Recursos de colección

Digital Access to Scholarship at Harvard (39.468 recursos)

DASH is a central, open-access repository of research by members of the Harvard community

SPH Theses and Dissertations

Mostrando recursos 1 - 19 de 19

  1. Comparative Safety of Antiretroviral Drugs to Treat HIV During Pregnancy

    Rough, Kathryn
    Each year, nearly 1.5 million women with HIV become pregnant, and require antiretroviral treatment to reduce risk of perinatal transmission of the virus and improve their own health. The safety of currently approved antiretroviral medications for the fetus is largely unknown; recommendations about preferred regimens during pregnancy are often based on a small body of clinical safety data, expert opinion, and programmatic considerations, including regimen harmonization across sub-populations. Therefore, there is a public health need to identify the specific antiretroviral drugs and combinations of drugs that are safest for use during pregnancy. Across the papers that comprise this Dissertation, we apply...

  2. Measuring the Quality of Reproductive Health Services in Mexico and the United States

    Holt, Kelsey
    A focus on quality of care in health services is important from both public health and human rights perspectives. From a public health perspective, a central premise underlying quality improvement work is that improving quality, including interpersonal aspects of care, will lead to better health outcomes. Good communication between providers and patients in various areas of health care has been shown to be highly correlated with adherence to treatment. From a human rights perspective, the Right to Health, as established by the United Nations Committee on Economic, Social, and Cultural Rights, entitles all people to healthcare information, services, and commodities...

  3. Utilization and Safety of Antipsychotic Medications in Special Populations

    Park, Yoonyoung
    Antipsychotic medications are widely used in the United States (US). Understanding the extent of use and comparative safety of antipsychotics is especially important for certain groups of people such as pregnant women or hospitalized patients, for whom the evidence on safety and effectiveness is limited. Previous studies lacked power to detect difference in safety endpoints or suffered from potential confounding bias. In this dissertation, we used large administrative claims databases to provide evidence for antipsychotic use among vulnerable population subgroups. In Chapter 1, we describe the pattern of antipsychotic utilization among publicly insured pregnant women in the US using a...

  4. Understanding Effects of Exercise and Diet to Improve Mental and Physical Health in Children With Behavioral Health Disorders

    Bowling, April B.
    Approximately 13%–20% of children living in the United States experience a diagnosable behavioral health disorder (BHD) in a given year. Children with BHDs have elevated risk of poor mental and physical health outcomes. It is established that diet quality and physical activity (PA) levels are predictors of both chronic disease risk and behavioral health. Unfortunately, children with BHDs experience increased risk of poor diet and low PA relative to typically developing peers. Given the high prevalence of BHDs and associated health disparities, this dissertation aims to help address major gaps in existing research. Chapter one investigates the effects on behavior...

  5. Neurological Soft Signs, Cognition in Childhood, Attention Deficit Hyperactivity Disorder and Lifetime Major Depressive Disorder

    Alamiri, Bibi
    Background: Neurological soft signs (NSS), subtle but abnormal motor and sensory signs and involuntary movements, have been implicated as risk factors for a number of psychiatric and neurodevelopmental disorders. Prior studies were based on small clinical samples, did not control for important confounding factors or examine domain or age specificity. Here we investigate the associations between NSS and multiple domains of cognitive functioning, Attention Deficit Hyperactivity Disorder (ADHD) and its subtypes and finally with lifetime diagnosis of major depressive disorder (MDD) and its age of onset in a large, population-based cohort, while adjusting for important confounding factors. Methods: We analyzed...

  6. Socioeconomic Status, Socioeconomic Context and Sexually Transmitted Infections

    Harling, Guy Duncan

  7. Socioeconomic Status, Socioeconomic Context and Sexually Transmitted Infections

    Harling, Guy Duncan

  8. Evaluating the Ability of Conditional Cash Transfers to Promote Human Capital Through the Protection of Health

    Velasquez, Esther
    Conditional cash transfer programs have diffused rapidly across the world since the mid- 1990s and have been adopted as a poverty-reduction tool in the majority of Latin American countries. This dissertation focuses specially on the Colombian conditional cash transfer program, Familias en Acción, and examines the relationship between social welfare policy and health in the Colombian context. The work is divided into three separate papers. Paper 1 assesses the impact of Familias en Acción on adult health outcomes that capture disruptions in daily life due to health conditions. The analysis utilizes data collected by the Colombian National Department of Planning for...

