Digital Commons Network^™

Intersection Of Religious And Antiretroviral Experiences And Its Implications For Medication Adherence In Hiv Positive Individuals In León, Nicaragua, Kimberly Stephanie Vasquez

Public Health Theses

Worldwide, in 2012, there were about 35.3 million people living with HIV/AIDS (PLWHA).1 Antiretroviral (ARV) significantly improved the livelihood of PLWHA through virological suppression, which has reduced HIV related mortality rates, and decreased the risk of HIV transmission through vaginal and anal sex.2,3 Optimal ARV adherence, around 95%, is required to maintain virological suppression.29 In 2000, a review paper reported that nonadherence rates were around 50-70%.30 Suboptimal adherence can lead to increased mortality, HIV transmission, and ARV resistance.2,3 Global suboptimal illustrates the importance of identifying barriers and facilitators to ARV adherence.7 Research is urgently needed to determine important barriers and …

Effectiveness Of A Diabetic Ketoacidosis Prevention Intervention In Children With Type 1 Diabetes, Rebecca J. Vitale

Public Health Theses

Diabetic ketoacidosis (DKA) continues to be common in youth with type 1 diabetes (T1D), with up to 10% of patients reporting at least 1 DKA event annually. Since many of these events should be preventable, we developed a brief educational intervention that was easy to implement in a busy practice setting and tested its effectiveness in reducing emergency department (ED) usage. Subjects aged > 13 years old or the parents of children aged <= 13 were given a short pre-test about their knowledge of signs and symptoms of DKA and sick day management practices. They were then instructed on sick day management specific to their treatment modality (pump vs. injection). Finally, they were given a printed tool for sick day management. 244 subjects in our pediatric T1D clinic received the intervention as part of a regular office visit. 76 of these subjects were given a follow-up survey 6-12 months later. Subjects/parents scored higher on the post-test than the pre-test (61.6% vs. 55.0% correct; p=0.007). Subjects/parents also recognized more diabetes sick days (p=0.014) following the intervention and called the emergency line more frequently (p=0.032). Among all subjects, ED use was reduced to 0.13 from 0.22 visits per person-year (p=0.07). ED visits significantly decreased among subjects > 13 years of age (0.10 per person-year after versus 0.21 per person-year prior; p=0.024). A short educational intervention and printed management tool is effective in improving sick-day and …

Differences In Hepatitis B Screening And Diagnosis Among Practices Serving Asian And Non-Asian Patients Using Electronic Health Records, Ha Vo

Public Health Theses

Background: Racial disparity in chronic infection with hepatitis B virus is a major public health issue in the United States. Limited data exist on rates of screening and diagnosis collected from providers instead of patient self-reported surveys.

Methods: Data were extracted from electronic health records (EHRs) of practices in New York City for 2013. Three measures of hepatitis B (Hep B) screening and diagnosis were collected: 1) lab tests for hepatitis B virus surface antigen (HBsAg); 2) diagnosis via International Classification of Diseases, 9th edition (ICD-9) codes; and 3) of lab tests ordered, positive results. Generalized estimating equation models were …

Cigarette Smoking And Thyroid Cancer Risk: A Population-Based Case-Control Study, Qian Wang

Public Health Theses

Abstract

Objective: Thyroid cancer incidence has increased substantially in the United States. Previous studies of the relationship between cigarette smoking and thyroid cancer have yielded conflicting results.

Methods: In order further clarify the association between cigarette smoking and risk of thyroid cancer, we analyzed data from a population-based case-control study in Connecticut in 2010-2011 including 462 histologically confirmed incident thyroid cancer cases and 498 population-based controls. Multivariate unconditional logistic regression models were used to estimate the associations between cigarette smoking and risk of thyroid cancer adjusting for potential confounders.

