Digital Commons Network^™

Development Of A Comprehensive Sexual Education Curriculum For A Private, Independent Day School For Students Pre-K Through 8th Grade, Haja I. Kamara

Public Health Theses

This paper describes the development of a comprehensive sex education (CSE) curriculum for The Country School (TCS), a coeducational, independent school in Madison, CT that serves approximately 200 students in Pre-Kindergarten through 8th grade. CSE describes a wide array of sex education programs and curricula that are scientifically accurate, culturally and age-appropriate, gender-sensitive and life skills-based. The goal for this project is multi-pronged: adapt existing health education programming, build out a new health and wellness program with a distinct scope and sequence for each grade level that includes resources and supports for ongoing parent education and professional development. To inform …

The Hiv Care Continuum And Barriers To Viral Suppression Among Men Who Have Sex With Men In Greater Kuala Lumpur, Malaysia., Lauren Haerin Kim

Public Health Theses

Background: Men who have sex with men (MSM) now account for nearly half of all new HIV cases in Malaysia. There has been little research, however, characterizing the HIV care continuum among MSM living with HIV in Malaysia. This study describes the HIV care continuum and examines factors associated with HIV viral non-suppression among newly diagnosed MSM living with HIV in Kuala Lumpur, Malaysia.

Methods: We enrolled 163 MSM living with HIV who were in care at a major university hospital in Kuala Lumpur, Malaysia. Participants completed a self-administered questionnaire. Electronic medical chart review also provided data on engagement in …

Investigating The Community-Level Variation In Hookworm Prevalence In The Kpandai District, Ghana: A Mixed-Methods Study, Harry Hyunteh Hyunteh Kim

Public Health Theses

Soil-transmitted helminths are a major cause of disability and morbidity in resource-poor settings: over 1.5 billion are estimated to be at risk of infection. Human behaviors and household socioeconomic conditions that facilitate contact with contaminated soil may increase exposure to parasites. The primary objective of the study was to investigate the community-level variation in hookworm prevalence in the Kpandai district of Ghana.

We used a mixed-methods approach to investigate behavioral, societal and environmental risk factors to hookworm exposure. 264 individuals from three neighboring villages (Jagbigbingdo [JG], Takumdo [TK], Wiae Chabor [WC]) were recruited using a convenience sampling strategy. Household questionnaires …

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 …

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 …

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 …

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. …

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 …

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 …

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 …

Hiv Testing During Antenatal Care In Eastern & Southern Africa: How Do Adolescents And Young Women Fare?, Claire Young

Public Health Theses

Background

To validate Elimination of Mother to Child HIV Transmission (eMTCT), pregnant women must receive antenatal care (ANC) HIV testing. Given challenges for adolescent girls in ANC, we hypothesized that adolescents were less likely to receive ANC HIV testing in Eastern and Southern Africa (ESA).

Methods

For 10 ESA countries, we use 2015-2018 Demographic and Health Surveys (DHS) to study 46,056 women attending ANC and giving birth in the last three years. We used age-stratified (15-19, 20-24, and 25-49 years of age at time of delivery) crude and adjusted logistic regressions to assess predictive factors for ANC HIV testing, both …

A Review On Antibiotic Stewardship In Pediatric Primary Care, Paulina Kaminski

Public Health Theses

Background. Misuse of antibiotics for upper respiratory tract infections (URTIs) in pediatric primary care settings persists despite growing concern over antibiotic resistance. Interventions aimed at improving prescription use, coined Antibiotic Stewardship Programs (ASPs) often target clinicians for improved clinical decision-making. More recently, ASPs have begun educating patients to antibiotic needs, and for pediatric cases, parents who might pressure clinicians into prescribing unneeded antibiotics. While many reviews have targeted adult patients or emergency settings, few evaluate practices for pediatric populations. For this reason, we performed a review of the literature to summarize common strategies used to reduce antibiotic overprescribing for pediatric …

Evaluating Fda Generic Approval After 2017 Agency Initiatives, Kuo Jiao

Public Health Theses

Importance: Generic drugs play an essential role in the US healthcare system, providing less costly alternatives to branded drugs that are equally effective and safe. The US Food and Drug Administration (FDA) regulatory policies influence the standards for generic drug approval. In 2017, the FDA instituted several initiatives to promote generic drug approval, particularly focused on those with limited competition.

