Public Health Commons^™

Milder Loss Of Insulin-Containing Islets In Individuals With Type 1 Diabetes And Type 2 Diabetes-Associated Tcf7l2 Genetic Variants, Maria J Redondo, Sarah J Richardson, Daniel Perry, Charles G Minard, Alice L J Carr, Todd Brusko, Irina Kusmartseva, Alberto Pugliese, Mark A Atkinson

Faculty, Staff and Students Publications

AIMS/HYPOTHESIS: TCF7L2 variants are the strongest genetic risk factor for type 2 diabetes. In individuals with type 1 diabetes, these variants are associated with a higher C-peptide AUC, a lower glucose AUC during an OGTT, single autoantibody positivity near diagnosis, particularly in individuals older than 12 years of age, and a lower frequency of type 1 diabetes-associated HLA genotypes. Based on initial observations from clinical cohorts, we tested the hypothesis that type 2 diabetes-predisposing TCF7L2 genetic variants are associated with a higher percentage of residual insulin-containing cells (ICI%) in pancreases of donors with type 1 diabetes, by examining genomic data …

Tanshinone Iia Inhibits Cell Viability And Promotes Puma-Mediated Apoptosis Of Oral Squamous Cell Carcinoma, Shuangze Han, Xinfang Yu, Ruirui Wang, Xiaocong Wang, Lulu Liu, Qing Zhao, Rongbo Xie, Ming Li, Zhong Su Zhou

Faculty, Staff and Students Publications

Apoptosis alteration is responsible for tumorigenesis and tumor resistance to therapies. The natural product Tanshinone IIA (Tan IIA) exhibits potent inhibitory effects against various tumors. However, the effect of Tan IIA on apoptosis and its underlying mechanism remains elusive in oral squamous cell carcinoma (OSCC). Here, we demonstrated that Tan IIA dose-dependently suppressed cell viability and colony formation in CAL27, SCC4, and SCC25 cells. Moreover, Tan IIA inhibited Akt activation from inducing Foxo3a dephosphorylation and PUMA-mediated apoptosis. PUMA or Foxo3a knockdown compromised the inhibitory effect of Tan IIA on OSCC cells. Tan IIA administration inhibited CAL27-deprived xenograft tumor growth and …

Advances In Prosthetic Technology: A Perspective On Ethical Considerations For Development And Clinical Translation, Hayden Gavette, Cody L Mcdonald, Kristin Kostick-Quenet, Ashley Mullen, Bijan Najafi, M G Finco

Faculty, Staff and Students Publications

Technological advancements of prostheses in recent years, such as haptic feedback, active power, and machine learning for prosthetic control, have opened new doors for improved functioning, satisfaction, and overall quality of life. However, little attention has been paid to ethical considerations surrounding the development and translation of prosthetic technologies into clinical practice. This article, based on current literature, presents perspectives surrounding ethical considerations from the authors' multidisciplinary views as prosthetists (HG, AM, CLM, MGF), as well as combined research experience working directly with people using prostheses (AM, CLM, MGF), wearable technologies for rehabilitation (MGF, BN), machine learning and artificial intelligence …

Real-World Experience With Cefiderocol Therapy For Pseudomonas Aeruginosa And Other Multidrug Resistant Gram-Negative Infections Within The Veterans Health Administration, 2019–2022, Andrew Chou, David Ramsey, Eva Amenta, Barbara W Trautner

Faculty, Staff and Students Publications

OBJECTIVE: Single-center and regional studies have reported outcomes after treatment with cefiderocol, a novel siderophore cephalosporin. We report on real-world use, clinical outcomes, and microbiological outcomes with cefiderocol therapy within the Veterans' Health Administration (VHA).

DESIGN: Prospective, observational descriptive study.

SETTING: Veterans' Health Administration, 132 sites across the United States, during 2019-2022.

PATIENTS: This study included patients admitted to any VHA medical center who received cefiderocol for ≥2 days.

METHODS: Data were obtained from the VHA Corporate Data Warehouse and through manual chart review. We extracted clinical and microbiologic characteristics and outcomes.

