Digital Commons Network^™

A Survey Of Heathcare Simulation In The State Of Oklahoma, Danyel Louise Germain

Yale School of Nursing Digital Theses

Introduction: Simulation is a critical tool that enables healthcare agencies and educational institutions to meet local, state, and national workforce education needs. In order to understand the current use of simulation and available resources at health professions schools in the state of Oklahoma, a comprehensive statewide assessment of simulation resources was conducted.

Methods: Administrators, faculty, and staff at health professions schools participated in an online statewide survey, replicated from the Florida Center for Nursing 2010 Nursing Simulation Resources in Florida survey.

Results: The overall survey response rate was 45.6%. Findings indicate that simulation is used to enhance the educational experiences …

Breast Cancer Referral And Screening Rates In A Federally Qualified Health Center: Implementing The Point Of Care Integrated Breast Cancer Screening Model, Jill Crawford Muhrer

Yale School of Nursing Digital Theses

Breast Cancer Referral and Screening Rates in a Federally Qualified Health

Center: Implementing the Point of Care Integrated Breast Cancer Screening Model

In this paper we discuss the implementation of the point of care integrated breast

cancer screening model (PCISM) to improve breast cancer screening rates in a federally

qualified health center. Comparison of mammogram patterns for 8 providers (classified

according to their use of PCISM versus conventional practice models) demonstrated a

statistically significant difference (p=

were referred and 2444 women (42%) completed mammograms versus the conventional

group where 1409 (37%) received referrals and 581 (16%) completed mammograms.

These results …

Building A Primary Care Nurse Practitioner Fellowship, Elizabeth Marie Dubois

Yale School of Nursing Digital Theses

The primary care workforce is at a critical juncture where fewer physicians are choosing primary care careers and more patients are availing themselves of outpatient care, through increased insurance coverage among other forces. With the increasing number of graduating nurse practitioners, now is a crucial time to validate an educational model to ensure these clinicians are providing quality care in the primary care setting. This paper explores the current educational model of nurse practitioners and the increasing complexity of care of medically underserved patients. This project illustrated a need for post-graduate training in this setting for nurse practitioners and validated …

Broadly Neutralizing Human Antibodies Inhibit Dengue Virus Infection In Aedes Mosquitoes, Colette Jolynn Matysiak

Public Health Theses

Introduction

Dengue virus is the leading cause of morbidity and mortality among mosquito-borne viruses globally. There are four Dengue serotypes; immunity to one serotype provides protective immunity to that serotype but increases the risk of severe disease upon infection with a second serotype. Dengue virus, like all Flaviviruses, utilizes class II fusion proteins to gain entry into the host cytoplasm. The fusion loop, which is responsible for viral-host fusion, lies within the envelope (E) glycoprotein and has nearly 100% amino acid identity among all Flaviviruses. Two anti-Dengue virus human monoclonal antibodies (hMAbs), 1.6D and D11C, were isolated from Dengue infected …

Hcv And Drug Transition In Ct Nonurban Injection Drug Users, Maria Ma

Public Health Theses

Aims: We sought to determine if age of first substance initiation (alcohol intoxication, marijuana use, pharmaceutical opioid use, polysubstance) was associated with faster rates of transition to injection drug use or heroin use. Subsequently, we examined if transition time was a predictor for hepatitis C infection.

Methods: From 2008-2012, 462 active injection drug users were recruited using respondent-driven sampling. Participants were interviewed about their injection-associated risk, and serological testing of HIV, HCV and HBV was performed. Kaplan-Meier analyses were used to examine the rate of transition from first substance event to initiation of heroin use or first injection. A Cox …

Conflict-Affected Youth Livelihoods Programming: Bridging The Gap Between Research & Practice, Chanel M. Marin

Public Health Theses

The current thesis project consists of a programmatic mapping of existing policy and programming related to conflict-affected youth livelihoods and a Rapid Evidence Assessment (REA) of the literature to identify the evidence base for effective interventions. The programmatic mapping identified key actors in the field and existing policy and programming, revealing a need for: data regarding evidence-based interventions; demand-driven intervention strategies; cross-sectoral partnerships providing holistic programming approaches; increased outreach to vulnerable sub-populations; and increased youth participation in program design, implementation, management, and evaluation. The REA revealed a severe shortage of evidence-based practice in this area, but sheds light on the …

Development And Psychometric Evaluation Of A Questionnaire To Assess Attitudes Towards Tobacco Policies, Margaret Elizabeth Mayer

Public Health Theses

Introduction: Over the past two decades, the landscape of tobacco control has rapidly changed. Currently there exists no widely-used measure to assess attitudes towards smoking and tobacco policies in the United States. The primary goal of this research project was to develop and validate a timely questionnaire to measure these attitudes, with a particular focus on e-cigarettes and flavorings/additives.

