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SPH Theses and Dissertations

Mostrando recursos 1 - 20 de 109

  1. 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...

  2. 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...

  3. Examining the Mortality of an Unsheltered Homeless Cohort From Boston, MA, 2000 Through 2009

    Roncarati, Jill S.
    Purpose: This dissertation addressed a gap in homelessness literature by examining mortality outcomes of an unsheltered cohort and by applying criteria developed at the Boston Health Care for the Homeless Program (BHCHP) to predict mortality. Methods: A 10-year prospective study was conducted with 445 unique unsheltered individuals. Data were collected during encounters with BHCHP’s Street Team clinicians, an integrated program providing care to homeless adults living outside. Decedent data were matched to the Massachusetts Department of Public Health death occurrence files. Analyses included describing the cohort and the high-risk criteria, calculating age-standardized all-cause and cause-specific mortality rates and age-stratified rate...

  4. 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...

  5. Green Buildings and Health

    MacNaughton, Piers
    40 years of public health research on buildings has identified the indoor environmental drivers of health and productivity. Concurrently, increased environmental awareness spurred the green building movement with the goal of encouraging more sustainable buildings. The question remains as to whether green buildings are also healthy buildings. The objective of this dissertation is to investigate the impact of green buildings on health and cognitive function in both laboratory and real-world settings, and furthermore quantify these impacts in comparison to the potential environmental and economic costs. First, 24 participants spent 6 work days in a controlled office environment. On different days,...

  6. 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...

  7. 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...

  8. 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...

  9. Estimating Health Effects of Temperature and pm2.5 Using Satellite-Retrieved High-Resolution Exposures

    Shi, Liuhua
    Human activities emit greenhouse gases (GHGs) and air pollutants, which would affect the environment and in turn affect human health. Accurate estimate of the health effects requires high resolution exposure data of environmental stressors, such as air temperature (Ta) and fine particulate matter (PM2.5). The availability of those exposure data, however, is usually limited by sparsely distributed ground-based monitoring network. Therefore, the first chapter estimates Ta at a fine scale on a daily basis by incorporating satellite-based remote sensing data. Satellite can provide a global daily estimate of 1 km × 1 km surface temperature (Ts), which is correlated with...

  10. 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...

  11. 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...

  12. 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,...

  13. Maternal, Behavioral, and Environmental Risk Factors for Gestational Diabetes and Preterm Birth Among Pregnant Women

    Alseaidan, Mohammad
    Background: Lifestyle changed in Kuwait with the rapid development and economic expansion and the Americanization of the Kuwaiti market. Fast food and sedentary lifestyle became very prevalent. Environmental exposures such as passive tobacco smoke and extreme temperatures are common in Kuwait where the prevalence of chronic conditions is increasing. We describe a Kuwait based pregnancy-birth cohort and examine the associations between perinatal exposures and the risk of chronic disease. Methods: We recruited women from antenatal clinics in Kuwait and administered baseline questionnaires then followed the women postnatally. We examined maternal and lifestyle risk factors of gestational diabetes mellitus (GDM). We examined...

  14. Environmental Origins of Methylmercury in Aquatic Biota and Humans

    Li, Miling
    Methylmercury (MeHg) is a neurotoxin found in fish and shellfish, that poses risks to human and ecological health. Exposure to MeHg adversely affects neurodevelopment of children and cardiovascular health in adults. Seafood consumption is the primary exposure route to MeHg in North America. An understanding of the link between environmental MeHg sources and human exposures is needed to determine the impacts of ongoing environmental change. However, few data exist for relating environmental exposures to human health outcomes. Imprecision in dietary recall data on fish consumption and variability in MeHg concentrations within and across seafood species consumed have made it challenging...

  15. Particle Pollution: Trends, Sources, Components and Health

    Achilleos, Souzana
    Eastern Mediterranean (EM) region experience poor air quality because it is highly influenced by local and transported pollution. For this reason, we examined the particulate pollution in Cyprus, an EU-member country located in the EM region. First, we analyzed daily PM10 (particulate matter with aerodynamic diameter less than 10 μm) data collected in an urban and background site for sixteen years (1993-2008). We investigated long term trends using a Generalized Additive Model (GAM) after controlling for day of week, month, temperature, wind speed, and relative humidity. Annual PM10 (50.4-63.8 μg/m3) exceeded the 2005 EU annual standard (40 μg/m3) every year...

  16. Plant-Based Diets and Risk of Type 2 Diabetes and Coronary Heart Disease

    Satija, Ambika
    Plant-based diets, defined as “vegetarian” diets, are associated with reduced risk of type 2 diabetes (T2D) and coronary heart disease (CHD). To examine the health effects of gradual reductions in animal food consumption while increasing plant food intake, and to distinguish between healthy and less healthy plant foods, we created three graded plant-based diet indices using semi-quantitative food frequency questionnaires (SFFQ). In the overall plant-based diet index (PDI), all plant foods received positive scores while animal foods received reverse scores. In the healthful PDI (hPDI) healthy plant foods (e.g. whole grains, fruits) received positive scores, while less healthy plant foods...

  17. Micrornas in Extracellular Vesicles as Novel Biomarkers in Environmental Epidemiology

    Rodosthenous, Rodosthenis
    Despite important achievements of Environmental Epidemiology in identifying major environmental health problems in recent years, little is known about the underlying biological mechanisms that link environmental exposures to certain outcomes. Recent discovery of extracellular vesicles (EVs) as a novel mechanism of cellular communication has opened new avenues for non-invasive access to subclinical molecular signals, which might help exposing such mechanisms. In this work, we evaluate the potential of microRNAs, molecular signals that are contained in EVs circulating in the blood, as biomarkers in two very important environmental health problems: (a) the causal association between air pollution and cardiovascular disease and...

  18. Genetics, Caffeine Consumption, Height and Non-Melanoma Skin Cancer

    Li, Xin
    Non-melanoma skin cancer (NMSC), including basal and squamous cell carcinoma (BCC and SCC, respectively), is the most common malignancy among populations of European ancestry. It is estimated that over 2 million cases of NMSC occur each year in the United States, with the incidence continues to increase. This disease imposes a growing burden on healthcare system, making it an important public health issue. However, understanding of its etiology and biological mechanisms remains incomplete. In Chapter 1 of this dissertation, we applied a novel approach that integrates skin expression-related single-nucleotide polymorphisms (eSNPs) and pathway analysis to identify potential novel biological pathways...

  19. 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...

  20. Discovery of HDL Subspecies and Investigation of Their Associations With Insulin Sensitivity and Early Carotid Atherosclerosis

    Yamamoto, Rain
    Recent findings from genome-wide association studies and pharmaceutical trials of CETP inhibitors suggest that HDL cholesterol might not fully capture the anti-atherogenic functions of HDL. The protein component of HDL might be more informative in explaining HDL functions because proteins have characteristics that can modify the biological properties of HDL. In Chapter 1, I examined whether some proteins located in the HDL size or density range by proteomics studies were present in distinct apoA-I HDL subspecies that could be identified and quantified by a novel sandwich ELISA. Known HDL subspecies containing apoA-II, apoC-III and apoE comprised 70%, 6% and 10%, respectively,...

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