Digital Commons Network^™

Immunotherapy For Advanced Cancer Patients With Autoimmune Disease, Huaqi Li

Public Health Theses

Purpose

Immunotherapy (IT) has been shown to improve cancer survival but there is limited evidence regarding use in patients with advanced cancer and pre-existing autoimmune disease (AI). We sought to address these knowledge gaps and determine IT utilization patterns and overall survival (OS) for these patients.

Patients and Methods

This retrospective cohort study used data from Flatiron Health’s nationwide oncology database. Patients diagnosed with advanced cancer where there was ≥ 1 FDA approved IT were included. Baseline demographics were analyzed using χ2 and t-tests. Patterns of IT use were assessed using logistic regression. OS was estimated using Kaplan-Meier and Cox …

Review Of Neurotechnological Interventions: A Need For A Recommended Public Health Response, Joel Lugones

Public Health Theses

After preliminary review of relevant research articles, the thesis was able to gain a deeper understanding of neurotechnological interventions (e.g. deep brain stimulation, and other neurostimulators), specifically in regards to their use in treatment of motor conditions (e.g. Parkinson’s, Epilepsy, etc.) and for some psychological disorders (e.g. depression, other mood disorders, etc.). A scoping review was conducted on a specific class of treatments used for particular conditions: invasive neurotechnological treatments for mood disorders. The reasoning behind this specified approach was due to the lack standardized policies and regulations in place for invasive neurotechnological interventions used for treatment of mood disorders …

Prevalence, Awareness And Control Of Hypertension And Diabetes Among Hiv Positive And Negative Patients At The Military Hospital Of Douala, Cameroon, Duane Killian Madziva

Public Health Theses

Background: With anti-retroviral therapy (ART) prolonging the survival of people of living with HIV/ AIDS, other chronic co-morbidities such as hypertension, and diabetes are becoming an increasing problem. Studies on hypertension and diabetes in Sub-Saharan Africa are still limited, even with the growing concern of Africa’s dual burden of chronic and infectious diseases. As such, we aimed to determine the prevalence, awareness and control of hypertension and diabetes among people living with and without HIV/ AIDS in Cameroon. Methods: This was a hospital-based cross-sectional study conducted at the Military Hospital of Douala, Cameroon. Participants aged 21 – 65 years were …

Acknowledgment Of Sexual Violence And Mental Health Among College Students, Francesca Maviglia

Public Health Theses

A significant number of individuals who experience a form of sexual violence that could be classifiable as rape or sexual assault do not label their experience as such. Studies found that rape acknowledgement status can impact a survivor’s postassault experiences and recovery process. This study examined how a sample of 236 college students who experienced some form of sexual violence labeled their experience. The association between different degrees of acknowledgement and posttraumatic stress and depression symptoms was tested. 162 (68.6%) of respondents did not label their experience as unwanted; the remaining 74 (31.4%) varied in their labeling of the experience …

A Review Of Mental Health Screening Tools Used In Disaster Research, Ashley Rose Moore

Public Health Theses

Introduction: The effects of disasters are widespread and heavily studied. While attention to disasters’ impacts on mental health is growing, knowledge about these effects is fragmented due to the wide variety of assessment tools used in post-disaster settings. The purpose of this study is to review mental health assessment tools and their use in populations affected by disasters.

Methods: A systematic search was conducted in PubMed, PsycINFO, and Google Scholar for commonly-used tools that assess PTSD, anxiety, depression, substance use disorder, and general mental health in disaster settings. Next, a search for scientific studies that used the selected tools in …

Assessing The Functional Impact Of Pfrh5 Genetic Diversity On Erythrocyte Invasion Pathway Utilization In Plasmodium Falciparum, Adam Joseph Moore

Public Health Theses

Malaria is still responsible for over 405,000 deaths and 228 million cases of disease globally each year, with the large majority of these cases being caused by the Plasmodium falciparum parasite subspecies1. The RTS,S P. falciparum malaria vaccine, the only malaria vaccine ever licensed, is currently being rolled out in three African countries as part of a pilot implementation program and targets a major circumsporozoite protein (PfCSP). After three doses and a seven-year follow up, the vaccine showed a 7% efficacy on average with a -56.8% efficacy for patients in regions with above average exposure to P. falciparum2. While the …

“You’Re Not Gonna Get Any Help, No Matter How Hard You Try” A Qualitative Analysis Of “Severity” As A Barrier To Mental Health Care, Krishna Naik

Public Health Theses

Abstract

Objectives: This qualitative analysis explores how severity of need influences how patients perceive, experience and navigate mental health care.

