Digital Commons Network^™

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 …

Safety Of Opat In Older Versus Younger Adults, Kaylen Elizabeth Brzozowski

Public Health Theses

Introduction Outpatient parenteral antimicrobial therapy (OPAT) is considered practical, safe, and cost-effective, but roughly 20% of all adult patients on OPAT experience an adverse event (AE). Frequency of AEs and healthcare utilization, defined as emergency department visits and infectious disease office visits, phone calls, and emails, may be greatest in the first two weeks of OPAT. Given that older adults (age ≥ 65) have greater cognitive decline, ADL limitations, and comorbidities than younger adults, we sought to evaluate the frequency and timing of AEs in older adults on OPAT. We examine patients on OPAT at Yale New Haven Hospital (YNHH) …

Quantifying Influenza Exposure Within Hospitals And Nursing Homes, Drew Taylor Dickinson

Public Health Theses

Abstract

Background: Influenza acquisition in hospitals and nursing homes (NHs) highlights the need for infection prevention to protect patients from contagious diseases while under the care of a healthcare facility. We quantified influenza exposure in both settings and compared facility-onset influenza rates in order to determine if risks of acquiring influenza differed by type of healthcare facility since infection prevention practices are less standardized and less rigorous in NHs.

Methods: We conducted a retrospective cohort study of California hospital and NH inpatients during the 2015-2016 influenza season, defined as the peak influenza month, plus the two adjacent months, using claims …

Using Host Response For Respiratory Virus Discovery And Surveillance, Amelia Erin Hanron

Public Health Theses

INTRODUCTION: In 2015 lower respiratory infections (LRI) were the fifth leading cause of

death and the leading cause of death for children under five years old. Despite increasing advances in viral detection technology, etiology is never established for a large portion of viral respiratory infections. The most recent of such advancements- next-generation sequencing (NGS)- has greatly improved the ability to discover and/or identify rare or novel viruses. However, NGS platforms are still not feasible in a clinical laboratory due to cost, complexity, personnel, etc. The ability to screen for unknown viruses using technology that is already present in most clinical …

The Effects Of Rurality And Cost Of Transportation On Time Of Evolution And Disease Complexity At Diagnosis For Cutaneous Leishmaniasis In Colombia, Miguel Paredes

Public Health Theses

Patients in Colombia affected by cutaneous leishmaniasis (CL) face significant geopolitical and socioeconomic barriers to accessing diagnosis and treatment. This study aimed to understand how the geosocial characteristics of a patient’s area of residence affect time to medical consultation and disease status at consultation. An observational cross-sectional study was performed of individuals with CL who consulted at a local clinical referral center (CIDEIM) in Cali and Tumaco, Colombia. Descriptive, bivariate, and multivariable simple and ordinal logistic regression analyses were done to examine how area of residence (urban or rural) and cost of transportation to the nearest urban center may influence …

Quantifying The Burden Of Contact Precautions Of Carbapenem-Resistant Enterobacteriaceae (Cre) In Hospital Settings, Carolyn Park

Public Health Theses

Carbapenem-resistant Enterobacteriaceae (CRE) are a group of multi-drug resistant organisms (MDROs) that is currently considered an important and urgent public health concern due to their high mortality rates, antibiotic resistance, and their potential for rapid transmission. These pathogens are more commonly seen in healthcare-associated infections with some also occurring in the community. This study focused on distinguishing CRE into two distinct groups based on resistance mechanism: carbapenemase-producing CRE (CP-CRE) and non-CP-CRE. In order to determine if testing for carbapenemase can be useful in infection prevention, we aimed to quantify the total hospitalization in days per patient within a 90-day follow-up …

Analysis Of Entomological Surveillance Data To Predict West Nile Virus Cases In Connecticut, Lena Marie Tayo

Public Health Theses

INTRODUCTION: Since 1999, West Nile Virus (WNV) has been identified in a wide variety of mosquito species. Seasonal epidemics occur in the summer in all regions of the United States, with varying degrees of intensity and spread. In Connecticut, the state mosquito surveillance system for WNV has been conducted since 2000, collecting entomological and site data, and acting as an early warning system for potential human disease risk.

AIMS: Re-analysis of the epidemiology of WNV in Connecticut after years of established endemicity will be conducted using recent mosquito surveillance and human case data. A predictive model will also be developed …

Average Time To Negativity Of New Alere Ultra-Sensitive Rapid Diagnostic Test After Treatment For Malaria., Azan Zahir Virji

Public Health Theses

Malaria remains one of the most challenging infections globally. Malaria RDTs have had the largest impact on malaria detection in recent years with almost 245 million RDTs delivered globally. (1) They work by detecting either the histidine-rich protein (HRP2) or the Plasmodium lactate-dehydrogenase (pLDH). (2) Following a malaria infection, the HRP2 and pLDH antigens often circulate in the blood stream for several weeks. (3) As new RDTs are constantly being developed, each with a better sensitivity, specificity and lower limit of detection than its predecessor, the need to understand the persistence of their positivity, following a malaria infection, remains. The …

State Vaccination Policies And Coverage For Adolescent Vaccines In The United States, 2017, Anthony Edward Yakely

Public Health Theses

Background: The wide-ranging nature of state vaccination requirements for school entry allows for suboptimal coverage of adolescent vaccination as well as missed opportunities where some adolescent vaccinations are received but not all of them. Variation exists both in the types of exemptions that are allowed and the process that is required to obtain an exemption. State-level policies have been shown to be associated with childhood vaccination coverage, but far fewer studies have examined adolescent vaccine coverage.

