Medicine and Health Sciences Commons^™

Genomic Epidemiology Of Clostridium Difficile Colonization And Transmission In An Intensive Care Unit Cohort, Brianne Ciferri

Dissertations and Theses

Abstract

Genomic epidemiology of Clostridium difficile colonization and transmission in an intensive care unit cohort

by Brianne Ciferri, MPH

Advisor: C. Mary Schooling, PhD

Introduction: Clostridiodes difficile (C. difficile) is a leading cause of healthcare associated infections (HAI) in the United States and responsible for an estimated incidence of 223,900 cases and 12,800 deaths per year^1,2. C. difficile can cause gastrointestinal illness with symptoms ranging from mild diarrheal illness to a life-threatening condition. C. difficile is an opportunistic pathogen in which spores can live in an undisturbed dormant state within the intestinal tract and become …

An Epidemiologic Study Of Vaccination Exemptions And Pertussis Risk, Corinne B. Tandy

Doctoral Dissertations

The incidence of pertussis, a vaccine-preventable disease that can have severe complications in infants, has been increasing in the United States over the past three decades. Vaccine hesitancy and refusal have also increased and are associated with vaccination exemptions, which in turn are associated with outbreaks of vaccine-preventable diseases, including pertussis. Understanding attitudes towards vaccinations and identifying geographic disparities of vaccination exemptions and pertussis risks is useful for guiding control programs. Therefore, the objectives of this study were to: (i) investigate attitudes towards vaccinations; (ii) identify county-level geographic disparities and sociodemographic predictors of vaccination exemptions in Florida; (iii) investigate county-level …

Examination Of The Association Between C - Reactive Protein(Crp) And Covid-19 Infection Severity And Length Of Hospitalization, Abdulahi Aremu Ayanwale

Open Access Theses & Dissertations

Chronic stress can lead to many systemic complications and low-grade systemic inflammation including increased levels of inflammatory cytokines, such as C-reactive protein (CRP). CRP is a marker of systemic inflammation and is associated with depression and perceived stress. Elevations can result in ineffective immune responses, thereby increasing the risk of complications and mortality from infections. Recent evidence suggests that uncontrolled inflammatory responses associated with COVID 19 are a major determinant of disease severity.  The COVID 19 is transmitted from one person to another through droplets from coughing, sneezing, talking, touching droplets on surfaces and contamination by hand-to-mouth routes. The mechanism …

Examining An Intersection Of Environmental Justice And Covid-19 Risk Assessment: A Review, Ashley Ellis

Honors Theses

This study views the risks associated with the novel coronavirus (COVID-19) as an environmental injustice issue due to the connection between existing environmental disparities and the disproportional negative impacts brought upon by the virus. The social and health determinants attributed to those environmental disparities have traditionally been evaluated as individual risk factors, an approach that fails to gauge the complexity of an environmental injustice issue. This study employs the emerging theory of intersectionality, a belief that phenomena cannot be linked to one principal cause but instead an interconnected web of influences, in order to synthesize the multitude of factors believed …

Ecology Of Hantaviruses In Rodent Reservoirs And Their Early Innate Immune Responses In Human Model Systems, Evan Peter Williams

Theses and Dissertations (ETD)

The spillover of zoonotic RNA viruses is responsible for a great deal of the disease outbreaks in human populations. These spillover events are set to continue due to anthropogenic and environmental changes that impact the distribution of these viruses. The viruses in the family Hantaviridae are classified as one of these emerging zoonotic RNA viruses. The spillover of the viruses in this family are responsible for two severe human diseases, hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). These viruses are distributed across the globe and are responsible for a large number of human disease cases with …

The Association Between Depression And Anxiety With Covid-19 Outcomes., Erica Miller

Electronic Theses and Dissertations

Previous studies have shown that mental disorders affect COVID-19 mortality. This study investigated the effect of depression and/or anxiety on COVID-19 outcomes. Depression/anxiety was defined by actively taking medication and/or diagnosis. The outcomes were ICU admission; ventilation; mortality; and time to mortality. Of 698 hospitalized patients, there were 204 (29%) defined to have either depression or anxiety. There were 109 deaths, and of those, 52 (48%) were diagnosed with depression/anxiety. Multivariable logistic regression and Cox proportional hazards models were used to examine associations. ICU admission and ventilation were not significantly associated with depression/anxiety. Depression/anxiety was associated with mortality (OR: 1.84, …

