Digital Commons Network^™

Area-Based Poverty And Community Associated Clostridium Difficile Infection In New Haven County, 2011-2013, Ranjit Dhaliwal

Public Health Theses

BACKGROUND: The relationship between socioeconomic status and CA-CDI incidence has not been examined. I hypothesize that there will be higher incidence rates of CA-CDI in areas of higher socioeconomic status, where individuals are more likely to have health insurance, better access to care and are more educated.

METHODS: Community onset (CO) cases from Emerging Infections program surveillance were defined as those with a CDI positive specimen sample less than four days after admission to a health care facility. Community associated CO cases were defined as those that did not have a healthcare exposure in the prior three months. Unadjusted CA-CDI …

Dengue Epidemiology In An Urban Slum Community In Salvador, Brazil, Kristine Gauthier

Public Health Theses

Brazil has experienced a major increase in the incidence of dengue fever and severe dengue since the mid-1990s. Due to incomplete vector-control and transmission prevention efforts, all four serotypes of the dengue virus now circulate in Brazil. Communities such as Pau da Lima, an urban slum in the city of Salvador, Brazil, face a high burden of disease. Beginning in 2009 enhanced surveillance for dengue fever and other acute febrile illnesses has been conducted at the São Marcos Emergency Center (CESM), the only public urgent care health center in Pau da Lima. This sentinel surveillance site serves as a model …

Human Behavioral And Ecological Risk Factors For Lyme Disease Infection On Block Island, Rhode Island, Casey James Finch

Public Health Theses

Peridomestic exposure to infected Ixodes scapularis nymphs is considered the dominant means of infection with tick-borne pathogens in the eastern United States. Previous studies of risk of developing tick-borne infection established a positive association between the density of infected nymphs and Lyme disease cases at the population level. Studies examining the effectiveness of personal protective behaviors have not included measures of tick exposure. This study simultaneously assesses the effect of tick exposure and human behavior in Lyme disease infection risk using a longitudinal serosurvey study on Block Island, RI. Tick exposure risk at all Island properties was estimated by identifying …

Geographic Variation In The Costs Of Prostate Cancer Care, Avantika Arun Saraf

Public Health Theses

Objectives: 1) To review costs of prostate cancer care in multiple countries 2) To summarize studies assessing regional variation in costs of prostate cancer care within the United States 3) To characterize variation across hospital referral regions (HRRs) in Medicare expenditures on initial prostate cancer care and evaluate its determinants. Methods: A thorough literature search was conducted to identify the costs of prostate cancer care in different countries and within the United States (to assess regional variation in costs). Subsequently, the thesis involved an in-depth use of the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database and the Medicare 5% …

Perceived Difficulty Accessing Medical Care And 30-Day Prescription Drug Adherence Post-Myocardial Infarction, Mitra Daneshvar

Public Health Theses

Introduction: Prescription drugs can reduce the risk of adverse events post-myocardial infarction (MI), but despite the known benefits, use of these drugs remains low. Prior research has found that younger patients, women, minorities, and those with limited access to care are less likely to be adherent. Currently, little is known on how perceptions of access to care affect adherence rates.

Objective: To determine the association between patients' perceived difficulty accessing care and adherence to prescription drugs 30 days after an MI event in young patients.

Methods: VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction …

Incidence By Area-Based Socioeconomic Indicators, Casey Lea Kelley

Public Health Theses

Objective: To examine the relationship between area-based socioeconomic (SES) measures and incidence of all laboratory-confirmed influenza, laboratory-confirmed non-hospitalized influenza, influenza-associated hospitalizations, and influenza-associated deaths, in Connecticut.

Methods: Laboratory-confirmed influenza cases in Connecticut from October 1, 2006 to April 30, 2012 were geocoded, and in accordance with the methods of Harvard's Public Health Disparities Geocoding Project, linked to census tract measures of SES. Total and seasonal incidence rates were determined for each of the four influenza-associated health outcomes by SES measure. For each outcome, a relative rate ratio was calculated between the highest and the lowest percent quantile of each SES …

Hypersensitivity Reactions To Ixodes Scapularis Bites And Protection Against Tick-Borne Infection, Gregory Kimball Nielsen

Public Health Theses

Background: Salivary proteins from insect bites result in a wide array of complex immune interactions within a bitten host. In the case of the deer tick, Ixodes scapularis, previous research has demonstrated that tick-induced hypersensitivity reactions may interfere with the transmission of Lyme disease. There are no prospective studies in humans regarding the spectrum of hypersensitivity reactions that occur with I. scapularis bites.