Methods: Building upon the previously validated Smoking Policy Inventory (SPI; 1994), items were developed to assess attitudes toward current and/or controversial issues in tobacco policy. Items querying issues that are generally considered settled (e.g., smoking in restaurants) were removed from the …

Health For Achievement: Greater Health Assets Associated With Better Standards-Based Assessment Scores Among Eighth Grade Students, Sarah Jane Maver

Public Health Theses

Purpose: Improving adolescent health and educational attainment remain national priorities. However, major gaps remain in coordination of these efforts. Study objectives were to: (1) document associations between health assets and academic achievement, (2) examine cumulative effects of health assets on academic achievement, and (3) identify health assets most strongly associated with academic achievement.

Methods: Participants include 8th grade students attending 12 randomly selected schools (N=517, 75% of all eligible students). Data include physical measurements, student surveys, and school records, including standards-based assessment scores in literacy and mathematics. We assessed 20 health indicators covering three related domains of health as proposed …

Factors Influencing Dietary Practices Among Liberian Refugees And Ghanaian Residents, Jennifer Mandelbaum

Public Health Theses

Buduburam Refugee Settlement was established in Ghana in 1990 by the United Nations High Commission for Refugees (UNHCR) in response to Liberia’s first civil war (1989-1997). A limited amount of research on intergenerational differences and acculturation with respect to diet in refugee populations has been published, despite refugees’ susceptibility to food insecurity and diet-related health conditions. As the worldwide refugee population continues to grow, it becomes increasingly important to develop socio-cultural frameworks to address specific health and nutrition needs of refugees. Therefore, the purpose of this qualitative study was to understand among Liberian refugees in Buduburam Refugee Settlement: 1) dietary …

Spatial And Temporal Dynamics Of Glossina Pallidipes In Nguruman National Park (Kenya)., Michael Frederic Mengual

Public Health Theses

Abstract:

Background: Glossina pallidipes is a significant vector of trypanosomiasis for humans and livestock across Sub-Saharan Africa. Nguruman national park in Kenya is regarded as a potential location for targeted vector control activity. We screened flies from three locations in Nguruman in 2003, 2009, and 2015 using 13 microsatellite loci to assess population structures of G. pallidipes.

Methods: We acquired Tsetse samples from three sites across Nguruman in Kenya at three time points. We then performed genetic analyses on 267 flies using 13 microsatellite loci and evaluated genetic structure of Tsetses across a geographic distance of about 22 km and …

Sociodemographic Differences In Human Papillomavirus Vaccine Impact: A Systematic Review, Alexandra Nichole Montano

Public Health Theses

IMPORTANCE: The majority of literature related to disparities in human papillomavirus (HPV) vaccination has been focused on sociodemographic differences in vaccine uptake. Now nearly ten years after the introduction of the vaccine, and with a better understanding of disparities in uptake, a small but growing body of evidence is beginning to examine the impacts of the vaccination campaign. Monitoring disparities in the impact of the vaccine is crucial in order to better understand the full implications of the vaccine and to properly guide future programs and recommendations.

OBJECTIVE: To systematically review the literature on the impact of the human papillomavirus …

Tying Community Engagement With Appropriate Technology At The Last Mile: A Cluster Randomized Trial To Determine The Effectiveness Of A Novel, Digital Pendant And Voice Reminder Platform On Increasing Infant Immunization Adherence Among Mothers In Rural Udaipur, India, Ruchit B. Nagar

Public Health Theses

Background: 500,000 children under the age of five die from vaccine preventable diseases in India every year. More than just improving coverage, increasing timeliness of immunizations is critical to ensuring infant health in the first year of life. Novel, culturally-appropriate, community engagement strategies are worth exploring to close the immunization gap. In this case, a digital pendant and voice call reminder (components of the Khushi Baby platform) are tested for the effectiveness in improving DTP3 adherence within two monthly camps from DTP1 administration.

