Digital Commons Network^™

Identifying Interactions Between Chikungunya Virus And Aedes Aegypti Salivary Gland Proteins, Alfred Jiang

Public Health Theses

Chikungunya virus (CHIKV), an emerging threat to global health, has been responsible for extensive arboviral epidemics in Southeast Asia and the Americas in recent years. In order to develop effective therapeutics and preventative measures, we must first gain a deeper understanding of both the host and vector factors that define the pathogen’s life cycle and transmissibility. Currently, the entry receptor and potential co-factors that facilitate CHIKV infection in the arthropod vector are unknown, highlighting a critical knowledge gap in our understanding of the viral life cycle. Furthermore, while secreted mosquito salivary proteins have been shown to modulate host infection through …

Connecting Emrs With Washington’S Pdmp: Benefits Of Integration, Gilah Benson-Tilsen

Public Health Theses

The Washington State Prescription Drug Monitoring Program collects records of all prescriptions for controlled substances in the state. If medical professionals check the database before prescribing, they can make better prescribing decisions. They may identify multiple legitimate or illegitimate prescriptions that put the patient at risk of harmful drug interactions, or uncover other relevant information. Reducing drug diversion and “doctor shopping” helps address the opioid crisis, which is partly fueled by inappropriate prescribing.

New integration software makes it significantly faster for prescribers to check the database, but the cost of the software may forestall its purchase and use. This study …

Violence And Postpartum Drug Abstinence Among Substance-Using Mothers, Pooja Reddy Bollampally

Public Health Theses

Background: Substance use during pregnancy can have numerous detrimental effects on maternal and infant health. This knowledge contributes to high rates of abstinence during pregnancy, but pregnant women with substance use disorders are at high risk for relapse postpartum. Experiences of violence can have a substantial impact on the behavioral and mental health of women; its compounded consequences with those of substance use can lead to a population vulnerable to drug relapse and other negative health effects. The objective of this study was to examine the association between experiences of violence and drug abstinence at delivery and postpartum.

Methods: Data …

Prep Uptake, Adherence, And Persistence: Qualitative Interviews With Women Experiencing Ipv, Ipv Service Providers, And Healthcare Providers, Amy Janet Caplon

Public Health Theses

Background: Intimate partner violence (IPV) has been associated with HIV susceptibility and

acquisition. Studies have found that women who had experienced IPV were at least three times more likely to have a diagnosis of HIV. Women are interested in taking PrEP, however barriers to uptake, adherence, and persistence are not widely known, and present knowledge excludes experiences of healthcare providers and IPV service providers. In this qualitative study, we examined the perceived facilitators and possible solutions to PrEP uptake, adherence, and persistence. This was done using a sample of women experiencing IPV, Reproductive Health Providers, PrEP Providers, and IPV service …

Safer Well Water: Exploring Environmental Screening Efforts For Family Child Care Homes, Devan Carr

Public Health Theses

Background

Children are widely recognized as particularly vulnerable to the harmful effects of environmental contaminants. As such, the physical environment in which they live, play, and breathe can have a significant impact on their health and development throughout their life. In 2007, Connecticut's Department of Public Health established the Screening Assessment for Environmental Risk (SAFER) program as a proactive, non-regulatory approach to screening child care centers in the state. Several screening methods are implemented in this voluntary process, including the identification of any hazardous waste sites within 1/8 of a mile of a proposed child care site. While successful, the …

Association Of Hpv And Oral Cancer, Qizheng Chen

Public Health Theses

According to the International Research on Cancer (AIRC) oral cancers are a type of cancer that develops in people’s lip linings, mouth, and the oropharynx. Studies have shown that the consumption of alcohol and tobacco products are the primary carcinogens that cause oral cancers. However, increasing cases of young individuals with no previous exposure to alcohol or tobacco who are getting oral cancers have prompted studies to look into the role of other carcinogens, especially viruses. Currently, the IARC presents oral cancers as the sixth most common type of cancer in the world. High-risk human papilloma virus (HPV) types are …

Symptom Clustering And Decision Tree Analysis Within The Vast-D Randomized Clinical Trial, Yangmin Chen

Public Health Theses

As a secondary analysis of the VAST-D clinical trial data, we employed a multi-layered strategy to describe the complicated clinical features of Major Depressive Disorder (MDD) and the heterogeneity among depressive symptoms, using the following analytical approaches:

(1) Cluster analysis was used to transform a large and heterogenous mix of survey questions into a small number of correlated MDD symptom clusters: Four robust and highly-interpretable MDD symptom clusters (core emotional, appetite and weight, sleep disorders, atypical) were identified within the VAST-D trial, consistent with the findings from other relevant studies.