Responding To The Pandemic: A Multicountry Study On Social-Political Factors And Health Outcomes Of Covid-19, Lan Yao

Theses and Dissertations (ETD)

Introduction. Coronavirus Disease 2019 (COVID-19) poses a major global threat to human beings, which has caused devastating consequences of population health, political, and economic crises in many countries. This dissertation was composed of three research activities to study the following aims: (1) review the existing literature focusing on political factors and health outcomes of COVID-19; (2) assess the relationship between democracy and case fatality rate of COVID-19 by controlling for the effect of age, comorbidity, health expenditure, healthcare workforce, and population density; and (3) identify the trajectory pattern cases peak days, deaths peak days, and peak periods.

Methods. We accessed …

Health Care Utilization By Immigrants With Multimorbidity: A Population Based Cross-Sectional Study Of The 2015-2016 Canadian Community Health Survey (Cchs), Chinmoy Talukder

Electronic Thesis and Dissertation Repository

Immigrants face unique healthcare barriers, which can negatively impact their health and health service use. Those with multimorbidity face a particular challenge as multimorbidity is associated with increased need for healthcare. The purpose of this study was to compare healthcare utilization, as measured by number of visits to family physicians and specialists, between immigrants and Canadian-born populations with multimorbidity, stratified by sex and for specific chronic diseases. A cross-sectional analysis using 2015-2016 Canadian Community Health Survey (CCHS) was conducted. After adjusting for relevant covariates, no statistically significant differences in visits to family physicians or specialists were observed between immigrants and …

Applied Infectious Disease Forecasting For Public Health, Graham Gibson

Doctoral Dissertations

Infectious disease modeling has emerged as a powerful data driven tool for monitoring outbreaks, assessing intervention strategies, and allocating public health resources. This thesis addresses a variety of challenges faced in real-world infectious disease forecasting. We first present methods for aggregating forecasts made at different spatial scales, where explicitly modeling the spatial dependency would be computationally prohibitive. We then extend the mechanistic model framework to create an operational forecasting model capable of handling real-world COVID-19 surveillance system issues. Finally, we propose a new framework for merging mechanistic and statistical approaches to infectious disease forecasting. This framework allows modelers to construct …

Accelerometer-Determined Physical Behavior Metrics And Their Associations With Sarcopenia Among Oldest-Old Adults, Eric M. Eberl

Masters Theses

INTRODUCTION: Sarcopenia is a loss of muscle function and muscle mass which frequently occurs among the oldest-old adult population (aged 85+ years). The analysis of accelerometer-determined physical behavior volumes and patterns of oldest-old adults might provide novel insights into the associations with sarcopenia and its components. METHODS: A total of 145 participants in the primary sample and 87 participants in the subsample with a mean age of 88.2 (2.5) years from the Health, Aging, and Body Composition study cohort provided cross-sectional data of handgrip strength, appendicular lean mass, gait speed, and accelerometry. Probable, confirmed, and severe sarcopenia were assessed based …

High-Dimensional Feature Selection And Multi-Level Causal Mediation Analysis With Applications To Human Aging And Cluster-Based Intervention Studies, Hachem Saddiki

Doctoral Dissertations

Many questions in public health and medicine are fundamentally causal in that our objective is to learn the effect of some exposure, randomized or not, on an outcome of interest. As a result, causal inference frameworks and methodologies have gained interest as a promising tool to reliably answer scientific questions. However, the tasks of identifying and efficiently estimating causal effects from observed data still pose significant challenges under complex data generating scenarios. We focus on (1) high-dimensional settings where the number of variables is orders of magnitude higher than the number of observations; and (2) multi-level settings, where study participants …

Sleep, Reproduction, And Pregnancy, Joshua R. Freeman

Doctoral Dissertations

Sleep, and particularly sleep timing, prior to conception may be important for reproductive and pregnancy health. Evidence of a biological mechanism relating sleep to reproductive health from laboratory studies suggests that sleep may influence the hypothalamic-pituitary-ovarian (HPO) axis. The role of sleep in the HPO axis may also impact many reproductive outcomes including reproductive hormones, ovulation, pregnancy, live birth, pregnancy loss, and adverse pregnancy outcomes. However, epidemiological evidence for associations between sleep, especially sleep timing, and these reproductive health endpoints is limited with most studies typically assessing shift work, and not sleep patterns directly. To address these gaps, we evaluated …

