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Pathways Of Hiv Risk And Vulnerability Among New Female Sex Workers In Northern Karnataka, India, Jordan Sloshower

Yale Medicine Thesis Digital Library

PATHWAYS OF HIV RISK AND VULNERABILITY AMONG NEW FEMALE SEX WORKERS IN NORTHERN KARNATAKA, INDIA. Jordan A. Sloshower and James F. Blanchard, Department of Community Health Sciences, University of Manitoba, Canada. (Sponsored by Kaveh Khoshnood, Yale University School of Public Health).

This qualitative research project sought primarily to understand why female sex workers (FSWs) from northern Karnataka, many of whom are Devadasi sex workers, seem to experience an elevated risk of contracting HIV in the initial period after starting sex work. More specifically, it attempted to elucidate key processes and moments of vulnerability around the time period of initiating sex …

The Contribution Of Place To Disparities In Life Expectancy And Cardiovascular Outcomes, Brian Wayda

Yale Medicine Thesis Digital Library

Socioeconomic disparities in health are well-documented, but the precise reasons for these disparities are poorly understood. Traditional explanations for health disparities focus on the influence of person-level disadvantages, such as those related to income, education, and health insurance status. However, the contribution of place to these health disparities is increasingly appreciated. By "place", we refer to the sum of the environmental and community-level factors that may contribute to health, as distinguished from person-level disadvantages associated with low socioeconomic status (SES).

These contextual factors can be categorized as 1) characteristics of the built environment (e.g. access to healthy food, space for …

Designing Multi-Layered Nanoparticles For Combination Gene And Drug Cancer Therapy., Asiri Saumya Ediriwickrema

Yale Medicine Thesis Digital Library

Cancer continues to be a highly prevalent and lethal disease, despite significant advances in understanding tumor biology and developing new chemotherapies. Major obstacles in cancer chemotherapy are drug resistance and systemic toxicities. Potential strategies for addressing these problems include delivering combination therapies to overcome drug resistance, and utilizing synergistic agents to minimize dosing and subsequently drug toxicity. In turn, delivery can also be optimized to target the tumor site and consequently minimize systemic side effects. Polymer nanocarriers are gaining interest as vehicles for cancer therapeutics for their abilities to not only deliver multiple agents, but also target the tumor itself. …

Finansiel Stabilitet Annual Report 2013, Finansiel Stabilitet (Fsc)

Documents

No abstract provided.

Emergency Airway Preparedness At Ambulatory Surgery Centers With Solo Anesthesia Providers: An Educational Intervention, Michael Shaylan Lord

Yale School of Nursing Digital Theses

Objectives: The unanticipated difficult airway is a life-threatening circumstance that requires skilled and immediate intervention by trained staff in order to avoid the complications of cardiac arrest, anoxic brain injury, and death. Ambulatory surgery centers with solo anesthesia providers are unique environments where interdisciplinary team members may be relied upon to support emergency airway management, thereby reducing the gap created by absent expert backup anesthesia personnel. An educational intervention was developed to increase emergency airway preparedness, as indicated by change in knowledge and self-efficacy.

Methods: A 75-minute pretest/posttest educational intervention focused on emergency airway preparedness at ambulatory surgery centers with …

Practice Authority For Advanced Practice Registered Nurses: Troubling Trends In Regulatory Variability, Susanne Johnson Phillips

Yale School of Nursing Digital Theses

In response to the national call to increase the healthcare provider workforce, states are enacting more laws to give APRNs full practice authority. However, the approach is incremental and often politically motivated, leading to wide variation in state laws. A significant area of regulatory variability relates to the point at which APRNs have full practice authority. Some states never allow it for one or more APRN roles; some states have a transition to practice, where, following licensure there is a period of oversight or supervision; some states allow full practice authority upon licensure. Full practice authority for APRNs upon licensure …

Predictors Of Patterns In Pediatric Pneumococcal Vaccine Uptake In Connecticut, 2000-2009, Aimee Marie Mead

Public Health Theses

Introduction:

Streptococcus pneumoniae is an important human pathogen with more than 92 identified serotypes of varying invasiveness. Asymptomatic colonization of the nasopharynx can later cause diseases such as sinusitis, AOM, or IPD. Children under age five are the major reservoirs of infection. Pediatric conjugate vaccines effectively reduce vaccine-type carriage and disease. Vaccinating children can have indirect effects on adults.