Methods: We analyzed data obtained from a prospective enrollment of the first 102 individuals who reported tick bite to a medical practice in Mansfield, Connecticut from 2005-2008. Clinical responses were recorded and subject based diaries were utilized …

Determinants Of Infant Feeding Practices Of Hiv-Positive And Hiv-Negative Mothers In Pretoria, South Africa, Keith L. Ellis

Public Health Theses

Background:

Exclusive breastfeeding (EBF) has been shown to result in lowered risk of postnatal vertical HIV transmission compared to mixed breastfeeding (Mixed BF). Early breastfeeding cessation, or not breastfeeding at all, is associated with an increase in morbidity and mortality amongst both HIV exposed and HIV unexposed infants. The South African tradition of giving nutritive and non-nutritive foods to breastfeeding infants in the first few months of life is unique within African nations and warrants closer examination to identify maternal determinants that lead to early mixed feeding practices, commonly used supplemental foods/liquids, the timing of supplemental food introduction, and maternal …

Incidence Of Salmonella And Neighborhood Poverty Level In Connecticut, 2000-2011, Christina Marie Mainero

Public Health Theses

Background: Surveillance by the FoodNet program has shown that Salmonella, unlike other foodborne illnesses, has increased during the past fifteen years within the United States. Little work has been done to examine the role of socioeconomic factors in incidence of Salmonella. Neighborhood poverty level, measured as the percentage of people living below the poverty line, at the census tract level has been accepted as a useful indicator of socioeconomic status. This study utilized geographic information system (GIS) technology and census tract data to examine the variation in Salmonella incidence among census tracts in Connecticut. The objectives of this study were …

Environmental Risk Assessment Of Community Acquired Legionellosis From Recycled Water Use In Los Angeles County California, Luis Lozano

Public Health Theses

Abstract

Legionellosis is caused by Legionella pneumophila, resulting in 8,000-18,000 yearly hospitalizations and 4,000 deaths in the United States (Bouwknegt, 2012) (Toshiaki, 2004) (World Health Organization, 2012). L. pneumophila may persist in the built environment due to unique intracellular characteristics. Although the mode of transmission of L. pneumophila is inhalation of aerosolized contaminated water, this bacterium is not transmitted human to human (World Health Organization, 2012). L. pneumophila infection may be facilitated by the increased use of recycled water in Los Angeles County. In a water stressed area such as Los Angeles County, a limited potable water supply may not …

Use Of The State Immunization System To Assess Influenza Vaccine Effectiveness Among Children 6-35 Months Of Age In New Haven County, Ct, 2003-2012, Lun Pei Ng

Public Health Theses

Population-based immunization information systems have been used successfully to assess vaccine effectiveness (VE) in children. The Connecticut Immunization Registry and Tracking system (CIRTS) and the Connecticut Emerging Infections Program (CTEIP) provided the opportunity to evaluate influenza VE among children 6-35 months of age in New Haven County, CT, 2003-2012. A total of 104 case children and 520 date-of-birth- and zipcode-matched controls were studied. The VE in matched analysis of full vaccination compared to no vaccination was 31% (95% CI, <0%-69%; p=0.38). The VE of at least one dose of influenza vaccine compared to no vaccination was 37% (95% CI, <0%-63%; p=0.09). Our study suggests that the overall total VE is unlikely to be greater than 69% among children 6-35 months of age and having had at least one dose of influenza vaccine could be protective from influenza-caused hospitalization compared with never having been vaccinated. This study should be extended for several more influenza seasons to determine a range of effectiveness that does not include zero.

Economic Coping Mechanisms In Response To Household Health Shocks In Kagera, Tanzania: 1991-2004, Rosina Pradhananga

Public Health Theses

ABSTRACT

Background: Chronic and acute illnesses pose substantial economic burden on households due to explicit health expenses and implicit costs engendered by decreased productivity and increased time allocation to care provision. This study examined economic coping mechanisms employed by households to respond to health shocks represented by chronic and acute morbidities.

