Digital Commons Network^™

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 …

Gender Differences In Linguistic Indicators Of Communion And Agency: Associations With Caregiver Stress, Hannah-Rose Mitchell

Public Health Theses

This study examined gender differences in caregivers' use of agentic and communal words when talking about their care recipients' suffering and how this related to their stress, in terms of cardiovascular reactivity and self-reported negative emotion. Seventy-six older adult caregivers of spouses with chronic pain were recorded while describing an incident of their spouses' suffering. Caregivers' heart rate (HR) was continuously monitored during their speeches, and they reported their emotions (distress and anger) after their speeches. In addition, respiratory sinus arrhythmia (RSA) was calculated using HR. Results indicated that male caregivers were more likely to talk about a relational episode …

Exploring The Prevalence And Effects Of Sexual Stigma, Gender Identity And Sexual Orientation On Mental Health In Men Who Have Sex With Men And Transgender Women In Chennai, India, Megan Marie Mcinnis

Public Health Theses

Men who have Sex with Men (MSM) and Transgender (TG) women are known to experience high levels of mental stress secondary to stigma associated with their gender identity or sexual orientation. We conducted a cross sectional study to assess how gender identity, sexual orientation, sexual stigma, violent sexual stigma, and important covariates (life satisfaction, social support, and alcohol dependency) influence major mental health outcomes (depression, anxiety and PTSD) among 101 MSM and 53 TG women recruited from 7 sex cruising zones in Chennai, India. Results showed that the gender identity and sexual orientation scale may provide a new method to …

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.

Predictors Of Retention In Hiv/Aids Care At The Yale-New Haven Hospital Nathan Smith Clinic: Exploratory Analysis Using The Community Careware Database, Chi Ngo

Public Health Theses

Background: A `test-and-treat' strategy for HIV prevention in the United States is a method that was proposed in an effort to curb and reduce HIV transmission. However, the magnitude of the limitations observed at the various stages in the spectrum of engagement in care can threaten the `test-and-treat' HIV prevention initiative because successful retention remains problematic. Based on the United States' retention statistics, approximately one fourth to one half of those who were diagnosed with HIV were out-of-care. This figure suggests we need more information about the best ways to retain HIV-infected individuals in care.

Objective: In order to determine …

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 …

Reproductive Health And Gender-Based Violence In Syrian Refugee Women, Amelia Reese Masterson

Public Health Theses

Background: The current conflict and humanitarian crisis in Syria continues to displace thousands of Syrians to neighboring countries, including Lebanon. There is a lack of information available to provide adequate health and related services to this displaced population, particularly women and adolescent girls, who comprise the majority of registered refugees. Methods: We conducted a rapid needs assessment from June-August 2012 in Lebanon by administering a cross-sectional survey in six health clinics and conducting three focus group discussions. Information was collected on reproductive and general health status and needs of displaced Syrian women, including exposure to violence and help-seeking behaviors. Results: …

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 …

The Role Of Race In The Association Between Weight Status And Risk Behaviors Among United States Adolescents, Jennifer M. Sanderson

Public Health Theses

Objective: To evaluate whether race and ethnicity moderate the association between weight status and risk behaviors in a nationally-representative sample of adolescents.

Methods: The 2009 and 2011 Youth Risk Behavior Surveys were combined (N = 25,550), and used to compare substance use, risky sexual behaviors, and violent behaviors between healthy weight, overweight, and obese adolescents. In both overall and race-stratified samples, chi-square tests and logistic regression were used to determine associations between weight status and engagement in risk behaviors among White, Black, and Hispanic adolescents. These analyses were performed separately in males and females.

Results: Overweight and obese adolescents had …

Assessing The Programmatic And Financial Sustainability Of The Seriousfun Global Parternship Program Among Camp Directors: A Qualitative Study, Kate Elizabeth Schedel

Public Health Theses

Background: After five years of programming, the SeriousFun Global Partnership Program (GPP) is looking to evaluate their model for programmatic and financial sustainability: specifically, among camp directors. To date, little is known about the facilitators and barriers camp directors face in working towards a sustainable program.

Objectives: To identify areas in which camp directors need more support from the SeriousFun staff to move towards programmatic and financial sustainability, and to highlight the Global Partnership Program's best practices for other public health programs striving for sustainability.

Design: A qualitative study that used in-depth telephone interviews with camp directors as well as …

The Association Between Allelic Variation In Bdnf, Scholastic Achievement, And Cognition, Andrew Carl Shore

Public Health Theses

Background

There is a growing need to understand the role of genetics in determining innate ability and cognition. The Brain Derived Neurologic Factor (BDNF) gene codes for a nerve growth factor protein whose association with cognitive disorders makes it a plausible candidate gene for association with cognitive functioning. This study looks at the association between allelic variation in six SNPs in the BDNF gene and cognition.

