Digital Commons Network^™

“You Are Just Trying To Make It Work”: A Qualitative Exploration Of Healthcare Provider Implementation Considerations For Integrating Mental Health And Hiv Care In Central Uganda, Divya Gumudavelly

Public Health Theses

There is a growing push to integrate mental health services within HIV care in urban Uganda. Amidst HIV clinics becoming comprehensive healthcare centers, there is a critical need to understand how providers can better adopt and implement mental health specific protocols in HIV practice. Semi-structured interviews were conducted with 16 healthcare providers at two different HIV care centers to understand current practices, routines, barriers, and facilitators to implementing mental health care services within HIV care. Abductive thematic analysis, drawing from Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF) frameworks, was used in conjunction with constructivist grounded theory …

Optimization Of An Elisa-Based Leptospirosis Diagnostic, Kevin Yuhang Zhao

Public Health Theses

Leptospirosis is an infectious zoonotic disease responsible for about 1 million cases annually. Issues in early diagnosis is a major contributor towards poor health outcomes. Current tests for diagnosis, such as whole-cell ELISA-based diagnostics or the microscopic agglutination test (MAT), importantly lack sensitivity during acute-phase disease. Therefore, creating an ELISA-based diagnostic, which is generally cheaper and easier to perform than the MAT, using highly-conserved targets, that has high sensitivity towards acute-phase disease, would be desirable. This study first attempted to optimize protocols for diagnosis, and next applied the optimized protocol against epitopes derived from hamsters vaccinated with a multi-recombinant protein …

Effect Of Digital Public Health Campaigns By The World Health Organization On Self-Reported Behavior, Recall/Knowledge, And Attitude Toward Interventions Related To Covid-19: A Meta-Analysis, Zili Zhou

Public Health Theses

The COVID-19 pandemic highlighted the need for effective scientific communication. The success of public health interventions are largely dependent on public knowledge and behavior. With the global rise of social media usage, as well as the increased prevalence of social media advertisement campaigns, the platforms present a tool with the potential to be utilized by public health authorities to deliver information and influence broad populations within a short period of time. From 2020 to 2022, the World Health Organization conducted 58 social media campaigns, totaling 176 brand-lift studies, in partnership with Meta on the subject of COVID-19. The campaigns conveyed …

The Undercurrents Of Disease In Armed Conflict: An Analysis Of Aggregate National Dstb And Mdr/Xdr Tb Screening & Diagnosis Trends During The 2022 War In Ukraine, Sakina Erika Reames

Public Health Theses

​​Tuberculosis (TB) is the second leading cause of death by an infectious disease worldwide after COVID-19. Extensive efforts have been made for decades to tackle this disease through bolstering healthcare systems especially in countries experiencing a disproportionate burden of TB. Ukraine is considered by the WHO to be one of the 30 high burden countries in the world with a notably high burden of MDR TB. In addition, Ukraine has the second largest HIV epidemic in Eastern Europe and Central Asia as well as the fifth largest number of extensive drug resistant cases in the world. Ukraine has made extensive …

Vector Status Of Aedes Albopictus In Connecticut: Analyses Of Invasion Pattern, Geographic Distribution, And Disease Risk, Meredith Bagger

Public Health Theses

Introduction: Aedes albopictus is a highly successful invasive mosquito. Its presence and expansion into Connecticut have implications for human and animal health. The factors limiting Ae. albopictus spread and risk by the pathogens it carries have not been previously examined. Methods: This study leveraged data from the Connecticut Mosquito and Arbovirus Surveillance Program during 2006-2022 and a project designed to characterize mosquito-borne filarial parasite species in Connecticut from 2020-2021. We examined correlations between mosquito abundance and winter temperature as well as land use. We described the arboviruses detected in Ae. albopictus collections and calculated the risk of Ae. albopictus transmitting …

Primary Liver Cancer In China From 2000-2020: Evolution Of Epidemiology, Clinical Disease, And Therapy, Wanqing Chi

Public Health Theses

Background & Aims: China contributed to 49% of all liver cancer deaths worldwide in 2020. We sought to investigate the relationship between clinical characteristics, antiviral therapy (ART), and multiple risk factors that affect the prognosis of primary liver cancer (PLC) patients over time to highlight proper chronic liver disease management.Methods: We identified 1322 PLC patients diagnosed between 2000 to 2020 in a major academic teaching hospital in Shanghai, China. We used descriptive epidemiology to characterize the evolution of liver cancer in China, and Cox proportional hazard models and Kaplan-Meier survival analysis to assess the relationship between evolving ART and survival …

