Digital Commons Network^™

The Financial Burden Of Physician Assistant Education - Do Who And Where Matter?, Kara Stencel

Public Health Theses

Purpose: Graduate level student indebtedness is a growing concern for various healthcare professions. This study describes the anticipated financial burden of Physician Assistant (PA) education as reported by newly matriculated students. We aim to provide the most comprehensive look to date at student and educational program characteristics associated with anticipated student debt and financial stress when starting PA studies.

Methods: We conducted a secondary cross-sectional analysis of de-identified data from the 2014 Physician Assistant Education Association (PAEA) Matriculant Survey and merged it with publicly available data abstracted from PA Programs’ websites. Our final dataset has 5081 unique PA students’ responses …

A Review Of Propensity Score Use In Drug Post-Marketing Safety Surveillance, Motao Sun

Public Health Theses

Drug post marketing safety surveillance is a very important part of pharmacovigilance, which is overseen by the Food and Drug Administration (FDA) and other regulatory agencies throughout the world. These studies are generally performed by pharmaceutical sponsors and academicians, although it is occasionally the case that a regulatory agency will either fund the research or have large databases which is analyzed by the regulators themselves. One example of agency surveillance is the FDA Adverse Event Reporting System (AERS). Generally, preapproval studies only involve several hundred to several thousand patients, so all possible side effects of a drug cannot be explored …

Food Insecurity In San Pedro, Ecuador: The Association Of Food Insecurity With Dietary Diversity And Bmi, Etna Tiburcio

Public Health Theses

Background: Limited research has examined the association between food insecurity and both dietary diversity and body mass index (BMI) in rural, Ecuador.

Methods: A cross-sectional analysis was conducted on a sample of 237 patients and family members visiting a primary care community clinic. To determine food security level, the Escala Latinoamericana y Caribeña de Seguridad Alimentaria (ELCSA) was employed. Outcome was measured using the Household Dietary Diversity Score (HDDS) and BMI was deduced using measured height and weight. These measures were then evaluated in their associations with food security level, adjusting for wealth stratum for the HDDS variable.

Results: As …

Animal & Human Leptospirosis In A High Transmission Setting In Fiji, Eri Togami

Public Health Theses

Leptospirosis is a neglected zoonotic disease with a worldwide distribution, yet disproportionally affects poor rural subsistence farmers in the tropics. The animal reservoirs for spill-over infection to humans in such settings in the South Pacific have not been well delineated, thus hampering effective control efforts. We conducted a case control investigation among households that participated in a seroprevalence survey for leptospirosis in Western Fiji. We surveyed domestic animals and trapped rodents at 45 cases and 73 control households who had one or more, and no inhabitants with evidence for anti-leptospire agglutinating antibodies. We performed serology among all animals and used …

Birth Weight And Risk Of Pediatric Hodgkin Lymphoma: A Population-Based Record Linkage Study In California, Corey Triebwasser

Public Health Theses

Abstract

Objective: To evaluate the relationship between birth weight and the risk of pediatric Hodgkin lymphoma (HL, age at diagnosis: 0-19 years).

Method: We linked California statewide birth records from 1978-2009 and cancer diagnosis data from 1988-2011 to conduct a population-based case-control study with 1,216 cases and 4,485 controls (matched on birth month and year, sex, and race/ethnicity). Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) of pediatric HL overall and by age of diagnosis, controlling for other perinatal factors.

Results: Compared to children with a normal birth weight (2500-3999 g), those …

Intermediate Assessment Of The Khushi Baby Crct: Implementation Of A Novel Mhealth Solution For Vaccination Record Keeping In Rural Udaipur, Rajasthan, India., Preethi Ganesh Venkat

Public Health Theses

Background: Khushi Baby (KB) is a mobile health platform that tracks child immunizations using a mobile application and a Near Field Communication (NFC) necklace worn by the child. Quantitatively assessing intermediate indicators of the KB program’s progress is important, especially when considering the program’s scalability.

