Medicine and Health Sciences Commons^™

Cleft Lip And Depression In Adults: A Multi-Ancestry Mendelian Randomization Study, Anne Lyon Havlik

Public Health Theses

Background: Clefting of the lip with or without cleft palate (CLP) is the most common congenital craniofacial abnormality globally, affecting one in 700 live births. Traditional observational studies suggest an increased risk of adult depression among subjects with CLP, but these studies are subject to residual confounding.Objective: We aimed to address residual confounding by evaluating the association between the genetically-predicted risk of CLP on the risk of adult depression in a Mendelian randomization framework. Methods: We used single-nucleotide polymorphisms strongly associated with CLP as genetic instruments. Genetic associations with adult depression were extracted from separate studies. Three ancestry groups were …

For “Them”, Not Us: A Qualitative Study Of Asian American Pacific Islander Perceptions Of Substance Use And Harm Reduction, Winnie Ho

Public Health Theses

Background: Asian American Pacific Islander (AAPI) substance use data is typically aggregated in a way that not only produces overly generalized results, but also potentially perpetuates stereotypes created by the Model Minority Myth (MMM). This has mutually reinforced a lack of representation and understanding of AAPI substance use experiences and needs. This presents a public health concern that is both excluding them from consideration by the field of harm reduction, but also themselves from considering harm reduction. Disaggregated data shows rising rates of substance use and associated harms that are often hidden or not taken as seriously as a public …

"Hair-Esteem Toolkit For Black Girls": The Development Of A Self-Esteem Toolkit For Black Adolescent Girls Centering Hair As A Tool For Empowerment, Sydney Hussett-Richardson

Public Health Theses

Background: For Black adolescent girls, hair is a strong staple of gender and ethnic identity, influencing intrapersonal and interpersonal interactions. Gendered racism and Eurocentric beauty standards pathologize Black girls and their hair, leading them to experience high rates of hair harassment and discrimination. These experiences negatively impact the self-esteem of Black girls, which has important implications for a host of health behaviors. The purpose of this study was to explore the relationship between self-esteem and hair among Black girls and integrate findings into a culturally relevant digital toolkit to promote and develop hair-esteem and self-esteem among Black girls.Methods: This study …

“I Was Reaching Out For Help And They Did Not Help Me”: Mental Healthcare In The Carceral State, Anna Grace Preston

Public Health Theses

Background: Despite the limitations the carceral environment may impose on mental wellness, mental healthcare is increasingly becoming a carceral endeavor. Over the course of the last several decades, prisons and jails have become the de facto mental healthcare provider for thousands of incarcerated individuals. Furthermore, practices like mandated mental healthcare for supervised individuals further broaden the population experiencing mental healthcare within the criminal legal system at large. This study examines the perspectives of nine individuals who experienced mental healthcare within the carceral state, whether in prison or on parole or probation, with a special focus on how attributes of the …

“To Live In The Body Of A Survivor ”: Unique And Cumulative Disaster Exposure And Mental Health In A Sample Of Hurricane Katrina Survivors, Noelle Serino

Public Health Theses

Introduction: Fueled by the escalation of climate change, weather-related disasters are increasing in frequency and severity. Existing research has documented the extensive harm induced by such disasters, yet few studies have examined how individuals’ psychological well-being fares when exposed to multiple, diverse threats, including other weather-related and public health disasters (e.g., COVID-19). As such, the present study explores posttraumatic and psychological distress in the context of unique and cumulative disaster exposure.Methods: The data utilized for this study came from the Resilience in Survivors of Katrina (RISK) Project. The sample was comprised of 381 predominantly Non-Hispanic Black (84.5%) women who experienced …

“For The Future, For Him, And For Our Life Together”: The Relationship Goals And Well-Being Of Persons Living With Dementia And Their Spousal Care Partners, Claire Leigh Szapary

Public Health Theses

Background. Identities and dynamics in relationships can change when one spouse develops dementia. This study aimed to understand the various types of goals both spousal care partners and persons living with dementia (PLWD) have for their relationship, and to explore whether approach or avoidance goals were associated with individual wellbeing and relational support – as well as their partners’ wellbeing and support.