Objective: To determine whether the initiatives begun by FDA in 2017 were associated with greater numbers of approvals of generic drugs with limited generic competition and histories of drug shortage.

Study Sample and Design: We conducted a cross-sectional study of …

Understanding How Displacement Affects Hiv Prevalence Among Displaced Populations- A Scoping Review, Ryan Evan Yucha

Public Health Theses

Over the course of the past two decades, the number of people who have been displaced has increased dramatically. With this brings a new set of health challenges for these populations as well as the countries to which these populations are displaced such as HIV/AIDS. There is evidence to show that forced displacement can cause an increase in the HIV prevalence among those displaced. However, there is evidence to suggest the contrary, as well.

The aim of this scoping review study is to determine what the existing literature can and cannot tell us about how forced displacement affects HIV prevalence …

Geospatial Analysis Of High-Grade Cervical Lesions To Address Health Disparities, Savanah M. Russ

Public Health Theses

Introduction: Incidence of high-grade cervical lesions (HGCL) caused by human papillomavirus (HPV) has declined in the U.S following the introduction of the HPV vaccine in 2006. However, disparities in HPV cervical infection and subsequent sequelae by race, ethnicity and income continue to persist. The purpose of this analysis was to identify spatial areas with significantly elevated HGCL burden in Connecticut, and determine socioeconomic characteristics associated with high incidence clusters.

Methods: Data from statewide surveillance in Connecticut for cervical intraepithelial neoplasia grades 2, 2/3, 3 and adenocarcinoma in situ (CIN 2+) from 2008-2016 were used for this analysis. Spatial analyses were …

Predictors Of Incomplete Evaluation Among Pediatric Household Contacts Of Pulmonary Tuberculosis Patients In Kampala, Uganda: A Secondary Analysis, Giyoung Lee

Public Health Theses

Background: Contact investigation is an active approach to identifying new TB cases by screening contacts of known patients for symptoms and risk factors. This is particularly important for child contacts of TB patients because young children are at higher risk of progressing to severe disease compared to adults. Moreover, children are unable or unlikely to travel to clinics for evaluation independently, so their access to TB evaluation may depend on the adults in their household.

Objective: To evaluate the association between individual- and household-level characteristics and completion of TB evaluation for children under 15 years.

Setting: Seven public tuberculosis (TB) …

Evaluating Clostridioides Difficile Infection (Cdi) Risk Factors By Comparing The Use Of Piperacillin/Tazobactam, Cefepime, And Ceftazidime, Shardul Rathod

Public Health Theses

Introduction: Over the past several years, Clostridioides difficile infection (CDI) incidence has been rising. The primary risk factor for CDI is antibiotic use. Many studies indicate that penicillin drugs are among the low-risk antibiotic classes associated with CDI whereas cephalosporin drugs are among the high-risk antibiotic classes. However, there is variation in studies evaluating the healthcare-associated CDI (HA-CDI) risk associated with antibiotics within a class and limited data comparing the use of penicillin versus cephalosporin drugs.

Methods: An observational cohort study was performed using patient data from BH and YNHH. Minitab (Version 18) was used to perform survival analysis and …

Single-Cell Transcriptomics In The Protozoan Parasite Trypanosoma Brucei During Acquisition Of Infectivity, Trisha Kaye Ramsdell

Public Health Theses

Single cell RNA-sequencing (scRNA-seq) is a recent innovation that allows sequencing of transcriptomes from a vast number of single cells, thus providing an unbiased view of cell-to-cell variability in gene expression within a population of cells. The Tschudi laboratory has previously established an in vitro differentiation system based on the inducible expression of the RNA-binding protein 6 (RBP6) in cultured non-infective procyclics, which recapitulates Trypanosoma brucei developmental stages that have been previously described in tsetse fly vector. Thus, I aimed to utilize scRNA-seq in this system to describe the potential heterogeneity in transcript abundance of known and suspected T. brucei …

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 …

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 …

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 …

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 …

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 …