  9. Maternal and Child Health, Nutrition, and Hiv

    Smith, Emily Rose
    Reducing maternal and child mortality was established as a global priority with the signing of the Millennium Declaration in September 2000. Neonatal vitamin A supplementation and very early breastfeeding initiation are scalable interventions which may improve infant survival. Although breastfeeding has proven benefits for infant health, the potential health consequences of breastfeeding for HIV-infected women are not well studied. In paper one, “The effect of neonatal vitamin A supplementation on morbidity and mortality at 12 months: A randomized trial”, we assessed the efficacy of neonatal vitamin A supplementation (NVAS) in reducing infant morbidity and mortality. Using data from an individually randomized...

  10. Communication to Promote Healthier Behaviors – Understanding the Roles of Channels and Message Formats

    Hayashi, Hanae
    Communication has been used to change people’s health knowledge, attitudes and behaviors, and it is critical for improving people’s lives, especially those who are in a disadvantaged group. Many studies suggest that communication is a powerful tool when it is used effectively for these population groups. In this dissertation I explored the roles of channels and message formats among vulnerable populations. Paper 1 investigated interpersonal diffusion of health information, specifically health information mavenism among people over age 65 in Japan, identifying the characteristics of health information mavens and whether they behave more healthily or report better health status. The study...

  11. Nutritional and Lifestyle Factors for Cancer Incidence and Survival

    Zoltick, Emilie Sela
    Background: The association between meat consumption and breast cancer risk and the relationship between vitamin D and colorectal cancer risk have been examined in numerous studies, but questions still remain. For colorectal cancer survival, research into diet has been sparse. Methods: Chapter one is a pooled analysis of 22 prospective cohort studies examining meat and egg consumption and breast cancer risk overall and by estrogen and progesterone receptor (ER/PR) status using Cox proportional hazards models to estimate study-specific relative risks which were then pooled using random effects models. Chapter two is a pooled analysis of 17 prospective cohort studies in...

  12. The Neurodevelopment and Mental Health of Children Affected by HIV in Sub-Saharan Africa

    Chaudhury, Sumona
    This dissertation assesses neurodevelopment in children affected by HIV in Botswana, by examining associations between a range of factors and neurodevelopmental outcomes at 24 months of age and adjusting for potential confounders through linear regression. We followed children from birth to approximately 24 months to assess their neurodevelopment with an adapted version of Bayley Scales of Infant Development third edition (BSIDIII: cognitive, gross motor, fine motor, expressive and receptive language domains) and with the Development Milestones Checklist (DMC: locomotor, fine motor, language and personal-social domains), a parent-completed questionnaire. Chapter I compares neurodevelopment between HIV-exposed uninfected (HEU) children whose mothers took...

  13. Epigenetic and Mitochondrial Biomarkers Linking Air Pollution and Temperature on Human Health: The Normative Aging Study

    Peng, Cheng
    Fine particulate matter (particulate matter with aerodynamic diameter ≤2.5 micron or PM2.5) exposure, as well as changes in ambient meteorological conditions are associated with adverse health consequences. However, the underlying mechanisms have not been clearly delineated. Systemic inflammation and oxidative stress are two of the primary pathways proposed to account for the association of PM2.5 / air temperature with health related outcomes. In this dissertation work, we proposed to use two types of novel molecular biomarkers: (1) nuclear DNA (nDNA) methylation, and (2) mitochondrial DNA (mtDNA) integrity to assess inflammatory and oxidative stress pathways linking environmental insults and health. Specifically, in...