Methods. A secondary analysis of data from sixty-two spousal dyads where one partner has dementia was conducted. Thematic goal-type categories were determined through a card-sort content analysis methodology using participants’ brief qualitative responses to a question asking about …

Surgical Outcomes Following Posterior Spinal Fusion For Adolescent Idiopathic Scoliosis, Wyatt Benajmin David

Yale Medicine Thesis Digital Library

Surgical Outcomes Following Posterior Spinal Fusion for Adolescent Idiopathic ScoliosisWyatt B. David and Michael DiLuna. Section of Pediatric Neurosurgery, Department of Neurosurgery, Yale University, School of Medicine, New Haven, CT. Hospital size has previously been shown to impact outcomes in adult spine surgery. However, there is a paucity of studies assessing the impact of hospital size on outcomes in adolescent spine surgery. Furthermore, gender-based differences have been suggested in disease progression and outcomes of adolescent idiopathic scoliosis (AIS), though only a few studies have investigated these disparities. The aim of this study was to determine the impact of hospital size …

International Academic Partnerships In Orthopaedic Surgery, Michael Jesse Flores

Yale Medicine Thesis Digital Library

Abstract: INTERNATIONAL ACADEMIC PARTNERSHIPS IN ORTHOPAEDIC SURGERY. Michael J. Flores. Department of Orthopaedics & Rehabilitation, Yale University, School of Medicine, New Haven, CT.

Introduction: Orthopaedic-related disease (ORD) is one of the leading health challenges faced worldwide and is a significant cause of global morbidity and mortality, especially in low- and middle-income countries (LMICs). In recent years, international orthopaedic outreach to address the global burden of ORD has received greater attention due to initiatives such as the Lancet Commission on Global Surgery (LCGS). Many strategies have been considered to address the global burden of ORD, most commonly though volunteer trips by …

Incarcerated Patients Have Higher Mortality After Trauma: An Unreported Healthcare Disparity, Harry Newmanplotnick

Yale Medicine Thesis Digital Library

While the U.S. has the highest incarceration rate in the world, at nearly 1% of the adult population, or over 2 million people, insight regarding health disparities in this population remains limited, particularly for traumatic injuries and surgical care. Our aims with this paper were two-fold. First, we sought to perform the largest national database analysis of criminal-justice system involved (CJI) trauma patients (specifically incarcerated patients). Second, we planned to investigate if incarceration status was associated with differences in a variety of outcomes after trauma for U.S. adults.To accomplish these aims we analyzed data from the National Trauma Data Bank …

Almajiri Health; A Scoping Review On Disease, Health Literacy And Space For Participatory Research, Muzzammil Imran Muhammad

Yale Medicine Thesis Digital Library

Introduction

Almajirai are male children who leave the care of their parents to learn the Qur’an and study Islam under the tutelage of a Mallam or Imam at a Tsangaya. Almajiranci refers to the system of education based on this relationship between almajiri and mallam, and which was the dominant mode of education in precolonial Hausaland – Northern Nigeria and Southern Niger. This system remains widespread and popular in both countries. In recent years, discourse around almajirai has featured prominently in media from and about this region, and has associated almajiranci with non-participation in formal education, abuse, poverty, and underdevelopment. …

More Than Meets The Eye: Improving Recognition Of Child Abuse In Emergency Departments, May Shum

Yale Medicine Thesis Digital Library

Background: Child abuse guidelines exist to help emergency department (ED) providers evaluate injured children for suspected child abuse. Little is known about the impact of these guidelines on provider decision-making in pediatric (PED) and community EDs (CEDs). Objective: To evaluate the impact of a child abuse guideline in pediatric and community EDs through three primary studies: 1. To examine guideline adherence and the appropriateness of decision-making by CED providers. 2. To determine the impact of the guideline on differences in evaluations of infants for abuse between a PED and three CEDs. 3. To implement and assess the use of a …

Estimating Urinary Nitrate Excretion In Rural Iowans From Dietary And Drinking Water Sources, Timothy Skalaban