Results: Our data showed a decreased risk of well-differentiated thyroid carcinoma …

The Impact Of Parenting On Stress And Stress Coping In Asian American Youth: A Qualitative Study, Lixuan Wang

Public Health Theses

Abstract

Exposure to high academic achievement pressure and parent-child conflict is associated with poor psychological adjustments among Asian American Youth. Analyzing qualitative interview data of COEAA project, this study explored how parenting is related to youth’s internalizing the high achievement motivation and impact youth perceived stress and stress coping strategy among families of East Asian origin.

Participants consisted of 15 youth aged 15-24 who were born in US or have been living in US since 4th grade and 7 parents who identified themselves as first generation immigrants from East Asian counties and had children aged 14-24;

Results: Findings revealed that …

The Microbiome And Pneumonia Disease Severity In Asthmatic Children, Sarah Rae Wannier

Public Health Theses

Background: Pnuemonia is a leading cause of morbidity and mortality worldwide and children diagnosed with asthma have been shown to be at greatly increased risk of recurrent Community-Acquired Pneumonia (CAP). CAP in asthmatic children can incur nearly double the healthcare costs and lead to poorer outcomes during the course of the pneumonia infection.

Objective: This study seeks to determine if sputum (SP) samples may be used in the pediatric population to better understand the microbiome environment during severe pneumonia in place or in conjunction with the more commonly used nasopharyngeal (NP) samples. Additionally, this study seeks to identify features of …

Pm2.5 And Ambient Air Pollution: Effects On Medicaid Spending And Hospitalizations, Joshua William Wei

Public Health Theses

Rationale: Fine particulate matter (<2.5 um), or PM2.5, and Ozone has been linked to a number of respiratory and cardiovascular conditions and is a known trigger for acute events. Though previous studies have addressed these correlations, few have examined PM2.5’s acute effects on inpatient admissions and health care costs, by utilizing narrower time intervals than other research projects.

Objectives: To identify whether trends in hospitalization spending in short time-intervals is associated with PM2.5 measures, and to create a predictive model for spending based on two major categories of outcomes: selected CV conditions and respiratory conditions known to be associated with PM2.5 exposure that we will identify by Medicaid charge codes. We also attempt to model inpatient admissions altogether as an alternative outcome.

Methods: We link Medicaid charge information for all procedures in Texas to daily air-quality data sourced from 63 EPA sites in the state (providing more comprehensive geographical and temporal coverage) and …

The Effect Of Exercise Versus Usual Care On Depression In Breast Cancer Survivors: The Hormones And Exercise (Hope) Study, Bridget Ann Winterhalter

Public Health Theses

Purpose: Despite effective therapies and treatments, breast cancer survivors often suffer from distressing side effects which may increase depressive symptomatology. Aromatase inhibitors (AI) are widely used as adjuvant treatment in breast cancer patients, but are associated with side effects such as joint pain that may impact quality of life. We conducted, in 121 breast cancer survivors receiving an AI, a yearlong randomized trial of exercise versus usual care on depressive symptomology.

Methods: Eligibility criteria included taking an AI for at least 6 months, reporting < 90 minutes per week of exercise and no strength training, and reporting > 3 on a scale of 10 for worst joint pain on the Brief Pain Inventory (BPI). …

Acculturation And Likelihood Of Exclusive Breastfeeding Among Liberian Refugees And Ghanaians Living In Buduburam Camp In Ghana: A Cross-Sectional Study, Meley T. Woldeghebriel

Public Health Theses

Poor breastfeeding practices can put children at increased risk of morbidity and mortality particularly due to diarrheal and respiratory diseases and impaired physical and mental development. It is therefore important to understand the determinants of exclusive breastfeeding, particularly among residents in refugee settlements who may not have access to key resources and health education. The purpose of this study was to explore if acculturation influenced exclusive breastfeeding practices among Liberian refugees living in the Buduburam refugee settlement. A cross-sectional survey was administered between July - August 2008 to Ghanaian and Liberian women, with at least one biological child between 6 …

Strategies For Recruiting Representative Samples Of Asian Americans, Native Hawaiians, And Pacific Islanders For Population-Based Studies, Celeste Wong

