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SPH Theses and Dissertations

Mostrando recursos 1 - 20 de 35

  1. Factors Affecting Patient Perceptions of Quality and Health-Seeking Behavior

    Ogbuoji, Osondu R. S
    In this dissertation, I address three issues related to patient-perceived quality of care: the impact of switching to the new World Health Organization (WHO) HIV treatment guidelines on patient perception of quality of care, the impact of rolling-out a quality improvement (QI) training intervention on mothers’ perception of the quality of postnatal care, and the association between patient perceptions of quality and their decisions to bypass healthcare facilities for care. Chapter one presents an overview as well as key insights form all three papers. In chapter two, I investigated the impact of early access to antiretroviral therapy (ART) versus national standard...

  2. Health Behaviors and Behavioral Economics in the Context of HIV, Malaria, and Exercise

    Moscoe, Ellen
    Although the challenges of population health differ widely between rich and poor countries, fundamental features of health behavior shed light on how individuals make choices about their health. These insights that can cut across countries and cultures. In this thesis, I apply concepts from behavioral economics to provide insights into how cognitive biases and social influences guide health behavior. Paper 1 addresses inter-household spillovers and knowledge of HIV status. Using regression discontinuity design and a population-based dataset from South Africa, I estimate how a person's ART eligibility affects their household member’s HIV status knowledge. ART led to a large increase...

  3. Assessing Capacity Development in Fragile States: an Indicator Development Process From Liberia

    Flannery, Jessica
    This thesis provides a practical example of systematically merging elements of two approaches to Capacity Development (CD), linear and adaptive approaches, for improved assessment of CD in fragile settings. Capacity, or the ‘ability to produce’ is a core constraint in fragile settings, both shaping and exacerbating fragility. In both fragile and non-fragile contexts, efforts to improve capacity through development projects have largely used linear approaches, based on pre-determined inputs and outputs as well as skill-based technical capacity. These efforts have underperformed throughout development contexts. In fragile settings where numerous, intertwined complex factors shape fragility and constrain capacity, technical linear approaches...

  4. Genetic Overlap and Causal Mediation Relationship Between Psychiatric and Non-Psychiatric Phenotypes

    Lin, Yen-Feng
    Genome-wide genotyping studies are providing evidence that psychiatric disorders are truly polygenic, that is they have a genetic architecture of many genetic variants. Cross-trait polygenic analysis has been applied to identifying genetic correlations between psychiatric and non-psychiatric phenotypes. However, causal models between shared genetic factors and the genetically-correlated phenotypes are mostly unclear. We used cross-trait polygenic risk score (PRS) association analysis to examine the genetic overlap between two phenotypes. We then performed causal mediation analysis to identify the causal relationship between common genetic variants and two genetically correlated traits. We examined if the effect of polygenic risk on one trait...

  5. The Socio-Demographic Characteristics of Diabetes, Hypertension, and Cardiovascular Disease Risk in India

    Geldsetzer, Pascal
    Cardiovascular disease (CVD) is the leading cause of mortality in India. Yet, the evidence is sparse on how diabetes, hypertension, and predicted CVD risk vary between population groups in the country. This dissertation aimed to determine how the prevalence of diabetes, hypertension, and predicted CVD risk in India varies by state, rural-urban location, and individual-level socio-demographic characteristics. Data were pooled from the Annual Health Survey (2012-2013) and the District-Level Household Survey-4 (2012-2014). Diabetes was defined as a plasma glucose 126 mg/dl if fasted or 200 mg/dl if non-fasted, and hypertension as a systolic blood pressure (BP) 140mmHg or a diastolic...

  6. Using Public Health Data to Monitor Killings by Law Enforcement in the United States

    Feldman, Justin M.
    Injuries inflicted by police constitute an important cause of death in the United States, yet public health data collection systems routinely undercount these incidents. This dissertation presents three epidemiologic studies that measure and analyze police-related deaths. The first is a matched-pair analysis of Massachusetts data (2004-2016) comparing news media-derived databases on police-related deaths (The Guardian, Washington Post, WGBH News, and Fatal Encounters) to Massachusetts vital statistics (N = 84 decedents). Demographic data reported in all four databases were highly concordant vis-à-vis death certificates, while vital statistics misclassified the cause of death (i.e. reported as diagnostic codes other than “legal intervention”)...

  7. Maternal Diet, Arsenic Exposure, and Pregnancy Outcomes in Bangladesh

    Lin, Pi-i
    This study investigated the relationship between maternal diet, arsenic exposure and birth outcomes in the Bangladeshi administrative regions of Sirajdikhan and Pabna Sadar. First, the study assessed the validity of a dish-based food frequency questionnaire (FFQ) by comparing it with two 3-day food diaries (FD). Food and nutrient intakes measured by FFQ and FD were compared using Pearson’s and Spearman’s correlation, paired t-test, percent difference, cross-classification, weighted Kappa, and Bland–Altman analysis. Results suggested that the FFQ exhibited good ability to assess and rank long-term dietary intake for most food groups and nutrients. Using this FFQ, the study then evaluated the...