RESULTS: In total, 8,763,652 patients received 1,142,940,842 prescriptions …

Bacteriuria In Older Adults Triggers Confusion In Healthcare Providers: A Mindful Pause To Treat The Worry, Eva M Amenta, Robin L P Jump, Barbara W Trautner

Faculty, Staff and Students Publications

The evidence base for refraining from screening for or treating asymptomatic bacteriuria (ASB) in older adults is strong, but both practices remain prevalent. Clinical confusion over how to respond to a change from baseline, when to order a urinalysis and urine culture, and what to do with a positive urine culture fuels unnecessary antibiotic use for ASB. If the provider can take a mindful pause to apply evidenced-based assessment tools, the resulting increased clarity in how to manage the situation can reduce overtreatment of ASB.

Distinct Temporal Trajectories And Risk Factors For Post-Acute Sequelae Of Sars-Cov-2 Infection, Chen Chen, Sairam Parthasarathy, Jacqueline M Leung, Michelle J Wu, Katherine A Drake, Vanessa K Ridaura, Howard C Zisser, William A Conrad, Victor F Tapson, James N Moy, Christopher R Defilippi, Ivan O Rosas, Bellur S Prabhakar, Mujeeb Basit, Mirella Salvatore, Jerry A Krishnan, Charles C Kim

Faculty, Staff and Students Publications

BACKGROUND: The understanding of Post-acute sequelae of SARS-CoV-2 infection (PASC) can be improved by longitudinal assessment of symptoms encompassing the acute illness period. To gain insight into the various disease trajectories of PASC, we assessed symptom evolution and clinical factors associated with the development of PASC over 3 months, starting with the acute illness period.

METHODS: We conducted a prospective cohort study to identify parameters associated with PASC. We performed cluster and case control analyses of clinical data, including symptomatology collected over 3 months following infection.

RESULTS: We identified three phenotypic clusters associated with PASC that could be characterized as …

Ecologic Analysis Of Antimicrobial Use In South Carolina Hospitals During 2020–2022, Pamela Bailey, Shujie Chen, Majdi N. Al-Hasan, Bankole Olatosi Ph.D., Xiaoming Li Ph.D., Jiajia Zhang Ph.D.

Faculty Publications

Background:

Factors influencing excessive antimicrobial utilization in hospitalized patients remain poorly understood, particularly with the COVID-19 pandemic.

Methods:

In this retrospective cohort, we compared administrative data regarding antimicrobial prescriptions in hospitalized patients in South Carolina from March 2020 through September 2022. The study examined variables associated with antimicrobial use across demographics, COVID status, and length of stay, among other variables.

Results:

Significant relationships were seen with antimicrobial use in COVID-19 positive patients (OR 2.00, 95% Confidence Interval (CI): 1.9–2.1), young adults (OR 1.08, 95% CI: 0.99–1.12, COVID-19 positive Blacks and Hispanics (OR 1.06, 95% CI: 1.01–1.11, OR 1.05, 95% CI: …

Association Between Residential Exposure To Air Pollution And Incident Coronary Heart Disease Is Not Mediated By Leukocyte Telomere Length: A Uk Biobank Study, Chia-Ling Kuo, Rui Liu, Lucas Da Cunha Godoy, Luke C. Pilling, Richard H. Fortinsky, Doug Brugge

Health Science Faculty Publications

Higher air pollution exposure and shorter leukocyte telomere length (LTL) are both associated with increased risk of coronary heart disease (CHD), and share plausible mechanisms, including inflammation. LTL may serve as a biomarker of air pollution exposure and may be intervened with to reduce the risk of CHD. To the best of our knowledge, we are the first to test the mediation effect of LTL in the relationship between air pollution exposure and incident CHD. Using the UK Biobank (UKB) data (n = 317,601), we conducted a prospective study linking residential air pollution exposure (PM2.5, PM10, NO2, NOx) and …

How Perspectives On Food Safety Of Vendors And Consumers Translate Into Food-Choice Behaviors In 6 African And Asian Countries, Sejla Isanovic, Shilpa V. Constantinides, Edward A. Frongillo Ph.D., Shiva Bhandari, Sharraf Samin, Emma Kenney, Sigrid Wertheim-Heck, Stella Nordhagen, Michelle Holdsworth, Paula Dominguez-Salas, Ramya Ambikapathi, Amos Laar, Crystal L. Patil, Bharati Kulkarni, Salome A. Bukachi, Mariah Ngutu, Christine E. Blake Ph.D., Rd