Public Health Theses

Nitrate levels are increasing in our environment, and epidemiological studies have found evidence of adverse health risks from this exposure. Therefore, it is important to characterize the magnitude of nitrate exposure from food and drinking water sources. This study assesses the magnitude of nitrate exposure for 47 farmers from the Agricultural Health Study (AHS) in 2018-2019. The participants in our study use private wells as their main drinking water source and live in agricultural area of Iowa (10 counties) where ground water is vulnerable to nitrate contamination. The extent of nitrate exposure is determined by several factors, including the types …

The Association Between Social Needs Care Coordination And Social Needs Status Amongst Patients In A Federally Qualified Health Center, Autumn Nobles

Yale Medicine Thesis Digital Library

Social needs screenings within healthcare systems have grown more common with increasing discourse around the contribution of systemic determinants to health outcomes. These screenings have been used to describe the prevalence of social needs within communities but have not been evaluated for the impact that they and the interventions to which they are attached may have on health outcomes. Here we evaluate social needs screenings and their potential impact on patient health at a federally qualified health center in New Haven, Connecticut. We describe the baseline needs at the facility, evaluate change in reported social needs among patients undergoing screening, …

Understanding Perceptions Of New-Onset Type 1 Diabetes Education In A Pediatric Tertiary Care Center, Gabriel Betancurvelez

Yale Medicine Thesis Digital Library

Background: Youth newly diagnosed with type 1 diabetes (T1D), and their families, require intensive education on the management of this chronic condition during this overwhelming period. Traditionally, our center conducts training in person during a hospital admission.

Methods: We studied family perceptions of our current patient education methods in an effort to elucidate strategies to augment education in the post-pandemic environment, where provider time in the room and visitation rules may limit face-to-face encounters.

Results: 25 families completed the survey (distributed to 156 in total, with approximately 21% response rate). The mean age at diagnosis was 9.52 ± 4.29 years …

Factors Influencing Decision For Contralateral Prophylactic Mastectomy Versus Unilateral Mastectomy, Julian Huang

Yale Medicine Thesis Digital Library

Background: Rates of contralateral prophylactic mastectomy (CPM) are increasing despite falling rates of contralateral breast cancer and controversy over survival benefit of the procedure. We investigated why and how patients choose to undergo CPM, with focus on the roles of financial burden, decision-making resources, and active participation in decision-making.

Methods:Female unilateral breast cancer patients older than 18 years old who had undergone mastectomy (with or without CPM) coming in to the Yale Breast Center for a follow-up or post-operative visit between June and August 2017 were approached with an opportunity to participate in this survey study. Chart review was completed …

Family Dyads, Emotional Labor, And The Theater Of The Clinical Encounter: Co-Constructive Patient Simulation As A Reflective Tool In Child And Adolescent Psychiatry Training, Isaiah Thomas

Yale Medicine Thesis Digital Library

Patient simulation has been used in medical education to provide a safe and supportive learning environment for learners to practice clinical and interpersonal skills. However, simulation involving pediatric medicine and child psychiatry is rare and generally does not reflect the child-caregiver dyad or the longitudinal aspects of this care and does not provide learners an opportunity to engage with and reflect on these dynamics. We organized a series of 7 observed patient simulation sessions with a cohort of 7 senior child and adolescent psychiatry fellows as an educational opportunity. In these sessions, we utilized the previously described co-constructive patient simulation …

“I Was Reaching Out For Help And They Did Not Help Me”: Mental Healthcare In The Carceral State, Anna Grace Preston

Yale Medicine Thesis Digital Library

Background: Despite the limitations the carceral environment may impose on mental wellness, mental healthcare is increasingly becoming a carceral endeavor. Over the course of the last several decades, prisons and jails have become the de facto mental healthcare provider for thousands of incarcerated individuals. Furthermore, practices like mandated mental healthcare for supervised individuals further broaden the population experiencing mental healthcare within the criminal legal system at large. This study examines the perspectives of nine individuals who experienced mental healthcare within the carceral state, whether in prison or on parole or probation, with a special focus on how attributes of the …

"Come On. I Need An Answer." A Mixed-Methods Study Of Barriers And Disparities In Diagnostic Odysseys, Zeyu Tang