Objectives: This study seeks to quantitatively examine three key intermediate outcomes of the KB cluster Randomized Controlled Trial (cRCT), using group comparisons of mothers’ survey responses, that are indicative of whether the necklace is discussed, visible, and liked by users. Two data collection tools were compared in this study: the NFC sticker and the NFC …

Macrophage Migration Inhibitory Factor Polymorphisms And Tuberculosis Disease Susceptibility In Kwazulu-Natal, South Africa, Max Mu Wang

Public Health Theses

Background: TB is a leading cause of mortality, infecting over one-third of the world’s population. Difficulties combating the disease are compounded by the fact that a majority of TB infections remain in an asymptomatic latent state. Macrophage migration inhibitory factor (MIF) is an innate cytokine that is encoded in a functionally polymorphic genetic locus with characterized allelic variants that correlate to TB progression. Understanding the genetic factors that regulate host immune responses to TB will help to identify individuals who are at higher risk of severe infection.

Methods: A case-control study of HIV+ active pulmonary TB cases and HIV+ controls …

The Effect Of Spatiotemporally-Dependent Air Pollution Exposure On Birthweight In The Lanzhou Birth Cohort, Dennis Wang

Public Health Theses

Introduction: Low birthweight serves as a proxy risk factor for a number of conditions later in development. Of China’s urban centers, Lanzhou has long been considered one of the worst-affected cities by air pollution.

Objectives: This study uses spatial heterogeneity in air pollution exposure across addresses in Lanzhou and temporal heterogeneity resulting from the differential timing of pregnancy in the Lanzhou Birth Cohort to investigate the association between PM10 exposure and birthweight.

Methods: The study population consisted of 4,865 mother-child pairs from the Gansu Provincial Maternity and Child Care Hospital. Participants completed an epidemiological questionnaire and patient data were collected …

Neurocognitive Impairment Impacts Hiv Medication Adherence, Damian Weikum

Public Health Theses

Objective: To examine neurocognitive impairment (NCI) and its association with antiretroviral therapy (ART) medication adherence among HIV-infected men who have sex with men (MSM) and transgender women (TGW) in Lima, Peru.

Methods: A cross-sectional survey assessed 313 HIV-infected Peruvian MSM and TGW prescribed ART using a computer-assisted survey instrument to examine NCI and its association with optimal ART adherence, defined as taking ≥90% of prescribed medications. The survey included demographic characteristics and standardized measures for drug and alcohol use disorders, depression, and other factors associated with non-adherence.

Results: An exploratory factor analysis was conducted to optimize an NCI self-report scale …

Whole-Genome Sequencing And Phylogenetic Analysis Of Novel Paramyxoviruses Discovered In Bats From Brazil, Heather Louise Wells

Public Health Theses

Wildlife disease surveillance has been increasing in recent years in an effort to identify and characterize novel emerging zoonoses. In particular, bats have been targets of active surveillance because of their recent associations with diseases of global public health importance, such as Ebola virus, SARS-like coronaviruses, and Nipah and Hendra virus. The high species richness, large population sizes, and frequent inter- and intra-species interactions of bats make them ideal reservoirs of infectious diseases. For this molecular epidemiological study, novel paramyxoviruses discovered through surveillance of bats in Brazil were fully sequenced to allow for a range of genetic analyses, including the …

Evaluating Resilience In Syrian And Jordanian Youth, Rebecca Wener Wener

Public Health Theses

This paper uses baseline data collected from the Child Youth Resilience Measure (CYRM) that was administered to a sample of 603 Jordanian and Syrian adolescents living in Northern Jordan during Fall 2015 as part of a broader evaluation of the impact of a mental health and psychosocial wellbeing intervention. Data were analyzed to 1) determine whether the questionnaire performed according to the 3-factor structure predicted in the literature and 2) explore relationships between CYRM scores, individual, family and contextual factors, and measures of mental health, stress and wellbeing. With some exceptions, the predicted 3-factor structure was found within the Syrian-Jordanian …

The Role Of Folate In The Association Between Perinatal Air Pollution Exposure And Birth Outcomes In Lanzhou, China, Rebecca Ann Wong

Public Health Theses

Background: China’s rapid economic and industrial development over the past few decades has been accompanied by tremendous increases in air pollutant emissions and come at a serious cost to the environment and public health. Recent research has revealed an increased risk of adverse birth outcomes associated with perinatal air pollution exposure. Although the mechanisms by which air pollutants contribute to adverse birth outcomes have not yet been established, folate intake has been shown to counteract several of the hypothesized biological pathways.