(2) Decision tree analysis was used to identify symptom thresholds …

Spatiotemporal Investigation Of Opioid-Involved Fatalities In Connecticut, 2009-2017, Natalee Frances Robson Desotell

Public Health Theses

Over the past two decades, overdose deaths involving pharmaceuticals, heroin and, more recently, synthetic opioids such as illicitly manufactured fentanyl have increased in the United States. Connecticut has one of the highest opioid-involved mortality rates when compared to other states, and between 2009 and 2017, the incidence of opioid-involved fatal overdoses in Connecticut increased by about 350%. We examined opioid-involved fatality data from the Connecticut Office of the Chief Medical Examiner over a 9-year period, from January 1st, 2009 and December 31st, 2017, to better understand the granular spatiotemporal trends of the crisis within CT with an eye toward informing …

Benchmark Policies And The Rationalization Of Cannabis, Ethan Handa

Public Health Theses

The process of creating new policy is frequently dependent on knowledge and study of precedent, which in turn, helps influence future strategy. In the case of legal cannabis state industries, there is much to be learned from policy mistakes made in how other states managed cannabis legalization. As such, these mistakes leave gaps in policy, which pose a threat to the rationality of the legal industry and set poor precedent for future efforts. In turn, the goal of this paper is to identify gaps in cannabis policy and highlight what should be seen as benchmark policy for further industry developments. …

Tb Knowledge And Outcomes In A Routine Care Setting In Kampala, Uganda, Tyler Scott Johnson

Public Health Theses

TB education and counseling (TEC) is universally recommended for individuals initiating treatment for active TB in Uganda. The effectiveness of routine TEC in Kampala and the association between specific knowledge domains and treatment outcomes is unknown. We sought to (1) to evaluate the effectiveness of routine TEC in helping individuals to increase and retain TB-specific knowledge and (2) to examine the association between TB knowledge and treatment outcomes among individuals diagnosed with TB. We enrolled adults (age ≥18) initiating treatment for active TB at Kisenyi Health Centre in Kampala, Uganda into a prospective, observational cohort study. We administered a verbal …

Development And Evaluation Of A Clinical Quality Scorecard For Cornell Scott-Hill Health Center, Hailey Jordan

Public Health Theses

Abstract

Background

Healthcare organizations are making the transition from volume to value-based care, thus relying on standardized performance measures for quality improvement. Some challenges of this strategy include the following: ambiguity and inconsistency of metric definitions across reporting systems, a dearth of measures that are representative of clinical care and patient experience, and unfair or inappropriate comparisons of organizations serving patients exposed to different sociodemographic risk factors.

Rationale

Developing and evaluating a clinical quality scorecard that is internal to a federally qualified health center will provide insight into its value-based performance. It will also allow for efficient improvement in clinical …

Influence Of Diabetic Kidney And Eye Complications On Annual Health Expenditures Using The Medical Expenditures Panel Survey 2012-2016, Akhil Kumar

Public Health Theses

Abstract

Background

Diabetes is a critical chronic disease that has exerted considerable health and economic influence on the United States population. Although diabetes has imposed a considerable economic burden on health systems worldwide, the incremental economic effect of certain diabetic complications has not been extensively studied and quantified. The aim of this study is to quantitatively define the economic burden resulting from the presence of diabetic eye and kidney complications.