Materials and Methods:

This paper used CIRTS to describe patterns of three- and four-dose PCV uptake throughout Connecticut in 2000 to 2009 birth cohorts. Spatial cluster analysis was used to detect any clusters with higher than expected proportions of unvaccinated children. …

Playforward: Elm City Stories Interactive Group-Based Curriculum: An Intervention On Hiv Risk Behaviors In Urban Racial And Ethnic Minority Youth, Anna North

Public Health Theses

There is a growing epidemic of HIV in young, racial and ethnic minority populations (Centers for Disease Control and Prevention, 2008). PlayForward: Elm City Stories is an evidence-based, theory-driven videogame intervention developed by the Yale School of Medicine research group, play2PREVENT to impact HIV risk behaviors in urban racial and ethnic minority youth, ages 11-14 (play2PREVENT). The PlayForward: Elm City Stories intervention manual seeks to build on the videogame by adding an in-person group dimension to the individualized intervention. The manual provides a group-based interactive, in-person curriculum addressing decision-making and risk behaviors for HIV exposure among 11-14 year olds, and …

Household Food Insecurity And Obesity Risk In An Urban Slum In Brazil, Krysta Peterson

Public Health Theses

Background: The prevalence of obesity is growing among the poor. Household food insecurity (HFI) may partly explain this trend as individuals experiencing it may cope by consuming low-cost high calorie meals with little nutritive value. This study aimed to estimate the prevalence of HFI, identify its risk factors, and assess the relationship with obesity among adults in an urban slum community in Salvador, Brazil.

Design: This cross-sectional study interviewed participants at home to assess socioeconomic status, demographics, HFI (measured by the Brazilian Food Insecurity Scale (EBIA)), and health. Anthropometric measurements (height, weight, waist circumference) of each respondent were taken to …

Predictors Of Babesia Microti Infection In Ixodes Scapularis Ticks In New England, Usa, Matthew David Phelps

Public Health Theses

Babesia microti is the primary etiological agent of human babesiosis (Vannier & Krause). Although it shares the same tick vector and mammal reservoirs as B. burgdorferi, the causative agent of Lyme disease, the geographic extent of B. microti is limited to a subset of the range of B. burgdorferi (Diuk-Wasser et al.). Despite the slower spread of B. microti, it is equally prevalent in ticks in certain areas where both B. burgdorferi and B. microti have been endemic for long periods. The slower rate of B. microti expansion as compared to B. burgdorferi has been attributed to a lower efficiency …

The Association Between Perceived Stress And Worse Adherence To Medical Discharge Instructions After Acute Myocardial Infarction, Qiaochu Qi

Public Health Theses

Objectives: This study prospectively followed a cohort of 349 individuals recovering from an acute myocardial infarction (AMI) to investigate the relationship between their perceived stress and their adherence to medical discharge instructions.

Background: Experiencing a heart attack is stressful, and stress post-MI leads to poor outcomes. Worse adherence to discharge instructions can be a pathway, but no prior research has investigated the impact of perceived stress on AMI patients' ability to comply with discharge instructions.

Methods: We assessed adherence to hospital discharge instructions over 12 months among 349 individuals who were hospitalized with AMIs. Linear mixed-effects regression model was used …

Exploring Social Networking Technologies As Tools For Hiv Prevention For Men Who Have Sex With Men In Connecticut, Jorge Augusto Ramallo

Public Health Theses

This study examined the use of social networking technologies (SNTs) and their potential utilization in HIV prevention interventions among HIV positive and HIV negative men who have sex with men (MSM). We conducted 5 focus groups and 1 individual interview of HIV positive and HIV negative individuals (total 34). All participants were recruited with the help of a local non–profit organization and through a Facebook event advertised in neighboring LGBT establishments.

MSM tend to compartmentalize and separate their gay social networks. SNTs are the main way in which MSM meet new sexual partners. Young MSM are high users and early …

Soil-Transmitted Nematode Infections Among School-Age Children In Rakai District, Uganda, Jensen Dalton Reckhow

Public Health Theses

One billion people are currently infected with at least one soil-transmitted nematode (STN), and over 161,600 school-aged children in sub-Saharan Africa live in areas where the prevalence exceeds 20%. STN infections cause malnutrition and cognitive deficits that limit productivity and may contribute to endemic poverty. Despite this significant and recognized disease burden, research on these diseases remains piecemeal; the majority of scientific understanding of these conditions is derived from a handful of small studies. Data regarding prevalence, intensity, and effectiveness of treatment of STN infections in Rakai District, Uganda is particularly limited, and the Ministry of Health has discontinued surveillance …