Methods: HPV, MenACWY, and Tdap vaccine receipt and demographic data from the 2017 National Immunization Survey-Teen (NIS-Teen) Public Use Dataset were combined with data …

The Cost And Burden Of Chikungunya In The Americas, Danielle Bloch

Public Health Theses

Background: Chikungunya virus (CHIKV) is a mosquito-transmitted virus that emerged in the Caribbean in late 2013 and proceeded to spread throughout the Americas. Acute CHIKV disease is characterized by high fever and potentially debilitating arthralgia. In a proportion of cases, serious long-term sequelae following acute disease have been reported. These conditions primarily include chronic inflammatory rheumatisms, but can also involve depression, sensorineural effects, headaches and cognitive delays following neonatal infection.

Methods: We developed data-driven computational simulation models for acute and long-term health conditions associated with CHIKV infection to estimate the economic cost and health burden of the 2013–2015 CHIKV epidemic …

Forced Migration & Health: A Course Proposal, Lauren Ashle Gaston-Hawkins

Public Health Theses

Forced migration is poised to be one of the leading public health issues of our time. The Syrian refugee crisis in particular has placed issues of forced migration firmly in the consciousness of everyday people in developed nations in a way that has not occurred arguably since the genocide in Rwanda. Thus it is important to capitalize on this moment of awareness to prepare future leaders and public health advocates to effectively address the host of issues that accompany the forced migration of populations. As the number of forced migrants increase and represents a larger proportion of the world’s population, …

Self-Medication And "Personal Medicine" As Alternatives To Pharmaceuticals Among Young Adults With Mental Health Conditions, Jessica Hahne

Public Health Theses

Background:

Many studies have documented high rates of non-adherence to prescribed psychiatric medications among individuals receiving mental health services. Few studies have sought to understand how young adults with mental health conditions who are not consistently connected to mental health services view psychiatric medications, or what types of self-directed symptom management strategies they might prefer to psychiatric medications.

Methods and Results:

This secondary analysis on 11 pairs of semi-structured interviews with young adults (aged 24-28) used a grounded theory approach to elucidate common themes in self-management of mental health symptoms. Many participants described alcohol or marijuana use as preferred strategies …

“For The Safety Of Our Health”: A Qualitative Analysis Of Pre-Exposure Prophylaxis (Prep) Acceptability Among Female Sex Workers In Malaysia, Shaylen Susalla Foley

Public Health Theses

Female sex workers (FSW) in Malaysia are at substantially increased risk of acquiring HIV compared to the general female population. Daily oral pre-exposure prophylaxis (PrEP) offers a novel way to prevent HIV transmission in this population. This research aims to inform culturally relevant implementation of PrEP through a qualitative exploration of the factors that determine FSW willingness to use PrEP. In-depth, semi-structured interviews (n=30) were conducted with FSW in English, Malay, or Tamil. Transcribed and translated interviews were analyzed using a grounded theory approach. FSW expressed positive interest in PrEP but preferred it as a supplement to condoms, not a …

Community Mental Health Workers And Capacity Building: A Qualitative Evaluation From Ghana, Jurema Gobena

Public Health Theses

Background: Ghana is among countries facing human resource shortages for mental healthcare. Since 2011, the country has shifted to a community-based model of mental healthcare and has used task-shifting to fill the mental health professional gap.

Methods and Results: A qualitative study was conducted using in-depth interviews with 17 community mental health workers (16 psychology college graduates and 1 community psychiatric nurse) employed through the publically funded health system to explore their experiences in mental health promotion and service delivery on the ground. Several findings characterize the CMHWs experiences: limited mental health literacy, overwhelming stigma, performing duties outside of their …

Livestock Prevalence Of Brucellosis And Q Fever In Thailand, Soledad Colombe

Public Health Theses

Background

Brucellosis and Q fever may impart high morbidity in humans and economic losses among livestock. Yet, a systematic investigation has not been performed in Thailand, where a significant proportion of the rural population may be vulnerable to these zoonotic diseases.

Objectives

We surveyed the seroprevalence of brucellosis and Q fever in livestock from Thai communities at the border with Cambodia, evaluated risk factors for seropositivity, and performed a risk assessment for potential transmission to farmers.

Methods

We selected herds of beef and dairy cattle and small ruminants (sheep and goats) for Sa Kaeo province in 2015 using a two-stage …

Time-To-Detection Of M. Tuberculosis As A Predictor Of Infectivity, Lea Elizabeth Ghee Hamner

Public Health Theses

INTRODUCTION: Tuberculosis (TB) transmission continues to be problematic in the United States. Contact investigations are essential for identifying new infections and must prioritize limited resources by pursuing more infectious cases. Current infectivity measures like sputum smear grade, chest x-rays, and nucleic acid amplification tests (NAAT) are sub-optimal. Time-to-detection (TTD) of Mycobacterium tuberculosis in liquid culture has shown promising results.

OBJECTIVES: Our objective is to examine the relationship between TTD and TB transmission.

METHODS: This study examined a retrospective cohort of pulmonary TB cases with TTD data from 2009-2014 from the King County Laboratory, Seattle, WA. The primary outcome was transmission …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …

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 …