Prevalence And Genetic Determinants Of Vancomycin Resistance Of Clostridioides Difficile Isolates In Connecticut, Zeyu Fu

Public Health Theses

AbstractIntroduction: The emergence of vancomycin-resistant strains of C. difficile has become a growing concern, as it can lead to treatment failure and increased morbidity and mortality. In this study, we aimed to investigate the prevalence and mechanisms of vancomycin resistance in C. difficile isolates in Connecticut from patients with confirmed C. difficile infection at Yale New Haven Hospital. Methods: We collected 89 stool samples from patients with confirmed C. difficile infection, isolated C. difficile, and performed susceptibility testing on the isolates using the E-strip test method. Isolates with an MIC value below 4 μg/ml were classified as susceptible and isolates …

Attribution Of Febrile Illness To Circulating Respiratory Viruses In The United States, July 2016 - March 2023, Lily Kitfield-Vernon

Public Health Theses

Background: SARS-CoV-2, an emerging epidemic respiratory virus, has circulated in the United States since early 2020. The dynamics of Influenza (flu) and Respiratory Syncytial Virus (RSV) have shifted, causing atypical timing and levels of illness across the country and in particular age groups. Fever, recorded on at-home bluetooth-enabled thermometers, is a promising new tool with which to monitor respiratory disease. Quantifying the proportion of fever attributable to these three viruses, at a particular time or within a particular age group, would strengthen the collective understanding of viral circulation in the U.S., and enable the use of fever data in the …

Protection Against Cholera From Killed Whole-Cell Oral Cholera (Kocv) Vaccines: Systematic Review And Meta-Regression Of Randomized Control Trials And Observational Studies, Helena Hojeong Kwon

Public Health Theses

Introduction: Although killed whole-cell oral cholera vaccines (kOCVs) are widely used as a part of cholera control strategy, mixed evidence around the vaccine induced protection remains.Objectives: The primary objective of this systematic review was to update estimates of kOCV protection: vaccine efficacy and effectiveness. A secondary objective was to estimate the waning dynamic of kOCV protection by duration of follow-up. Methods: On August 15th, 2022, we searched for randomized control trials and observational studies that reported kOCV protection in low- and middle-income countries on PubMed, EMBASE, Scopus, ISI Web of Science, and The Cochrane Review Library with a start date …

Drivers Of Global Waterborne Disease Transmission Following Extreme Precipitation Events: A Systematic Review, Claire Latendresse

Public Health Theses

Precipitation events such as hurricanes, typhoons, and heavy rainfall can have devastating impacts on water and sanitation infrastructure around the world and have led to large-scale waterborne outbreaks. As climate change amplifies the frequency and intensity of extreme weather events, it is also triggering an increase in waterborne disease transmission. This master’s thesis consists of a systematic review of academic literature pertaining to extreme precipitation events and the pathways by which they trigger waterborne outbreaks.

A systematic review of the literature in PubMed was conducted to identify waterborne disease outbreaks associated with extreme precipitation. The initial search yielded 3,248 results …

The Ethical And Legal Considerations Of Ai-Driven Healthcare In Infectious Diseases, Natalie Makableh

Public Health Theses

Artificial intelligence (AI) has been rapidly growing in the healthcare sector, with the potential to improve patient outcomes, increase efficiency, and reduce costs. However, as with any technological advancement, AI-driven healthcare presents ethical and legal challenges that must be addressed to ensure the responsible and beneficial use of the technology. To the best of our knowledge this is the first study to examine the ethical and legal considerations of using AI technology in healthcare, with a particular focus on infectious diseases. With the growing use of AI in healthcare, it is crucial to evaluate its potential benefits and challenges in …

Knowledge, Attitudes, And Practices (Kap) About Lassa Fever Prevention And Control: A Survey Of Three Rural Communities In Central Liberia-Epidemiology Of Microbial Diseases, Joseph Gibson Jepru Lewis

Public Health Theses

Introduction: Since the discovery of Lassa fever in 1969 in Nigeria, the disease has become endemic in many West African countries. An estimated 500,000 cases of Lassa fever virus occur each year, leading to approximately 5,000 deaths annually. Liberia continues to record outbreaks almost every subsequent year in regions once considered non-endemic. With no effective vaccines, many studies have underscored the importance for residents in Lassa-endemic regions to have good knowledge and good prevention practices in place to prevent Lassa fever.