Methodology: A cluster randomized trial was conducted in which 96 village health camps were randomized to three …

Knowledge And Attitudes Towards Non-Communicable Diseases (Ncd) Amongst Village Health Teams (Vht) In Iganga And Mayuge Districts, Uganda., Temitope Ojo

Public Health Theses

Background: Community health workers (CHW) have successfully contributed to prevention, management and care for NCD interventions in several low and middle income countries (LMIC). In Uganda, the CHW, known as Village Health Teams (VHT) are the initial point of care in their communities. Though their present roles only attend to infectious diseases, maternal and child health issues, their skills could potentially be utilized in national efforts to promote NCD prevention in communities.

Aim: To assess baseline knowledge of and attitudes toward NCD and NCD care among VHT in Uganda as a step towards identifying a potential role for VHT in …

Respiratory Syncytial Virus In Connecticut: Predictors Of Seasonal Epidemic Timing, Douglas Brian Noveroske

Public Health Theses

Introduction: Respiratory syncytial virus (RSV) is a primary cause of hospitalizations in children worldwide. Prophylaxis (Palivizumab) can be given to infants who are at high-risk of a severe RSV infection, but the timing of seasonal RSV epidemics need to be known in order to administer prophylaxis at the appropriate time.

Methods: This study used data from the Connecticut State Inpatient Database to identify RSV hospitalizations based on ICD-9 diagnosis codes. A harmonic regression analysis was used to evaluate RSV epidemic timing at the county level; subsequently, a hierarchical model was fit to assess RSV epidemic timing at the ZIP code …

A Systematic Review Of Sexual Violence And Hiv In The Post-Disaster Context: Latin America And The Caribbean, Jane O'Bryan

Public Health Theses

ABSTRACT

INTRODUCTION: In the last decade, over 800 disasters struck Latin America and the Caribbean, cumulatively affecting an estimated 64 million people. Three quarters of the region’s population lives in disaster risk areas. There is widespread consensus that sexual violence increases in the aftermath of disasters, however historically its prevention has not been prioritized, and in general it remains a vastly understudied phenomenon at the intersection of health and human rights. The linkage between sexual violence and Human Immunodeficiency Virus (HIV) in the post-disaster context is similarly unrepresented in the literature.

OBJECTIVES: This systematic review aims to assess the extent …

Barriers, Motivators, Facilitators Related To Engagement In Hiv Care Among Ghanaian Men Who Have Sex With Men (Msm) Living With Hiv: A Qualitative Study, Adedotun Ogunbajo

Public Health Theses

In Ghana, men who have sex with men (MSM) bear a high burden of the HIV epidemic. To identify factors related to engagement in HIV care, we conducted an explorative qualitative research study with 30 HIV-positive Ghanaian MSM between May 2015 and July 2015. We sought to explore barriers, motivators, and facilitators to engagement in HIV care. Common barriers were fear of being seen in HIV-related health facility, financial difficulties, and other logistical issues. Major sources of motivators for engagement in care included social support, fear of mortality from HIV, and knowledge of effectiveness of HIV treatment. Care facilitators were …

“Reverse Mortgage Buys Time”: A Qualitative Analysis Of Time In Scarcity, Timing Of Scarcity, Displacement Of Scarcity And Reverse Mortgages, Eunsong Park

Public Health Theses

As a financial product, reverse mortgage are often used by elderly homeowners to protect against future felt needs, or to address present and past felt needs. Today, reverse mortgages are increasingly used for the latter two. By converting equity in homes into cash, reverse mortgages effectively spend a resource saved from the past, in order to increase options in the future, often at the expense of limiting options in the future. This is in response to many and multiple forms of scarcity faced by elderly homeowner households. Reverse mortgages are an important case study for Shafir and Mullainathan’s theory of …

Exposure To Pesticides And Food Packaging Materials And Bmi In Samoan Mothers And Children, Jennifer Park