Methods

Data was analyzed from the Medical Expenditure Panel Survey (MEPS) 2012-2016 to provide an updated evaluation on the association between several forms of annual health expenditures and the presence …

Addressing Racial Health Inequities In San Francisco: A Qualitative Research Project With The Maternal Child And Adolescent Health (Mcah) Section Of The San Francisco Department Of Public Health (Sfdph), Lydia Kwarteng

Public Health Theses

A qualitative research project was conducted within the MCAH section of SFDPH to explore how to equip the public health workforce to address racial health inequities and disparities in the city. 34 interviews were conducted, and analyzing the results suggested that additional training, increased community engagement, and transforming organizational culture were the main ways to equip staff and leadership.

The Estimation Of Age, Period And Cohort Effects For Lung Cancer, Yijie Li

Public Health Theses

Lung cancer is one of the most fatal diseases in the world, so it is important to understand the pattern of lung cancer trends at population level. The age-period-cohort model (APC model) is used in this article to analyze the effects of age, year at diagnosis and year at birth on lung cancer in the U.S. The results suggest the age, period and cohort curvature effects are all significant on the lung cancer incidence and mortality. By looking at the plot of the age, period and cohort effects, we found historical events of interest like world war, sales strategies by …

Exposure To Heavy Metals In Relation To Thyroid Dysfunctions In U.S. Adults, Xiwen Liao

Public Health Theses

Abstract

Background: Thyroid hormones are fundamental in regulating normal body functions like metabolism, development, and reproduction. There are a limited number of studies examining the association between thyroid dysfunctions and heavy metals, particularly population-based studies. The current study aimed to examine this relationship in the U.S. population.

Method: The current study used data of the National Health and Nutrition Examination Survey from 2007 to 2012. Study population included adults older than 20 years old without any medication that might impact thyroid hormones. Based on the clinical standard of thyroid dysfunctions, eligible participants were classified into two groups by their thyroid …

Food Insecurity And Youth Homelessness: A Qualitative Approach To Understanding Barriers And Strategies Of Food Obtainment, Marina Marmolejo

Public Health Theses

Objectives: The goal of this project is to better understand the intersection between food insecurity and youth homelessness, and more extensively explore how youth develop survival skills while combating barriers to healthy eating.

Methods: Semi-structured interviews were conducted with 30 youth (18-25 years old) experiencing homelessness in Los Angeles (LA). Interviews were conducted on site at a drop-in center in LA. An Outreach & Engagement Program Manager assisted the principle interviewer in criterion sampling. Each interview lasted approximately 20-80 minutes and participants were compensated with $20. Data saturation was determined through preliminary analysis, and thematic coding was conducted through Dedoose. …

Assessment Of Lead Exposure To Children In A Historically Contaminated Area, Copsa Mica, Romania, Xiangting Meng

Public Health Theses

Copsa Mica is an industrial town with primary zinc and lead smelter operating from 1930s to

1990s in northwestern Romania. Even after the shutdown of the factory and a series remediation effort,

lead is ubiquitous in its environment and remains as a big risk for local health. Previous study

evaluating the blood lead level of children in this region revealed a range of mean from 20.51µg/dL to

53.04 µg/dL, which exceeded the recognized CDC guidelines. The paper aims at providing detailed

information about spatial distribution of lead in soil and dust to better understand the lead exposure

and choose the …

Prevalence Of Asymptomatic Malaria Among Children In Kumasi, Ghana, Natalie Olson

Public Health Theses

As the landscape of malaria in sub-Saharan Africa changes due to improved control efforts, there is increasing interest in elucidating the epidemiology of asymptomatic P. falciparum infection and its role in disease transmission, particularly in school age children. We conducted a cross-sectional survey in the summer of 2018 of children attending 4 primary/junior high schools within a 5 km radius of HopeXchange Medical Centre in Kumasi, Ghana, a city of 2.5 million inhabitants with year-round malaria transmission. Informed consent/assent and demographic information was obtained from 634 subjects (ages 5-17 years), after which measurements of height/weight/body temperature were recorded and a …

Effect Modification Of Greenness In The Residential Environment On Temperature-Mortality Relationship Among Older Adults In China, Chengcheng Qiu