Methods: A cross-sectional data extracted from a longitudinal, observational, cohort study conducted using voluntary participant self-reported and study visits …

Demographics Of Hospitalized Covid-19 And Influenza Cases In Connecticut During The 2021-2022 Influenza Season: Is There Evidence Of Viral Interference?, Molly Mclaughlin

Public Health Theses

Since the COVID pandemic began in March 2020, the epidemiology of influenza has changeddramatically in the United States. During the 2021-2022 influenza season in Connecticut, only 262 hospitalized influenza cases were recorded in New Haven and Middlesex Counties from October 2021-June 2022, while there are usually well over 1,000 cases in a single season. While the decline in influenza cases could be due to preventive measures adopted early in the pandemic, viral interference could also be to blame. Viral interference is the process by which infection with one virus transiently protects against infection by another virus via a generalized immune …

The Impact Of The Covid-19 Pandemic On Non-Typhoidal Salmonella Incidence And Exposures In Connecticut, 2015-2022, Adeline Morris

Public Health Theses

Background: During 2020, Salmonella incidence decreased by 22% in the United States.1 At the same time, many common activities were reduced or restricted, including travel and eating food prepared at restaurants or events, which are known risk factors for Salmonella infection. Methods: A descriptive analysis using Salmonella surveillance data collected in Connecticut between 2015 to 2022 was performed to characterize the changes in travel and outside food exposures. Frequencies of exposures were compared before the pandemic, during the pandemic, and after the vaccine was implemented and restrictions eased. Rate ratios of observed to expected cases were calculated to explore trends …

Impact Of The Covid-19 Outbreak On Mental Health And Public Practices In Rural Communities In China, Wenxin Liang

Public Health Theses

Coronavirus disease (COVID-19) has significant impact on people’s mental health. However, no nationwide study has investigated the mental health among rural residents during the COVID-19 outbreak in China. This study was aimed to investigate the impact of the COVID-19 outbreak on the mental health and public practices for controlling and preventing the COVID-19 in rural communities in China. An anonymous online survey was sent to participants through WeChat, the most widely used Chinese social-networking app, from March 2 to 11, 2020. We recruited 4607 individuals from 11 representative provinces in mainland China. The analytical sample was 2159 rural residents. The …

Indirect Effects Of Covid-19 Vaccination Against Sars-Cov-2 Omicron: Rapid Review & Meta-Analysis, Brett Anthony Martini

Public Health Theses

Background: First identified in Wuhan, China in late 2019, the infectious viral disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions of lives worldwide and poses the largest public health crisis in the past century. The development and deployment of vaccines have been a key public health measure to mitigate the subsequent harm associated with the viral infection. Despite the mRNA vaccine platform being in development for 15+ years, the mass vaccination campaigns were the first large-scale use of this technology, leaving much to be learned about their effectiveness and longevity. Mass vaccination campaigns influence …

Epidemiology Of Human Hookworm (Necator Americanus) Infection In Rural Ghana: Investigating Host-Parasite Factors That Mediate Infection, Savanna Randi

Public Health Theses

Abstract

Introduction: Hookworms are soil-transmitted helminths (STHs) that cause significant morbidity in high-risk populations, posing a global health concern in locations of rural poverty [1-5]. While there have been ventures by the World Health Organization to eliminate hookworms in Africa by 2030, there is variability in the effectiveness of current chemotherapy regimens. Studies have shown that benzimidazole anthelmintics have reduced effectiveness, and people living in endemic areas are quickly reinfected [6]. Critical gaps remain in understanding parasite-host interactions within communities, further challenging successful disease control. A study initiated in 2022 investigated the epidemiology of human hookworm infection in Beposo, Ghana. …

Antibiotic Prophylaxis For Prevention Of Surgical Site Infections In Orthopedic Surgery, Edwin Ruiz Fuentes

Public Health Theses

Background: In the past decades, there has been an increase in the proportion of orthopedic surgical site infections (SSIs) caused by gram-negative bacilli in various healthcare settings. SSI prevention guidelines suggest that gentamicin can be added to prophylactic antibiotic treatment to target gram-negative bacilli. However, the effectiveness of this strategy remains to be confirmed in orthopedic surgery.