Hypothesis: Dietary folate intake and folic acid supplementation modify the association between perinatal air pollution exposure (PM10, NO2, SO2) …

Pirnas Variants And Lung Cancer Risk: A Post-Gwas Study, Rui Ye

Public Health Theses

Background: Lung cancer is the most frequently diagnosed cancer and one of the top cause of cancer death worldwide. The recent discovery of PIWI-interacting RNAs (piRNAs), one type of non-coding RNAs, has been shown to be involved in tumorgenesis pathways of various types of cancer types by accumulating evidences. However, the role of piRNAs in lung cancer development is underexplored.

Methods: Genotype and phenotype data were obtained from a genome-wide association study of lung cancer risk (3,702 cases and 3,739 controls) and 1,173 imputed piRNAs variants were analyzed by association analysis for lung cancer risk. A secondary expression analysis is …

Cost-Effectiveness Of Multidisciplinary Management And Exercise Training In Heart Failure Treatment, Anji Yi

Public Health Theses

Background: Multidisciplinary management program (MMP) or exercise training program (ETP) is cost-effective in treating heart failure patients compared with usual care (UC), but no comparison across these three strategies has been made.

Objective: To estimate and compare the cost-effectiveness of MMP, ETP, or UC.

Design: Cohort simulations using a Markov model.

Data Sources: Derived from literature.

Participants: Heart failure (HF) patients aged 56-80 years old.

Time horizon: 10 years.

Intervention: UC, MMP (including disease education and continuous social and psychological support) and ETP (including exercise training and the basic support in MMP).

Outcome Measures: Life-year saved, lifetime costs, and incremental …

All-Source Exposures To Arsenic For Residents Living Near Historic Gold Mine Areas In Northwest Romania, Zhen Zhang

Public Health Theses

Background: Roşia Montană gold mine is the site of historic mining operations since Roman times. Contamination of nearby communitiesby historic mining activities is of serious concern.

Objective: The study objective is to investigate whether living in the vicinity of historic gold mining increases risk of arsenic exposure from the surrounding environment, and if dietary intake from home gardens is associated with reduced risk of arsenic exposure.

Methods: We performed assessments in 64 participants from 57 households within the target communities. All study participants gave written informed consent. The study was approved by the institutional review boards of the regional public …

Predictors Of Prenatal Care Satisfaction Among Pregnant Women In American Samoa, Oluwaseyi A. Adeyinka

Public Health Theses

Objectives: Women of reproductive age in American Samoa have a high-risk for pregnancy complications, due to their high levels of overweight and obesity. Prenatal care can mitigate this risk; however, many women do not seek care. The low rate of prenatal care utilization may stem from a low-level of prenatal care satisfaction. By understanding the predictors of prenatal care satisfaction in America Samoa, targets for improvement may be identified, with the ultimate goal of increasing prenatal care utilization.

Methods: A cross-sectional survey was distributed to women (n=174) in the waiting areas of the clinic at the Lyndon B Johnson Tropical …

The Effect Of Union Status On Injury Risk And Severity In A Manufacturing Cohort, Khaled Abdulrahman Altassan

Public Health Theses

Objective: This study aimed to investigate the effect of union status on risk of injury among a cohort of aluminum manufacturing workers.

Methods: This cohort study included all hourly employees at 19 U.S. plants, which were in operation between 2000 and 2007. Workers were classified into unionized and non-unionized groups. The final dataset combined a human resources database, which includes information about job history and socio-demographic information, and an incident management system, which includes information on work-related injuries. Injuries were classified by severity into four mutually exclusive categories: injuries requiring first aid, medical treatment, work restriction, and lost work time. …

Outbreaks Reveal Deficiencies In Biotech R&D For Emerging Diseases, Rebecca Byler