Mental Health And Adiposity: The Effects Of Racial Discrimination And Social Relationships, Nicole D. Fields

Doctoral Dissertations

Excess adiposity is associated with increased risk of cardiovascular disease, type 2 diabetes, and premature mortality. It is well-documented that Black women are disproportionately affected by excess adiposity. Research has focused on lifestyle factors, such as diet and physical activity, to explain the higher prevalence of obesity among Black women compared to white women; however, there is much less research on the association between psychological distress and adiposity, which may be important for understanding racial disparities. To date, no studies have examined the social context by which mental health and physical health are related. Black women in U.S. society live …

Policing And Health: Police Encounters As A Fundamental Cause Of Racial Health Disparities, Richard S. Carbonaro

Doctoral Dissertations

Structural racism has taken many forms throughout American history and to this day continues to drive social, economic, and health inequalities. Mass incarceration is a modern tool of social marginalization with well documented and deep-rooted racial inequalities. Research has continually shown that mass incarceration negatively impacts the health of disadvantaged communities. Even police stops, the most common and mundane form of criminal justice contact has been linked with deleterious health outcomes at the individual and community level. In this dissertation, I identify specific social and biological mechanisms connecting encounters with the police and health outcomes. In the first chapter, I …

Utilization Of Remote Sensing To Analyze Aedes Mosquito Egg Abundance With Combined Weather Variables In Two Southeastern Coastal Cities, Danielle M. Johnson

Theses and Dissertations

Several vector-borne diseases have recently resurfaced, and many have suddenly spread to new areas in the United States (U.S.) due to climate change and tropicalization. Two vectors of public health importance are Aedes aegyptiand Aedes albopictus. The Southeastern region of the U.S. appears to be a preferential ecological niche for both Aedes species. Aedes aegyptiand Aedes albopictus are highly susceptible to environmental conditions, such as humidity, precipitation, temperature. Remote sensing technology has proven to be useful for estimating vector populations. Miami-Dade County is an established hotspot for disease transmission. Charleston County is newly vulnerable due to similar …

School-Based Sex Education In The United States And Its Association With Sexual And Reproductive Health Outcomes, 2000-2020, Priscilla M. Lopez

Dissertations and Theses

Background: There are significant sexual and reproductive health disparities in the United States (US). A significant proportion of sexual health disparities among adolescents is likely due in-part to inadequate school-based sex education. Sex education encourages sustainable and informed sexual behavior and has the potential reach adolescents prior to sexual debut and throughout the years at highest risk for adverse sexual health outcomes. However, the way in which sex education is defined and operationalized, as described in the literature, varies substantially, which may lead to wide variation in implementation in schools and this might explain the disparities seen. State-level sex …

The Association Of Demographics, Social And Personal/Family Characteristics With Treatment Utilization Among Young Adults With Opioid Use Disorder In The United States, Marva L. Frederick

Dissertations, Theses, and Capstone Projects

Background

Opioid use disorder is a life-threatening medical condition and an ongoing public health problem in the United States. Treatment is necessary to combat opioid use disorder and to minimize the health-associated problems. Opioid use disorder is treatable with life-extending medications. Studies that examined treatment utilization among young adults with opioid use disorder in the United States was scarce. This study investigated the characteristics posited in the Andersen Behavioral Model of health utilization which may be associated with treatment utilization, among young adults with opioid use disorder in the United States. The urgency posed by the continuing opioid crisis in …

Multi-Stage Stochastic Optimization And Reinforcement Learning For Forestry Epidemic And Covid-19 Control Planning, Sabah Bushaj

Dissertations

This dissertation focuses on developing new modeling and solution approaches based on multi-stage stochastic programming and reinforcement learning for tackling biological invasions in forests and human populations. Emerald Ash Borer (EAB) is the nemesis of ash trees. This research introduces a multi-stage stochastic mixed-integer programming model to assist forest agencies in managing emerald ash borer insects throughout the U.S. and maximize the public benets of preserving healthy ash trees. This work is then extended to present the first risk-averse multi-stage stochastic mixed-integer program in the invasive species management literature to account for extreme events. Significant computational achievements are obtained using …