Faculty Publications

Background: Consumption of unsafe foods increases morbidity and mortality and is currently an issue, particularly in low- and middle-income countries. Policy actions to ensure food safety are dominated by mitigation of biological and chemical hazards through supply-side risk management, lessening the degree to which consumer perspectives of food safety are considered. Objectives: This study aimed to provide an in-depth understanding, from vendor and consumer perspectives, of how food-safety concerns of consumers translate into their subsequent food-choice behaviors in 6 diverse low- and middle-income countries. Methods: Six Drivers of Food Choice projects (2016–2022) provided transcripts from 17 focus group discussions and …

Public Health Product Hops, Michael S. Sinha

All Faculty Scholarship

Pharmaceutical product hops are anticompetitive maneuvers that often represent a last-ditch effort by brand manufacturers to preserve market share in the face of generic competition. An integral part of product life cycle management strategies, product hops may offer marginal benefits to patients but can substantially increase costs to payers and patients alike. Yet industry advocates maintain that this is essential follow-on research and development, resulting in the development of novel products that would otherwise never reach the market.

Is there a middle ground between these two diametrically opposed views? Might certain product hops be considered beneficial, perhaps if they furthered …

The Psychology Of Science Denialism And Lessons For Public Health Authorities, Brenna Moreno, Molly J. Walker Wilson

All Faculty Scholarship

As it wreaked tragedy on the world, the outbreak of COVID-19 helped expose a pandemic of a different kind, one steeped in distrust and contrarianism. This movement, termed science denialism, has been lurking and undermining public health efforts for decades. Specifically, it is “the employment of rhetorical arguments to give the appearance of legitimate debate where there is none, an approach that has the ultimate goal of rejecting a proposition on which a scientific consensus exists.” Unlike skepticism, which is “doubt as to the truth of something” and works to progress both science and society, denialism is characterized by individuals’ …

Effectiveness Of An Integrated Multilevel Early Child Development Intervention On Caregiver Knowledge And Behavior: A Quasi-Experimental Evaluation Of The Malezi Program In Tanzania, Gretchen Antelman, Josephine Ferla, Michelle M. Gill, Heather J. Hoffman, Teopista Komba, Amina Abubakar, Pieter Remes, Ola Jahanpour, Martha Mariki, Mary A. Mang’Enya, Roland Van De Ven

Institute for Human Development, East Africa

Background The quality of caregiving and the parent-child relationship is critical for early child development (ECD) and has been shown to be modifiable. This study evaluated an ECD project in Tanzania, assessing the effectiveness of radio messaging (RM) alone and a combined radio messaging/video job aids/ECD (RMV-ECD) intervention.

Methods This two-arm pre-post evaluation study enrolled a cohort of caregivers of children 0–24 months in four districts of Tabora region, following them for 9 months. ECD radio messages were broadcast on popular stations at least 10 times/day reaching all study districts. In two districts, community health workers (CHW), trained in UNICEF’s …

“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 …

Perceptions Of Adults With Type 1 Diabetes About Diabetes Management And Exercise, Meera Swaminath

Public Health Theses

This study was conducted to understand participants’ experiences with diabetes management and relationships with exercise for a sample of adults (27-65 years old) with Type 1 diabetes living in the United States and identify potential technological features for a digital health tool supporting physical exercise and diabetes management. The sample consisted of 12 participants living across the nation. Participants were recruited online, through social media and healthcare system platforms. Participant data was collected in the form of surveys and interviews and analyzed using a constructivist framework and thematic analysis. Findings were collapsed into four major themes: 1) making exercise decisions …

A Deeper Dive Into Food Insecurity Among Women Involved In The Criminal Justice System, Jessica Robles

Public Health Theses

Background: The U.S. has the highest incarceration rate globally and a recent study found that 91% of formerly incarcerated individuals report being food insecure. Given that, women have become the fastest-growing segment in the incarceration system. Women who are involved in the criminal justice system (WICJ) are more at risk for experiencing food insecurity and chronic diseases. Therefore, this study aims to contribute to existing knowledge on the overall health of WICJ by assessing the prevalence of food insecurity and the social determinants of health (SDOH) that may contribute to food insecurity.Objective: To provide information on the overall health of …

Associations Between Involvement In Shared Activities With Plwd, Relationship Closeness, And Loneliness Of Friends And Family, Marielle W. Quinn

Public Health Theses

Objectives. To examine the association between self-reported relationship closeness, loneliness, and engagement in shared activities with a person living with dementia (PLWD) in a community sample of family members and friends of PLWD. Methods. Using data from a Qualtrics-administered online survey, we examined involvement in shared activities of 51 respondents who have or had a family, friend, or intimate relationship with a PLWD. Outcome variables included relationship closeness, measured with the Inclusion of Other (IOS) scale, and loneliness, measured using a revised three-item questionnaire from the UCLA loneliness scale. Results. The main findings of the study were as follows: 1. …