Public Health Theses

Older adults are highly vulnerable to adverse climate-related impacts, with temperature-related mortality that are likely to vary according to geographic characteristics, vegetation abundance and socioeconomic conditions. We examined how mortality among older adults in China was associated with different temperatures over 14 years (2000-2014), and how geolocation, vegetation abundance in the residential environment and socioeconomic conditions modulate this association. We used case-crossover study design with distributed nonlinear modeling method to estimate heat- and cold-related mortality, and stratified the analysis by the level of vegetation abundance, calculated from light reflectance of remotely sensed imagery, and socioeconomic characteristics including education and residence …

Evaluation Of The Ltbi Cascade Of Care At The Winchester Chest Clinic, Alyssa Manni Robinson

Public Health Theses

Background: Latent tuberculosis infections affect around two billion people world-wide. In order to effectively control and reduce TB incidence, latent TB cases must be identified and treated. The latent TB cascade of care involves screening, diagnosis, evaluation, prescription of a treatment regimen, and completion of treatment. Existing studies have identified low rates of LTBI treatment completion among patients in diverse settings.

Objective: The aim of this study was to assess certain steps in the cascade of care among the LTBI-positive patients referred to the Winchester Chest Clinic in order to determine where patients were lost to follow up and potential …

Impacts Of Hepatitis C Virus Infection Treatment For Patients In Treatment For Opioid Use Disorder, Brooke Severe

Public Health Theses

Hepatitis C virus (HCV) infection is common among patients with opioid use disorder (OUD), a population who faces barriers to HCV treatment access. Co-located treatment for HCV within an opioid treatment program (OTP) addresses gaps in the HCV care continuum. Few reports have analyzed outcomes related to OUD, such as OUD treatment retention, associated with onsite HCV treatment. Patients (N=89) treated for chronic HCV infection in a Connecticut OTP from January 2014 through July 2017 were compared to control patients (N=199) with HCV-based ICD10 coding (B18.2) who were not treated during the same period. All patients received opioid agonist treatment …

Time Series Analysis For Effect Of Vaccines On Pneumonia Or Gastrointestinal Disorders In Brazil, Kang Shen

Public Health Theses

It is important for public health professionals to understand the effects of vaccine introduction and compare different types of vaccinations. This study will focus on understanding the pre and post vaccination effects of two different infectious diseases: pneumonia and gastrointestinal disorders. One of approaches of getting the accurate estimate of vaccine impact is by comparing rates or trends of the targeted disease in the years after introduction with rates of trend in the year before introduction using a time-series analysis. Specifically, in this study, the synthetic controls method implements an approach to estimating the causal effect of a designed intervention …

Serious Psychological Distress Is Associated With Higher Healthcare Expenditure Among Adults With Or Without Atherosclerotic Cardiovascular Diseases, Yunrong Shen

Public Health Theses

Serious psychological distress (SPD) can adversely impact health and quality of life for people with atherosclerotic cardiovascular disease (ASCVD). The purpose of this study is to examine the association between SPD and the use of medical expenditure and utilization among people with and without ASCVD. A total of 18770 adults with ASCVD and 2083 adults without ASCVD as comparison group were identified from the population-based Medical Expenditure Panel Survey (2015). SPD was assessed using 6-item Kessler Psychological Distress Scale. We examined the use of medical expenditure and utilization in ASCVD patients and comparison adults with/without SPD. Two-part econometric models analyzed …

Impacts Of Ambient Temperature On Foodborne Salmonella Infection, Victoria E. Shirriff

Public Health Theses

Foodborne Disease (FBD) impacts individuals through the ingestion of foods contaminated with microbes and can lead to an array of adverse health consequences ranging from mild symptoms such as nausea to those that evolve to become life-threatening (World Health Organization, 2015a). The incidence of FBD is expected to increase in the presence of climate change due to an increase in ambient temperature creating an environment where microbes can rapidly multiply and thrive (Gregory, Johnson, Newton, & Ingram, 2009; Kovats et al., 2004). Foodborne cases of Salmonella make up the second largest cause of gastrointestinal infection in the United States (Scallan …

Medical Education And The Stigmatization Of Mental Illness In The Philippines, Candice Mae Taguibao

Public Health Theses

BACKGROUND:

Mental health stigma is a worldwide problem that affects health care providers, as well as the general population. The current study used survey data from students and physicians in the Philippines to examine the association of higher levels of medical education with levels of

stigma. Further, attitudes among medical students in the Philippines were compared with levels among medical students in the US, Brazil, Ghana, Nigeria and China. Qualitative interviews were used to further understand these data.

