Medicine and Health Sciences Commons^™

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 …

Sex-Based Differences In Periprocedural Outcomes Of Left Atrial Appendage Occlusion With The Watchman Device, Andrew Jake Arakaki

Public Health Theses

Background/Purpose: Left atrial appendage occlusion (LAAO) is a procedure recommended for individuals with non-valvular atrial fibrillation (NVAF) who have contraindications for long-term anticoagulation. The WATCHMAN is the only FDA approved LAAO device and has been commercially available since 2015. To date, there have been no studies evaluating sex-based differences in safety and outcomes of LAAO with the WATCHMAN device. In this study we sought to determine if there were differences in baseline characteristics, medical history, and periprocedural outcomes of WATCHMAN implantation between women and men.

Methods: Using data from the National Cardiovascular Disease Registry (NCDR) - Left Atrial Appendage Occlusion …

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 …

Experiences And Beliefs About Violence And Sexual Health: A Qualitative Analysis Of The Experiences Of Female Migrant Lao Workers At The Border Of Thailand And Laos, Rachel Michele Brase

Public Health Theses

Background: It is estimated that 10% of Thailand’s total labor force is estimated to be made up of migrant workers. While the exact number of migrant workers from nearby countries is unknown, border towns and provinces are acknowledged to utilize a large population of undocumented and documented migrant workers. A majority of undocumented and a nearly half of documented migrants were reported to be female. While previous research has explored the health needs of female migrant workers in specific industries, such as the sex work industry and manufacturing industry, few studies have examined the health needs and beliefs of female …

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 …

Assessment Of Children’S Personal And Land Use Regression Model-Estimated Exposure To No2 In Springfield, Massachusetts, Sarah Esenther

Public Health Theses

Personal NO2 measurements were taken for a cohort of seventh-grade students (n=25) attending a magnet school in Springfield, MA with an elevated prevalence of pediatric asthma (17.2%). These personal measurements were compared with exposures predicted through a land use regression (LUR) model constructed from built environment and land use characteristics across the area to assess personal exposures in NO2 exposures within the cohort. Springfield, Massachusetts was chosen as the study location because of its elevated prevalence of pediatric asthma (19%) compared to the state average (11%) coupled with the recognized sensitivity of asthmatic children to traffic-related air pollutants. The exposure …

Association Between Maternal Depressive Symptoms And Hypertension Among African American Mothers In The Intergen Study, Xiaosong Gao

Public Health Theses

Purpose: The purpose of this paper is to examine the association between maternal depressive symptoms and hypertension among African American mothers from the InterGEN study.

Data Source: The Intergenerational Blood Pressure (InterGEN) Study was a longitudinal study which enrolled 250 African American mother-child dyads based in Southwest and Central Connecticut.

Methods: We used logistic regression models to examine the association between depressive symptoms and hypertension, and adjusted for educational level, employment in the past 6 months, and Race-Related Events Score (RRES). We used growth curve modeling to examine the association of systolic blood pressure (SBP) and diastolic blood pressure (DBP) …

Ethnic Differences And Risk Of Early-Onset Hodgkin Lymphoma, Connor Ashton Graham

Public Health Theses

Ethnic differences in the risk of early-onset Hodgkin lymphoma (HL) have been understudied. We evaluated potential associations between birth characteristics and early-onset HL in the California Linkage Study of Early-onset Cancers, a population-based case-control study that included a large number of non-Hispanic white and Hispanic subjects. This analysis included 2,819 HL cases (non-Hispanic white: 1651, Hispanic: 1168) diagnosed at the age of 0-37 years in California during 1988-2015 and 140,950 controls matched on race/ethnicity and year of birth. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from multivariable logistic regression models. Among non-Hispanic whites, a birthweight of ≥4,000g …

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 …

Marketing Of (Bms): Content Analysis Of Breast Milk Substitutes Digital Marketing On Chinese E-Commerce Platforms, Shannon Han

Public Health Theses

Background: China has one of the largest and fastest-growing breast milk substitutes (BMS) industries and a disproportionately low exclusive breastfeeding rate. The rapid penetration of technology and the internet, together with convenience-oriented lifestyles, has led to the dominance of the e-commerce industry in China. Many BMS manufacturers have established e-commerce flagship stores and use them as main retail and marketing channels.