Public Health Theses

The absence of commercial diagnostics, therapeutics, and vaccines hindered control efforts during the recent Zika and Ebola epidemics. This study evaluates the connectivity and productivity of both viruses’ R&D networks before, during, and after the epidemics to ascertain the ability of current R&D practices to support the development of crucial biotechnologies. Both network maps exhibited low baseline connectivity with emergent collaborative R&D practices during the identified outbreak period that correlated with increased research productivity. It is argued that formally establishing permanent collaborative, open R&D practices prior to epidemics can enhance scientific knowledge and innovation capabilities to more effectively advance commercial …

Care-Seeking Patterns Among Rural Communities In The Republic Of Congo, Haotian Cai

Public Health Theses

In 2014, a mobile pharmacy project was launched to provide accessible and affordable medicines to Yaka hunter-gatherer communities in the Likouala and Sangha regions of the Republic of Congo. This mixed methods study describes the use of available health services by the minority Yaka and the majority Bantu served by the mobile pharmacy and to compare the health-care seeking behavior among these different communities. Overall, 178 households were surveyed about their utilization of available health services and the order in which they seek health services in the event of illness. To provide context to these responses, 18 key informants were …

Shaping Service Delivery For Cervical Cancer Screening: Understanding Knowledge, Acceptability And Preferences Among Women In The Neno District Of Malawi, Melissa Marie Emilie Carvalho

Public Health Theses

Background: Located in south-eastern Africa, Malawi is a low income country with a population of 16.4 million. It is currently estimated to have the highest age-standardized rate of cervical cancer in the world at 75.9 per 100,000 population. Cervical cancer accounts for 28% of all reported female cancers in the country, and 80% of women diagnosed with the disease die from it, making cervical cancer a public health priority for the country. Despite the fact that cervical cancer screening services (by visual inspection with acetic acid (VIA)) has been offered free of charge at public health facilities in the country …

Refining The Staging Scheme For Human Papillomavirus-Related Oropharyngeal Carcinoma, Tiange Chen

Public Health Theses

Current TNM staging system derived empirically from human papillomavirus (HPV) unrelated oropharyngeal cancer (OPC) has been shown inadequate to predict survival for HPV-related OPC. This study used three recursive partitioning algorithms, Classification Trees (CART), Conditional Inference Trees (CTree) and Model-based Recursive Partitioning (MOB) to derive a new staging scheme based on data from the National Cancer Data Base (NCDB). The derived staging systems were compared to the current system using the criteria such as hazard consistency within staging groups, hazard discrimination between groups, predictive ability and balance of distribution across groups. A total of 5,712 patients were included in the …

Predictors Of Nutritional Status Among Young Samoan Children, Courtney C. Choy

Public Health Theses

The nutrition transition is associated with the rising burden of non-communicable diseases in low-and middle-income countries and in Samoa, young children are particularly vulnerable to malnutrition in various forms. In this present study, we documented the current prevalence and co-existence of child nutritional status outcomes within this population and by census region. We then examined the role of selected child, maternal, and household characteristics as potential predictors of child nutritional status. A cross-sectional, community-based design was used to collect data from singleton pairs of a non-pregnant mother and child between 24 to 59 months olds in the Samoan island of …

A Qualitative Analysis Of Multi-Level Barriers To Hiv Testing Among Women In Lebanon, Kirsty Amy Clark

Public Health Theses

The Middle East and North Africa (MENA) is a region of concern in regards to the global HIV epidemic. In 2015, a call to action was released through the American University of Beirut urging an expansion of research and policy regarding women and HIV in the MENA region. Through individual, semi-structured interviews with sexual healthcare providers and NGO staff, we sought to understand barriers to HIV testing among women in Lebanon. Using purposive and snowball sampling strategies, key informants were recruited from neighborhoods in greater Beirut (N=21; 12 physicians, 9 NGO staff). Data were analyzed utilizing a Grounded Theory inductive …

Predictors Of Breast Density In Hispanic And Latino Women Living In The Northeast Region Of The United States, Emma Claye

Public Health Theses

Introduction: Breast density, the fibroglandular, non-fatty tissue in the breast, has been shown to be a significant risk factor for breast cancer. Little is currently known about the predictors of breast density among the understudied but increasing population of Hispanic and Latino women in the United States.

