subgroups of children with ADHD based on likelihood of response to treatment within the 4 randomly assigned treatment groups of the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA).

To identify clinical characteristics of predictive value selected data points were utilized for regression and receiver operating curve (ROC) analysis. Response to treatment at 14 months (defined as a 25-30% reduction in standardized score of symptoms obtained from the SNAP scale) for each treatment …

Multimodal Evaluation Of Cerebrospinal Fluid (Csf) Dynamics Following Extradural Decompression For Chiari I Malformation, Jennifer Quon

Yale Medicine Thesis Digital Library

Chiari I malformation is a hindbrain abnormality characterized by tonsillar herniation > 5 mm below the level of the foramen magnum. Extradural decompression is a minimally invasive technique for treating Chiari I that involves a suboccipital craniectomy with removal of the outer dural layer. Other techniques the involve opening of the dura, arachnoid or even manipulation of the cerebellar tonsils have since been the mainstay of treatment, but are associated with a higher complication rate and longer hospital stays. While there is no agreement on which surgical method is optimal, mounting evidence demonstrates that extradural decompression effectively treats clinical symptoms with …

Patients' Experiences Managing Cardiovascular Disease Risk Factors In Prison, Emily Herron Thomas

Yale Medicine Thesis Digital Library

Despite greater risk of cardiovascular disease (CVD) mortality in patients with a history of incarceration, little is known about how prisons manage CVD risk factors (CVR-RF) to mitigate this risk.

We conducted in-depth interviews with men and women with CVD-RF and who had been recently released from prison (n=26). Using a grounded theory approach and applying the constant comparative method, we inductively generated themes about CVD- RF care in prison. Data collection and analysis occurred iteratively to refine and unify emerging themes.

Four themes emerged from patient perspectives: (1) Access to care for chronic conditions is present, yet complicated in …

Student Characteristics Associated With Positive Attitudes Toward Interprofessional Education, Risa Liang Wong

Yale Medicine Thesis Digital Library

Attitudes of health professional students may determine the effectiveness of interprofessional education (IPE). We sought to identify student characteristics associated with more positive attitudes toward IPE by surveying a cohort of medical (M), nursing (N), and physician associate (PA) students first and third year using the Readiness for Interprofessional Learning Scale (RIPLS) and Interdisciplinary Education Perception Scale (IEPS). We collected demographic and experiential information and performed one-way ANOVA, independent and paired t-tests, and multiple linear regression. 110 of 213 students (52%) completed the RIPLS and 106 (50%) completed the IEPS at both time points. Nursing students consistently had the highest …

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A Descriptive, Comparative Health Assessment Of Unique Older-Adult Populations In Israel, Eliana Marcus Aaron

Yale School of Nursing Digital Theses

Background: Israel is among the nations with the fastest growing older adult population in the world, due to Baby Boomer aging, high immigration rates, and high life expectancies. The country is mandated to provide health coverage to all citizens, but it has historically been poorly equipped to provide geriatric health care. Israel's elders include numerous minorities and special groups, and despite research of many groups over decades, disparities continue to exist. Methods: A descriptive analysis of special geriatric populations and their health issues was performed based on national and international literature, government reports, and statistics. Results: Five research-based unique populations …

Missing Domains Of Lung Transplant Patient Selection, Nancy Picard Blumenthal

Yale School of Nursing Digital Theses

The goal of consistent, predictable, improved outcomes has continued to elude the scientific community in the thirty years since lung transplantation became the procedure of choice for patients with terminal, non-malignant lung disease. Background: Though there is a consensus regarding disease-specific indications for a lung transplant, ambiguity remains regarding how patient-specific attributes should influence lung transplant candidacy. This project had three aims: 1) to establish the missing domains of the interdisciplinary assessment of the lung transplant candidate, 2) to have these domains validated by an international panel of lung transplant experts, and 3) to recommend the next step for inclusion …

A Model Of Primary Care To Meet The Needs Of The Underserved: Haven Free Clinic, Mary Ella Bartlett

Yale School of Nursing Digital Theses

Many organizations have recognized the need for a broader safety net of health care systems to care for the underserved. The Society for Student-run Free Clinics has 149 registered clinics throughout the United States and Canada2. At this time, HAVEN Free Clinic, a collaboration of the Schools of Nursing, Medicine, Physician's Assistants and Public Health at Yale University and the Fair Haven Community Health Center (FHCHC), is the only student clinic that partners with a free-standing Federally Qualified Health Center (FQHC).

Outcomes for HAVEN have been published while a description of the clinic, its structure, and how the collaborative practice …

Design Of An Evidence-Based Second Victim Curriculum For Nurse Anesthetists, Regina Daniels

Yale School of Nursing Digital Theses

The concept "second victim" is not a well-known or understood phenomenon among healthcare professionals, especially nurse anesthetists. No published research is currently available on the impact of second victim in nurse anesthetists. However, it is known second victim poses significant challenges for health care professionals. Therefore, it is important to acknowledge its occurrence and develop an educational curriculum based on the evidence to promote peer and organizational support infrastructures. A comprehensive literature review was conducted and educational domains on second victim were developed and validated by an expert panel.