Public Health Theses

There is limited data on effective methods for recruiting ethnically and culturally diverse populations into population-based studies. For case-control studies in particular, appropriate selection and successful recruitment of representative control subjects remain a challenge. In a population-based case-control study assessing novel risk factors for breast cancer among Asian Americans, Native Hawaiians, and Pacific Islanders (AANHPIs), we utilized a unique combination of population-based sampling, community-based recruitment methods, and internet- and media-based approaches for recruiting controls who were frequency matched to cases identified through a population-based cancer registry in the San Francisco Bay Area. We characterized the populations drawn from each recruitment …

The Impact Of Maternal Trauma And Posttraumatic Stress Disorder On Parenting Stress, Maureen Wright

Public Health Theses

Purpose: The goals of this study were to determine the prevalence and type of maternal trauma since childbirth, to examine the association between maternal trauma, PTSD, and maternal stress, and to assess the impact of PTSD symptom severity on maternal stress.

Methods: Participants consisted of 297 women who were screened for trauma, PTSD, and maternal stress at 28 (±2) weeks gestation, 8(±4) weeks postpartum, and at approximately 3 years after their child's birth. Using results from the 3 year survey, unadjusted and adjusted associations between PTSD status and parental stress were examined using ANOVA F-test and multiple regression, respectively.

Results: …

Development And Validation Of A Nomogram To Predict Pathological Complete Response To Neoadjuvant Chemotherapy For Breast Cancer, Qi Yang

Public Health Theses

Purpose The purpose of this study was to combine clinical pathologic variables that are associated with pathological complete response (pCR) following neoadjuvant chemotherapy into a prediction nomogram.

Methods A total of 15,553 women who underwent neoadjuvant chemotherapy for invasive breast cancer in 2010 and 2011 were identified from National Cancer Database (NCDB). Univariate analysis and multivariate logistic regression analysis were used to examine the association of patient age, race, tumor histology, tumor grade, molecular type, and clinical stage with pCR. A nomogram was then developed to predict individual patient probability of pCR to neoadjuvant chemotherapy. Internal validation was performed in …

Gender And Caregiving Network Differences In Adult Child Caregiving Patterns: Associations With Care-Recipients’ Physical And Mental Health, Hongjin Yan

Public Health Theses

Abstract

Purpose of the study: To examine gender and caregiving network differences in the care provided to older adults by adult children and the association with care-recipients’ physical and mental health at baseline and longitudinally. To test the hypothesis that poorer health at baseline and better health over time will be observed in care-recipients with multiple caregivers compared to care-recipients with one caregiver.

Design and Method: A secondary analysis of the most recent national cross sectional survey – National Health and Aging Trends Study (NHATS) conducted from 2011 to 2013 with 5616 older adults (65 years of age or older). …

The Federal Trade Commission As Convenor: Developing Regulatory Policy Norms Without Litigation Or Rulemaking, William E. Kovacic

Colorado Technology Law Journal

No abstract provided.

The Law And Ethics Of Experiments On Social Media Users, James Grimmelmann

Colorado Technology Law Journal

No abstract provided.

Two Cheers For Corporate Experimentation: The A/B Illusion And The Virtues Of Data-Driven Innovation, Michelle N. Meyer

Colorado Technology Law Journal

No abstract provided.

Are A Competition Authority And An Industry Regulator Equivalent?, Fiona Scott Morton

Colorado Technology Law Journal

No abstract provided.

Antitrust Policy And Communications Regulation: May The Twain Meet, Jon Sallet

Colorado Technology Law Journal

No abstract provided.