Public Health Theses

Background: Growing evidence suggests that environmental chemicals, including certain pesticides and bisphenol A (BPA), may be linked to obesity because of their ability to disrupt metabolic functions. Methods: We conducted a community-based, cross-sectional survey of 319 non-pregnant mothers, ≥18 years old, with a child aged 2-Samoa, a country with high obesity prevalence, understudied agricultural and residential pesticide use and BPA consumption from canned and packaged goods. We measured weight and height of the mother-child pair and interviewed mothers about their potential environmental exposures. Using multivariable logistic regression, we evaluated the association between pesticide and BPA exposure surrogates and weight status. …

The Role Of Family History In Predicting Dissection Outcomes, Yaeji Park

Public Health Theses

Background: Studies have shown a significant association between family history and aortic aneurysm but this relationship has yet to be explored in depth with dissections. This study examined the role of three family histories (dissection, aortic aneurysm, and sudden death) with the objective to find the best indicator of dissection development.

Methods: A total of N=278 patients seen at Yale between 2013-2015 for aortic aneurysm and dissections were enrolled and their family histories obtained. Six indicators were examined 1) family history of dissection 2) family history of aortic aneurysm 3) family history of sudden death 4) family history of dissection …

“You Want To Go Home”: Search For Home Among Young Trans Women Of Color, Rebecca Suzanne Pepe

Public Health Theses

A wealth of literature explains the existence of barriers to accessible housing for the trans community. However, none have elucidated the story of how young trans women manage and navigate these barriers as they experience finding not only a housing structure, but also a place to call home. The aim of this work is to describe the experience finding home for a group of young, trans, women of color. This is done via qualitative analysis of semi-structured interviews of 17 trans women associated with the Ruth Ellis Center in Detroit, Michigan. Utilizing a grounded theory approach and coding with Dedoose …

Trust And A Respect For Persons: Public Health As A Profession Of Relationships, Michael Anthony Perrin

Public Health Theses

The purpose of this thesis is to explore the concept of empathy, or “the ability to share someone else’s feelings," in public health, examining the concept’s effect on both the ethical mandates of the profession and the validity of community-engaged research results. The ethical guidelines of the profession, as outlined by the American Public Health Association and other prominent public health researchers, were used to inform such an exploration, as was personal experience and Yale public health researcher insights. A case study of homelessness public health research was conducted. Interviews and surveys were conducted with prominent homelessness community advocates with …

Patterns Of Drug Use And Correlates Of Active Amphetamine-Type Substance Use Among Sex Workers In Kuala Lumpur, Malaysia, Courtney Jo Pedersen

Public Health Theses

Objective: To describe the female and transgender sex worker population in Kuala Lumpur, Malaysia, understand their patterns of substance use, and examine the correlates of active amphetamine-type substance (ATS) use.

Methods: We administered a cross-sectional survey and performed biological testing on 492 sex workers to assess lifetime and active substance use history and frequency, criminal justice involvement, alcohol and substance abuse disorders, sexual risk behaviors, experience of childhood and adulthood physical and sexual abuse, depression, and prevalence of HIV, syphilis, chlamydia, and gonorrhea. We performed descriptive statistics to describe demographics and lifetime and active drug use patterns and employed bivariate …

Evaluating Substance Use In A Network Of Emerging Adult Males Via Analysis Of Text Messages Sent And Received, Lia Pizzicato

Public Health Theses

Introduction: With the ubiquity of mobile phones, mobile health (mHealth) has the ability to transform healthcare specifically in regard to substance use interventions. Current mHealth interventions targeting substance use are limited as they require self-monitoring and user input.

Objectives: The objective of this study was to determine if text message content can predict substance use attitudes and behaviors. The aims were three-fold: (1) To assess the prevalence of discussion of substance use in text messages (2) To evaluate the relationship between text message content and substance use attitudes and behaviors; and (3) To examine social network structure using texting interactions …

Barriers To Care For Cardiovascular Risk Factor Management, Morgan Anne Pratte

Public Health Theses

Introduction: Hypertension, high cholesterol, diabetes, obesity, and smoking are established risk factors for cardiovascular disease (CVD), and the presence of several risk factors is associated with worse health outcomes. Access to healthcare has a major influence on the management and treatment of these modifiable conditions. The objective of this study is to examine barriers to care among non-elderly adults with multiple risk factors for CVD, and to furthermore identify socio-demographic disparities within this group.

