Medicine and Health Sciences Commons^™

A Prediction Model Of Rotavirus Vaccine Performance Based On Meta-Analysis And Variable Selection, Yueqi Li

Public Health Theses

Background: Rotavirus is the leading cause of diarrheal diseases worldwide and is responsible for substantial morbidity and mortality among children younger than 5 years of age. The introduction of national immunization programs against rotavirus has greatly reducedhospital admissions and deaths from rotavirus gastroenteritis, but vaccine efficacy and effectiveness vary substantially between high- and low-income settings. Given the disparity of vaccine performance across countries, we built a model to predict how well the vaccines would work in settings without vaccine introduction. Methods: Data on vaccine performance and relevant predictor variables were extracted from the literature and repositories. We performed a meta-analysis …

Evaluating The Cost-Effectiveness Of Varied Vaccination Strategies For Ebola Virus Disease In The Democratic Republic Of The Congo, Rachel Amanda Lobe-Costonis

Public Health Theses

Introduction: The 2018 outbreak of Ebola virus in the Democratic Republic of Congo was the first to occur in the context of an ongoing complex humanitarian emergency. Despite optimism for an effective response given the efficacious one-dose Merck vaccine (ERVEBO), the immense challenges to public health efforts caused by the ongoing armed conflict posed unprecedented complications to the recommended ring vaccination strategy. In the end, contract tracing efforts for ring vaccination reached only 82% of individuals at best estimate, and the outbreak lasted 89 weeks with a total cost of $734 million. In comparison, transmission dynamic modeling has shown the …

Evaluation Plan For A Mortality Surveillance System In Northwest Syria, Hanna Peterson

Public Health Theses

AbstractIntroduction: Cause-specific population mortality data is one of the most useful metrics used to monitor and evaluate the severity of a crisis. However, the unique context of fragile and protracted armed conflicts creates obstacles for establishing a mortality surveillance system. When CRVS are not feasible, VA can be used to generate high-quality mortality rate estimates. There is currently little documentation of implementation and evaluation of mortality surveillance systems in conflict settings, and guidance for both is extremely limited. This thesis aims to contribute to these two knowledge gaps by providing an evaluation plan for a mortality surveillance system in Northwest …

Xylazine In The Drug Supply: Emerging Threat In Connecticut And Lessons Learned From Philadelphia, Thomas A.G. Quijano

Public Health Theses

Background: Xylazine, a sedative analgesic drug approved as an animal tranquilizer but not for human use, has become an adulterant in the supply of heroin/fentanyl.(Greene & Thurmon, 1988) Between 2019 and 2020, prevalence of xylazine in overdose death reports increased by 44.8% nationally.(Friedman et al., 2021) The three jurisdictions in 2020 with the highest prevalence of xylazine were Philadelphia (25.8%), Maryland (19.3%), and Connecticut (10.2%).(Friedman et al., 2021) Not much is known about how xylazine’s impacts on service provider’s practices and the people they serve.

Objectives: Use a multiple methods approach to understand xylazine’s presence and impact in Connecticut, and …

Assessing Changes In The Epidemiology Of Cutaneous Leishmaniasis In Southwest Colombia Following The Peace Accord With Fuerzas Armadas Revolucionarias De Colombia (Farc), Matthew Stephen Benczkowski

Public Health Theses

The Colombian Conflict persisted for over 50 years, recently coming to an end in November 2016 after the signing of Colombia’s Peace Agreement between the government and FARC guerrilla group. Internal armed conflict is often entangled with the exacerbation of health outcomes, including promoting the spread of infectious diseases like cutaneous leishmaniasis (CL). CL is a vector-borne parasitic disease localized to the human tegument that decreases quality of life through lesions leading to scars and associated stigmatization. This study assessed changes in demographic and clinical characteristics of patients with CL in Southwest Colombia before and after the signing of the …

The Utility Of A Maximum Entropy Species Distribution Model For Ixodes Scapularis In Predicting The Public Health Risk Of Lyme Disease In Ontario, Canada, Holly Alexandra Burrows

Public Health Theses

Introduction: Lyme disease is an emerging public health threat in Ontario, Canada due to the range expansion of the tick vector, Ixodes scapularis. Tick abundance and density are important predictors of human Lyme disease risk and are typically measured using active tick surveillance (dragging). New cost-effective tools are needed to augment current surveillance activities.Objective: The objective of this study was to evaluate the ability of a Maximum entropy species distribution model to predict I. scapularis density and abundance in three regions of Ontario – Ottawa, Kingston, and southern Ontario – in order to determine its utility in predicting the public …

Sexual Orientation Disclosure And Depression Among Thailand Men Who Have Sex With Men: Associations With Intimate Partner Violence And Social Support, Eduardo Encina

Public Health Theses

Objectives: The analytical goal of this project is to better understand the association of sexual orientation disclosure among different social networks of Thailand men who have sex with men (MSM) and depression. Along with this, we aim to extensively explore the intersectional influence of social support and intimate partner violence (IPV) experiences with each other, with disclosure, and ultimately depression outcomes.