Methods: Participants are English-speaking adults aged 18-64 with private insurance who have severe mental illness (SMI). After gauging interest in participating in telephone interviews, the principle investigators sampled those that used an out-of-network mental health provider (n=8), in-network mental health provider (n=8) and oversampled those that tried to use a mental health provider but ultimately didn’t (n=14). The 30 participants were interviewed for ~30 minutes each using semi-structured interview guides. All coding took place within Dedoose version 8.2.32.

Findings: “Severity” …

Live Birth Bias In Epidemiological Study Of Timing Specific Exposure Effect During Pregnancy And Child Health: A Simulation Study, Ngoc Tram Nguyen

Public Health Theses

In reproductive and perinatal epidemiological studies, measurement of child health outcomes that can only be ascertained in live born children may be incomplete since only 60 – 70% of fertilized eggs result in live births and early pregnancy loss is often undetected. Studies assessing outcomes among live born children are subject to live birth bias, a phenomenon previously proposed as a form of collider-bias in which conditioning on live-birth status induces a non-causal association between exposure and outcome. In this study, we expanded a previously proposed common structure of this bias to evaluate its impact on the estimation of time-specific …

Drug Use And Severe Outcomes Among Patients Hospitalized With Influenza Over Three Seasons, Christina Elizabeth Parisi

Public Health Theses

Influenza is a significant public health problem in the United States and around the world, causing considerable morbidity and mortality annually. Drug use is also a significant issue that is associated with numerous health complications and conditions. However, the relationship between severe influenza outcomes and drug use is not well understood. The objectives of this investigation are to compare the prevalence of demographic and behavioral factors associated with severe influenza outcomes between persons who use drugs (PWUDs) and non-PWUDs hospitalized with influenza and, by controlling for those factors we find are significant, determine if there is an association between severe …

Geospatial Analysis Of Drug-Resistant Tuberculosis In Santiago De Cali, Colombia, Oscar Norberto Perales

Public Health Theses

Infectious diseases like tuberculosis are undergoing an epidemiological transformation in developing countries such as Colombia and throughout Latin America. Recent economic and social developments may drive heterogeneous burdens of disease in the region, especially in urban settings. Geographic Information Systems (GIS) may allow us to better appreciate the geospatial distributions of TB in these contexts. In this study, we aimed to identify regions in Santiago de Cali facing disproportionate TB burdens and sought to determine whether the distribution of drug resistant TB differed. Additionally, we aimed to identify patient risk factors that could lead to differential drug resistance testing. This …

Wealth Inequality And Health: Understanding Health Disparities Without A Wealth Of Knowledge, Emily Bunker Peterson

Public Health Theses

Even though wealthier individuals have better health outcomes than their poorer counterparts surprisingly little research has attempted to demonstrate the link between wealth and health at the individual level. Instead, previous research into the wealth-health connection has primarily focused on analyzing the connection between annual income and health outcomes. However, analyzing income alone understates the full magnitude of socioeconomic disparities and their impact on health.

This study is a secondary analysis of responses from 2,442 respondents to waves 1 and 2 of the Perceptions of Economic Security Survey conducted through the American National Election Studies program. A created variable that …

Relationship Between Food Craving And Food Selection, Elizabeth Marie Raiff

Public Health Theses

Objective: The primary aim of this study was to determine the influence of craving on food selection.

Research Methods and Procedures: A total of 95 viable participants completed the food craving inventory

(FCI), a restaurant meal selection questionnaire, and various demographic questions. Linear regression

modeling was used to analyze the relationship between FCI craving score and various forms of caloric intake.

Logistic regression models were utilized to analyze the relationship between “high-craving” status and food

selection.

