Digital Commons Network^™

The Undercurrents Of Disease In Armed Conflict: An Analysis Of Aggregate National Dstb And Mdr/Xdr Tb Screening & Diagnosis Trends During The 2022 War In Ukraine, Sakina Erika Reames

Public Health Theses

​​Tuberculosis (TB) is the second leading cause of death by an infectious disease worldwide after COVID-19. Extensive efforts have been made for decades to tackle this disease through bolstering healthcare systems especially in countries experiencing a disproportionate burden of TB. Ukraine is considered by the WHO to be one of the 30 high burden countries in the world with a notably high burden of MDR TB. In addition, Ukraine has the second largest HIV epidemic in Eastern Europe and Central Asia as well as the fifth largest number of extensive drug resistant cases in the world. Ukraine has made extensive …

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 …

Decolonizing Humanitarian Aid: Addressing Racism And Health Inequities In The Context Of Africans Displaced From Ukraine, Nassim J. Ashford

Public Health Theses

The Russian invasion of Ukraine in February 2022 led to one of Europe's largest humanitarian crises since World War II. With over 14 million people forcibly displaced from Ukraine, this thesis delves into the lesser-known aspect of anti-Black discrimination impacting displaced Africans and those of African descent during the conflict. This thesis research has two primary objectives: (1) to explore the personal experiences and struggles of displaced African persons as they encountered barriers to safety while escaping the war-torn region, and (2) to examine NoirUnited International's efforts to create a framework that addresses humanitarian crises with a focus on racial …

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 …

Vector Status Of Aedes Albopictus In Connecticut: Analyses Of Invasion Pattern, Geographic Distribution, And Disease Risk, Meredith Bagger

Public Health Theses

Introduction: Aedes albopictus is a highly successful invasive mosquito. Its presence and expansion into Connecticut have implications for human and animal health. The factors limiting Ae. albopictus spread and risk by the pathogens it carries have not been previously examined. Methods: This study leveraged data from the Connecticut Mosquito and Arbovirus Surveillance Program during 2006-2022 and a project designed to characterize mosquito-borne filarial parasite species in Connecticut from 2020-2021. We examined correlations between mosquito abundance and winter temperature as well as land use. We described the arboviruses detected in Ae. albopictus collections and calculated the risk of Ae. albopictus transmitting …

Community Perspectives On Mental Health Stigma In American Samoa, Vanessa Luzmila Blas

Public Health Theses

Despite reports of mental health concerns among adolescents in American Samoa, little is known about the current mental health burden. Furthermore, previous literature has identified mental illness-related stigma as a significant barrier to mental health care access and treatment. By gathering various perspectives of adult stakeholders and adolescent participants, this community-partnered qualitative study aimed to describe the perceived stigmatization of mental health in American Samoa.

This study stems from a larger qualitative project on adolescent mental health in American Samoa. Employing the Fa’afaletui research framework, 28 adult informants of differing professions, ages, and gender participated in semi-structured, in-depth virtual interviews …

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 …

“So We Create Happy Synergies” How An Overall Enabling Environment Helped Lao Pdr Legislate The Who Code On Breastmilk Substitutes: Lessons Learnt, Devina Buckshee

Public Health Theses

ABSTRACT

Background: Exclusive breastfeeding rates in Lao People’s Democratic Republic (Lao PDR) remain at 44% against a global goal of at least 50%, partly due to a weak understanding of the multifactorial and multilevel determinants of breastfeeding (UNICEF, 2021). Therefore, evidence-based advocacy efforts call for a systems approach to improve the enabling environment around breastfeeding. Aim: This study aims to stitch together the comprehensive patchwork of actors and dynamic ‘gears’ in the socio-ecological environment that came together to develop a much more enabling environment to improve child nutrition through breastfeeding promotion and protection in Lao PDR. Further, it aims to …

“You Need To Give All Of Yourself To This Field Or It's Not Enough”: A Qualitative Study Of The Medical Education Experience Among Medical Students With Chronic Health Conditions, Peyton Cabaniss

Public Health Theses

Medical students with chronic health conditions are an underrepresented and often overlooked population in medical education. Previous research has described the dual roles these students hold as both health care recipients and providers and has detailed challenges they face related to accommodations and accessibility. However, less is known about how these students navigate the day-to-day requirements of medical school and how having a chronic health condition shapes the medical education experience on an interpersonal level. To address this gap in knowledge, I conducted semi-structured interviews with eighteen medical students with chronic conditions and examined data using reflexive thematic analysis. Findings …