Methods: Data from Kagera Health and Development Survey (1991-2004) were utilized to examine household health status and economic coping. Pooled OLS regression models were used to analyze the association between household health status and economic burden and coping mechanisms controlling for household size, mean age, income, and characteristics of …

A Predictive Model Of Avian Influenza Among Poultry In Egypt, Natalie Price

Public Health Theses

Background: Avian Influenza (H5N1) has become entrenched in Egypt since its emergence in 2006. Control measures have failed and surveillance systems remain inadequate. A relatively new method for regression called Random Forests is presented here with the goal of providing accurate and timely predictions of the weekly number of outbreaks in each of the Egyptian governorates.

Methods: Predictions were generated from Random Forests models using outbreak data from the FAO EMPRES-i database, and local weather data from Weather Underground. This data was lagged by one and two weeks in order to make prospective predictions with the current week's data in …

The Impact Of Intimate Partner Violence On Breastfeeding: A Demographic And Health Surveys Analysis Of India, Nepal And Timor-Leste, Aliya Cecilia Roginiel

Public Health Theses

Objective: The objective of this study is to evaluate the association between lifetime experience of intimate partner violence (IPV) and breastfeeding in India, Nepal and Timor-Leste.

Methods: Women respondents, between the ages of 15 and 49 years, whose last child was under or equal to 2 years of age and a singleton birth and who were applied the domestic violence module, were included in the final study sample for each country. Logistic regression analyses were used to investigate any unadjusted associations between any lifetime IPV, any physical IPV, any sexual IPV or both and the following breastfeeding outcomes: early breastfeeding …

Modeling The Epidemiological Impact Of Human Hookworm Infection, Laura Skrip

Public Health Theses

Background: Chronic hookworm infection affects an estimated 576 to 740 million people worldwide. Despite mass drug administration efforts, the morbidity associated with this soil-transmitted helminth remains a significant public health issue. Due to inter- and intra- community heterogeneity in susceptibility to infection, mathematical modeling can serve as an effective and efficient tool for investigating hookworm transmission in different settings and for guiding policymakers to consider new treatment and prevention strategies.

Methods: Here we developed an age-structured, compartmental S-I model to identify epidemiological parameters for hookworm infection and to assess rates of attributable anemia within the population of Zanzibar. The model …

Comparisons Of Patients With Recurrent Vs. Incident-Only Clostridium Difficile-Associated Diarrhea: A Case-Control Study Of Treatment Effectiveness At Yale New Haven Hospital, 2010-2011, Mark Stuntz

Public Health Theses

Background: Clostridium difficile infection (CDI) is the most frequent cause of hospital-acquired infectious diarrhea in developed countries. Approximately 19-20% of affected patients will experience a symptomatic recurrence following their first episode of Clostridium difficile-associated diarrhea (CDAD). Risk factors for the initial CDAD episode have been well-documented, however, epidemiologic risk factors for recurrent CDAD have not been described in as much detail. It is hypothesized that initial treatment could be a risk factor for recurrent CDAD. The CT Emerging Infections Program (EIP) conducts laboratory-based surveillance for CDAD in New Haven County, however, routine surveillance does not collect treatment data. Therefore, we …

Mdi-Specific Igg Exposure Biomarker And Role Of Intervention, Ann Y. Teng

Public Health Theses

Background:

Diisocyanates are sensitizing agents that are used in many industries in the production of polyurethane foams, coatings and other products. Methylene diphenyl diisocyanate (MDI) exposure can occur through dermal and inhalation routes resulting in sensitization and leading to isocyanate asthma. MDI-specific IgG (MDI-IgG) bio-monitoring has been proposed to be used as a predictor of exposure.

Methods:

A prospective longitudinal study was used to assess annual MDI- IgG serum markers in 223 workers in a fabric-coating company. Kaplan Meir Survival Analysis determined whether there was a difference in seroconversion based on exposure level. A Cox proportional hazard model was used …

Neighborhood Level Socioeconomic Status And Rurality And Shiga Toxin-Producing Escherichia Coli Incidence: Connecticut, 2000-2011, Bridget Morrissey Whitney

Public Health Theses

Background: Shiga toxin Escherichia coli (STEC) O157 and other STEC strains are a well-known cause of enteric illness. National estimates are that STEC O157 causes approximately 96,534 illnesses every year in the United States, with another 168,698 illnesses caused by non-O157 STEC serotypes. Determining economic and sociodemographic factors associated with enteric disease incidence may provide new understandings of the transmission of these illnesses, particularly community transmission, and may prove useful in the prevention of disease.