Quantifying Timely Access To Surgery: A Global Modelling Study, Joo-Hyun Jeong

Electronic Thesis and Dissertation Repository

The Lancet Commission on Global Surgery proposed six core indicators to track access to safe, timely, and affordable surgery. We identified published data for countries reporting Indicator 1 (Access to timely essential surgery), defined as a country’s proportion of population living within two hours from the nearest surgery-capable facility, and conducted geospatial analyses to estimate this metric in other countries. In the primary analysis using this data, linear regression models were run to project this indicator for all countries globally according to their Human Development Index; followed by secondary analyses using broader definitions for surgical access, then by sensitivity analyses …

Residential Greenness And Substance Use, Evan R. Wiley

Electronic Thesis and Dissertation Repository

INTRODUCTION: Research has identified positive associations between green space and health and green space and mental health. Substance use outcomes, however, have received considerably less attention.

OBJECTIVE: The purpose of this study was to investigate associations between residential greenness and patterns of substance use among transitional aged youth (age 15-25) in Canada.

METHODS: This study utilized three waves (2016-2018) of the Canadian Community Health Survey (CCHS) as well as residential greenness data from the Canadian Urban Environmental Health Consortium (CANUE). Multivariable regression was used to explore variation in the pattern of substance use between greenness quartiles. The sample included 14,070 …

Roles Of A Bradykinin Storm And A Cytokine Storm In Covid-19 Cases, Nouha H. Odeh

Honors College Theses

In the light of recent events, it is imperative to understand the key inflammatory response elements that appear to be the source of more severe ailments resulting from a SARS-CoV-2 viral infection known as Covid-19 The more severe cases of Covid-19 are characterized by a severe inflammatory response resulting in tissue damage. My research proposal aims to investigate the two possible culprits of this response: a bradykinin (BK) storm and an interleukin-6 (IL-6) mediated cytokine storm. In both systems respectively, the excess release of these signals subsequently signals the production of even more of the same response element, resulting in …

Translation And Validation Of The Spanish Version Of The Quality Of Life Inventory For Adolescents (Qolie-Ad-48), Perla Michelle Martinez

Open Access Theses & Dissertations

Background: In 1999, an instrument was developed to assess quality of life (QoL) among adolescences with epilepsy. To our knowledge there is not a validated Spanish version of this questionnaire. There is a gap in the literature about QoL and epilepsy among speaking Spanish populations. Objectives: 1) To conduct an English-Spanish translation of the QOLIE-AD-48; 2) to evaluate the reliability of the Spanish version of the QoLIE-AD-48; and 3) to assess the validity of the Spanish version of the QoLIE-AD-48. Method: Phase 1 translation: Methods followed the published work of Sousa and Rojjanasrirat (2010). Phase 2 Pilot study: the sample …

A Secondary Data Analysis Of The Prevalence Of Reported Dementia And Subjective Cognitive Decline Across U.S. National Surveys, Matthew C. Picchiello

Arts & Sciences Electronic Theses and Dissertations

Within the United States, many large-scale, nationally representative studies exist with the goal of tracking and monitoring aspects of health. These studies are often used to establish the prevalence of dementia and subjective cognitive decline (SCD) in the population. The goal of the current study is to examine how different population-based studies probe respondents about conditions related to cognitive impairment, and to assess similarities and differences in point estimates. We reviewed eight studies and identified comparable items related to dementia and SCD. We calculated design-appropriate point prevalence estimates and compared weighted estimates across studies, finding a wide range and statistically …

Trends In Hysterectomy In Hospital And Ambulatory Settings In Kentucky 2017-2020., Felicia A. Pugh

Electronic Theses and Dissertations

Hysterectomy is the most common treatment for benign uterine conditions in the United States. Data suggest that one in nine women will have the procedure in their lifetime (1). Previous studies indicate that abdominal hysterectomy rates for non-malignancies are declining as alternative methods are increasing for decades; however, those trends do not apply for all women in the country (2-5). In this cross-sectional study, hysterectomy procedures completed between 2017-2020 are described in Kentucky Cabinet for Health and Family Services data. Multivariable logistic regression is used to assess the odds of abdominal hysterectomy for benign indications in Kentucky. Conclusion: Rates of …