Yale Medicine Thesis Digital Library

Background: The boom of next generation DNA sequencing over the past decade has improved our ability to provide accurate genetic diagnoses for children with previously undiagnosed diseases, in turn leading to important advances in management and prognostication. Even given this progress, two areas of ongoing need are the accurate definition of further novel genetic diseases and to make genetic expertise and diagnostics widely available to children and families who have frequently endured grueling diagnostic odysseys. The Pediatric Genomics Discovery Program (PGDP) at Yale is an advanced genomics program focusing on both these areas, enrolling over 700 patients since its inception …

Computerized Cognitive Behavioral Therapy For Patients With Post-Treatment Lyme Disease Syndrome, Katherine Fry

Yale School of Medicine Physician Associate Program Theses

Lyme disease is the most common vector-borne illness in North America. Post-treatment Lyme disease syndrome is defined as a subset of patients appropriately treated for Lyme disease who continue to experience generalized symptoms, such as depression. However, treatment options for depressive symptoms in post-treatment Lyme disease syndrome largely remain unknown. The objective of this study is to examine whether computerized cognitive behavioral therapy, an internet-delivered form of traditional cognitive behavioral therapy, can reduce depressive symptoms in patients with post-treatment Lyme disease syndrome. Here, we conduct a parallel randomized controlled trial to evaluate whether computerized cognitive behavioral therapy can reduce depressive …

Cardiac Rehabilitation Adherence Rates In Elderly Patients Using A Mobile Application, Amanda Wilson

Yale School of Medicine Physician Associate Program Theses

Adherence to cardiac rehabilitation reduces cardiovascular disease mortality. Despite this, adherence rates remain suboptimal especially among older patients. Mobile applications are increasingly utilized to deliver virtual healthcare with similar health outcomes. However, no studies have determined whether cardiac rehabilitation delivered via mobile applications can increase adherence rates in elderly patients who may be limited by logistical barriers, such as difficulties with transportation. The aim of this study is to examine whether cardiac rehabilitation conducted via mobile application can increase adherence rates to cardiac rehabilitation in patients over 65 years old compared with traditional cardiac rehabilitation. We will conduct a randomized, …

The Effect Of Platelet-Rich Plasma On Recovery In Athletes With A Grade Iii Lateral Ankle Sprain, Matthew Attolino

Yale School of Medicine Physician Associate Program Theses

Lateral ankle sprains are the most common cause of missed athletic participation. One emerging therapy that has been used to hasten recovery from orthopedic injuries is injection with platelet-rich plasma. However, the effect of platelet-rich plasma on recovery from lateral ankle sprains has only been studied in the context of less severe injuries (grades one and two). We hypothesize that a platelet-rich plasma injection will decrease the mean days to return to play in athletes with a severe (grade three) lateral ankle sprain. We will conduct a multicenter randomized controlled trial to investigate the mean days to return to play …

Extracorporeal Membrane Oxygenation Facilitated-Resuscitation For Out Of Hospital Cardiac Arrest, Gloria Ho

Yale School of Medicine Physician Associate Program Theses

Survival rates for out-of-hospital cardiac arrest are abysmal and have largely remained unchanged over the last several decades. A recent single center study of patients with out-of-hospital cardiac arrest found that early cannulation with extracorporeal membrane oxygenation could improve mortality rates. It is unclear if these findings are generalizable to and reproducible at other hospitals. The goal of this study is to assess the rate of survival to hospital discharge for patients treated with early extracorporeal membrane oxygenation compared to standard advanced cardiovascular life support. To this end, we will conduct a multi-center, intention-to-treat, randomized controlled trial in adults with …

Efficacy Of Topical Silymarin In Melasma Treatment During Pregnancy And Breastfeeding, Warunee Nowak

Yale School of Medicine Physician Associate Program Theses

Melasma is a common hyperpigmentation disorder that negatively impacts quality of life. Melasma predominately affects women of reproductive age and is commonly acquired during pregnancy. Current treatment options focus on prevention with limited therapies available once melasma has developed for patients who are pregnant or breastfeeding. One potential therapy that has shown promise for the treatment of melasma is silymarin, a derivative of milk thistle. However, the effect of silymarin on melasma in the pregnant and breastfeeding population has never been investigated. This double-blind randomized placebo-controlled trial will investigate whether topical silymarin can improve the severity of melasma in pregnant …

