Department of Epidemiology

PhD


November 24, 2020

The 2014 chikungunya virus outbreak in the U.S. Virgin Islands: epidemiology, long-term health outcomes, and economic burden

Background: Chikungunya virus (CHIKV), an emerging and acutely debilitating alphavirus transmitted by the Aedes aegypti and Aedes albopictus mosquito, was introduced into the Americas in December of 2013. As of April 2016, almost 2 million suspected or confirmed cases have been reported in 45 different countries in the Americas. Acute symptoms of the virus include…


Safety of oral tenofovir disoproxil fumarate-based pre-exposure prophylaxis for HIV prevention: prospective studies in HIV-uninfected men and women

Antiretroviral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF) alone or when co-formulated with emtricitabine (FTC), the same medication used for treatment of HIV infection, is a recommended and highly effective strategy to reduce the risk of sexual acquisition of HIV. The central objective of the studies described in this dissertation was to quantify the…


Hypertension and diabetes treatment and risk of adverse outcomes among breast cancer patients

Background: Management of comorbidities is a critical issue among 2.9 million breast cancer survivors in the U.S. Hypertension and diabetes are two common chronic conditions affecting this patient population. Despite the generally good safety profile of widely used antihypertensive medications and diabetes treatments, few studies have examined their relationships with adverse breast cancer outcomes. In…


Methylomic and Transcriptomic Insights Linking Air Pollution and Atherosclerosis

Background: Current literature demonstrates a compelling relationship between long-term air pollution exposure and cardiovascular diseases such as atherosclerosis. DNA methylation is a potential mediator of the air pollution-atherosclerosis association because 1) exposure to particulate matter is associated with alterations in DNA methylation, and 2) alterations in DNA methylation are found in atherosclerotic lesions and are…


Prevalence of mixed neuropathologies in autopsied older adults and associations with clinical disease progression

Introduction: Many older adults have multiple brain pathologies (aka mixed neuropathologies) at autopsy; however, the clinical importance of mixed neuropathologies is not well established. The objectives of this dissertation were 1.) to examine the prevalence of Alzheimer’s disease neuropathologic change (ADNC), Lewy body disease (LBD), vascular brain injury (VBI), and their co-occurrence and 2.) to…


Environmental Enteropathy and Fibroblast Growth Factor 21 are associated with early childhood growth in Bangladesh

Chronic undernutrition, marked by stunting (low height for age), is associated with increased child morbidity and mortality worldwide. Current intervention strategies are often ineffective at preventing or reversing stunting; while some children grow in response to nutrition programs, many do not. This dissertation aims to improve understanding of two major challenges in the prevention and…


Changing etiologies of childhood acute febrile illness: implications for management in an era of declining malaria

Background: Acute febrile illness (AFI) is a common syndrome among children presenting to a healthcare facility in resource-limited settings and a substantial contributor to childhood mortality. In sub-Saharan Africa, malaria has historically been a leading cause of childhood AFI but malaria incidence and mortality have declined dramatically over the past decade. At the same time,…


Gender Based Violence and HIV Risk: Mediating Pathways and Strategies for Prevention

The studies within this dissertation address gender-based violence (GBV) and its relationship with risk factors for HIV acquisition in African women. Women exposed to GBV have a higher risk of HIV infection, but the mechanisms for this association are not well understood, and the mechanisms may differ according to the patterns of violence experienced. Therefore,…


Using HIV Surveillance Data for Public Health Evaluations and Interventions: Common Challenges & Proposed Methodological Solutions

In the United States (U.S.), the purpose of HIV surveillance and related data systems is changing. Evolving programmatic priorities and complicated care needs of an aging population has led to greater demand for timely, accurate, and detailed data. My dissertation evaluates three prominent data systems: (1) National HIV Surveillance System (NHSS), (2) Medical Monitoring Project…


Lipopolysaccharide-binding protein, associated factors, and colorectal cancer

BACKGROUND – Recent research has pointed to a possible key role of gut microbial communities (GMC) in understanding the link between obesity, chronic inflammation, and the development of colorectal cancer (CRC) [1]. While some studies have demonstrated a strong association between obesity and circulating levels of lipopolysaccharide (LPS) [2-5], an endotoxin which is found on…



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