Development Of An Educational Program On Prevention Of Hypoglycemic Events Among Elderly Veterans With Type 2 Diabetes, Maud Meulstee

Yale School of Nursing Digital Theses

Abstract

Purpose

The purpose of this project was to develop an evidence-based educational program to reduce hypoglycemic events in elderly veterans with type 2 diabetes mellitus (T2DM) enrolled in the Veterans Healthcare Administration system. US elderly persons are especially affected by T2DM and at great risk for complications. Until recently, tight glycemic control has been advocated to avoid hyperglycemic events. However, this approach has been shown to have no major benefit but instead has resulted in increased hypoglycemic events, morbidity, and mortality. Hypoglycemia is now seen to be the most serious complication in the treatment of T2DM in all adults, …

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 …

Protein Intake And Hookworm Infection Susceptibility In Rural Ghanaian School- Age Children: A Mixed-Methods Study, Luis Enrique Maldonado-Vásquez

Public Health Theses

Background: Because human and animal cross-sectional studies cannot assess temporality, a longitudinal study is needed to assess the association between protein intake and hookworm infection susceptibility. Cultural preferences and belief systems have been noted to affect the intake of food in some African societies but extensive research has not been conducted to characterize them.

Methods: Children (n=274) 7-13 years of age who attended school in the Kintampo North Municipality of Ghana were screened for participation in a longitudinal study assessing the relationship between protein intake and hookworm infection susceptibility. Protein intake was calculated by 24-hour recalls. A qualitative sub-study recruited …

Factors Associated With Interest In Receiving Methadone Treatment Among Opioid Dependent Prisoners In Malaysia, Trena Mukherjee

Public Health Theses

Background: Criminalization of drug use in Malaysia has led to a concentrated epidemic of HIV and substance use disorders within prisons. In response, Malaysia introduced prison-based methadone maintenance therapy (MMT) programs to treat opioid dependence and reduce risky behaviors. Despite the introduction of this program, MMT uptake has been suboptimal in prison settings. Therefore identifying individual-level factors associated with MMT initiation is key to improving uptake.

Methods: 200 incarcerated individuals with a history of opioid use in the 12 months prior to incarceration were enrolled in a study to determine factors associated with interest in receiving MMT. All participants were …

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 …

Training Housestaff To Begin Interviews With Patient-Centered Strategies: Housestaff Evaluation And Effects On Patient Experience, Oladoyin Oladeru

Public Health Theses

Background: Physician communication skills during a medical visit may be a central factor in achieving optimal patient experience because it improves the exchange of important clinical and psychosocial information. While many medical schools emphasize communication skills training for students, formal training in patient-centered communication for housestaff has received less attention. Few studies have examined communication skills training for housestaff with regards to its impact on actual patient experience survey results.

Aim: To assess whether an education initiative that teaches patient-centered strategies for starting medical interview improves housestaff perception and patient experiences in the resident clinics and inpatient wards.

Method: We …

Association Between Pediatric Vaccination Rates And Patterns Of Pneumococcal Disease In Adults In The Pcv7 And Pcv13 Eras, Sundia Cassandra Pingali

Public Health Theses

BACKGROUND: Pneumococcal conjugate vaccine (PCV) is now recommended for use in adults in the United States. Because vaccination of children with PCVs protects adults from the targeted serotypes, local variations in PCV uptake among children could influence the effectiveness of direct immunization of adults. The effect of variations in PCV7 and PCV13 uptake in children will be compared to assess the possible effectiveness of PCV vaccination in adults.

METHODS: We obtained ZIP Code-level invasive pneumococcal disease (IPD) data from an active population-based surveillance system in Connecticut (1998-2013) and ZIP Code-level data on immunization with 3+ or 4+ doses of PCV …

Determinants Of Early Feeding Practices Among Hiv+ Mothers In Sub- Saharan Africa: A Realist Review, Camille Adrianne Pottinger

Public Health Theses

INTRODUCTION: Exclusive breastfeeding has been shown to provide many benefits that can be life saving for the infant and mother in low resource settings7. Although the potential effects of breastfeeding appear large, exclusive breastfeeding rates remain low in this area of the world, and are even lower among the HIV population8-10. It is important to understand what influences HIV + mothers to exclusively breastfeed, as well as formula feed and adhere to ARV (antiretroviral) medication while breast feeding in order to make comprehensive policy recommendations that are as culturally sensitive and practical as possible. The objective of this review is …

Evaluating The Effectiveness Of Smoking Cessation Intervention Program In Low Income Emergency Department Adult Populations Using Moderation And Meditational Analysis, Harish Prabhala