Methods: A total of 764 incident STEC cases were reported in CT from 2000 to 2011. Incident cases were geocoded based on the case's address …

The Influence Of Maternal Obesity On Adolescent Obesity In Santiago, Chile, Yunnuo Zhu

Public Health Theses

Objective: To examine the relationship between adolescent obesity and associated maternal obesity variables of interest, specifically maternal pre-pregnancy obesity and maternal obesity 10 years postpartum.

Design: Secondary data analysis of a longitudinal study in Santiago, Chile (N=786 adolescents). Variables were extracted from multiple waves of data collection. The maternal obesity variables of interest and covariates were stratified by gender and associations of interest examined using univariate logistic regression analyses and multivariate logistic regression models with missing data imputation. Covariates included were birth weight percentile, breastfeeding for 6 months, father's presence, maternal age, and maternal education.

Results: Adolescent obesity was associated …

Resilience And Its Mediating Effect On The Relationship Between Life Stress And Health-Related Quality Of Life In Older Adult People Living With Hiv/Aids, Xindi Fang

Public Health Theses

Background: By 2015, 50% of all HIV/AIDS cases in the United States will be persons 50-plus years of age. Very little, if any, research has examined resilience in older people living with HIV/AIDS (PLWHA). This research explored the conceptual construct of resilience and investigated the mediating effect of resilience on the relationship between life stress and health-related quality of life (HRQoL) in PLWHA over fifty.

Methods: Data from a sample of 299 PLWHA over 50 was analyzed using structural equation modeling (SEM) to define a hypothesized Resilience construct (represented by Coping Self-Efficacy, Active Coping, Hope/Optimism and Social Support) and to …

Epidemiology And Characterization Of Methicillin-Resistant Staphylococcus Aureus From Swine Workers In Romania, Eileen Damin Huang

Public Health Theses

Methicillin-resistant Staphylococcus aureus (MRSA) is a potent human pathogen associated with high morbidity and mortality worldwide. Livestock are known reservoir for MRSA, which pose substantial health risks for livestock farmers and their community contacts. However, little is known about MRSA among swine workers in Eastern Europe. In this study, we conducted a prevalence survey of swine workers in Romania. Three livestock-associated S. aureus strains (spa type t034, t011, and t4872) and one community-associated S. aureus strain (spa type t321) were isolated from workers on seven commercial swine farms in Transylvania. The rate of MRSA carriage in workers was 6.8%. Veterinarian …

Hepatitis C Virus Infection And Prostate Cancer Risk: A Population-Based Case-Control Study Using The Seer-Medicare Dataset, Shan Jiang

Public Health Theses

Prostate cancer is the most common type of non-skin malignancy diagnosed among men, but the disease etiology and risk factors remain inconclusive. Hepatitis C virus (HCV) infection's prevalence is increasing in the US population. Studies have shown that the concentration of free serum testosterone, which may be directly associated with prostate cancer risk, was decreased among men with HCV infection. In order to evaluate the relationship between HCV infection and prostate cancer risk, we conducted a population-based case-control study using the SEER-Medicare dataset.

The study included 194,339 prostate cancer cases and 54,481 controls which were frequency-matched to the cases by …

Diaper Need And Maternal Mental Health: A Geographic Assessment In The City Of New Haven, Anna Kruse

Public Health Theses

Introduction: With the burden of poverty currently falling heavily on women and poverty as an established risk factor for poor mental health, it is important to understand the pathways by which poverty influences maternal mental health. Diaper need may represent a form of material hardship that has adverse consequences for the mental health of low income mothers. The aim of the present study was to examine the association between maternal mental health, diaper need, and neighborhood context. We hypothesized that mothers who reported diaper need would also report poor mental health and that neighborhood context would significantly impact this association. …

The Role Of Antibiotics In Microbial Interactions Of Copd, Kimberly Lay

Public Health Theses

Background: Chronic Obstructive Pulmonary Disease (COPD) exacerbations caused by bacterial infections account for more than 50% of all exacerbation episodes, with Haemophilus influenzae as the most frequently isolated pathogen. The role of antibiotics in treating COPD bacterial exacerbations remains unclear.

Objective: The current analysis evaluates the interaction of H. influenzaes with other pathogens while controlling for the use of antibiotics.