Methods: The secondary dataset for this project was comprised of results from a cross-sectional study. This study utilized a web-based epidemiological and behavioral survey, distributed among young MSM ages 15-24. Self-reported data was provided through collaboration with Mahidol University …

Developing A Framework For Civilian-Military Public Health Operations Involving Non-State Armed Groups, Andrew James Chambers

Public Health Theses

Introduction: The interface of military forces, civilian actors and non-state armed groups (NSAGs) during a public health emergency within an active conflict is a situation fraught with legal and ethical challenges not adequately addressed in established doctrine or international guidance documents. Ongoing public health crises in Yemen and Afghanistan represent the real-world consequences of threats to population health and security if these critical gaps are not addressed. Methods: A list of five diverse medical scenarios was developed as an initial attempt to produce a practical, historically-informed framework for use in future civilian-military (CIV-MIL) training events and guidance. Ten virtual interviews …

Exploring Thai Physicians’ Perceptions Of And Willingness To Prescribe Pre-Exposure Prophylaxis (Prep), Brandi E. Moore

Public Health Theses

Background: Oral pre-exposure prophylaxis (PrEP) is a daily medication that can prevent HIV infection. PrEP may further support HIV prevention initiatives in Thailand, particularly as it becomes more accessible in the country’s government clinics and hospitals. While studies have explored perceptions of PrEP for at-risk people in Thailand, there has been limited investigation into Thai physicians’ opinions of and willingness to prescribe PrEP. Methods: Using convenience sampling, this cross-sectional study recruited 132 Thai physicians to complete an anonymous, online survey. The survey assessed physicians’ concerns about PrEP, experience with PrEP, and willingness to prescribe PrEP. Bivariate and multivariable logistic regressions …

Screening For Legionnaires’ Disease: A Predictive Model For Improving Health And Economic Outcomes, Alyssa K. Amick

Public Health Theses

Introduction: Legionnaires’ disease (LD), caused by the Legionella bacterium, is a rare but serious atypical pneumonia that is often underdiagnosed in the clinical setting. Recent guideline changes by the American Thoracic Society limited use of the urinary Legionella tests, the primary form of diagnosis, due to the excessive costs of regular testing. Delays in testing and diagnosis of LD result in increased cost of treatment and risk of death.

Objective: To develop a predictive model to estimate a patient’s probability of having LD. This model would serve as a screen to better target diagnostic efforts, prevent misdiagnosis, and reduce the …

A Prospective Cohort Study To Evaluate The Efficacy Of A Peer-Led Tuberculosis Education And Counseling Intervention In Kampala, Uganda, Anna Dawn Baker

Public Health Theses

Tuberculosis (TB) is one of the leading causes of death worldwide and disproportionally burdens low- to middle-income countries (LMICs). Upon initiation of treatment for an active TB diagnosis, universal TB education and counseling (TEC) is recommended to promote knowledge and medication adherence. Though previous studies have shown that there are areas that can be improved when delivering routine TEC, there is limited data on how peer-led TEC can fill these gaps in Kampala, Uganda. Our study evaluated the efficacy of a peer-led TEC intervention among newly diagnosed adults initiating TB treatment in Kampala and assessed capacity for scale-up. We used …

The Impact Of Medicaid Expansion On Childhood Vaccination Rates, 2010-2018, Chandra K. Couzens

Public Health Theses

Background

The relationship between coverage expansions and vaccination coverage is not well characterized, through previous work as linked coverage expansions with insurance rates and insurance rates with vaccination completion. We examined whether Medicaid expansions implemented by the end of 2015 in 29 states and D.C. were associated with changes in MMR vaccination and 7-series vaccination completion among low income children from 2010-2018.