Estimating The Incidence Of Japanese Encephalitis In Divisions Of Bangladesh, Craig Michael Rothenberg

Public Health Theses

Japanese Encephalitis (JE) is a mosquito-borne viral disease responsible for 30,000 to 50,000 reported cases and up to 15,000 reported deaths every year. The disease is a significant public health concern in Bangladesh, but there is no regular surveillance or immunization for JE in the country. The objective of this study is to determine whether a practical model to estimate the incidence of JE in Bangladesh can be developed using data on population, environmental characteristics, and/or vector distribution for JE-endemic countries in Asia and the Western Pacific. Information on JE incidence, area, land cover, climate, population characteristics, land elevation, and …

Genome-Wide Association Study Identifies Novel Ethnic-Specific Associations With Body Mass Index, Yasmmyn D. Salinas

Public Health Theses

Background. Obesity affects over one-third of the US population, and is a risk factor for various chronic conditions, including type 2 diabetes, heart disease, and stroke. The disease results from a combination of behavioral and environmental risk factors and genetic predisposition. To date, over 50 genetic polymorphisms have been associated with increased body mass index (BMI), but these associations explain only a small percentage of the heritable risk of obesity. Moreover, the majority of these associations have been identified in populations of European ancestry. We sought to identify novel associations with BMI and to evaluate their generalizability across ethnic groups, …

Prenatal Depressive Symptoms And Sexual Risk Among Young Urban Pregnant Women Of Color, Abigail Taylor

Public Health Theses

Objective: To determine whether prenatal depressive symptoms are related to sexual risk outcomes 12 months postpartum.

Methods: Participants included 757 pregnant women aged 14-21 years, mainly Latina (54.4%) and Black, non-Latina (37.0%). Women completed structured interviews during the second and third trimester of pregnancy and one-year postpartum. Depressive symptoms were measured using the affect-only items of the Center for Epidemiologic Studies-Depression Scale (CES-D). Outcomes included sexual risk behavior (percent condom use, number of partners) and sexually transmitted diseases (STDs) measured via laboratory testing.

Results: Prenatal depressive symptoms significantly predict a decrease in condom use one-year postpartum, even when controlling for …

Leptospirosis Pulmonary Hemorrhage Syndrome In Salvador, Brazil From 2003 - 2012, Annie J. Tsay

Public Health Theses

ABSTRACT

Objective: Leptospirosis pulmonary hemorrhage syndrome (LPHS) is a severe form of leptospirosis, with a case fatality rate exceeding 50%. Recently, LPHS has become the principal cause of mortality in leptospirosis patients in Salvador, Brazil. This study aims to describe the epidemiology of LPHS since 2003, characterize its clinical presentation, and identify risk factors.

Methods:

Patients admitted between January 1, 2003 and December 31, 2012 in the active hospital-based surveillance who met the clinical case definition for leptospirosis were included in the study. A standardized questionnaire was used to collect data from patient charts and in-person interviews. Unadjusted logistic regression …

The Impact Of Architecture And Natural Ventilation On The Risk Of Tuberculosis Transmission In Brazilian Prisons, Juliana Urrego

Public Health Theses

Tuberculosis (TB) incidence in Brazilian penitentiaries is extremely high as prisons provide ideal conditions for airborne contagion by congregating infectious and susceptible individuals for extended periods of time. We aimed to determine the effects of architectural, environmental, and ventilation factors that impact TB transmission probabilities across prison cells in three penitentiaries of Mato Grosso do Sul, Brazil. We collected descriptive data on cell architectural characteristics and estimated ventilation rates using steady-state exhaled carbon dioxide levels. A hierarchical linear, multivariable model was used to examine cell level architectural and environmental factors affecting absolute ventilation. We then estimated the probability of TB …

Executive Function In Survivors Of Childhood Acute Lymphoblastic Leukemia, Adrienne Suzanne Viola

Public Health Theses

BACKGROUND Childhood acute lymphoblastic leukemia (ALL) survivors are at risk for impaired executive function, but it is unclear how to best screen for such impairment. We sought to determine 1) the reliability of neurocognitive assessment by performance-based testing versus parent report, and 2) how the measures relate to everyday function.