  14. Health Effects of PM2.5 and Its Components on Mortality, Blood Pressure, and DNA Methylation

    Dai, Lingzhen
    Epidemiological studies have examined the association between PM2.5 mass and mortality, but there remains uncertainty about the relative importance of species. PM2.5 contains various species, such as organic carbon, elemental carbon, and metals. Determining the differential toxicity of PM2.5 species and identifying species with greatest toxicity is of great importance to emission-control strategies and regulations. In the dissertation thesis, effects of PM2.5 species on health outcomes on different levels were estimated. The first study examined the association between PM2.5 species and mortality on approximately 4.5 million deaths for all causes, cardiovascular diseases, myocardial infarction, stroke, and respiratory diseases in 75...

  15. Development of Satellite-Based Emission Inventories and Indoor Exposure Prediction Models for PM2.5

    Tang, Chia-Hsi
    Epidemiological studies have documented significant relationships between outdoor particle exposure and adverse health effects whilst indoor residential PM2.5 exposure is found to be the most influential on total PM2.5 exposure as people spend more than 80% of their time indoors. Accurate exposure assessments for ambient and indoor environments are therefore of equal importance. In this dissertation, we aim to develop methodologies that enhance our ability to quantify fine particulate matter (PM2.5) exposure in both macro and micro perspective. With advanced remote sensing technologies becoming more prevalent and less expensive, there is great potential in employing satellite date to analyze and illustrate...

  16. Optimal Use of New and Existing Drugs for Tuberculosis Control

    Kunkel, Amber
    Tuberculosis (TB) recently surpassed HIV as the world’s leading infectious killer. Because antibiotic therapy forms the cornerstone of TB control, prevention, and treatment, it is important to apply TB drugs in a way that maximizes their potential benefits while minimizing the risks of resistance. Here, I present three modeling analyses intended to explore these tensions inherent in the use of TB drugs. Preventive therapy involves the use of antimicrobials in asymptomatic and noninfectious individuals, and has been applied to diseases ranging from TB to HIV to malaria. In my first paper, I outline how population use of preventive therapy could increase,...

  17. Identifying Opportunities to Improve the Integration of Sexual and Reproductive Health Services into Primary Care: Qualitative and Quantitative Approaches

    Janiak, Elizabeth
    Objectives: Unintended pregnancy is endemic in the United States. Primary care physicians (PCPs) are optimally positioned within the health care system to improve the prevention and management of unintended pregnancy by offering comprehensive contraception and abortion care. Factors at the individual, health center, health systems, and policy levels may influence whether PCPs offer these services. Current practice, knowledge, and attitudes about contraception and abortion among PCPs are poorly understood. This investigation fills these gaps using original quantitative and qualitative data. Methods: This mixed-methods investigation included: 1) a quantitative survey querying a national probability sample of practicing PCPs about contraception, abortion, and...

  18. Improving Health and Safety in Construction: The Intersection of Programs and Policies, Work Organization, and Safety Climate

    Sparer, Emily Helen
    Statement of Problem: Despite significant advancements in occupational health and safety in recent decades, injury rates in commercial construction remain high. New programs that address the complexity of the construction work environment are needed to keep workers healthy and safe. Methods: The first step of this dissertation was to explore associations between organizational programs and policies, as measured by a Contractor Safety Assessment Program (CSAP) score, and worker safety climate scores. Next, a safety communication and recognition program was developed and piloted. It was evaluated through a mixed methods approach in a randomized controlled trial. Primary outcome measures included safety...

  19. Improving Health and Safety in Construction: The Intersection of Programs and Policies, Work Organization, and Safety Climate

    Sparer, Emily Helen
    Statement of Problem: Despite significant advancements in occupational health and safety in recent decades, injury rates in commercial construction remain high. New programs that address the complexity of the construction work environment are needed to keep workers healthy and safe. Methods: The first step of this dissertation was to explore associations between organizational programs and policies, as measured by a Contractor Safety Assessment Program (CSAP) score, and worker safety climate scores. Next, a safety communication and recognition program was developed and piloted. It was evaluated through a mixed methods approach in a randomized controlled trial. Primary outcome measures included safety...

Aviso de cookies: Usamos cookies propias y de terceros para mejorar nuestros servicios, para análisis estadístico y para mostrarle publicidad. Si continua navegando consideramos que acepta su uso en los términos establecidos en la Política de cookies.