Objective: This study aimed to analyze the BMS retail websites on the largest business to consumer (B2C) e-commerce platform TMall, to characterize the marketing themes and strategies used to target consumers. It was specifically designed to improve our understanding …

Analysis Of Medical Device Reclassification: An Evaluation Of The 515 Program Initiative, Tiffany Ning Hu

Public Health Theses

Background: The US Food and Drug Administration (FDA) is in charge of regulating medical devices and one key power the FDA has to ensure safety and effectiveness of these devices is risk reclassification. One example of this regulatory power is the 515 Program Initiative, where the FDA was tasked with reclassifying preamendment devices that had never undergone initial rigorous review before entering the market.

Objective: The objective of this thesis project is to characterize the device types reassessed under this program and determine what characteristics the FDA heavily considers when making a risk classification determination.

Methodology: Data was collected on …

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 …

Impact Of A 6-Month Exercise Intervention On Cognitive Function Among Ovarian Cancer Survivors: The Women’S Activity And Lifestyle Study In Connecticut (Walc), Jonica Yu Kao

Public Health Theses

Purpose: Cancer survivors often exhibit symptoms of impaired cognitive abilities after chemotherapy treatment. Physical activity has been shown to be promising in improving cognitive function among survivors for various types of cancer. However, very few studies have addressed this concern among the ovarian cancer patient population specifically.

Methods: The study randomized 111 physically-inactive ovarian cancer survivors into a 6-month exercise intervention (n=59) or an attention-control group (n=52). The FACT-Cog scale was self-reported to understand survivor perceptions of cognitive abilities at baseline and at 6 months. Generalized linear models (GLMs) were executed to examine the effect of the intervention versus attention-control …

Immunotherapy For Advanced Cancer Patients With Autoimmune Disease, Huaqi Li

Public Health Theses

Purpose

Immunotherapy (IT) has been shown to improve cancer survival but there is limited evidence regarding use in patients with advanced cancer and pre-existing autoimmune disease (AI). We sought to address these knowledge gaps and determine IT utilization patterns and overall survival (OS) for these patients.

Patients and Methods

This retrospective cohort study used data from Flatiron Health’s nationwide oncology database. Patients diagnosed with advanced cancer where there was ≥ 1 FDA approved IT were included. Baseline demographics were analyzed using χ2 and t-tests. Patterns of IT use were assessed using logistic regression. OS was estimated using Kaplan-Meier and Cox …

Prevalence, Awareness And Control Of Hypertension And Diabetes Among Hiv Positive And Negative Patients At The Military Hospital Of Douala, Cameroon, Duane Killian Madziva

Public Health Theses

Background: With anti-retroviral therapy (ART) prolonging the survival of people of living with HIV/ AIDS, other chronic co-morbidities such as hypertension, and diabetes are becoming an increasing problem. Studies on hypertension and diabetes in Sub-Saharan Africa are still limited, even with the growing concern of Africa’s dual burden of chronic and infectious diseases. As such, we aimed to determine the prevalence, awareness and control of hypertension and diabetes among people living with and without HIV/ AIDS in Cameroon. Methods: This was a hospital-based cross-sectional study conducted at the Military Hospital of Douala, Cameroon. Participants aged 21 – 65 years were …

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 …

A Feel For The Space: Engagement With The Built Environment Of Treatment Spaces Among Individuals In Recovery, James Richey

Public Health Theses

Background

Treatment spaces for substance use disorders (SUD) are diverse with respect to treatment modality and population served. However, there is a lack of literature describing the design of treatment spaces and treatment engagement. This project aims to identify how the built environment of SUD treatment spaces play a role in treatment acceptability, retention, and outcomes.