METHODS 256 survivors of standard risk childhood B-ALL (mean age 13.9 years at evaluation) were evaluated for executive function with three performance-based measures (Weschler Intelligence Scale for Children-IV (WISC-IV), Controlled Oral Word Association Test, and Conners' Continuous Performance Test-II) and one parent-report measure (Behavior Rating Inventory of Executive Function (BRIEF)). …

Foodnet Population Survey 2006-2007: Differences In Prevalence Of Health Care Seeking Behaviors And Exposures To Risk Factors For Foodborne Illness By Socioeconomic Status, Jessica Anne Wagner

Public Health Theses

Background: Previous studies in Connecticut (CT) have shown an association between higher incidence of bacterial foodborne pathogens, including Salmonella, Campylobacter, and shiga-toxin producing E. coli. Two hypotheses have been proposed to explain this association: 1) individuals of higher SES are more likely to seek medical care and be diagnosed following an episode of diarrhea or 2) the prevalence of risk factors for bacterial foodborne pathogens is higher among those of higher SES. CT is positioned to examine these two hypotheses because the FoodNet population survey, a source of data on SES, prevalence of healthcare-seeking behavior specific to diarrhea and prevalence …

Modeling The Zoonotic Transmission Dynamics Of Nipah Virus: Implications For Outbreak Control And Model-Guided Fieldwork, Natasha Wenzel

Public Health Theses

Introduction: Nipah virus is considered a biosafety level-4 pathogen that is endemic to bats of the genus Pteropus. Infection in humans presents clinically as febrile encephalitis with an extremely high case-fatality rate (78.2%). Outbreaks of Nipah virus infection have occurred in Bangladesh and India almost annually since 2001, most recently in January 2013.

Methods: To elucidate Nipah virus persistence at the endemic host and human population level we developed a Susceptible-Exposed-Infectious-Recovered dynamic model and parameterized it from published epidemiological case data and serological bats surveys on the Nipah Virus-Bangladesh variant. We conducted a Markov Chain Monte Carlo simulation to estimate …

Factors Influencing Hiv Testing In A Small Public Hospital In Manglaralto Ecuador, Magdalena Marie Wilson

Public Health Theses

Increasing rates of HIV testing is critical to reducing the spread of the HIV epidemic in Ecuador. HIV testing serves a number of purposes; it can be a gateway for people to enter the HIV care continuum, it may reduce risk behaviors among those tested, and it can influence social norms around HIV. This study investigated individual, interpersonal, institutional, and community level factors influencing HIV testing. A cross sectional survey was administered to a convenience sample of patients at a small, rural, public hospital in coastal Ecuador. Educational attainment, HIV knowledge, and perception of confidentiality of test results were significantly …

Alcohol And Early-Onset Basal Cell Carcinoma In A Case-Control Study, Yanchang Zhang

Public Health Theses

Background: Previous epidemiologic studies of overall alcohol intake and basal cell carcinoma (BCC) are inconsistent, with some evidence for differences by type of alcoholic beverage. While alcohol may enhance the carcinogenicity of ultraviolet (UV) light, this has not been evaluated in existing epidemiologic studies.

Objective: To evaluate alcohol intake in relation to early-onset BCC, and explore potential interactions with UV exposure.

Methods BCC cases (n=380) and controls with benign skin conditions (n=390) under age 40 were identified through Yale Dermatopathology. Participants provided information on lifetime alcohol intake, including type of beverage during an in-person interview. Self-report data on indoor tanning …

Stress, Discrimination And Repeat Pregnancy In Adolescent Parents, Meghan Angley

Public Health Theses

Objective

Adolescent mothers are at high risk of repeat pregnancy and repeat birth with short birth intervals. Perceived stress is known to affect young women's use of contraception, and therefore risk of unintended pregnancy. The primary aim of the study was to examine how stress, stressful life events, discrimination and economic hardship affect adolescent mothers' risk for repeat pregnancy. Secondary aims included examining if the association between stress and repeat pregnancy was mediated by contraception use, if the stress experienced by the mother's partner was associated with risk of pregnancy and if the association between stress and repeat pregnancy was …

Conflict And Vaccine-Preventable Disease In Children Under Five In The Eastern Mediterranean Region: A Systematic Review, Alexandra Marion Adams

