Medicine and Health Sciences Commons^™

The Health Action For Psychiatric Problems In Nigeria Including Epilepsy And Substances (Happiness) Project: A Preliminary Mixed-Method Evaluation, Casey Jia-Chyi Chu

Public Health Theses

Background: The Health Action for Psychiatric Problems in Nigeria Including Epilepsy and Substances (HAPPINESS) Project is a mental health capacity building intervention based in Imo State, Nigeria that incorporates the World Health Organization’s Mental Health Gap Action Programme (mhGAP). So far, the HAPPINESS Project has trained 36 primary care workers (doctors, nurses, and community health extension workers) in one initial training (covering 5 local government areas) and one refresher training. The goal of this project is to leverage Imo State’s widespread primary care network, to address gaps in access to mental health care.

Objective: To evaluate the impact 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 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 …

“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, …

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 …

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 …

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 …

Acknowledgment Of Sexual Violence And Mental Health Among College Students, Francesca Maviglia

Public Health Theses

A significant number of individuals who experience a form of sexual violence that could be classifiable as rape or sexual assault do not label their experience as such. Studies found that rape acknowledgement status can impact a survivor’s postassault experiences and recovery process. This study examined how a sample of 236 college students who experienced some form of sexual violence labeled their experience. The association between different degrees of acknowledgement and posttraumatic stress and depression symptoms was tested. 162 (68.6%) of respondents did not label their experience as unwanted; the remaining 74 (31.4%) varied in their labeling of the experience …

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 …

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 …

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 …

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 …

Glycemic Variability And Indices Of Glycemic Control Among Pregnant Women With Type 1 Diabetes Based On Use Of Constant Glucose Share Technology, Julie Sklar

Public Health Theses

Pregnant women with type 1 diabetes (T1D) experience increased glycemic variability as a result of changing insulin sensitivity and resistance throughout gestation. Therefore, strategies that help pregnant women with T1D manage their glycemic control are of great interest. We examined whether remote monitoring of Continuous Glucose Monitor (CGM) data by friends and family affects glycemic variability during pregnancy compared to CGM use alone in a pilot non-randomized trial (n = 28). During preconception or the first trimester, women with T1D were placed in one of two groups based on device compatibility: (1) CGM Alone (n = 13): women without iPhone, …

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 …

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 …

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 …

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 …

Intimate Partner Violence, Colorism, And Stress Coping In Barbados, Nkandu Yumbe

Public Health Theses

Persons who experience intimate partner violence (IPV) have higher rates of chronic disease. This is thought to be due, in part, to the adoption of health risk coping behaviors, as well as the detrimental biological response to chronic stress associated with violence. The role of colorism (perceived skin tone discrimination) in the experiences of victims of IPV, their stress and stress coping behaviors has not previously been examined. The objective of this study was to explore the intersecting experience of black skin, coping strategies and stress among women with IPV histories in Barbados. Women above the age of 18, who …

Accelerometer-Measured Physical Activity And Sedentary Time Among Samoan Adults And Associations With Type 2 Diabetes And Hypertension, Parmida Zarei

Public Health Theses

Objectives: (1) To describe accelerometer-measured physical activity among Samoan adults; (2) to determine associations between physical activity and type 2 diabetes and hypertension; and (3) to assess adherence to global physical activity recommendations.

Participants: Three hundred eighty-five Samoan adults aged 30-72 years.

Setting: Participants were recruited from 23 villages on the Samoan island of ‘Upolu (eight urban, seven peri-urban, and eight rural).

Measurements: Self-reported demographic information including age, census region of residence, and occupation was collected. Anthropometric measurements including weight and height were taken in light island clothing, and body mass index was calculated. Sedentary time, light-intensity physical activity, and …

A Simple Technique For The Management Of Refractory Gastrostomy Site Complications A Technical Innovation In Gastrostomy Tube Site Revision, Rebecca M. Rentea, Wendy Jo Svetanoff, Charlene Dekonenko, Courtney Pisano, Charles L. Snyder

Manuscripts, Articles, Book Chapters and Other Papers

Introduction

Longstanding gastrostomy sites are prone to leakage and excoriation secondary to protrusion of gastric mucosa into the tract, dilation of the site over time, and development of refractory granulation tissue. Surgical revision with creation of a new gastric and skin exit site can be difficult. We describe a technique to re-site a gastrostomy tube (GT) utilizing the existing GT site.

Materials and methods

For one patient with gastrostomy site refractory complications, we re-sited the GT using the existing site. A clamp was placed through the old GT site and was palpated through the abdominal wall. An incision over the …

Pentalogy Of Cantrell, Muhammad Khawar Sana, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Pentalogy of Cantrell (POC) is a collection of five congenital midline birth anomalies that present a distinctive challenge for clinicians and surgeons. Those five defects are of the heart, pericardium, diaphragm, sternum, and abdominal wall. This condition has been divided into two categories, complete or partial. Complete, as the name indicates, refers to the presence of all five defects, while others may present with only partial defects. It is also referred to as thoracoabdominal ectopia cordis, a condition where the heart is covered by an omphalocele-like membrane. Ectopia cordis (EC) is often found in fetuses with POC. Infants usually have …

Retroperitoneal Hematoma, Christopher Mondie, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Retroperitoneal hematoma is defined as bleeding into the retroperitoneal space. This clinical entity is often occult and under-recognized by clinicians and is a cause of significant morbidity and mortality. Often patients do not manifest clinically apparent signs and symptoms until a substantial amount of blood loss has occurred. It is not uncommon for patients to present in frank hemorrhagic shock due to an underlying retroperitoneal hematoma. The retroperitoneal space lies directly posterior to the peritoneal cavity. An organizational schema dividing the retroperitoneal space into three different “zones” is widely prevalent in the surgical literature. The central-medial zone (Zone I) falls …

Rna Sequencing Of Human Peripheral Nerve In Response To Injury: Distinctive Analysis Of The Nerve Repair Pathways., Andrew S. Welleford, Jorge E. Quintero, Nader El Seblani, Eric Blalock, Sumedha Gunewardena, Steven M. Shapiro, Sean M. Riordan, Peter Huettl, Zain Guduru, John A. Stanford, Craig G. Van Horne, Greg A. Gerhardt

Manuscripts, Articles, Book Chapters and Other Papers

The development of regenerative therapies for central nervous system diseases can likely benefit from an understanding of the peripheral nervous system repair process, particularly in identifying potential gene pathways involved in human nerve repair. This study employed RNA sequencing (RNA-seq) technology to analyze the whole transcriptome profile of the human peripheral nerve in response to an injury. The distal sural nerve was exposed, completely transected, and a 1 to 2 cm section of nerve fascicles was collected for RNA-seq from six participants with Parkinson's disease, ranging in age between 53 and 70 yr. Two weeks after the initial injury, another …