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 …

Racism-Related Stress And Health Behaviors And Outcomes Among Emerging Adult Sexual Minority Men Of Asian Heritage, Lauren Li-Min Chin

Public Health Theses

Rationale: Acts of racial discrimination impart racism-related stress on the individual and have been linked to decreased psychological well-being and physical health. While there are numerous studies of other groups of sexual minority (SM) men of color in this area, little research has focused on HIV-negative, Asian-identifying SM men. Objectives: This study investigates whether racism-related stress is associated with substance use, general and oral health outcomes, and attitudes towards PrEP in a sample of emerging adult Asian SM men. The study also evaluates whether these behaviors affect the relationships between racism-related stress and the other outcomes. Methods: This secondary data …

Primary Liver Cancer In China From 2000-2020: Evolution Of Epidemiology, Clinical Disease, And Therapy, Wanqing Chi

Public Health Theses

Background & Aims: China contributed to 49% of all liver cancer deaths worldwide in 2020. We sought to investigate the relationship between clinical characteristics, antiviral therapy (ART), and multiple risk factors that affect the prognosis of primary liver cancer (PLC) patients over time to highlight proper chronic liver disease management.Methods: We identified 1322 PLC patients diagnosed between 2000 to 2020 in a major academic teaching hospital in Shanghai, China. We used descriptive epidemiology to characterize the evolution of liver cancer in China, and Cox proportional hazard models and Kaplan-Meier survival analysis to assess the relationship between evolving ART and survival …

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 …

Awareness Of Racial Disparities Among Breast Cancer Providers, Inessa Cohen

Public Health Theses

Background: Cancer patients who self-identify as Black and Hispanic are more likely to receive delays in care as compared to their Non-Hispanic White counterparts. Current research suggests that while providers are aware of racial-ethnic disparities in access to treatment at a nationallevel, they either fail to recognize hospital-level or practice-level disparities (occurring within the provider’s own clinical care) or attribute it to patient-level factors. However, this phenomenon of decreased awareness among providers regarding factors specific to them or their hospital/practice is not well understood and has yet to be studied in the oncology space. Methods: We conducted a non-randomized pre-post …

Perceptions Of Hiv Pre-Exposure Prophylaxis And Correlates Of Interest Among Women At Shebeens In Rural South Africa, Arielle Kaminer Hazi

Public Health Theses

Background: South Africa has the highest HIV burden in the world. In KwaZulu-Natal province, 27% of adults are living with HIV and 25% of new cases are in adolescent girls and young women. High prevalence of hazardous alcohol use complicates delivery of HIV testing, care, and prevention services. Gaps exist in knowledge on alcohol use among rural women and the association with HIV outcomes. We sought to understand facilitators and barriers to HIV pre-exposure prophylaxis (PrEP) initiation in women, focusing on local alcohol venues, called shebeens.Methods: Surveys and interviews conducted among women attending shebeens assessed alcohol use, HIV risk behaviors, …

Prostate Cancer Clinical Characteristics And Treatment Among Asian-American Persons In The United States: An Analysis Of The National Cancer Database 2004-2020, Farah Jeong

Public Health Theses

Introduction: Given the considerable cultural diversity within the Asian population, numerous factors can significantly impact health status and management. Objective: This study examined the differences in demographic characteristics, clinical characteristics, and treatment status among each Asian American patient with PCa compared to non-Hispanic White and non-Hispanic Black patients by analyzing PCa dataset from National Cancer Database (NCDB) 2004-2020 data. Methods: Patients (n=860,669) with localized PCa diagnosed between 2004 and 2020 who identified as White, Black, Chinese, Japanese, Filipino, Korean, Vietnamese, Asian Indian, or Pakistani within NCDB were extracted and stratified by risk level: low-risk and intermediate/high-risk. The effect of racial …

Depression And Anxiety Among Plurisexual Teens In The U.S., Olivia Goodwin

Public Health Theses

Background: Little research focuses on the mental health consequences of stigma for plurisexual teens, with even less research comparing cisgender plurisexual youth to nonbinary plurisexual youth.Aims: To assess whether having both a marginalized sexual orientation and a marginalized gender identity is associated with greater risk or greater resilience in depression and anxiety outcomes among teens in the US. Methods: Data was analyzed from the 2022 LGBTQ Teen Survey. Inclusion in the study required being an English speaker living in the US, being 13-18 years old, and identifying as cisgender and plurisexual (n=1547) or gender nonbinary and plurisexual (n=1867). Statistical tests …