Public Health Theses

Background: Conflict is one of the main reasons for our failure to reach worldwide immunization targets. An objective of 90% immunization coverage is included in the fourth Millennium Development Goal to reduce under-five mortality by two thirds, which is still far from achieved in the conflict-ridden Eastern Mediterranean Region (EMR). Despite global progress, vaccine-preventable deaths still account for 20% of childhood mortality under five years of age in the EMR, and communicable disease a third of all mortality. Conflict remains a critical root cause of low vaccination coverage in the EMR, resulting in high levels of vaccine-preventable disease, disability, and …

Epidemiology, Risk Factors, And Effectiveness Of Treatment Of Crimean Congo Hemorrhagic Fever In Turkey, 2007-2012, Eda Akyar

Public Health Theses

Objective: Crimean Congo Hemorrhagic Fever (CCHF) is caused by a Nairovirus of the Bunyaviridae family. It was first reported in Turkey in 2002. Infections commonly result from bites from ticks of Hyalomma marginatum marginatum or Rhipicephalus bursa species. Nosocomial infections also occur. CCHF infection occurs in over 30 countries in Europe, Asia and Africa. No vaccine exists and the effectiveness of ribavirin treatment remains controversial. This study's objective was to identify significant epidemiological, environmental, and clinical risk factors associated with disease and death caused by CCHF in Turkey. This study also evaluated the effectiveness of ribavirin as treatment for patients …

Hpv Vaccine Effectiveness In New Haven County, Connecticut Women Age 18-39, 2008-2012, Jennifer Lynn Berry

Public Health Theses

Background: HPV vaccines have demonstrated high efficacy in clinical trials against cervical lesions and infections by HPV vaccine types 16 and 18. Together these two types are responsible for approximately 70% of cervical cancer. Data on HPV vaccine effectiveness in general populations is limited.

Methods: Surveillance data monitoring high-grade cervical lesions in Connecticut was used. Medical records were reviewed and patients were interviewed to ascertain HPV vaccine history. Patients' biopsy specimens were typed to determine the presence of vaccine or non-vaccine type HPV. Odds ratios were determined using logistic regression, adjusting for age at diagnosis, grade of cervical lesion, race/ethnicity, …

Obesity Not A Risk Factor For Adverse Seasonal Influenza Outcomes Among Hospitalized Adults: Evidence From A Us Multisite Study, Elise Braun

Public Health Theses

Background Data on the association between obesity and seasonal influenza complications is unclear.

Objectives We explored the association between body mass index (BMI) and the adverse outcomes of artificial ventilation, intensive care unit (ICU) admission, and X-Ray confirmed pneumonia among patients hospitalized with laboratory-confirmed influenza during the 2012-2013 influenza season.

Methods We used a large, multi-site database with laboratory-confirmed influenza hospitalization surveillance data to examine the association between obesity and influenza complications. We controlled for various demographic characteristics, comorbidities, lifestyle factors, and patient care factors.

Results We explored the association between obesity and three influenza-related complications: artificial ventilation, ICU admission, …

Risk Factors For Q Fever Seroconversion In A Cohort Of Veterinary Students: A Comparative Analysis, Jessica Bonthius

Public Health Theses

Introduction: Coxiella burnetii (C. burnetii) is an extremely infectious, environmentally persistent intracellular bacterium and the causative agent of the zoonosis Q fever. An unprecedented epidemic in the Netherlands between 2007 and 2010 revealed its public health importance. Recent investigations have focused on C. burnetii seroprevalence among livestock workers. The burden of disease in veterinary students, a group with arguably similar exposures, has been insufficiently characterized.

Methods: Students beginning veterinary study at Utrecht University's Veterinary Medical School in 2006 were invited to participate. Questionnaires and serum samples for the detection of IgM and IgG antibodies against C. burnetii were collected at …

Risk Of Hypoglycemia Among T1dm Individuals Who Exercise Regularly, Jennifer Audrey Campbell

Public Health Theses

ABSTRACT

Objective: Exercise training and sport activity are important for good health among those with type 1 diabetes mellitus (T1DM); however, fear of hypoglycemia is a clear barrier to participation. We examined both the main demographic and exercise training risk profiles for exercise-associated and nocturnal hypoglycemia, including indicators of unawareness. Mode of insulin delivery, whether multiple daily injections (MDI) via pen or continuous subcutaneous insulin infusion (CSII) via pump, was an important consideration.

Research Design: Our study was based on data from an internet-based survey in the Netherlands that attracted T1DM participants who engage in routine exercise or sport activity. …