Methods: Data were from a longitudinal study of COPD patients conducted at a VA medical center from 1994-2010. Analysis was restricted to sputum samples collected over the course of one year in a total of 130 patients. Presence of Moraxella …

A Program Evaluation Of A Mobile Clinic In New Haven, Connecticut, Britton Ashley Gibson

Public Health Theses

Background: Barriers to health care typically exist amongst poor and marginalized communities that are burdened by a number of factors, such as unemployment, lack of insurance, and homeless. These groups also hold a disproportionate disease burden due to increased risk of exposure. Thus, they are likely to go without care for treatable conditions because they are unable to access traditional health care settings. One way of overcoming these barriers to care is through the use of mobile clinics. These clinics are able to offer a variety of services within disadvantaged communities to both prevent the spread of disease and alleviate …

Sex Trafficking In Kolkata, India: Employment Histories And Perceptions Of Risk, Madison Leigh Rose

Public Health Theses

Abstract

Sex trafficking is a significant public health and human rights concern in India. This paper aims to (1) replicate questions about predisposing factors and trafficking mechanisms previously asked of women and girls released from trafficking to a sample of women actively involved in commercial sex work; and (2) go beyond existing research by determining first-hand information on pre-trafficking employment histories and subjective perceptions of trafficking and health risks.

Interviews with 57 trafficked female sex workers in Kolkata (Calcutta), India. Most women were born in India. Bangladesh and Nepal were also reported nations-of-origin. Illiteracy was prevalent in the sample (67.9%, …

Hpv Type Distribution In New Haven County, Ct Among Women With Cin2+ Diagnoses From 2008-2010, Chelsea Anne Russ

Public Health Theses

Background

The human papillomavirus is a necessary cause of cervical cancer leading to >12,000 cervical cancer diagnoses and >4,000 deaths in the United States in 2007. In 2006, the first HPV vaccine was approved by the US FDA, which prevents the acquisition of high-risk types of HPV (16/18) that cause 70% cervical cancer cases in the US and 50% of precancerous lesions. Our objectives were to examine HPV type distribution among women with cervical intraepithelial neoplasia 2/3 (CIN2+) by area-based measures of race, ethnicity, and poverty and individual level characteristics.

Methods

In 2008, the Connecticut Department of Public Health (DPH) …

Characterization Of Bis-(3', 5')-Cyclic Dimeric Adenosine Monophosphate As A Mucosal Adjuvant And Its Relevance In A Model Of Hookworm Pathogenesis, Shawn Terryah

Public Health Theses

Most pathogens invade their human host or establish infection at mucosal surfaces. In contrast to parenteral vaccines, mucosal immunization has the potential to induce a robust immune response at mucosal surfaces capable of blocking the entry and establishment of many pathogens. Despite these advantages, very few mucosal vaccines are licensed for human use, largely because antigens administered by the mucosal route are either poorly or non-immunogenic. A strategy to overcome this problem is co-administering vaccine antigens with a mucosal adjuvant. Recently, bis-(3',5')-cyclic dimeric adenosine monophosphate (c-di-AMP) was identified as a potential mucosal adjuvant. To evaluate c-di-AMP as a mucosal adjuvant …

Obesity As A Risk Factor For Hospital Acquired Infections In Pediatric Trauma Patients: A Pilot Study, Elyor Vidal

Public Health Theses

Context

The prevalence of obesity among young Americans in the 6 to 19 year old category has tripled since the 1960's. Today, 50% of individuals in this age group are either overweight or obese (Kimm, 2002). Studies have shown that increased percentage of body fat weakens the body's immune system (Falagas, 2009). Moreover, trauma can be an immuno-compromising condition. A study by Brown et al. in 2006 showed that obese pediatric trauma patients had more sepsis (15% vs 4%, P = .007) and wound infection (26% vs. 8%, p = .03), along with other clinical complications.

Objective

This project serves …

Governance Implications Of Global Infectious Disease Epidemics Under Shared Health Governance Scheme. Lessons From Sars, Ruosi Wang

Public Health Theses

The world is becoming flat. With the progress of globalization and world integration, the past century has witnessed a growing number of emerging and reemerging diseases. It has become a common concern the world will face a deadly infectious disease pandemic and the international community needs to set up a functional system to face up the challenge. Over the past decade, outbreaks of SARS, H5N1 and H1N1 pandemic have raised concern among public health officials and the public in general on the need of global and local pandemic control. Infectious agents have been able to take advantage of the dramatic …