Acculturation And Diabetes Risk Among Mexican Americans, Chelsea Anderson

Public Health Theses

Mexican Americans experience a disproportionate burden of type 2 diabetes in the United States, but it is unclear how acculturation influences diabetes risk in this Hispanic subgroup. We studied the influence of acculturation on diabetes risk in a large cohort of Mexican Americans. Acculturation was assessed at baseline by means of language use, birth country, and duration of residence in the U.S. (among Mexico-born participants). Self-reported diabetes status was ascertained during annual follow-up interviews. Cox proportional hazards regression was used to model the influence of each acculturation proxy variable on incident diabetes. Interactions with each acculturation measure were also tested …

Namati: Innovations In Legal Disempowerment For Health? A Sierra Leonean Case Study, Ikenna Okezie Achilihu

Public Health Theses

Drawing on eleven weeks of fieldwork for Namati’s Health Accountability and Social Empowerment Program, this case study investigates whether Namati interventions reinforce existing formal and customary structures for the amelioration of grievances between health clinics, their associated staff, and intended beneficiaries. Furthermore, this study questions Namati’s role as an organization that fosters sustainable change at: the level of the grassroots in its ability to influence government health policy, and at the level of the elites in its ability to improve administrative and policy deficiencies in the area of health access. Finally, this study answers critical questions on the equity-enhancing effects …

Evaluation Of Yale New Haven Health System Employee Wellness Program, Raj Ahsan

Public Health Theses

Objective: To assess the effectiveness of the Yale New Haven Health System (YNHHS) Employee Wellness Program.

Methods: A pre- and post- study design of wellness-enrolled employees from YNHHS was conducted. Biometric screening, Health Risk Assessment, one-on-one counseling and other wellness interventions were made available to 20,630 employees across the health system. There were 8,164 individuals who participated in both 2013 and 2014. Analysis was performed on the biometric measurement data obtained at initial screening in 2013 and follow up screening in 2014.

Results: Clinically and statistically significant improvements were seen after one year in biometric measures: BMI, systolic blood pressures …

Who Gets An Iud: The Impact Of Patient Race And Number Of Past Sexual Partners On Clinical Decisions To Prescribe Intrauterine Devices, Tiffany Nicole Bell

Public Health Theses

While disparities by race/ethnicity in reproductive and sexual health outcomes are well documented, the role that healthcare providers play in contributing to these disparities is only beginning to be explored. This investigation sought to examine medical and nursing students' bias surrounding the prescription of intrauterine devices (IUDs, i.e., long-acting reversible contraception) to adolescents based on the patient's race and sexual history. An online survey presented participants with a clinical vignette of an IUD-seeking sexually active adolescent, with the patient's race and number of past sexual partners systematically manipulated. Participants reported predictions about patient risk of getting pregnant with and without …

A Mathematical Investigation Of The Drivers Of Lyme Disease Ecology At Two Ecologically Contrasting Sites, Malia Joy Carpio

Public Health Theses

INTRODUCTION: Lyme disease is an emerging tick-borne disease of increasing concern in the United States. In order to create and to implement effective public health interventions for Lyme disease, there must be a better understanding of the factors driving pathogen transmission.

OBJECTIVES: The primary objectives of this study were to determine how presence/absence of “super-spreaders” and observed differences between two ecologically contrasting sites influence Borrelia burgdorferi transmission.

METHODS: A next generation matrix R0 model was parameterized with field data from an island site (Block Island, Rhode Island) and a mainland site (Connecticut) in order to generate R0 estimates. A local …

Five-Year Resistance Trends Of Bacterial Isolates In Kigali, Rwanda, Makeda Aminah Carroll

Public Health Theses

Antimicrobial resistance (AMR), the phenomenon of decreased sensitivity to pharmaceutical agents that kill or inhibit the growth of bacterial pathogens, is a serious threat to public health worldwide. Many countries, including Rwanda, lack current information on antibiotic sensitivity profiles that would greatly aide clinicians and policy-makers. The current study aims to describe the time trends of antibiotic sensitivity for the isolates of six different bacterial pathogens from patients at King Faisal Hospital in Kigali, Rwanda and to make inference about future patterns of drug resistance in the study setting, to guide physicians in their prescribing practices and provide baseline data …

The Epidemiology Of Clostridium Difficile Infections Among Oncology Patients, Yunyoung Gina Chang