The Effects Of Mindful Meditation Skills-Training For Healthcare Providers On Patient Satisfaction, Gaia Mohr-Tonachini

Yale School of Medicine Physician Associate Program Theses

Mindfulness-based interventions have become an increasingly popular and accepted approach to reducing burnout, depression, anxiety, and stress among healthcare professionals. However, the effects of how a mindfulness-based intervention might impact a clinician’s patient care and patient-provider relationship are not known. In this study, we aim to discover if providing healthcare professionals with a Mindfulness-Based Stress Reduction program will improve their patient-provider relationship as indicated by a statistically significant change in Press Ganey patient satisfaction scores. Providers recruited from Yale Health will be randomized into an intervention group or wait-list control group. Mean patient satisfaction scores will be analyzed for each …

Impact Of Acculturation In Mediating Barriers To Screening Mammography Among Arab American Women, Nour Ebid

Yale School of Medicine Physician Associate Program Theses

Breast cancer is the most common malignancy in women. Early detection and screening (including breast self-examination, clinical breast examination, and mammography) are vital for early identification and treatment, but there are established cultural differences in screening. Arab women have lower screening rates and are more likely to be diagnosed with late-stage disease. Cultural differences can be attributed to medical mistrust and inadequate knowledge. However, the extent to which they impact screening practices is not fully known. In this cross-sectional study, we assess the rate and regularity of screening mammography in the U.S., comparing Arab versus non-Arab/Hispanic White women. We will …

Topiramate For Weight Loss In Adults With Obesity And Loss Of Control Eating After Bariatric Surgery, Amanda Faxon

Yale School of Medicine Physician Associate Program Theses

Diagnostic criteria for binge eating disorder may preclude a diagnosis in post-bariatric surgery patients because they require consumption of abnormally large quantities. Loss of control eating is considered the salient feature of binge eating disorder in some eating disorder literature, and some of the field is moving towards excluding the quantity of food criterion. Loss of control eating is associated with poorer weight outcomes post-surgery. Topiramate, an anticonvulsant, has been shown to improve weight outcomes in patients with binge eating disorder after surgery, therefore its evaluation in patients with loss of control eating and obesity post-surgery is warranted. We aim …

Support Or Interference: Relational Influences On Mother’S Exclusive Breastfeeding Practices In Ghana, Georgiana Esteves

Public Health Theses

Childhood malnutrition is a challenge that needs to be understood as a global health threat. Exclusive breastfeeding (EBF) is recognized as the best practice to improve a child’s growth and cognitive development in the first months of life. The World Health Organization recommends EBF until 6 months. Mothers need family support to adhere to EBF practices. This study aimed to understand the interpersonal level relational influences of fathers, grandmothers, and other family members on the mother-child dyad adherence to EBF practices, as well as document community and societal influences on EBF. This study took place in the Central Region of …

The Role Of Childhood Trauma In Intergenerational Trauma (Igt), Audrey Huang

Public Health Theses

Emerging research has focused on the intersection of personal and parental trauma within intergenerational trauma (IGT) transmission, specifically offspring adverse childhood experiences due to trauma-related parenting behaviors. However, the role that offspring childhood trauma and its various subtypes may play in moderating or mediating IGT transmission, as well as the impact of caregiver sex, are still remains largely understudied. We examined how the transmission of PTSD between survivors of the 1994 genocide to their offspring might be either (a) mediated by overall and subtypes of offspring childhood trauma, or (b) moderated by overall and subtypes of offspring childhood trauma, and …

Exploring Climate Policy And Health Perspectives In Samoa: A Mixed Methods Study, Erika-Ann Fumiko Kim

Public Health Theses

Background: Greenhouse gas emissions have driven human-induced climate change, bringing several impacts to small island nations in the Pacific. Samoa, a small island developing state located in the south Pacific Ocean, is at disproportionate risk from impacts of climate change such as rising surface temperatures, rising sea levels, increases in frequency and degree of heavy precipitation events, and increases in the frequency of droughts. Simultaneously, Samoan populations possess a high prevalence of non-communicable diseases such as diabetes, heart disease, and hypertension. For multiple decades, the Government of Samoa has framed climate change as a key issue that threatens the lives, …

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 …