Evaluating The Direct Medication Costs Associated With Advanced Non-Small Cell Lung Cancer (Nsclc) Treatment By Biomarkers In The United States: A Coarsened Exact Matching Retrospective Cohort Study, Juanyi Tan

Public Health Theses

IMPORTANCE Most NSCLC patients are diagnosed at an advanced stage. Given recent advancements in immunotherapy and targeted therapies, identifying the biomarker status—such as targetable gene alterations and immune checkpoints—of patients becomes critical in selecting the appropriate treatment. Despite the substantial economic burden of lung cancer, little is known about the medication costs associated with advanced NSCLC treatment by different biomarkers.OBJECTIVE To investigate the association between biomarker status and first-year direct medication costs associated with advanced NSCLC treatment. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted using the Flatiron Health electronic health record (EHR)-derived de-identified database. The study population …

Towards A Saliva-Based Pcr Test For The Detection Of Mpox, Russell J. Thomas

Public Health Theses

Current recommendations for the diagnosis of mpox (monkeypox) rely on lesion-swabs as the gold-standard specimen type even though many patients experience symptoms prior to lesion-onset. Earlier detection could bolster the mpox response by mitigating transmission and facilitating access to antiviral treatments. In this study, we validated five PCR assays and compared their detection of mpox virus DNA extracted from 30 saliva specimens collected into Spectrum SDNA-1000 tubes. We found the Logix Smart™ Mpox (2-Gene) RUO assay (Co-Diagnostics, Inc., Salt Lake City, UT) performed statistically significantly better than the other assays. Next, we tested five raw (unsupplemented) known-positive saliva samples in …

“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 …

A Robust Bayesian Model Averaging Method For Basket Trials With Different Endpoints, Xueting Wang

Public Health Theses

Oncology drug research in the last few decades has been driven by the development of targeted agents. In the era of targeted therapies, basket trials are often used to test the antitumor activity of a novel treatment in multiple indications sharing the same genomic alteration. As patient population are further fragmented into biomarker-defined subgroups in basket trials, novel statistical methods are needed to facilitate cross-indication learning to improve the statistical power in basket trial design. Here we propose a robust Bayesian model averaging (rBMA) technique for the design and analysis of phase II basket trials. We consider the posterior distribution …

A Retrospective Cohort Study: Association Of Sex And Race Differences On 30-Day Retention In Addiction Treatment For Substance Use Disorders After Discharge, Bingning Wang

Public Health Theses

Objective: Little is known about the association of sex and racial differences in accessing SUD treatment. little is known whether these disparities continue despite hospitalization. The main objective was to determine the association of race and sex differences on 30-day retention in addiction treatment for all substance use disorders after discharge. Design: A Retrospective Cohort Study using the Yale Addiction Medicine Consult Service databaseSubjects: Patients with SUD who were hospitalized at Yale New Haven Hospital from Oct 26th, 2018 to Jun 30th, 2021 are eligible, which has 2557 observations. Methods: Mixed effect multivariable logistic regression for sex and racial differences …

Hiv Treatment Patterns Across A Us Data Network: 2012-2021, Raechel Elizabeth Davis

Public Health Theses

IntroductionOnce-daily combination antiretroviral therapy is recognized as the standard treatment for people living with Human Immunodeficiency Virus (HIV) in the United States.1,2 Treatment strategies for HIV have changed substantially over the years, influenced by individual and clinical factors, new medication options, and changing clinical guidelines.1–3 Observational data sources provide a unique opportunity to characterize populations and provide insight into medication usage under real-world conditions that differ systematically from controlled trial scenarios.3,4 Methods We evaluated the treatment patterns and characteristics of 12288 individuals diagnosed with HIV and continuously treated with antiretroviral medications across four, US-based observational databases using the Observational Health …

“It’S Like A Partnership”: Exploring The Primary Care Experiences And Self-Defined Goals Of People Who Use Drugs, Katherine Dunham

Public Health Theses

Background: Primary care is an important yet underutilized resource in addressing the overdose crisis. Previous studies that have explored people who use drugs’ (PWUD) experiences in primary care have found patient involvement in care decisions and goal-setting to be especially important. However, there has been limited research describing PWUD’s goals specific to primary care. This study utilized qualitative methods to explore how PWUD navigate primary care with a focus on understanding participants’ primary care goals.