Incidence Of Cancer And Stage At Diagnosis Among People With Recent-Onset Psychotic Disorders, Jared C. Wootten

Electronic Thesis and Dissertation Repository

Evidence on cancer incidence in people with psychotic disorders, compared to the general population, is equivocal, although those with psychotic disorders so have more advanced stage of cancer at the time of diagnosis. The objective of this thesis was to compare cancer incidence and stage at diagnosis for people with psychotic disorders, relative to the general population. Our systematic review did not observe a significant difference in overall cancer incidence among people diagnosed with psychotic disorders (RR = 1.08, 95% CI: 1.00 to 1.16), however people with psychotic disorders were more likely to be present with advanced stage cancer at …

Evaluating Public Masking Mandates On Covid-19 Growth Rates In U.S. States, Angus K. Wong

Masters Theses

U.S. state governments have implemented numerous policies to help mitigate the spread of COVID-19. While there is strong biological evidence supporting the wearing of face masks or coverings in public spaces, the impact of public masking policies remains unclear. We aimed to evaluate how early versus delayed implementation of state-level public masking orders impacted subsequent COVID-19 growth rates. We defined “early” implementation as having a state-level mandate in place before September 1, 2020, the approximate start of the school-year. We defined COVID-19 growth rates as the relative increase in confirmed cases 7, 14, 21, 30, 45, 60-days after September 1. …

Examining The Co-Infection Effects Of Helminths And Malaria In An Indonesian Community, Andrea Rodríguez-Sánchez

Masters Theses

Malaria is one of the most prevalent vector-borne infectious diseases with major morbidity and mortality in sub-Saharan Africa and Southeast Asia. Recent epidemiological studies have shown that co-occurrence of soil-transmitted helminth (STH) infections, or infection caused by parasitic worms, are associated with increased risk of malaria infection. However, studies of the association between STH and malaria, and the effect of antihelminth (deworming) treatments that are more commonly used in areas with high STH infection rates, are sparse. Therefore, we explored the relationship between STH and malaria infection in an Indonesian community (N=1997) with high prevalence of both STH and malaria …

Birthweight And Risk Of Autoimmune And Thyroid Conditions Within The Women’S Health Initiative, Brian C. Monahan

Masters Theses

Autoimmune and thyroid conditions account for a substantial proportion of the morbidity and mortality experienced in the United States, affecting >40 million Americans combined. Co-occurrence of both an autoimmune and thyroid condition is also likely, particularly among women. Epidemiologic studies on both sets of conditions have examined many risk factors, including demographic, lifestyle, genetic, and environmental risk factors. However, one area which has been neglected is the effect of early life exposures on the development of autoimmune and thyroid conditions. To investigate the potential association between an individual’s birth weight (by category;in uteroand early childhood, extending the hypothesis to include …

Dysbiosis-Related Medications And The Association With Cognitive Decline, Cognitive Impairment, And Dementia, Nicholas Victor Resciniti

Theses and Dissertations

The main objectives of this dissertation were to quantitatively assess whether there is an association between medications (e.g., antibiotics, PPIs, antipsychotics) and cognitive performance over time, conduct a causal mediation analysis to evaluate the role of inflammation (C-reactive protein) in the association between medications and subsequent cognitive decline, and examine if dysbiosis-related medications (DRM) are associated with a greater risk of dementia for participants that were cognitively normal and had MCI at baseline.

The Health and Retirement Study (HRS) was used to conduct a secondary data analysis that used longitudinal data from 2004 to 2016. The HRS is an ongoing, …

Intersection Of Maternal Disability Status, Prescription Opioid Use Before And During Pregnancy, And Adverse Birth Outcomes, Chelsea Lynes Richard

Theses and Dissertations

Nationally, individuals with disability, like those with chronic health conditions, have higher rates of opioid use and misuse and are prescribed higher dosages than those without disability. Because opioid agonists and antagonists can cross the placenta rapidly, there is biological plausibility that they may have an impact on birth outcomes. Therefore, monitoring prescription opioid use, particularly among pregnant women, is of great public health importance. While evidence for the impact of opioid use on preterm birth and low birthweight are conflicting; findings are consistent that opioid use during pregnancy is associated with a higher risk of small for gestational age, …