Methods

Changes in mean vaccination coverage were compared between the four years before expansion (2010-2013) and the four years post expansion (2015-2018), using data from the 2010-2018 National Immunization Child Survey. The final study sample (N=36,591) included children …

Evaluation Of Pilot Methadone Treatment Programs For Inmates With Opioid Use Disorder In Connecticut Jails, 2014-2018, Alissa Haas

Public Health Theses

Background and Aims. Methadone treatment is underutilized in correctional facilities, despite high prevalence of opioid use disorder in criminal justice settings. In 2013 and 2014, two pilot programs were established by the Connecticut Department of Corrections in the New Haven and Bridgeport Correctional Centers to provide methadone for inmates who had been in medication-based treatment prior to incarceration. We sought to assess post-release outcomes (non-fatal overdose, fatal overdose, recidivism, and resumption of methadone in the community) associated with implementation of methadone treatment in these correctional centers.

Methods. This was a retrospective observational cohort study, linking datasets from the Connecticut Department …

Measuring Tb Stigma In Kampala, Uganda, Amber James

Public Health Theses

Tuberculosis (TB) is one of the leading causes of death worldwide and adversely affects persons living with HIV. TB is a highly stigmatizing disease and has been shown to interfere in household TB contact investigation. The objective of this study was to investigate the severity and characteristics of TB stigma through a multiple methods approach. Quantitative methods involved distributing Van Rie Stigma Scales validated in Southeast to household contacts of Index TB patients during routine household TB contact investigation. Qualitative methods involved interviewing household contacts about their attitudes towards household contact investigation, knowledge of TB transmission and treatment, and perceptions …

Geospatial Analysis Of Drug-Resistant Tuberculosis In Santiago De Cali, Colombia, Oscar Norberto Perales

Public Health Theses

Infectious diseases like tuberculosis are undergoing an epidemiological transformation in developing countries such as Colombia and throughout Latin America. Recent economic and social developments may drive heterogeneous burdens of disease in the region, especially in urban settings. Geographic Information Systems (GIS) may allow us to better appreciate the geospatial distributions of TB in these contexts. In this study, we aimed to identify regions in Santiago de Cali facing disproportionate TB burdens and sought to determine whether the distribution of drug resistant TB differed. Additionally, we aimed to identify patient risk factors that could lead to differential drug resistance testing. This …

Hiv Testing During Antenatal Care In Eastern & Southern Africa: How Do Adolescents And Young Women Fare?, Claire Young

Public Health Theses

Background

To validate Elimination of Mother to Child HIV Transmission (eMTCT), pregnant women must receive antenatal care (ANC) HIV testing. Given challenges for adolescent girls in ANC, we hypothesized that adolescents were less likely to receive ANC HIV testing in Eastern and Southern Africa (ESA).

Methods

For 10 ESA countries, we use 2015-2018 Demographic and Health Surveys (DHS) to study 46,056 women attending ANC and giving birth in the last three years. We used age-stratified (15-19, 20-24, and 25-49 years of age at time of delivery) crude and adjusted logistic regressions to assess predictive factors for ANC HIV testing, both …

Assessing The Functional Impact Of Pfrh5 Genetic Diversity On Erythrocyte Invasion Pathway Utilization In Plasmodium Falciparum, Adam Joseph Moore

Public Health Theses

Malaria is still responsible for over 405,000 deaths and 228 million cases of disease globally each year, with the large majority of these cases being caused by the Plasmodium falciparum parasite subspecies1. The RTS,S P. falciparum malaria vaccine, the only malaria vaccine ever licensed, is currently being rolled out in three African countries as part of a pilot implementation program and targets a major circumsporozoite protein (PfCSP). After three doses and a seven-year follow up, the vaccine showed a 7% efficacy on average with a -56.8% efficacy for patients in regions with above average exposure to P. falciparum2. While the …

Identifying Interactions Between Chikungunya Virus And Aedes Aegypti Salivary Gland Proteins, Alfred Jiang

Public Health Theses

Chikungunya virus (CHIKV), an emerging threat to global health, has been responsible for extensive arboviral epidemics in Southeast Asia and the Americas in recent years. In order to develop effective therapeutics and preventative measures, we must first gain a deeper understanding of both the host and vector factors that define the pathogen’s life cycle and transmissibility. Currently, the entry receptor and potential co-factors that facilitate CHIKV infection in the arthropod vector are unknown, highlighting a critical knowledge gap in our understanding of the viral life cycle. Furthermore, while secreted mosquito salivary proteins have been shown to modulate host infection through …

Persistence Of Ebola Virus In Survivors & Risks Of Sexual Transmission: A Systematic Review, Allison Cheung

Public Health Theses

Background: Longitudinal cohort studies of Ebola virus disease (EVD) survivors from the 2014-2016 West African outbreak have found evidence of Ebola virus (EBOV) and EBOV RNA persistence in the bodily fluids of survivors, particularly in semen. This new evidence has raised the possibility of sexual transmission of EBOV by EVD survivors. The current interim guidance issued by the World Health Organization (WHO) recommends safer sex practices for at least 12 months after acute disease onset (ADO). However, based on new evidence, these recommendations may require revision.