Results: No significant findings resulted from modelling the relationship between craving category FCI scores

and craved caloric intake using Pearson’s coefficient. Likewise, no significant …

Cost Effectiveness Of A Produce Prescription Intervention, Danielle Raso

Public Health Theses

In this study, we examined the effectiveness, cost, and cost-effectiveness of a produce prescription program. The program analyzed in this study is run by Community Health and Social Services (CHASS) Center, a Federally Qualified Health Center (FQHC) in Detroit, Michigan. The prescription produce intervention begins with eligibility screening and referral by patients’ physicians at clinical visits for eligibility. Eligible patients are then given “prescriptions” for free fruits and vegetables that they can exchange at participating farmers markets or farm stands. Farmers markets also host cooking demonstrations and distribute healthy recipes. Finally, coordinators and volunteers follow up with patients and provide …

Evidence-Based Interventions For Antimicrobial Resistance In Conflict-Afflicted Lmics, Noora M. Reffat

Public Health Theses

Introduction: Although control strategies for antimicrobial resistance (AMR) have been described in high-income settings, interventions to curb the emergence and spread of AMR in conflict-afflicted low- and middle-income countries (LMICs) have not been systematically explored.

Objective: The objective of this review was to identify and assess the effectiveness of various control strategies in curbing the emergence and spread of AMR in conflict-afflicted LMICs.

Methods: A systematic scoping review of the literature was conducted using Embase, PubMed, and Scopus to identify primary literature reporting on AMR in Pakistan, Lebanon, Jordan, or Turkey published in the last decade (Jan. 2010 – Jan. …

How Discrimination, Social Support, And English Proficiency Impact Depression In South Asian Immigrants: The Mediators Of Atherosclerosis In South Asians Living In America Study, Shireen Roy

Public Health Theses

Objectives: Discrimination, low social support, and low English proficiency negatively impact the mental health of immigrants. More work is needed to investigate the relationship between these factors and depression in South Asian immigrants. We examined the cross-sectional associations between chronic discrimination, low social support, low English proficiency, and depression in South Asians using data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study.

Methods: We fit logistic regression models to evaluate the associations between discrimination, social support, English proficiency, and depression in a sample of 887 South Asian adults. We also explored how discrimination, social support, …

The Relationship Between Race And Gender And Healthcare Outcomes For Patients In The Intensive Care Unit, Ria Rungta

Public Health Theses

Objective: Although racial and gender disparities in healthcare treatment have been widely studied, relatively few studies have focused on the critically ill population and have had conflicting results. In this study, we sought to assess the associations between a patient’s race and gender and their ICU mortality, length of stay, and any observed delays in the discharge process.

Methods: We utilize a large single-center database called MIMIC-III to analyze the association be- tween a patient’s race and gender and the outcomes of hospital mortality, ICU length of stay, and delays in discharge process. All analysis is conducted using R. Multivariable …

Are Food Baskets Helpful For Refugees With Chronic Illnesses In Sub-Saharan Africa?, Anthony Russell

Public Health Theses

ABSTRACT

Refugees are among some of the most vulnerable populations in our world today. Food insecurity appears to be a consistent state among many refugee populations regardless of length of refugee status and setting. The primary study aims were to: a) identify factors influencing refugees’ ability to manage their chronic illnesses; b) describe food insecurity and dietary intake among refugees with chronic illnesses; c) understand the role food baskets play for this population.

A cross-sectional mixed methods study was conducted in two phases. Phase 1 consisted of 10 in-depth interviews with older adult refugees to identify factors influencing their management …

Nitrous Oxide: Use In Labor & Delivery And Steps Toward Healthcare Sustainability, Bethany Sanchez

Public Health Theses

Objective: This study explores trends in procurement for 3 hospitals in Connecticut over a four-year period to better understand how much N2O is released. N2O use and frequency of conversion to epidural after N2O, as well as emergency cesarean section after N2O use is also examined. A plan for N2O destruction technology testing is outlined.