Methods

We conducted 15 semi-structured interviews with individuals in outpatient SUD treatment in southern Connecticut. These interviews explored individuals’ experience with the built environment of treatment spaces and facilities, including architectural and design-related features (e.g., functionality, spatial arrangement), and how space influences adherence to …

Nitrous Oxide: Use In Labor & Delivery And Steps Toward Healthcare Sustainability, Bethany Sanchez

Public Health Theses

Objective: This study explores trends in procurement for 3 hospitals in Connecticut over a four-year period to better understand how much N2O is released. N2O use and frequency of conversion to epidural after N2O, as well as emergency cesarean section after N2O use is also examined. A plan for N2O destruction technology testing is outlined.

Background: Nitrous Oxide (N2O) is a well-documented greenhouse gas (GHG) and ozone-depleting agent. N2O use continues to be unregulated, and concurrently it has also become more widely adopted for use in labor and delivery in the US, though it has been popular in Europe and …

The Effects Of Rental Assistance On Housing Stability, Quality, Autonomy And Affordability, Rebecca G. Schapiro

Public Health Theses

In light of the current affordable housing crisis in the United States, this paper examines how rental assistance is associated with four housing outcomes: housing stability, quality, autonomy, and affordability to expand the current knowledge base on benefits of rental assistance. We use data from the first four waves (2017-2019) of the JustHouHS Study, a cohort study of low-income adults designed to examine the intersection of housing, mass incarceration, and health in New Haven, Connecticut. We use Generalized Estimating Equations to examine how rental assistance is associated with participants’ housing stability, quality, autonomy, and affordability. Participants receiving rental assistance had …

Medical Student Mistreatment And Burnout: An Intersectional Approach, Bethelehem Getachew Teshome

Public Health Theses

Importance

While prior studies have described mistreatment in an undergraduate medical setting by sex, sexual orientation, and race/ethnicity, no studies have examined the degree of mistreatment and symptoms of burnout experienced by students with multiple marginalized identities with national data.

Objective

To describe the association between mistreatment, burnout, and having multiple marginalized identities during undergraduate medical education.

Design

This cohort study utilized data from the Graduate Questionnaire administered annually by the Association of American Medical Colleges.

Setting

This study utilized student responses from the 140 U.S. medical schools accredited by the Association of American Medical Colleges’ Liaison Committee on Medical …

You Win Some, You Lose Some: An Analysis Of Medicare For All’S Differential Impact On Hospital Finances, Leah Sussman

Public Health Theses

Background: High health care costs have led to an unprecedented number of policy proposals to reform the United States health care system. Proponents of Medicare For All (M4A) argue that a single-payer system would reduce costs by allowing the government to obtain better prices from providers. M4A would have varying effects on sources of hospital revenue, increasing some payment while decreasing others. This paper explores the differential effects of M4A on hospital income.

Methods: This paper uses data from CMS’s Healthcare Cost Report Information System (HCRIS) to create a baseline model reflecting hospital revenues and costs under current hospital payment …

Evaluating The Appropriateness Of Oral Antibiotic Therapy Following Discharge For Patients With Urinary Tract Infection, Sera Yoo

Public Health Theses

Introduction: Inappropriate use of antibiotics is common in healthcare settings, with urinary tract infections (UTI) being one of the most common indications for antibiotic prescriptions. This study evaluated the appropriateness of oral antibiotic therapy among adult patients with suspected UTI who were admitted to Yale New Haven Hospital during January 2018. We hypothesized that 60% of antibiotics were inappropriate, and that inappropriate therapy was associated with Clostridioides difficile infection, hospital readmission and/or mortality.

Methods: We conducted a retrospective cohort study of adult patients who were admitted to Yale New Haven Hospital from January 1, 2018 to January 31, 2018. Data …

Provider Experiences Implementing Group Care: A Qualitative Study, Noureen Ahmed

Public Health Theses

Objective/Purpose: Group Well Child Care is an innovation in primary care delivery that may help meet the quadruple aim of health care. The objective of this study is to characterize Group Well Child Care providers’ experiences, perceptions, and strategies.