Objective: The main aim of this article is to present and evaluate evidence on …

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

Public Health Theses

Abstract

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

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

A Review On Antibiotic Stewardship In Pediatric Primary Care, Paulina Kaminski

Public Health Theses

Background. Misuse of antibiotics for upper respiratory tract infections (URTIs) in pediatric primary care settings persists despite growing concern over antibiotic resistance. Interventions aimed at improving prescription use, coined Antibiotic Stewardship Programs (ASPs) often target clinicians for improved clinical decision-making. More recently, ASPs have begun educating patients to antibiotic needs, and for pediatric cases, parents who might pressure clinicians into prescribing unneeded antibiotics. While many reviews have targeted adult patients or emergency settings, few evaluate practices for pediatric populations. For this reason, we performed a review of the literature to summarize common strategies used to reduce antibiotic overprescribing for pediatric …

Predictors Of Incomplete Evaluation Among Pediatric Household Contacts Of Pulmonary Tuberculosis Patients In Kampala, Uganda: A Secondary Analysis, Giyoung Lee

Public Health Theses

Background: Contact investigation is an active approach to identifying new TB cases by screening contacts of known patients for symptoms and risk factors. This is particularly important for child contacts of TB patients because young children are at higher risk of progressing to severe disease compared to adults. Moreover, children are unable or unlikely to travel to clinics for evaluation independently, so their access to TB evaluation may depend on the adults in their household.

Objective: To evaluate the association between individual- and household-level characteristics and completion of TB evaluation for children under 15 years.

Setting: Seven public tuberculosis (TB) …

Association Between Engagement In A Community-Based Home Visitation Program And Birth Spacing Between First And Second Children, Hing Ting Connie Li

Public Health Theses

OBJECTIVE: To identify patterns in engagement in the Connecticut-based home visitation program, Nurturing Families Network (NFN), and to determine whether associations exist between various engagement patterns and birth-to-pregnancy intervals between first and second children.

METHODS: Repeated measures latent class analysis was employed to identify patterns in program engagement among 5,248 families enrolled in NFN with available home visit information. Maternal socio-demographic characteristics were examined to identify potential predictors of engagement patterns. Propensity score matching was used to identify firstborn children of families in Connecticut with comparable eligibility and tendency to enroll in NFN. Survival analysis was conducted to assess the …

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

Public Health Theses

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

Evaluating Clostridioides Difficile Infection (Cdi) Risk Factors By Comparing The Use Of Piperacillin/Tazobactam, Cefepime, And Ceftazidime, Shardul Rathod

Public Health Theses

Introduction: Over the past several years, Clostridioides difficile infection (CDI) incidence has been rising. The primary risk factor for CDI is antibiotic use. Many studies indicate that penicillin drugs are among the low-risk antibiotic classes associated with CDI whereas cephalosporin drugs are among the high-risk antibiotic classes. However, there is variation in studies evaluating the healthcare-associated CDI (HA-CDI) risk associated with antibiotics within a class and limited data comparing the use of penicillin versus cephalosporin drugs.

Methods: An observational cohort study was performed using patient data from BH and YNHH. Minitab (Version 18) was used to perform survival analysis and …

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

Public Health Theses

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

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

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

Public Health Theses

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

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

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

Public Health Theses

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

Single-Cell Transcriptomics In The Protozoan Parasite Trypanosoma Brucei During Acquisition Of Infectivity, Trisha Kaye Ramsdell

Public Health Theses

Single cell RNA-sequencing (scRNA-seq) is a recent innovation that allows sequencing of transcriptomes from a vast number of single cells, thus providing an unbiased view of cell-to-cell variability in gene expression within a population of cells. The Tschudi laboratory has previously established an in vitro differentiation system based on the inducible expression of the RNA-binding protein 6 (RBP6) in cultured non-infective procyclics, which recapitulates Trypanosoma brucei developmental stages that have been previously described in tsetse fly vector. Thus, I aimed to utilize scRNA-seq in this system to describe the potential heterogeneity in transcript abundance of known and suspected T. brucei …