Background: Nitrous Oxide (N2O) is a well-documented greenhouse gas (GHG) and ozone-depleting agent. N2O use continues to be unregulated, and concurrently it has also become more widely adopted for use in labor and delivery in the US, though it has been popular in Europe and …

The Effects Of Rental Assistance On Housing Stability, Quality, Autonomy And Affordability, Rebecca G. Schapiro

Public Health Theses

In light of the current affordable housing crisis in the United States, this paper examines how rental assistance is associated with four housing outcomes: housing stability, quality, autonomy, and affordability to expand the current knowledge base on benefits of rental assistance. We use data from the first four waves (2017-2019) of the JustHouHS Study, a cohort study of low-income adults designed to examine the intersection of housing, mass incarceration, and health in New Haven, Connecticut. We use Generalized Estimating Equations to examine how rental assistance is associated with participants’ housing stability, quality, autonomy, and affordability. Participants receiving rental assistance had …

The Effect Of Childhood Maternal Trauma Experienced Before The Age Of 18 On Young Adolescent Children Ages 8-15, Alyssa Schneider

Public Health Theses

Childhood trauma is a pervasive and prevalent issue, and one that impact the entirety of the familial unit. Furthermore, maternal childhood trauma, or childhood trauma that was experienced by individuals that are now mothers, has the potential of being passed down and having far-reaching impacts for their children. This is known as the intergenerational transmission of trauma. However, this has primarily been studied in infants and children. As such, this study aimed to elucidate the effects of maternal childhood trauma on young adolescent children using a diary study method with the children and assessing childhood trauma in the mothers. It …

Confidentiality In The Clinic: A Qualitative Analysis Of Adolescent Girls’ Experiences Of Confidentiality In Sexual And Reproductive Health Care, Karen Teekadai Singh

Public Health Theses

Purpose: Adolescents in Connecticut can legally consent to sexual and reproductive health (SRH) care themselves and their parents do not have the right to view their confidential SRH treatment records. A qualitative study capturing information about adolescent girls’ experiences when receiving SRH care was conducted to explore how confidentiality and privacy play out in the clinic from the perspective of adolescents, the facilitators and barriers to adolescents’ confidentiality and privacy in SRH care, and the influence of family members or other guardians on adolescent patients’ confidentiality and privacy.

Methods: A secondary analysis of 31 interviews with adolescent girls was conducted. …

Glycemic Variability And Indices Of Glycemic Control Among Pregnant Women With Type 1 Diabetes Based On Use Of Constant Glucose Share Technology, Julie Sklar

Public Health Theses

Pregnant women with type 1 diabetes (T1D) experience increased glycemic variability as a result of changing insulin sensitivity and resistance throughout gestation. Therefore, strategies that help pregnant women with T1D manage their glycemic control are of great interest. We examined whether remote monitoring of Continuous Glucose Monitor (CGM) data by friends and family affects glycemic variability during pregnancy compared to CGM use alone in a pilot non-randomized trial (n = 28). During preconception or the first trimester, women with T1D were placed in one of two groups based on device compatibility: (1) CGM Alone (n = 13): women without iPhone, …

Neighborhood And Environmental Factors And The Relationship To The Willingness To Use And Actual Uptake Of Pre-Exposure Prophylaxis (Prep) Uptake, A Rapid Scoping Review, Steven Susana-Castillo

Public Health Theses

PrEP (Pre-Exposure Prophylaxis), which appeared on the market after FDA approval in 2012, is more than 90% effective against HIV transmission via sexual contact and more than 60% effective against HIV transmission via intravenous drug use. Current interventions focus on individual behavior or clinical guidelines, however, there has been little focus on the environmental factors affecting PrEP willingness and uptake. To investigate the relationship between neighborhood, environmental factors and PrEP willingness and uptake in the United States, a rapid scoping review was conducted with three electronic databases of articles (January 2012 – March 2020). Of the 2,016 citations screened, 11 …

You Win Some, You Lose Some: An Analysis Of Medicare For All’S Differential Impact On Hospital Finances, Leah Sussman

Public Health Theses

Background: High health care costs have led to an unprecedented number of policy proposals to reform the United States health care system. Proponents of Medicare For All (M4A) argue that a single-payer system would reduce costs by allowing the government to obtain better prices from providers. M4A would have varying effects on sources of hospital revenue, increasing some payment while decreasing others. This paper explores the differential effects of M4A on hospital income.