Methods

Demographic and schooling information was gathered from school aged children in the Eastern Province of Zambia. The four subtests of the Zambian Achievement Test were used to capture academic achievement. Three subtests of …

Factors Associated To Adolescent Sexual And Reproductive Health: A Parental Perspective From Calca, Peru, Ana Sierra

Public Health Theses

Abstract

Background: There are more than 5.8 million adolescents (10-19 year olds) in Peru. Their sexual debut is between 14 and 17 years old. Despite efforts to increase sexuality-related knowledge within this population, condom and contraceptive use is low.

Problem: Knowledge is important; but there are many other factors also influencing adolescent behavior. Parent-child communication has been found to be an important factor influencing adolescent sexual and reproductive health (ASRH) outcomes in Lima. However, little is known about ASRH in the rural Andean regions of Peru and parental attitudes and factors of influence.

Methods: Six focus groups were carried out …

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 …

Prevalence, Sample Size, And Power Investigation In Neoadjuvant Therapy For Breast Cancer Clinical Trials, Jennifer So

Public Health Theses

Common practice in neoadjuvant therapy clinical trials for breast cancer that use pathological complete response rate (pCR) as an endpoint are conducted within a Human Epidermal Growth Factor Receptor 2 (HER2) indication group for both Estrogen Receptor - positive (ER+) and Estrogen Receptor - negative (ER-) cancers. Given the clinical background and trends of breast cancer therapy trials, this study aims to demonstrate in cases where the observed prevalence and response rates may be so different from the expected values that priori sample size calculation and power analyses were based on, that dangers may arise in producing an insufficiently powered …

Effect Of Exercise On Vo2max In Breast Cancer Survivors Taking Aromatase Inhibitors: The Hormones And Physical Exercise (Hope) Study, Mia Sorkin

Public Health Theses

Purpose: The purpose of this study was to investigate the effects of a yearlong exercise intervention compared to usual care on cardiorespiratory fitness in sedentary breast cancer survivors who were taking aromatase inhibitors and experiencing arthralgia.

Methods: Participants were randomized to either an exercise intervention group that met twice weekly with a personal trainer or usual care. Participants completed self-administered questionnaires, including reporting demographic and personal characteristics, and a graded treadmill test using a modified Branching protocol at baseline and at the end of the 12-month study. T-tests and chi-squared analyses were used to assess change in cardiorespiratory fitness, measured …

Silicosis, Tuberculosis (Tb) And Hiv/Aids: The Triple Epidemic Among Gold Mineworkers In South Africa (Literature Review And Policy Analysis), Surabhi Srivastava

Public Health Theses

The scourge of the triple epidemic of silicosis, tuberculosis (TB) and HIV/AIDS has plagued the South African gold mineworkers, with black mineworkers in particular, for over two decades now. Factors such as oscillating migration patterns, hazardous working conditions, and crowded living arrangements allow for the perfect conditions needed to sustain and amplify the epidemic within this population. The objective of this thesis is to provide a detailed review of the epidemiological literature regarding the different aspects of the silicosis, TB and HIV epidemic in South Africa, followed by an in-depth analysis of the current policy response, and its implications for …

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 …

Modeling Of Ambient Black Carbon Concentration Using Traffic, Temporal And Meteorology Data In Connecticut, Kunfeng Sun

Public Health Theses

Black carbon is a component of fine particle pollution that exerts adverse effects on both global climate change and human health. It is produced through incomplete combustion of fossil fuels and biofuels. Therefore, some of its major emission sources are diesel engines, residential heating and industry. Due to its strong ability to absorb solar energy, black carbon is one of the major contributors to global warming. In addition, black carbon and other fine particle pollutants can be inhaled into the lower respiratory track, causing and exacerbating health conditions such as asthma, chronic obstructive pulmonary disease, low birth weight, cardiovascular diseases …

Characteristics And Clinical Outcomes Of People Living With Hiv/Aids Participating In A Home-Delivered Meal Program In New Haven, Ct., Isy Victoria Tavarez

Public Health Theses

ABSTRACT

Background: Food insecurity is an issue of great concern among people living with HIV/AIDS (PLWHA). Food insecurity can lead to anxiety, and depression which is in turn associated with poor medication adherence. Food insecurity is a threat to the nutritional status of PLWHA. PLWHA already have a higher energy demand due to the presence of the virus. The lack of food intake can further compromise the immune system and encourage wasting. Because Food insecurity is such a concern among PLWHA, Caring Cuisine which is a program run by Aids Project New Haven in CT, delivers meals for clients who …

Community Greenspace's Impact On Perceived Health Of New Haven Adults, Bridget Elizabeth Teevan

Public Health Theses

Background: In 2008, for the first time in history, urban space is the predominant dwelling place of the human race, which raises concerns about how the presence or absence of green spaces influences the health of residents. The Urban Resources Initiative (URI) in New Haven, Connecticut offers a Community Greenspace Program that provides community members with resources for designing and stewarding an area within their neighborhood. The goal of this study is to determine if these community-developed green spaces improve the self- perceived health of the adults living in that neighborhood.