Objectives: The objective of this study is to identify predictors of breast density among Hispanic and Latino women in Connecticut and to determine if these differ from those described in other populations. Because the hormonal milieu is somewhat different in Hispanic/Latinas compared with White women, we are interested in how these variables impact …

Investigating Fear, Shyness, And Discomfort Related To Menstrual Hygiene Management In Rural Cambodia, Gabrielle Joy Daniels

Public Health Theses

Over the last decade, increasing attention has been given to understanding girls' menstrual hygiene management (MHM) experiences in school. However, little has been done to understand girls' MHM experiences in other contexts, such as the home environment. The purpose of this study was to explore the knowledge, attitudes, and practices of MHM and menstrual related experiences among rural Cambodians, with an expanded scope to include both the home and school environments, and five participant perspectives. Our study was conducted in eight rural secondary schools and eight rural villages from two Cambodian provinces, Banteay Meanchey and Kratie. Our target participants included …

Aldehyde Dehydrogenase 1 (Aldh1) Genes In Cancer Clinical Prognosis Outcomes, Mengyi Ding

Public Health Theses

ABSTRACT

Background & Hypothesis

It has become clear that ALDH1 genes are involved in the pathobiology of various human cancers. Several lines of evidence indicated that ALDH1 gene expression in tumors may be associated with clinical prognosis outcomes. This hypothesis of our study is that ALDH1 genes may be used to predict human cancer prognosis. In order to test this hypothesis, a systematic review of published articles, a meta-analysis using Random-Effects model was conducted to assess the association between ALDH1 genes and clinicopathological features as well as survival outcomes.

Methods

Using PubMed, EMBASE and Web of Science, this study identified …

Exploring The Link Between Early Adversity And Behavioral Health, Erin Dowling

Public Health Theses

Background/Rationale Adverse childhood experiences (ACE) and their lasting sequelae are a significant public health concern. ACEs are a risk factor for increased risk of detrimental health behaviors, chronic disease morbidity, and mortality. Though this connection has been supported by an abundance of evidence, how best to address these issues in practice and in the community has yet to be confirmed. Prior research examining the health promoting factors exhibited by adults who have experienced several different ACEs yet have experienced few negative health outcomes, have identified social support, education, and physical activity as potentially protective factors. This study seeks to identify …

Survival Analysis Of Nfl Concussions During The 2014 And 2015 Regular Seasons, E.S. Emme

Public Health Theses

Prior to the 2015 season, the National Football League reported that regular season in-game concussions had fallen 35% from 2012 to 2014. However, the number of concussions suffered during the 2015 regular season increased to 182, the highest total since the league implemented a standardized protocol for diagnosing and treating concussions after the 2011 season. To determine whether this large increase likely represented an increase in actual incidence or simply an increase in diagnosed injuries, survival analysis was used to compare the risk of injury between the 2014 and 2015 seasons. To show that the risk environment of the game …

Virtual Risk: How Msm And Tw In India Use Media For Partner Selection, Heather Ferguson

Public Health Theses

In India, criminalization of adult consensual same-sex relationships and sexual encounters along with stigma toward men who have sex with men (MSM) and transgender women (TW) may impact the use of social media to help MSM and TW connect to their community and find sexual partners. Through 30 individual qualitative interviews with MSM, TW, and key informants, we sought to understand how social media shape how MSM and TW connect to their community, meet men for relationships and sex, and how use of social media influences sexual risk. Qualitative data were transcribed, translated, coded, and analyzed using grounded theory. Results …

Hands Up: A Systematized Review Of Policing Sex Workers In The U.S., Fabian Luis Fernandez

Public Health Theses

This work lays the foundation for a study of criminalization and its effects on the health of street-based sex workers in the U.S. seeking to: 1) conduct a systematized review of sources from across the country settling on seventeen that describe experiences of harassment, false arrests, theft, physical abuse, sexual assault, HIV criminalization, survival tactics, reporting practices, and positive relations with law enforcement and 2.) compare the U.S. literature to international research, reflecting on the ways that public health researchers remain complicit in sustaining these harmful institutions by failing to consider diversity, the criminalized context of sex work, the links …