Methods: This paper uses data from CMS’s Healthcare Cost Report Information System (HCRIS) to create a baseline model reflecting hospital revenues and costs under current hospital payment …

Medical Student Mistreatment And Burnout: An Intersectional Approach, Bethelehem Getachew Teshome

Public Health Theses

Importance

While prior studies have described mistreatment in an undergraduate medical setting by sex, sexual orientation, and race/ethnicity, no studies have examined the degree of mistreatment and symptoms of burnout experienced by students with multiple marginalized identities with national data.

Objective

To describe the association between mistreatment, burnout, and having multiple marginalized identities during undergraduate medical education.

Design

This cohort study utilized data from the Graduate Questionnaire administered annually by the Association of American Medical Colleges.

Setting

This study utilized student responses from the 140 U.S. medical schools accredited by the Association of American Medical Colleges’ Liaison Committee on Medical …

Major Depression Among Immigrants: Findings From The Nis-2003, Trang Tran

Public Health Theses

Lawful permanent residents (LPRs) are immigrants who come to the US through a variety of countries and circumstances. Most studies focus on subsets of immigrant populations, however, this study utilized data from the 2003 New Immigrant Survey, a nationally representative, cross-sectional survey of LPRs (n = 8,573). Participants were grouped into three main visa categories (i.e. Refugees/Asylees/Parolees, Legalization, Family/Employment/Diversity) and the objective was to examine the association between visa status and depression outcomes among adult survey respondents. We used bivariate analyses to measure the relationship between sociodemographic variables and visa status. Approximately 98% of the Legalization category originated from Latin …

Tobacco Use, Knowledge Of Tobacco Risks, And Perception Of Smoking Behaviors Among Urban And Rural Youth In South Sulawesi, Indonesia, Ryan Andrew Sutherland

Public Health Theses

This observational study surveyed knowledge, practice, and attitudes (KAP) of N=959 youth 13 – 18 years of age in South Sulawesi, Indonesia and assessed how age, sex, familial smoking status, friend group smoking status, teacher smoking status, parental education, parental employment, exposure to tobacco-related advertisements, access to internet-connecting technological devices (INT-D) and television, and monthly pocket money were associated with youths’ perceptions of tobacco users and smoking, knowledge of tobacco health risks, and smoking status. This study also examined how urban or rural environment and schooling — access or lack of access to formal education — shaped youths’ decisions to …

Meteorological Determinants Of Mosquito Populations In Connecticut, Melpomene Vasiliou

Public Health Theses

As climate change continues at an alarming rate, it is important to quantify and characterize its wide-ranging impacts at both the global and more localized scales. This study aims to build on this body of evidence that details the local impacts of climate change that have already begun to and will increasingly harm human health. The study explores time trends in Connecticut’s mosquito abundance, as well as potential meteorological determinants of abundance for one key species. Secondary analysis using computational techniques was performed on mosquito abundance data provided by the Connecticut Agricultural Experiment Station (CAES). Simple linear regression was performed …

Promoting Ecosystem And Human Health Under Climate Change ——An Integrated Analysis Of Sustainable Olive Cultivation In Cyprus, Ningjing Wang

Public Health Theses

Achieving agricultural sustainability has become a high priority to ensure society’s current and future food needs without compromising ecosystem health, economic profitability, and human well-being. Organic agriculture has been proposed as an alternative to conventional farming for meeting sustainable goals. However, empirical evidence linking organic farming, human health, and sustainability in the context of climate change is scarce. In addition, previous studies comparing organic and conventional agriculture have not considered the variation in farming practices within the same management regime.

In this study, a multi-criteria sustainability assessment framework with ten indicators has been developed and proposed for sustainable olive cultivation …

Evaluating The Appropriateness Of Oral Antibiotic Therapy Following Discharge For Patients With Urinary Tract Infection, Sera Yoo

Public Health Theses

Introduction: Inappropriate use of antibiotics is common in healthcare settings, with urinary tract infections (UTI) being one of the most common indications for antibiotic prescriptions. This study evaluated the appropriateness of oral antibiotic therapy among adult patients with suspected UTI who were admitted to Yale New Haven Hospital during January 2018. We hypothesized that 60% of antibiotics were inappropriate, and that inappropriate therapy was associated with Clostridioides difficile infection, hospital readmission and/or mortality.

Methods: We conducted a retrospective cohort study of adult patients who were admitted to Yale New Haven Hospital from January 1, 2018 to January 31, 2018. Data …