Methods: A retrospective cohort study was conducted to investigate the association between antibiotic prophylaxis with adjunctive gentamicin and SSI rates in orthopedic surgeries. 5,571 patients who underwent hip, knee, spine, and hip fracture surgeries between January 2019 and July 2021 at Yale-New Haven …

Characterizing Populations Living Near Concentrated Animal Feeding Operations: Implications For Health Equity And Environmental Justice, Leah Salzano

Public Health Theses

Current literature has highlighted that concentrated animal feeding operations (CAFOS) are associated with adverse health outcomes among populations living in close proximity to the farms and that, in certain states, vulnerable populations may be disproportionately exposed to CAFOs. However, none of the existing studies have assessed the sociodemographic makeup of areas highly exposed to CAFOs across a diverse geographic range. Using locations of CAFOs across six states with robust operations, we conducted logistic regression models assessing the likelihood of high exposure vs. low exposure at the census tract level for each 10% increase in sociodemographic variables (percent unemployed, percent minority, …

From Theory To Practice: Zoonotic Spillover, One Health And The Role Of Local Indigenous Communities, Pranav Prabhu Savanur

Public Health Theses

This paper discusses the impact of zoonotic spillovers on public health and the need for a One Health approach to preventing future pandemics. Zoonotic spillovers occur when pathogens are transmitted from animals to humans, facilitated by anthropogenic land changes, migration or trade, increased human-animal contact, and poor biosafety. However, anthropogenic land use change is the primary driver for zoonotic spillovers. Most emerging infectious diseases in humans are of zoonotic origin, and the impact of these spillovers on public health is significant. The paper emphasizes the need to prevent spillover events for primary pandemic prevention, which requires a coordinated and collaborative …

Role Of Covid-19 Attributions In Inciting Violence Toward Older Asian Individuals, Emily Zhen Ning Hwang

Public Health Theses

Older adults in the Asian Americans and Pacific Islanders (AAPI) community faced heightened levels of violence and discrimination during the COVID-19 pandemic. Yet, little is known about the factors driving Asian-specific violence. This study investigated if individuals who attributed COVID-19 to stable factors and anything related to China were more likely to commit violence against older Asian adults. From April 23 to May 5 2020, a survey was conducted with 1498 American individuals (M = 55.19 years, SD = 17.97 years) using two online platforms. Participants who made stable attributions about the origin of COVID-19 were significantly more likely to …

Trends In Recurrent Clostridioides Difficile Infection In New Haven County, Chinenye Maryanne Okafor

Public Health Theses

Background: Recurrent Clostridioides difficile infection (CDI) is a cause of increased burden on the healthcare system and factors associated with this disease merit understanding. This study aimed to determine the incidence rate and to describe the factors associated with recurrent CDI cases in New Haven County from 2015 to 2020. It also examined the trends in annual recurrent CDI cases across epidemiological classes. Methods: This study utilized data from a population-based surveillance program of the Healthcare-Associated Infectious Community Interface (HAIC) Program within the Connecticut Emerging Infectious Program (CT EIP) at Yale School of Public Health which served all residents of …

A Scoping Review Comparing Sustainable Diet Indices, Natalie Henning

Public Health Theses

Interest in environmentally sustainable diets (i.e., diets beneficial for both human and planetary health) has increased as the role of food systems in climate change and population health has become better understood. Sustainable diet indices have been proposed as a holistic approach to assessing diets around the world with regards to human and planetary outcomes. The aim of this scoping review was to summarize and compare sustainable diet indices and their applicability to various populations.A literature search of three databases (Scopus, PubMed, and the Climate Change and Human Health Literature Search Portal) was conducted to identify articles that developed, validated, …

Comprehensive West Nile Virus Phylogenetic Analysis: Europe And Beyond, Robert T. Koch

Public Health Theses

ABSTRACT West Nile virus (WNV) inhabits a unique position in the infectious disease landscape. It is both the most widespread arbovirus in the world, and yet is one of the least known. WNV is spread by mosquitoes and has high morbidity and mortality in birds, humans are dead-end hosts of the virus but can develop a serious neuroinvasive form of the disease (WNND). The incidence of such cases is on the rise around the world. To explore WNV, we created a comprehensive phylogenetic analysis with all available WNV genomes in genbank database using Nextstrain to identify use cases for increasing …