Methods: From June — August 2022, we conducted 17 semi-structured interviews with PWUD currently in care at The REACH Program, a harm reduction-based primary care …

Recommendations For Climate Adaptation To Preserve Connecticut Drinking Water Quality And Quantity, Matthew Salvatore Di Vitto

Public Health Theses

Climate change impacts drinking water both directly and indirectly. Increases in temperature, drought frequency, and precipitation are among the climate impacts which currently and are projected to affect water quality and quantity in the continental United States. These impacts limit access to clean and abundant water sources by damaging habitat, spreading toxic substances via runoff and favoring the growth of harmful algal blooms. States can learn from one another to adopt best practices and policies to increase water resilience around the country. This paper explores how Connecticut can employ strategies from the States of New York, New Jersey, Massachusetts, Minnesota, …

“You Are Just Trying To Make It Work”: A Qualitative Exploration Of Healthcare Provider Implementation Considerations For Integrating Mental Health And Hiv Care In Central Uganda, Divya Gumudavelly

Public Health Theses

There is a growing push to integrate mental health services within HIV care in urban Uganda. Amidst HIV clinics becoming comprehensive healthcare centers, there is a critical need to understand how providers can better adopt and implement mental health specific protocols in HIV practice. Semi-structured interviews were conducted with 16 healthcare providers at two different HIV care centers to understand current practices, routines, barriers, and facilitators to implementing mental health care services within HIV care. Abductive thematic analysis, drawing from Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF) frameworks, was used in conjunction with constructivist grounded theory …

Understanding The Current Role Of Social Media In American Samoan Adolescent Lives, Mukund Desibhatla

Public Health Theses

Purpose: This exploratory study investigated the social and cultural factors that shape social media use among adolescents in

American Samoa. Methods: This project was a secondary qualitative analysis. Methodological considerations included an

interpretivist approach to epistemology and alignment with the Fa’afaletui Pacific framework. Phenomenology methods were

used to “bracket” researcher biases. A 21st-century flexible coding approach proposed by Deterding et al. 2021 was applied

to the dataset [31]. Transcript excerpts were re-sorted by the index code: social media/technology as a predictor of mental

illness. An abductive thematic analysis, stemming from inductive and deductive reasoning, was used to analyze the codebook …

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 …

Do Longitudinal Trends In Caloric Intake Vary By Income, Education, Or Race?, Daniel Davila

Public Health Theses

Background: The prevalence of obesity in the United States has increased over the last few decades. Reasons for the increases are abundant, but one factor consistently stands out, caloric intake. Cross-sectional data on differences in caloric intake by race/ethnicity and socioeconomic status are common; however, few studies have evaluated the long-term trends in calorie intake by these factors. Methods: We evaluated trends in average calories consumed by adults in the United States by income decile, educational attainment level, and race/ethnicity from 1971 to 2018 using data from the National Health and Nutrition Examination Survey (NHANES), which purposely assessed and recorded …

Pre-Admission Depression And 6-Month Post-Discharge Sleep Disorders In Elderly Covid-19 Survivors, Yixiao Zhang

Public Health Theses

ABSTRACTObjective: This study aims to evaluate the association between depression at baseline and presence of three sleep disorder symptoms (fatigue, daytime sleepiness, and insomnia) following 6-month hospital discharge in elderly COVID-19 survivors. It also aims to identify which other baseline patients’ characteristics or post-discharge factors may be associated with these sleep disorder symptoms. Methods: The participant datasets were obtained from VALIANT, a prospective longitudinal study of community-living adults aged ≥ 60 years who were admitted with COVID-19 to hospitals within the Yale New Haven Health System (YNHHS) from June 2020 - June 2021. Multiple logistic regression models were performed to …

Copd And Asthma: Genome-Wide Associations And Genetic Pleiotropy, Yixuan Yang

Public Health Theses

This study aimed to describe the overlap between genetic variants that are independently associated with COPD and asthma, then dissect the cross-phenotype associations to characterize patterns of pleiotropic effects. The COPD and asthma datasets were separately extracted from an aging population consisting of white European subjects from the UK Biobank database. Genome-wide association tests were performed separately with the COPD and asthma data to first investigate significant genetic variants independently associated with each of the two phenotypes. With the GWAS summary statistics, several significant genetic loci that exhibit potential pleiotropic effects on COPD and asthma on a genome-wide significant level …