  8. Effect of Smoking Cessation and Other Lifestyle Modifications on Weight Gain and Risk of Stroke: An Application of the Parametric G-Formula

    Jain, Priyanka
    Developing public health policies for chronic disease prevention requires estimating the effects of long-term lifestyle interventions. In the absence of randomized trials conducted over long periods of time, the parametric g-formula can be used to estimate the risk of an outcome in a study population under hypothetical lifestyle “interventions” using observational data, under the assumptions of no model misspecification and no unmeasured confounding. In this dissertation, we apply the parametric g-formula to data from large prospective cohort studies to investigate the long-term effects of smoking cessation and other lifestyle modifications on weight gain and risk of stroke. In Chapter 1,...

  9. Understanding Psychological Well-Being From the Behavioral Perspective

    Or, Jun Lin Flora
    Despite the great burden of mood disorders, much of the treatment gap remains due to under-recognition. One way to alleviate this burden would be to target unhealthful behaviors that are more prevalent among those who experience symptoms of mood disorders. This dissertation aims to evaluate new ways to measure and to understand behaviors related to psychological well- being drawing from the fields of behavioral economics, marketing, and engineering in a systematic review (Paper 1), a mixed methods study (Paper 2), and an online survey and experiment (Paper 3). Paper 1 is a systematic review that evaluated the most up-to-date evidence...

  10. Summary Score-Based Confounding Control in Studies of New Drugs

    Bohn, Justin
    Epidemiological studies of newly marketed drugs are often undertaken to assess questions of safety and effectiveness that did not arise during a drug’s pre-approval studies. However, unlike in randomized controlled trials, such observational studies are prone to confounding., which can bias estimates of a drug’s effect on the study outcome. In this dissertation, we explore three challenges to confounding control in the study of new drugs. In Chapter 1 we propose a family of privacy-preserving, propensity scored-based methods that allow for adjustment for many confounders when not all confounders are physically stored in the same location. We evaluate the performance of...

  11. Child Nutrition: From School Nutrition Policy to Diet Quality

    AlJazzaf, Manar
    Overweight and obesity in children continues to be a concern in the US. Many factors play a role in this epidemic including decrease in physical activity, increase in sedentary time, and increase in the consumption of sugar sweetened beverages. Dietary behaviors develop in early childhood and these behaviors are influenced by individual experience as well as the larger environment. Paper 1 examines whether school district characteristics are related to school district compliance with the Massachusetts 2012 school competitive food and beverage standards. A linear mixed effects regression model with random effects for schools nested within school district is used to...

  12. Social Support and Older Adult Health in China

    Zhang, Lu
    Social support refers to the provision of support through the real or perceived existence of resources in social relationships, which is one of the main mechanisms through which social networks may influence health outcomes. Due to scant long-term care institutions with limited healthcare infrastructure in China, social support and the underlying social networks may be especially pertinent to older Chinese adults. Additionally, rapid population ageing accompanied by reductions in family size and intergenerational co-residence highlights the need to examine social support in relation to older adult health in China. We used the China Health and Retirement Longitudinal Study (CHARLS), which...

  13. Healthy Workforce, Healthy Baby? Quantitative and Political Analyses of Health Workers in Mexico

    Ladhani, Karima
    Each year, almost five million babies die within their first year of life, from largely preventable causes. Insufficient availability of health workers has been identified as one of the most common barriers to delivering effective newborn healthcare. This dissertation focuses on the allocation and effectiveness of health workers at improving child health in Mexico. The first two chapters of this dissertation use municipality-level fixed effects analyses to assess the relationship between health workers and child health, specifically infant mortality rate (IMR) and two key risk factors for infant mortality: preterm birth prevalence and low birth weight prevalence. In the first...

  14. Long-Term Use of Cardiovascular Medications: Identifying and Encouraging Optimal Duration

    Krumme, Alexis A.
    In the face of increasingly widespread availability and uptake of medications to treat and prevent cardiovascular disease, this dissertation is motivated by two broad research questions regarding the duration of cardiovascular therapy. First: how long should patients continue therapy when there are risks and benefits that may change over time? Second: how can continuation be encouraged when therapies are known to be safe and effective? In Aim 1, we compared exposure definitions of antiplatelet discontinuation versus continuation at 12 months after a drug-eluting coronary stent and associations with ischemic and bleeding events. We found that increasing restrictions on the definition...

  15. 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...

  16. 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...

  17. 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...

  18. 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...

  19. 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...

  20. Socioeconomic Status, Socioeconomic Context and Sexually Transmitted Infections

    Harling, Guy Duncan

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