Identification Of An In Vitro Medium For Leptospira Spp. As A Surrogate For Host Environment, Using Rna-Seq Transcriptome Analysis, Zitong Lin

Public Health Theses

Pathogenic Leptospira species causes millions of leptospirosis cases around the world and is an urgent public health issue that needs to be properly addressed. The infection leads to clinical manifestations ranging from self-limiting febrile illness to severe life-threatening symptoms. Currently, there is a lack of sensitive assay for early diagnosis of leptospirosis, and there is no FDA-approved vaccine for human use in the United States. Despite the worldwide occurrence of this zoonotic disease, low and middle-income countries are disproportionately affected by it. A better understanding of the pathogenesis of Leptospira is a crucial step for the development of better diagnostic …

This Place Is A Message: A Case Study Examining The Role Of Emotion, Storytelling, And Interactive Performance Art In Climate Change Communication, Maryanne Rebstock Cosgrove

Public Health Theses

Objectives. This Place Is A Message is a populist performing arts piece created by Faultline Ensembles to explore the relationship between the individual emotional experience and the collective trauma of the climate change crisis. Through personal narratives and emotional appeals, this production seeks to build community solidarity through community-led storytelling and harness participatory theater for climate change communication to be used to find climate solutions in a joint manner. Methods. Data was collected and analyzed using a mixed-methods approach utilizing self-reported surveys, including audience pre-show (N=75) and post-show (N=48) assessments and a survey of cast and crew members (N=14). Additionally, …

Using Community-Based Screening To Quantify The Relationship Between Hiv And Hypertension In A Rural South African Community, Jessica Ainooson

Public Health Theses

Background: Over the past three decades, the prevalence of hypertension has increased in sub-Saharan Africa, paralleling the HIV/AIDS epidemic. The aim of this study is to assess the relationship between HIV status and elevated blood pressure in a rural South African community. Methods: A secondary analysis was conducted from a community-based screening program providing TB/HIV/blood pressure/glucose screening in the rural sub-district of Msinga, KwaZulu-Natal, South Africa from 2011 - 2017. Descriptive analyses were used to characterize the frequency of measured and self-reported hypertension, HIV status, and sociodemographic variables. Multivariable logistic regressions were used to estimate the relationship between HIV status …

Descriptive Characteristics Of Injury Recidivism Among Adults In The Us: Population-Based Study, Mahna Alyami

Public Health Theses

Abstract

Introduction: In the United States (US), injury-related morbidity and mortality is a public health burden in terms of lives lost, healthcare costs, and lost productivity. In 2020, according to the Centers for Disease Control and Prevention (CDC), unintentional injuries were the fourth leading cause of death (200,955) behind heart disease, cancer, and COVID-19. Many of the studies of injury recidivism were limited to demographic data and often focus on a specific type of injury, such as motor vehicle crashes, interpersonal violence, or falls. The aim of this study is to present the descriptive characteristics of injury recidivism among adults …

Identification And Correction Of Normalized Deviance In Healthcare Systems To Prevent Healthcare-Associated Infections And Improve Patient Outcomes, Elliana Sophia Barbell

Public Health Theses

Introduction: In healthcare, normalized deviance is characterized by the steady transition away from standard practice toward variations in practice behaviors. This deviation presents minorly at first and is accepted to save time and increase efficiency. However, initial evaluations of innocuity do not represent actual safety. While the deviant practice may not cause immediate patient harm, its alignment with additional system weak points has the potential to lead to poor patient outcomes, including the development of healthcare-associated infections (HAI). One behavior that may influence HAI development and patient outcomes is hair removal during preoperative skin preparation.Methods: An observational study of hair …

Trends In Antimicrobial Resistant Non-Typhoidal Salmonella Before And After The Food And Drug Administration’S Guidance For Industry #213, United States 2013-2020, Lily Valentina Carruthers

Public Health Theses

Background: Previous research has shown a potential link between antibiotic use among food-producing animals and antimicrobial resistant enteric pathogens. In late 2016, the Food and Drug Administration completed the implementation of its Guidance for Industry #213, through which growth promotion was removed as an indication for use of medically-important antimicrobials among food-producing animals. This study aimed to describe trends in antimicrobial resistance among human Salmonella isolates from 2013-2020 in the United States before and after the implementation of this regulation.Methods: All non-Typhoidal Salmonella isolates sent to the National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS) from 2013-2020 were included …