Introduction: In Group Care, also known as shared medical appointments, patients with similar medical needs attend appointments together. The practice of Group Care has spread, particularly where social support is beneficial (e.g., early parenting) and among those who might experience shame or stigma for their diagnosis or background (e.g., poverty). Group Care has shown promise in improving patient outcomes, such as …

Racial/Ethnic And Sociodemographic Disparities In Lipid Screening And Risk Factor Awareness Among Pregnant Women Receiving Prenatal Care, Reed Mszar

Public Health Theses

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality with younger women being disproportionately affected by traditional risk factors including dyslipidemia. Despite recommendations for lipid screening in early adulthood, many younger women currently do not undergo screening. Prenatal and early pregnancy care represent underutilized opportunities for lipid screening and ASCVD risk assessment. We aimed to assess the prevalence and variations in pregnant women reporting a prior lipid screening and an awareness of high cholesterol as a risk factor for ASCVD.

METHODS: We administered a survey to 234 pregnant women receiving prenatal care at one of the …

Covid-19 Risk Among Temporary Protected Status Beneficiaries, Diana Estefania Estrada Alamo

Public Health Theses

The current federal response of the United States to the COVID-19 pandemic has created conditions and resulted in unintended consequences that may be disproportionately increasing the risk of COVID-19 infection and sequelae for immigrant populations. This investigative thesis explores whether states with a greater percentage of Temporary Protected Status beneficiaries experience more COVID-19 related deaths as compared to the rest of the United States. Using a multiple linear regression model for statistical analysis, covariates under consideration include the number of COVID-19 confirmed cases, tests performed, hospitalizations reported, as well as the population density of each state and the proportion of …

Association Between Opening A Jail And Sexually Transmitted Infections In Rural Counties Across The United States, Tyler Harvey

Public Health Theses

Abstract

Objective

To estimate the effect of openings jail in rural counties on county-level chlamydia, gonorrhea, and syphilis prevalence rates.

Methods

We used county-level data from the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (2005-2017) to obtain chlamydia, gonorrhea, and syphilis rates, and the American Correctional Association’s National Jail and Adult Detention Directory (2013-2014) to locate rural jail openings. Using a generalized synthetic control method, we estimated the effect of opening jails in 41 rural counties between 2010 and 2012 across the United States on sexually-transmitted infections.

Results

We found an average treatment effect for chlamydia prevalence …

The Freshair Wristband: Comparison Of Personal Exposure Measured Using Different Wearable Form Factors, Elizabeth Ziying Lin

Public Health Theses

Organic air pollutants are widely used in building materials, personal care and household products. Studies have been linking the exposure to these organic air pollutants with adverse health outcomes, including respiratory, cardiovascular, neurobehavioral outcomes, and cancer. Techniques to measure personal exposure to organic air pollutants include backpacks containing filters/pumps, and a set of single pollutant monitors. These techniques usually involve solvent extraction of filters. They are expensive, time-consuming, and inefficient which are not suitable for large scale, longitudinal exposome studies. The FreshAir samplers were developed to capture a wide range of compounds simultaneously throughout the exposure, its high degree of …

Cost Effectiveness Of A Produce Prescription Intervention, Danielle Raso

Public Health Theses

In this study, we examined the effectiveness, cost, and cost-effectiveness of a produce prescription program. The program analyzed in this study is run by Community Health and Social Services (CHASS) Center, a Federally Qualified Health Center (FQHC) in Detroit, Michigan. The prescription produce intervention begins with eligibility screening and referral by patients’ physicians at clinical visits for eligibility. Eligible patients are then given “prescriptions” for free fruits and vegetables that they can exchange at participating farmers markets or farm stands. Farmers markets also host cooking demonstrations and distribute healthy recipes. Finally, coordinators and volunteers follow up with patients and provide …

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 …

“Malicious Medicine”: A Qualitative Study Of Medical Mistrust And Prep Perceptions For African American And Hispanic Men And Women In New Haven, Ct, Alexandra Lee Grimaldi

Public Health Theses

Objective: To understand how medical mistrust impacts perceptions of PrEP and willingness to use PrEP for African American and Hispanic men and women in New Haven, Connecticut.

Methods: This qualitative study utilized semi-structured interviews to examine medical mistrust, PrEP awareness, and willingness to use PrEP amongst African American and Hispanic men and women in New Haven, Connecticut.

Results: The majority of participants did not know about PrEP before their first interview of this study and the majority of participants did not decide to use PrEP over the course of this study. For those who are not interested in using PrEP, …