Methods: Data on self-perceived health was gathered from the …

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 …

Is Time Since Food Safety Training Associated With Inspection Score?, Mary Traglia

Public Health Theses

Objective: To determine if the time since food safety training is associated with inspection scores in class III and IV kitchens in Connecticut

Methods: Ledge Light Health District, which represents five towns in southeastern CT, provided 2011 inspection records and qualified food operator (QFO) training certificates for licensed kitchens in its jurisdiction. Establishments were included in analysis if they were class III or IV and had one identifiable QFO present at the time of inspection, with the corresponding QFO training record on file. Data was collected on establishment type, QFO certifying exam, inspection score, and risk factor violations. A linear …

Age Differences In Social Support And Mental Health In Male Veterans, Melissa Rachel Weiner

Public Health Theses

Psychological concerns among United States veterans of all ages are considerable, however social support may help improve the mental health of these individuals. The protective effect of social support on mental health has been observed in older and younger samples of veterans, but it is unclear whether social support may be more beneficial at certain life stages. By assessing cross-sectional survey data from a large sample of veterans using an extreme groups approach (EGA), the impact of perceived support, structural support, and community integration on mental health difficulty and screening positive for a mental disorder was assessed. The effect of …

Evaluation Of Malaria Surveillance In Bhutan, 2006-2012, Nicole Gail West

Public Health Theses

Bhutan is embarking on elimination over the course of the next decade. The purpose of this evaluation is to assess the ability of the current surveillance system to meet the objectives of the Vector-borne Disease Control Programme (VDCP), to highlight the priorities of the surveillance system as the nation transitions into an era of elimination, and to identify areas that require attention for this goal to be achieved. An evaluation of the national malaria surveillance system of Bhutan from 2006 to 2012 was conducted using the CDC updated guidelines for evaluation. National malaria surveillance data, written VDCP protocols, and informal …

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 …

Remote Monitoring Of Implantable Cardioverter-Defibrillators From 2006 To 2010: Patterns Of Utilization And The Impact Of New Current Procedural Terminology Codes, Yao Yang

Public Health Theses

Background: The PREDICt-RM study found that Remote Patient Monitoring (RPM) was used by less than half of eligible patients with implantable cardioverter-defibrillators (ICDs) between 2006 and 2010 despite guideline recommendations. We investigated whether the addition of new Current Procedural Terminology (CPT) codes for RPM in January 2009 had impact on utilization of RPM technology and whether the impact varied by race or geographic region. Methods: We used multivariable logistic regression to determine whether subjects in the PREDICt-RM study cohort receiving an ICD post-coding change were more likely to enroll in an RPM program or activate RPM (transmit RPM data) within …

Distinct Trends In 30-Day Observed And Risk-Standardized Mortality Rates Of Acute Myocardial Infarction Patients, 2005-2010, Caroline Yoo

Public Health Theses

In the effort of comparing health care quality across hospitals and profiling hospitals, the Centers for Medicare and Medicaid Services (CMS) utilize risk-standardized outcome in which the hospital-level outcome is standarized adjusting for patient-covariates using hierarchical model for patients outcome clustered within hospital. Even though standardized measure is useful for comparing hospitals, we believe the analysis of observed hospital-level outcome without standarization can reveal additional information at the hospital-level. The implication of using both types of mortality rates was studied in the context of analyzing 30-day mortality trend of Acute Myocardial Infarction (AMI) patients. Therefore the objective of this study …

Assessing Diabetes Integrated Patient Education And Glucose Control And Differential Diabetes Treatment Response By Gender In Jordan, Osama Zayyad

Public Health Theses

Background: Between 1994 and 2004 the prevalence of diabetes in Jordan increased from 13.0% to 17.1%. Among individuals with diabetes in Jordan, 54% had unsatisfactory blood glucose control. In response to the diabetes epidemic in Jordan, the National Center for Diabetes Endocrinology and Genetics (NCDEG) was founded. NCDEG's primary objective is to improve diabetes treatment in Jordan, and does so by offering treatment facilities specific for diabetic patient needs. In 2008 NCDEG began implementation of an integrated patient education strategy (IPE). Certified diabetes educators joined NCDEG and were provided space within each diabetes clinic within the center for individual patient …