Public Health Theses

Cigarette and tobacco use is common among ED patients from lower socioeconomic backgrounds. Our goal in this study was to conduct moderation and mediation analysis to evaluate the effectiveness of an enhanced smoking cessation intervention involving enhanced care as compared to standard care for adult smokers in the ED. Our study is a secondary analysis of a two-arm randomized clinical trial conducted by Dr. Bernstein, which involved two intervention arms; one with enhanced care where the subjects received a motivational interview by a trained research assistant, 6 weeks of nicotine replacement therapy (NRT) initiated in the ED, a faxed referral …

Identification Of Environmental Health Gaps In State-Recognized American Indian Tribes In Connecticut, Meera Ravichandran

Public Health Theses

This study assessed the sanitary infrastructure and policies affecting the environmental health aspects of three state-recognized American Indian Tribes in Connecticut. A historical search was conducted to gather records pertaining to the Paucatuck Eastern Pequot, Golden Hill Paugussett, and Schaghticoke Tribes at the state and town levels to determine what, if any, data were available on drinking water and wastewater quality and disposition on Tribal lands. This investigation was supplemented by questionnaires and an on-site survey of sanitation conducted in cooperation with the Connecticut Department of Public Health. The survey included the collection of drinking water samples for analyses along …

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), …

Assessment Of Foodnet Population Survey Respondents As A Control Group To Determine Stec Risk Factors, Maria Andrea Rincon

Public Health Theses

Introduction: Shiga toxin-producing Escherichia coli (STEC) are important foodborne pathogens, causing approximately 30 deaths a year in the US. Case-control studies to monitor risk factors are challenging; finding representative controls can be labor-intensive. The FoodNet Population Survey (FNPS) is conducted periodically and asks about foodborne disease risk factors.

Objectives: To determine leading risk factors for STEC in Connecticut using the 2006 FNPS participant responses as controls.

Methods: Cases were reported STEC cases in Connecticut 2000-2009 who were interviewed for risk factors following onset. Controls were respondents to the Connecticut portion of the 2006 FNPS. Comparable questions for exposure to dietary, …

Factors Associated With Type 2 Diabetes Management In Santa Elena, Ecuador, Suhana Sarkar

Public Health Theses

Background: There has been a growing prevalence of diabetes in rural populations in low and middle income countries. Over a third of Ecuador’s population lives in rural areas, which tend to experience poorer health outcomes than urban areas. Therefore, the objective of this study was to examine potential risk factors associated with diabetes management in this region.

Methods: A sample of 150 diabetes patients from the Futuro Valdivia clinic in Santa Elena, Ecuador were surveyed and tested for HbA1c. The interview collected data on a variety of risk factors including diet, exercise, eating habits, food insecurity, medication usage, medication adherence, …

Leptospira In The Environmental Reservoir: Quantification And Persistence Of The Pathogen In An Urban Slum Setting Of Endemic Transmission, Andrew Gustav Schneider

Public Health Theses

Introduction

The ecology of Leptospira, the spirochete agent for leptospirosis, in its environmental reservoir is poorly understood. We quantified the presence of pathogenic leptospires in soil and sewage from a high-risk slum community for leptospirosis, and characterized its persistence in this environment.

Methods

We collected soil and sewage samples from three sites within a slum community in the city of Salvador, Brazil, and measured the concentration of leptospires using real-time quantitative PCR targeting lipL32, a gene exclusively present in pathogenic Leptospira. Additionally, we investigated the persistence of L. interrogans serovar Copenhageni, the agent for urban leptospirosis, in soil and sewage …

Nurse-Led Intervention To Reduce Intimate Partner Violence And Associated Health Risks: Qualitative Program Evaluation And Nurse Reflections, Kelsey Kae Schuder

Public Health Theses

Background: Intimate partner violence (IPV) is a highly prevalent issue worldwide. A large randomized controlled trial (RCT) evaluating a nurse delivered intervention to reduce IPV and associated health risks took place between 2012 and 2014 in Mexico City. This study will focus on qualitative interviews performed with a sample of the nurses who were the interventionists in the large RCT. Minimal work has explored implementation issues around large RCTs in resource poor settings or characteristics of the interventionists that may influence the implementation of the intervention and their health care delivery after completion of the intervention.

Methods: Semi-structured, qualitative interviews …

Critical Review And Stratified Meta-Analysis Of Lung Cancer Risk In Petroleum Refinery Workers, Sherman Selix

Public Health Theses

Several publications have proposed a workplace risk of lung cancer in petroleum refineries, with asbestos as the potential agent. To examine the associations between petroleum refinery work and lung cancer related to occupational asbestos exposure, in addition to smoking and other concurrent occupational exposures, a systematic review and stratified meta-analysis was employed. Cochrane-Mantel-Haenszel statistics were used to combine SMR/SIR data separately for all male and female refinery workers, as well as SMR/SIR and RR/OR measurements for the subset of male maintenance workers, who were exposed to higher levels. Of 219 studies identified in the literature search, 78 studies were selected …