Psychosocial Experiences And Genetic Knowledge In Individuals With Pathogenic And Uncertain Tp53 Variants In The Prospective Registry Of Multiplex Testing (Prompt) Cohort, Dana Kahle

Public Health Theses

Germline mutations in the TP53 gene confer increased risk of diverse malignancies in children and adults in the Li Fraumeni cancer susceptibility syndrome, a rare condition with estimated prevalence of about 1 in 3,555 in the population. The Prospective Registry of Multiplex Testing (PROMPT) study is a registry of individuals undergoing genetic testing for inherited cancer susceptibility using multi-gene panels regardless of test results and agreeing to participate in questionnaire studies about their experience. The purpose of this study was to investigate how the psychosocial experience of genetic testing and level of genetic understanding and knowledge differs for those 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). …

Attribution Of Febrile Illness To Circulating Respiratory Viruses In The United States, July 2016 - March 2023, Lily Kitfield-Vernon

Public Health Theses

Background: SARS-CoV-2, an emerging epidemic respiratory virus, has circulated in the United States since early 2020. The dynamics of Influenza (flu) and Respiratory Syncytial Virus (RSV) have shifted, causing atypical timing and levels of illness across the country and in particular age groups. Fever, recorded on at-home bluetooth-enabled thermometers, is a promising new tool with which to monitor respiratory disease. Quantifying the proportion of fever attributable to these three viruses, at a particular time or within a particular age group, would strengthen the collective understanding of viral circulation in the U.S., and enable the use of fever data in the …

Are News Media Organizations Protecting Youth Mental Health? A Content Analysis Of The Top 4 News Organizations On Tiktok, Caroline Ann Pastrana Helsen

Public Health Theses

Background: In response to worsening mental health among adolescents, the U.S. Surgeon General issued an advisory on December 7, 2021 calling for action to address the youth mental health crisis. The advisory makes several recommendations, including actions media organizations can take to protect viewers’ mental health. The advisory specifically mentions news coverage that can negatively impact mental health, such as depictions of mental illness and traumatic events including natural disasters, pandemics, and mass violence. High rates of youth consume news on social media, with TikTok as one of the most popular apps for this demographic. Although research indicates that both …

Barriers And Facilitators For Implementing The Who Safe Childbirth Checklist In Mozambique: A Qualitative Study Using The Consolidated Framework For Implementation Research (Cfir), Anqi He

Public Health Theses

High maternal and neonatal mortality rates persist in Mozambique, with the issues of stillbirth remaining understudied. Most maternal and neonatal deaths in the country are due to preventable and treatable direct childbirth-related complications that often occur in low-resource settings. The World Health Organization (WHO) introduced the Safe Childbirth Checklist (SCC) in 2015 to reduce adverse birth outcomes. The SCC, a structured list of evidence-based practices, targets the main causes of maternal and neonatal deaths and stillbirths in healthcare facilities. Despite successful implementation in over 15 countries, the SCC has not been adopted in Mozambique. This study aimed to identify potential …

Prevention Of Mother-To-Child Transmission Of Hiv(Pmtct) Efforts In Kwazulu-Natal, South Africa: Lessons From Botswana, Jin Hee Kim

Public Health Theses

In sub-Saharan Africa (SSA) where mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV) continues to be an ongoing problem, scale up of prevention of mother-to-child transmission (PMTCT) services remains a priority. Between 2001 and 2012 globally, the 52% decline of new pediatric HIV infection was attributed to the expansion of PMTCT services. In December of 2021, the World Health Organization (WHO) announced that Botswana was certified as having attained the silver-tier status in the elimination of mother-to-child transmission of HIV, because it had successfully reduced the MTCT rate to less than 5%, had provided antenatal care (ANC) and antiretroviral …

Association Between Parity And Bmi In A Suburban Nepalese Community, Dhulikhel, Se Ryung Lee

Public Health Theses

This study aims to examine the link between parity and BMI in women in a suburban Nepali community, Dhulikhel. This study is a secondary data analysis of the Dhulikhel Heart Study (DHS). The study sample included women aged 18-59 years. BMI was based on measured height and weight. The result shows that prevalence of obesity is very high in women with high parity. Furthermore, the result of the ordinal logistic regression show that higher parity is associated with higher odds of being in a higher BMI category (overweight/obese). The odds were the highest in women who gave birth to 3 …

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 …