Public Health Theses

Clostridium difficile is the leading cause of hospital-acquired diarrhea. Oncology patients are a group of immunosuppressed patients who are at increased risk for C. difficile infection. The primary objective of this study was to describe the demographic factors, medical history, and clinical characteristics and identify risk factors for C. difficile infection among oncology patients. A retrospective chart review was conducted for this case-control study. Seventy-seven cases were compared to two control groups; one control group of patients with diarrhea but whose stool samples were tested and were negative for C. difficile (n=77), and a second control group of patients matched …

Implications Of Discordances Between Stroke Clinical Diagnoses And Icd-9-Cm Codes – 2013 Data From The Paul Coverdell National Acute Stroke Program, Tiffany Elizabeth Chang

Public Health Theses

Background/ Purpose: Epidemiology and health services research often use International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to translate clinical information contained in administrative databases. Since errors in ICD-9-CM codes can affect the interpretation of results from these studies, we sought to expand upon existing research by determining if there are systematic variations in concordance between stroke patient clinical diagnoses and ICD-9-CM codes by hospital characteristics and degrees of stroke severity.

Methods: We used patient records with a discharge date in 2013 from the Paul Coverdell National Acute Stroke Program (PCNASP). Our primary analysis quantified the concordance between …

Environmental Policy Assessment & Observation (Epao) In Daycare Centers: Does The Daycare Provider And Environment Matter?, Jenna Ciotti

Public Health Theses

Abstract

Background: Prior to the development of the Activity Begins in Childhood (ABC) Trial, no cluster-randomized control trial has investigated the effectiveness of a physical activity intervention with daycare providers in Canada.

Rationale: Educating daycare providers about the importance of improving their preschooler’s gross motor skills, physical activity, and reducing sedentary time in their daycare environments is an important step toward diminishing the rates of childhood obesity and overweight across Canada.

Method: A total of N = 15 daycare centers were enrolled in the ABC trial and equally randomized to: Intervention 1, Intervention 2, or a Comparison Group. Intervention providers …

Extended Conventional Therapy In Adult Xlh Patients, Jessica Ann Connor

Public Health Theses

Context: Treatment of X-linked hypophosphatemia (XLH) with active vitamin D metabolites and phosphate can partially correct skeletal deformities. It is unclear if therapy influences the occurrence of two major long-term morbidities in XLH: enthesopathy and dental disease.

Objective: To investigate the relationship between treatment and enthesopathy and dental disease in adult XLH patients.

Design: Observational and cross-sectional.

Setting: Academic medical center’s hospital research unit.

Participants: 52 XLH patients aged >= 18 at time of study.

Interventions: None

Main outcome measures: Number of enthesopathy sites identified by radiographic skeletal survey and dental disease severity (>5 or <=5 dental abscesses), identified historically.

Methods: Associations between proportion …

Safety Climate And Healthcare Worker Injury Rates, Jacqueline Cook

Public Health Theses

BACKGROUND: Safety climates that support safety-related behavior are associated with a fewer work-related injuries, and prior research in industry suggests that safety knowledge and motivation are strongly related to safety performance behaviors; this relationship is not well studied in healthcare settings. METHODS: We performed analyses of survey results from a Veterans Health Administration (VHA) Safety Barometer employee perception survey, conducted among VHA employees in 2012. The employee perception survey assessed six safety program categories, including management participation, supervisor participation, employee participation, safety support activities, safety support climate, and organizational climate. We examined the impact of safety climate from the survey …

Confusion In The Marketplaces: A Qualitative And Experimental Assessment Of The Decision-Support Tools Used By Northeastern State-Based Health Insurance Exchanges, Taylor Robert Daily

Public Health Theses

The state-based exchanges created under the Affordable Care Act are not passive marketplaces that merely offer health insurance plans; they also endeavor to provide support to consumers in selecting those plans that best fit their healthcare needs. This paper examines the method by which six state-based exchanges (Connecticut, Maryland, Massachusetts, New York, Rhode Island, and Vermont) attempt to accomplish this goal using their online shopping infrastructure, also known as a decision-support tool. First, these decision-support tools are qualitatively compared in order to access the design choices made by policymakers and relate those design choices to how they may impact consumer …