METHODS:

A convenience sample was collected from medical students before and after medical school psychiatric training from the University of the Philippines …

Intergenerational Effects Of Adverse Birth Outcomes Of Parents And Offspring Autism Spectrum Disorder (Asd) Risk In Denmark: A Population-Based Cohort Study, Jingyuan Xiao

Public Health Theses

Abstract

Introduction: Animal studies have suggested that exposure-induced epigenetic reprogramming of the germlines affects neurodevelopmental outcomes in the next generation, but possible transgenerational effects of parental adverse birth outcomes and offspring autism spectrum disorder (ASD) risk have not been studied in humans.

Objective: To evaluate whether parents being born preterm or low birth weight were associated with risks for ASD in their offspring.

Methods: We conducted a Danish population-based cohort study including mothers and fathers born since 1978 who also have had an offspring registered in Denmark during 1990-2013. Information on gestational age and birth weight were recorded in the …

The Potential Of Next Generation Whole Genome Sequencing Using Dogs As A Model To Understand Human Diseases, Emily Xie

Public Health Theses

Abstract

Background: There has been extensive research in the study of the dog genome and comparative genomics to human diseases. Dogs were proposed as a candidate primarily because of the relatively low variation within breeds but high variation between breeds. In this study, we used a conserved gene among dogs, SMN, to understand the genetic variability across dog breeds and to compare with human SMN1.

Methods: Using a sequential method design, new dog samples are added into the database as they become available. This paper is an application of the newly developed algorithms in studying the similarities and differences in …

Declines In Human Papillomavirus (Hpv) – Associated High-Grade Cervical Neoplasia By Sociodemographic Factors After Introduction Of Hpv Vaccines In Connecticut, Usa 2008-2017, Mike Yepes

Public Health Theses

Abstract

Background: In 2006, the FDA approved the first vaccine against human papillomavirus. Trends in HPV-related sequalae are an effective method of analyzing HPV vaccine impact. Our primary objective was to measure trends in cervical neoplasia based on sociodemographic characteristics including race, ethnicity, and socioeconomic status.

Methods: Since 2008, Connecticut has required reporting of cervical intraepithelial neoplasia labeled grade 2+ and adenocarcinoma in situ. CIN 2+ diagnoses trends were modeled by area-based measures of age, race, ethnicity, and socioeconomic status using negative binomial regression and change-point analysis. Incidence rate measurements were adjusted to reflect inclusion of women who had completed …

Association Of Age On Diagnosis And Treatment Of Locally Advanced And Metastatic Prostate Cancer, Chi Zhang

Public Health Theses

Background Prostate cancer is an aging-related disease. As the result of the radiation are of STAMPEDE trial came out, major shifts in the use of local therapy (LT) are expected for men newly diagnosed with locally advanced and metastatic disease. This study aims to determine the role of patient age on LT.

Methods We identified 6882 and 37382 locally advanced and metastatic prostate cancer diagnosed in 2004-2014 using the National Cancer Database (NCDB). We used logistic multivariable regression to determine the role of age in the receipt of prostate and/or pelvic radiation or radical prostatectomy after adjusting for demographic and …

Putting The T In Mlp: The Role Of Trust In Medical Legal Partnerships, Jenny Ajl

Public Health Theses

The United States spends more on healthcare than any other country, while health outcomes lag behind many nations. This is often attributed to the disproportionately low spending on social services, and social determinants of health (SDOH) need to be addressed in order to improve the nation’s health. SDOH are increasingly understood to be key factors in predicting health outcomes. Medical legal partnerships (MLPs) are one intervention that seek to address SDOH. The MLP model comprises three core components: providing legal care for patients, improving systems of healthcare, and creating policy change outside the healthcare system. In this qualitative study, we …