Methods: Analyses utilized data from a subset of 39 U.S. states and territories that implemented the optional healthcare access module in the 2013 Behavioral Risk Factor …

Likelihood Of Achieving Who Leprosy Goals: An Expert Survey, Alex Rittel

Public Health Theses

Much progress has been made in the global fight against leprosy, as evidenced by dramatic declines in prevalence rates in recent years. However, leprosy has proven elusive. New case detection rates have remained fairly stable, particularly in countries with remaining pockets of high endemicity such as India, Brazil, and Indonesia. In 2012, the World Health Organization spearheaded the London Declaration, which in part aimed for the goal of interruption of transmission of global leprosy by 2020. Aggregating the opinions of experts can supplement existing data to help determine the feasibility of reaching the WHO goals. To obtain the opinions of …

Time In Ghana And Dietary Patterns In Liberian Refugees, Wilhelmenia Lee Ross

Public Health Theses

Previous research suggests acculturation (i.e. exposure and assimilation to local culture) is associated with changes in dietary patterns among immigrants. This study investigates this association in a refugee population using time in refugee settlement as a proxy for acculturation. A cross-sectional survey was conducted among a convenience sample to: (i) identify dietary patterns in Liberian refugees and Ghanaians living in or near a refugee settlement; (ii) compare adherence to these dietary patterns between groups; and (iii) investigate the association between acculturation and dietary patterns in Liberian refugees. Time in refugee settlement was assessed by self-report; food consumption was assessed by …

Determinants Of Perceived Insufficient Milk And The Infant Feeding Practices Of New Mothers In León, Nicaragua, Cara Safon

Public Health Theses

Breastfeeding has been shown to improve maternal and child health. In Nicaragua, the primary risk of death and disability-adjusted life years among children under 5 years of age is suboptimal breastfeeding. Although the Nicaraguan Ministry of Health promotes exclusive breastfeeding from within the first half hour through the first 6 months of life, less than a third of children in the country under 6 months are exclusively breastfed. As part of a larger, mixed-methods study, 21 semi-structured, in-depth interviews were conducted with new mothers recruited from 3 primary health centers between June and August 2015 in order to identify the …

Perspectives For Adolescent Engagement: The Bright Bodies Program, Athena Theodora Samaras

Public Health Theses

While responses to the obesity epidemic have largely encompassed top-down approaches with a focus on health-related outcome evaluation, for successes to be sustained, a greater emphasis is needed on local initiatives and intervention process evaluation. Pediatric weight management programs in the healthcare and community settings represent local initiatives that have had considerable health-related impacts, yet are often limited by high attrition rates. Because adolescence is marked by substantial weight shifts and the formation of long-lasting health habits, it represents a critical point for implementing obesity prevention and treatment. Accordingly, this study sought to assess factors that promote adolescent participant engagement …

Practice Patterns Of Genetic Testing And Target Therapy Use In Metastatic Lung Cancer, Tannaz Sedghi

Public Health Theses

Introduction

All patients with metastatic non-small cell lung cancer (NSCLC) should undergo EGFR mutation testing and receive appropriate therapy, however, variation in testing and therapy use is a growing concern. The objective of this investigation was to identify physicians’ practice patterns and predictors of physicians’ genetic testing and targeted therapy use in metastatic lung cancer.

Methods

Approximately 360 physicians caring for CanCORS patients with lung or colorectal cancer completed a survey between 2012 to 2013 assessing attitudes and practices with respect to genetic testing and targeted therapies. The outcome variables were: (1) physicians’ reports that they would likely recommend (a) …

A Process Evaluation Of A Relationship Strengthening Hiv Prevention Intervention: The Partners In Life Curriculum Amongst Adolescent Parents In New Haven, Connecticut, Modupeore Shenbanjo

Public Health Theses

In impoverished urban areas in the Northeast, the prevalence of HIV among heterosexuals is more than 28 times greater than the prevalence in the general U.S. heterosexual population.1,70 In the United States, America’s youth (ages 15-24) account for half of all new STIs occurring among young men and women (Center for Disease Control and Prevention, 2013).1 Numerous couple-based HIV studies have found that couple-based approaches are generally efficacious in promoting safer sex behaviors (El-Bassel et al., 2010).4 This project aims to examine the implementation (Campbell et al., 2000)1 of the Partners in LIFE curriculum to identify successes and limitations of …